Cancer treatment has changed drastically in the last 20 years, and a cancer diagnosis is no longer considered a death sentence. Along with early detection and other factors, targeted cancer treatments are responsible for much of that success. From diagnosis to aftercare, cancer care providers are finding the disease varies so greatly that specializing in site-specific cancers has become the most effective method of treatment.
"Cancer is 100 diseases in one," says Mattie J. Hobley, director of oncology services at East Jefferson General Hospital (EJGH). "Each cancer acts differently in the body and needs to be treated differently."
EJGH urologist Dr. Sean Collins offers further explanation: "Seminoma, for example, a cancer of the testes, is exquisitely susceptible to radiation, but other cancers are more susceptible to chemotherapy, others respond to surgery and others require combinations. Why some respond well to one treatment and poorly to another, we can't always say. If we had the answer to that, it would be the Holy Grail for cancer treatment."
Because certain cancers are sensitive to some treatments and others are not, physicians specializing in a particular part of the body may be able to hone in on the most effective course of treatment more quickly than those with a broader knowledge base. For example, providers who treat mostly breast cancer patients may not be aware of the latest treatment regimens and resources available for prostate cancer patients.
More oncologists are graduating from medical school with an interest in specializing in fighting one particular kind of cancer. "The oncologists we meet now all want to know what our philosophy is on cancer treatment," Hobley says. "They want to know that they can practice in one area of expertise."
Some of the most successful treatments begin with early detection, so diagnosticians already have adopted site-specific practices. Radiologists at EJGH represent specialties from across the medical landscape including neuroradiology, abdominal imaging, musculoskeletal imaging, interventional radiology and breast imaging. Tools used to diagnose cancers in different parts of the body also vary. Breast imaging, for instance, can call for one or several of the following procedures: digital mammography, computer-aided detection, breast ultrasound, breast MRI, cyst aspiration, stereotactic, ultrasound and MRI-guided needle biopsies, ductograms, and needle localization for surgical biopsy.
The field of cancer navigation also is evolving into site specialties. Cancer navigator programs, which guide patients through the cancer and hospital experience, are fairly new components of patients' overall care but are fast becoming integral parts of treatment. The American College of Surgeons Commission on Cancer, the credentialing agency for cancer programs, will institute patient navigation as a standard of care in 2012. All programs should have a cancer navigator program in place by 2015.
EJGH established its cancer navigator program in 2008. This year, the hospital expanded the program to include site-specific navigators for the four most-often treated cancers at EJGH: breast, lung, colorectal and prostate.
"They assist physicians in expediting patients' treatment and care and make sure that clinical protocols are adhered to from diagnosis through survivorship," Hobley says.
The programs also provide resources for patients in an organized, easy-to-understand way. Registered nurse Debbie Schmitz, who began the navigator program at EJGH and now acts as a navigator for prostate and other cancers, explains, "Navigators act as patient advocates, physician liaisons, comrades and support.
"When we meet patients, they are nervous and anxious and a little upset. The navigator listens to the patient, presents them with a binder where they can keep all of their medical records, appointments, notes and other resources. We also give them access to outside resources like legitimate websites and cancer support groups. We have resources for how to talk to children about cancer, nutritional information ... you name it."
Now that the program has expanded, navigators will continue to extend care to patients through the first five to 10 years of recovery. Having a navigator specializing in just one type of cancer means the patient can be with the same navigator through his or her entire journey.
The key component of making site-specific cancer care work and continuing improving the quality of care patients receive is to rethink the notion that one doctor should have the final say in a patient's treatment. Hobley and Collins agree that the trend in cancer care is moving toward multimodality therapy. This approach combines the site-specific expertise of surgeons, oncologists, pathologists, radiologists, nurses, cancer care navigators and ancillary personnel.
"We want to focus on the disease," Collins says. "We identify people with expertise in the area who can combine their efforts. We are going to demand quality in a certain area, and we are going to identify the people who can achieve that."