Understanding the Role of a Care Team in Treatment Planning

By: Anthony Sireci, M.D., senior vice president, clinical biomarkers and diagnostics development, Loxo@Lilly

When someone is diagnosed with cancer, it is critical that they and their caregivers take an active role in decisions about their treatment from the very beginning. The emotional impact of the diagnosis and lack of patient-friendly information may prevent active engagement. Additionally, the sheer number of team members on a care team and the complexities involved in mapping out a personalized treatment plan can often create challenges for patients to advocate for themselves, but patients and those caring for them should feel empowered to take a more dynamic role in their comprehensive care through collaboration and shared decision-making with their providers.

Conversations with their care teams about additional opportunities such as comprehensive testing, can play a vital role early on during treatment. Access to comprehensive genomic testing is a perfect example of how patients and their care givers can influence and shape their treatment plans. While testing can take up to two or more weeks after receiving a cancer diagnosis, it can be worth the wait when creating a personalized treatment plan in partnership with your care team.(1) Discussions with the care team is critical to ensuring the appropriate testing is done at the appropriate time.

Communicating with Important Members of Your Health Care Team

Cancer treatment typically consists of a complex team with a lot of moving parts. Understanding the role of each healthcare team member can empower patients and caregivers to feel comfortable having necessary discussions around their treatment plans with the correct provider. Let’s break down the standard care team for a typical patient with NSCLC:

• Oncologist: An oncologist specializes in diagnosing and treating cancer and oversees patient care from diagnosis throughout the course of the disease. After receiving a diagnosis, the patient and their caregiver can speak with their oncologist to determine whether comprehensive biomarker testing is appropriate for them. Before treatment begins, patients can confirm whether the appropriate biomarker testing to be done will cover all the genomic changes and signatures relevant to NSCLC.
• Proceduralist: Following discussions with the oncologist, a proceduralist or surgeon will perform the biopsy or procure tissue (the removal of cells or tissues from a tumor for examination). The patient and their caregiver may communicate with proceduralists who obtain the biopsy to confirm that adequate tissue for molecular testing has been procured.
• Pathologists: A pathologist will examine the appearance of the cells and tissues to determine a diagnosis and this analysis is critical in determining the type and stage of cancer. The pathologist will also select the appropriate sample for molecular testing. The pathologist will send the tissue to a special lab for comprehensive molecular testing and results can take up to two weeks to be received by the oncologist.(1) All lab results are recorded in a pathology report and patients can request a copy for their records.(1) In most cases, one pathologist will review the tissue collected by the proceduralist for diagnosis and a different pathologist will conduct the lab tests.
• Nurse/Physician Assistant: A nurse or physician assistant will typically input and execute orders for testing and therapies throughout the treatment journey and will be a helpful resource for answering questions or concerns and assisting patients in understand the players on their care team.
• Primary care provider: It’s likely that a primary care provider may be more familiar with the needs of the patient and their loved ones than the oncology team. Keeping the primary care provider well-informed of the patient’s cancer treatment journey is important as it influences how they might care for coexisting illnesses and conditions.

You Are Not Alone on Your Treatment Journey

When it comes to cancer, there is almost always a gap between diagnosis and treatment. Cancer treatment is multifaceted and can feature large care teams and include a lot of moving parts. It can be intimidating for a patient or caregiver to speak up and ask important questions when so many individuals are involved. However, doing so helps to ensure the patient receives a specialized treatment plan that best fits their needs.

It’s also important for patients and caregivers to remember they are not alone. Utilizing informative resources from trusted advocacy groups, such as The Happy Lungs Project, or connecting with patient community groups can be a huge help for patients and caregivers to bridge the gap between diagnosis and treatment.

When patients and caregivers are well-informed on the complexities involved in the diagnosis and treatment process, they become better advocates for their health.

Anthony “Nino” Sireci, M.D., senior vice president, clinical biomarker and diagnostics development, Loxo@Lilly. Dr. Sireci is a board-certified clinical pathologist and a practicing molecular pathologist. Prior to joining Loxo@Lilly, he was an assistant professor of pathology and cell biology at Columbia University and a medical director in the Laboratory of Personalized Genomic Medicine at Columbia Medical Center. He is an active member of the Association for Molecular Pathology (AMP), where he serves as the vice chair for new codes and pricing on the Economic Affairs Committee. He is also a member of the Pathology Coding Caucus in the College of American Pathologists (CAP) and the Molecular Pathology Advisory Group in the American Medical Association (AMA). Dr. Sireci received a B.A. in chemistry from New York University and an M.D. from the Johns Hopkins University School of Medicine. He completed his residency training in clinical pathology at the New York Presbyterian Hospital-Columbia University Medical Center where he also served as chief resident. During this residency, he also received an M.Sc. in biostatistics from the Mailman School of Public Health at Columbia.