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Prakash Chandran (Host):  Your best care relies on strong partnerships between your primary care provider and cancer specialists. It can improve your cancer treatment and your long term health after cancer. We’re going to talk about it today with Julian Sayner, an Oncology Nurse Navigator at Northfield Hospital Cancer Care and Infusion Center and Jodi Wieczorek, the Director and Advanced Practice Registered Nurse of the Cancer Care and Infusion Center at Northfield Hospital.

This is Northfield Hospital and Clinics Health Matters podcast. I’m Prakash Chandran. So, Juliana and Jodi, thanks so much for educating us here today. Juliana, let’s start with you. Who exactly might be part of a person’s cancer care team?

Julian Sayner, BSN, RN, OCN (Guest):  Absolutely. When you come to the Northfield Hospital for your cancer treatment, you will meet with a team of cancer specialists. And this team will help you with each step in your cancer treatment. So, in addition to meeting with the medical oncologist who is your – generally your primary cancer doctor; you may also see a surgeon, or a radiation oncologist depending on your diagnosis and your treatment plan. And there are some other members of the care team here and that includes our Advanced Practice Nurse, a Clinical Nurse Specialist, Oncology Nurse Navigators, Oncology Certified Nurses and a Nursing Assistant.

And if there’s a need, there is also social workers available and dieticians. And of course, the primary care provider will also be a part of the cancer care team. The medical oncologist will establish and appropriate treatment plan and tailoring the care plan for the specific diagnosis and patient’s own goals as well. And then the nurse navigators and oncology nurses sit down with new patients, provide detailed information about their treatment, also help manage side effects along the way, assist with other appointments if those are needed and be available to address any questions or concerns that come up.

Host:  Yeah, it sounds really wonderful that there’s that big multidisciplinary team available for the patient care. You mentioned the primary care provider and I’m curious as to why they are an important part of a person’s team?

Juliana:  When living with a cancer diagnosis, your once healthcare needs may change, and the best healthcare will include a partnership with the primary care provider and then your team of cancer specialists. So, for example, in addition to continuing with your routine healthcare, follow up with your primary care provider; sometimes people may need adjustments in their diabetic management if they are receiving steroids for example during cancer treatments and that management is best done by the primary care provider.

Host:  Okay, that makes sense. So, I’ve heard that there can be benefits to someone’s overall health from cancer treatment. Can you speak to that a little bit?

Juliana:  I think this is a really interesting question because one wouldn’t always think about overall healthcare benefits from coming in for cancer treatments. But part of cancer care is about taking good care of yourself and taking time to practice self-care. And so, let’s talk about self-care and fatigue for example. Fatigue is the most common side effect of cancer treatments. One of the best strategies to help manage fatigue is to include daily physical activities. A great exercise is walking but sometimes walking is tough so, it’s also beneficial to just engage in gentle movements throughout the day such as engaging activities around your house, moving around the house or even taking very short strides or walks outside. Adding some exercise or activity is good for your overall health in so many ways. Exercise is heart healthy. It helps with muscle strength. Exercise can also benefit someone’s emotional health. It can help with sleep at night. These are just a few examples.

So, therefore when going through cancer treatment, patients may be more intentional about taking care of themselves. We encourage them to continue these practices even after treatment is completed. Another example, we also talk about the importance of nutrition, not just during cancer treatments but also ongoing and supporting patients to continue to be intentional about their food choices and thinking about maintaining a healthy weight is also going to benefit their overall health.

During cancer treatment, we are also keeping a close eye on patient’s physical health. This is done through frequent labwork, blood pressure checks, weight checks. Also patients see the oncologist regularly for follow up visits and these visits may also include imaging with a CT scan or a PET scans and sometimes when we do all this monitoring, we may actually pick up on other issues that need to be attended to.

Host:  So, Jodi, I want to shift over to you. I’m sure a person who might be listening to this, they may get different information or options from different providers. So, when that happens, what should they do?

