Women usually see more than one health professional during the course of their treatment for secondary breast cancer. The medical oncologist will most likely lead the team, so it is important that you choose someone you feel comfortable with. The quality of this relationship could influence how you feel about your treatment, how many questions you ask and your sense of being generally well cared for.
'I found a good GP who I see regularly and I have a good oncologist. They both listen, check that I understand their advice and talk optimistically about the future - they give me hope!' - Sylvia
The number and kinds of people treating you at any one time will depend on the stage of your cancer, where you live and where you are being treated. In some centres they will be part of a multidisciplinary team, where everyone involved in your care meets regularly to discuss your progress.
Members of your treatment team might include:
- Medical oncologist: specialises in diagnosing and treating cancer using chemotherapy, hormone blocking therapy and targeted therapy.
- Radiation oncologist: determines whether radiotherapy will be useful and, if so, prescribes the appropriate dose and duration. The radiation oncologist will usually work closely with the medical oncologist and GP.
- Specialist surgeon: operates to improve an area affected by cancer, such as bone, brain or lung. This may include, for example, pinning a bone to strengthen it, or surgically removing a cancer.
- Oncology/chemotherapy nurse: administers chemotherapy and other treatments and helps with radiotherapy. The nurse also helps to manage pain, nausea and other symptoms.
- General Practitioner (GP): can coordinate your care, clarify the information given to you by your specialists, help you with treatment decisions, assist in finding practical support for you, visit you at home if needed, and offer emotional support. Ask your specialists to send copies of all tests and planned treatments to your GP.
You might also find the services provided by the following specialists helpful:
Breast care nurse
Breast care nurses can provide information, counselling and support, and can help to coordinate your care. Not all women with secondary breast cancer will have access to a breast care nurse, but you may like to ask your hospital or medical oncologist if it is possible to be referred to one if you think it would be helpful for you.
Palliative care specialist
Palliative care specialists include doctors, nurses, social workers and others who have specific skills and who work as a team to help people from soon after their diagnosis. They can assess and manage physical symptoms such as pain and poor appetite, and can help to ensure your home environment is safe and comfortable. Many people fear that seeing a palliative care specialist means they are nearing the end of life. However palliative care specialists can provide care at any stage of your treatment for secondary breast cancer. Many women find the pain control offered by palliative care specialists extremely helpful.
Social workers can help you and your family to cope with the impact secondary breast cancer has on emotional, psychological and practical issues, such as employment, finances, accommodation and legal issues. They can arrange care at home if needed. Oncology social workers can provide counselling and support for you and your family.
Many women with secondary breast cancer will seek counselling at some stage. A psychologist can help you and your family talk through relationship issues, concerns such as fear, loss and grief, and can help with strategies for getting the most from life.
Your GP may refer you to a psychiatrist if you have depression or other emotional needs that may benefit from specialist care.
Physiotherapists can help you to manage some of the side effects of secondary breast cancer and its treatment. They can help to relieve pain without medication, and to improve your movement and activity. They can also help you to manage lymphoedema.
Lymphoedema practitioners used specialist massage, compression garments and bandaging, exercise therapy and other therapies to help manage lymphoedema.
Occupational therapists can visit your home and suggest changes that would make your life easier, including home supports and special equipment.
Nutritionists and dietitians can help you to assess you diet and provide advice on nutrition. They can also help with problems such as poor appetite, nausea and constipation.
Pastoral care worker
Pastoral care workers can help you to adjust to your situation and explore issues related to spirituality, hopefulness and meaning, regardless of your faith or religious belief.
Pharmacists can explain possible side effects of treatments and medications, and suggest ways to alleviate some of them.
Getting the most out of your consultations
- Communication with your doctors is the key. Don't be afraid to talk to them and ask questions until you're sure you understand the answers.
- Write down any questions you might have before your appointment as it is easy to forget things. If you have a lot of questions, prioritise your list before you go to the appointment so that the most important issues are covered first.
- If you can, take someone with you to your appointments. They can take notes in case you forget something later on. You can also ask your doctors if you can record your consultations, if you think that would be helpful.
Not all women with secondary breast cancer see the same specialists they saw during their treatment for early breast cancer. While you may be referred to a particular specialist, you do have a choice in who you see. Word of mouth is a powerful reference and recommendations from other women are valuable.
If you are unhappy about who you have been referred to, we encourage you to seek a second opinion. If you are a private patient, choice of your team is in your hands.
- Issue 59 of The Beacon (Winter 2012) includes an article on communicating with your medical oncologist, and an article on seeking a second opinion.