BEYOND YOUR DOCTOR: WHO'S WHO ON YOUR CANCER CARE TEAM

The physical and emotional effects of cancer and treatment can be significant. The good news is that help is available from the different people who make up your cancer care team.

Below is a description of the health care professionals who work with those who have cancer. Each of these people plays a vital role in helping you obtain the best treatment possible and maintain the highest quality of life throughout your diagnosis and treatment.

It may seem obvious, but it is important to remember that you are the most important member of your health care team. As with any type of health care you receive, you are a consumer of services, and you should not be afraid to ask questions about what you are getting and who is providing it.

In order to be a better consumer, you should consider these tips:

• When you are going to meet with someone (a doctor, nurse, or specialist), bring someone else with you. It helps to have another person listen to what is said and think of questions to ask.
• Write out your questions beforehand to make sure that you don't forget to discuss anything.
• Write down the answers you get, and make sure you understand what you are hearing.
• Finally, don't be afraid to ask your questions or ask where you can find more information about what you are discussing. Being well-informed is your most important task on the health care team.

A social worker can provide you with counseling, find a support group for you, locate services in your community that help with home care or transportation, and guide you through the process of applying to the government for Social Security Disability or other forms of assistance. They also help you understand your diagnosis and talk to you about treatment side effects, and what to expect. If you need help finding a social worker in your area, start at your local hospital, or contact Cancer Care, Inc. at 1-800-813-HOPE.

A psychologist is a professional who can assist you if you are feeling depressed, anxious, or sad. While not medical doctors, psychologists have obtained a Ph.D. in psychology and counseling; many specialize in marital counseling or chronic illness. Some cancer centers have psychologists on staff; ask your doctor, your HMO, your hospital, or a social worker for a referral.

Nurses are a crucial part of your health care team. Nurses have a wide range of skills and are usually in charge of implementing the plan of care your doctor has set up for you. They are trained to administer medication and monitor side effects and all major hospital centers have nurses who specialize in cancer. Whether you are staying in the hospital for care, or receive it on an outpatient basis (which means you go home after each treatment), you will benefit greatly from seeking assistance, asking questions, or getting tips and advice from your nurse or nurse-practitioner. Nurses are often aware of support services in your community and usually provide you with educational materials and pamphlets.

You may also arrange or request a registered nurse to visit you at home. If your doctor approves the visit, it will usually be covered by insurance. Another option is to hire a private duty nurse who doesn't work for your hospital or health care service. This can be expensive and often not covered by insurance, but can ease the burden of care on your family or loved ones.

Another form of home care is from a home health aide. Home health aides assist people who are ill and need help moving around, bathing, cooking, or doing household chores. Some state Medicaid programs will pay for home health aide care, provided they are supervised by a nurse. However, private insurance or managed care plans rarely pay for a home health aide. To find home health aide care, ask your physician, nurse, or social worker, and remember to ask if the charges vary based on income. Also, the National Association of Home Care (202-547-7424) publishes a free booklet, How to Select a Home Care Agency. The Yellow Pages are a good source, but be sure to check credentials, find out whether the agency is bonded, and ask for references.

Rehabilitation services help people recover from physical changes caused by cancer or cancer treatment. They include the services of physical therapists, occupational therapists, counselors, speech therapists, and other professionals who help you physically recover from cancer. For example, physical therapy can help you rebuild the muscles in your arm and shoulder if you have had chest surgery.

Most physicians will refer you to rehabilitation services if you need them; be sure to ask if you think you might want them. Also, check to see if these types of services are covered under your insurance plan. Additionally, some cancer or social service organizations may provide you with free rehabilitation services if you are not insured for them.

Cancer and cancer treatment may cause weight loss. For this reason, dietary or nutritional counseling or services are commonly prescribed for people with cancer. A dietitian helps to choose foods which provide enough calories, vitamins, and protein to help you feel better and control your weight, and gives you tips about increasing your appetite if you experience nausea, heartburn, or fatigue from your illness or treatment.

Most hospitals have registered dietitians on staff, and you can ask your doctor about meeting with them. If you are trying to locate a dietitian in your community, be sure to ask about experience and training - they should have at least a bachelor's degree. Remember to check if the services of a dietitian are covered under your insurance. If not, ask your doctor, nurse, or social worker about community-based programs that offer free services.

Prayer and spiritual counseling can be very important in coping with a serious illness such as cancer. Many people find it useful to get help from clergy or other spiritual leaders, and there is no question that a strong sense of spirituality can help people face difficult challenges with courage and a sense of hope. Some studies show that people with cancer have less anxiety and depression, even pain, when they feel spiritually connected. Even if your beliefs are challenged by your illness, don't be afraid to reach out to others for help. It is important to remember that you are not alone at this time.

Hospice care focuses on the special needs of people who have terminal cancer. Sometimes called palliative, this type of care centers around providing comfort, controlling physical symptoms like pain, and giving emotional or spiritual support. Hospice care is usually provided at home, although there are hospice centers that operate much like hospitals and provide full-time care. Your doctor can refer you for hospice care.

Home hospice care is usually coordinated through a nurse, who works with a home health aide, social worker, occupational therapist, clergy, or whatever specialist is appropriate for the needs of the hospice patient. Hospice care is not for everyone and is not an easy decision to face. It is important to discuss this option carefully and seek guidance from your doctor, nurse, or social worker.

A diagnosis of cancer may be the most difficult challenge you or your loved ones will ever face. That is why it is important to find help wherever you can, and try to maintain your sense of hope no matter what your situation. Your team of health care professionals is knowledgeable about the many different aspects of cancer - medical, physical, emotional, or spiritual. They are available to you as much or as little as you need, but it is difficult for them to know if you need help unless you ask for it. Don't be afraid, embarrassed, or hesitant to ask questions, voice your opinion, and seek the care you need and deserve.