Jodi Wieczorek, APRN, AGNS-BC, ACHPN, OCN (Guest):  Thank you for asking that question. I appreciate what Juliana has shared so far and I would say that it is possible and it’s actually likely that at some point in time either upfront or at some point in the cancer journey; you may get different information and recommendations from different providers and there are some good reasons. The first reason that sometimes there’s more than one right answer. Sometimes different providers like medical oncologists or surgeon or nurses are actually looking at you and your situation from a different lens and that can be good. Because cancer care is complex and so being considered from different perspectives actually gives a better care plan, better options, pick up on things and actually come to better solutions.

However, it can be anxiety producing and a concern for patients and families when they are hearing different things. so, I guess that the advice that I would offer, and I often offer to patients and families is that it’s okay to ask questions. If patients and family members are hearing different recommendations; ask questions, ask why they’re making those recommendations and let them know what’s important to you along the cancer journey and what you are thinking about. That also impacts the care that you are receiving because better decisions will be made that way and providers and healthcare team members, nurses, pharmacists, should be open to answering your questions when you ask them. That’s an important part of the relationship and that’s when the best care is delivered.

Sometimes after you ask a question, doctors will go back, and they’ll actually pick up the phone and talk to their colleagues more based on what you’ve told them or what your question is and come back with a better answer or a different answer that actually more fully addresses your situation. And there’s actually formal processes that we do sometimes in cancer care. Sometimes your case will be discussed at what’s called a tumor board or a cancer conference where all the different members of the cancer team look at your case and actually talk about it. and lots of learning happens with those discussions. In addition, if you are hospitalized because of something going on with your care or you are having a medical issue; you can request a care conference and oftentimes that’s very helpful especially if there are multiple different types of doctors or specialists involved in your care or if there are complex decisions that need to be made.

Sometimes sitting down with different doctors or different members of the healthcare team, the information can be re-shared, and discussion can happen to more fully understand and better decision making happens out of those situations.

Host:  Yeah, I think the big takeaway there is that it’s so important that you are your own biggest advocate especially when it comes to your health so don’t be afraid to ask those questions. Jodi, I’m curious as to after the cancer treatment is completely done; how does a primary care provider help out at that stage?

Jodi:  So, once your cancer treatment is over; usually the oncologist will monitor you for a period of time and that’s different based on treatment and the type of cancer you have. And they will watch you for delayed treatment toxicities and other issues you might be having and also surveillance of your cancer situation. But we also want to partner with primary care because those visits will actually stop, and we will transition you back to primary care. They also are experts in screening and those types of pieces of information and so, they will be continuing on for the rest of your lifetime after your immediate cancer treatment and that initial surveillance and follow up happens; you will go back with primary care and they will continue that monitoring. They are experts at part of their knowledge and part of their promotion of health within the community that we serve.

The oncology team will give you information to help with further recovery and screening cancer prevention. Sometimes there’s even a formal process or formal program called a survivorship treatment care plan which summarizes the treatments you’ve received, what surveillance you should have and screening you should have as well as cancer prevention strategies. Primary care overlaps those strategies as we transition you back and it’s also important that those routine screenings are not only for cancer and the strategies for cancer prevention are the same not only for cancer, but also other serious illnesses like Juliana had talked about earlier.

So, things like exercise and nutrition and other healthy lifestyle things that you can do not only help with prevention of cancer and prevention of cancer reoccurrence but also heart issues and lung issues and kidney issues as well.

Host:  Yeah, you mentioned screening a couple of times and I want to get into that a little bit. We’re familiar with the screenings for the different systems in our bodies like mammograms and colonoscopies but what are the recommendations for screening for the most common types of cancer?

Jodi:  So, there are multiple guidelines for surveillance and screening guidelines for the most common types of cancer. I can tell you the most common types of cancer for men in the United States are prostate, lung cancer and colon cancer. And for women are lung cancer, colon cancer and breast cancer. Your primary care provider is the expert to know what screenings are best for you based on your health and your history. Two types of guidelines that are commonly followed at the US Preventative Task Force guidelines and there’s also the American Cancer Society guidelines. But there are many and primary care works to determine what are the best guidelines to follow and they’ll also incorporate that based on what they know about you as a person and your health and your history. So, when you visit your primary care provider on a regular basis, you’ll be informed about what the screenings and timing of those screenings should be.

Host:  Well thank you so much Juliana and Jodi for educating us today. Learn more about cancer care at Northfield Hospital and Clinics at our website www.northfieldhospital.org. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll talk next time.