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  • Dr. Robert A. Nagourney, MD

What Do Medical Oncologists Do?

If you ask most patients, even their doctors, what medical oncologists do, they will tell you that they give chemotherapy. But is that the right answer?

Patients diagnosed with cancer find themselves in an unfamiliar realm. As their primary care physicians are not expert in oncology, these long time allies must now relinquish control to the cancer experts.

Types of Oncologists

There are three types of oncologists; surgical, radiation and medical. We have a good handle on the surgical part and most have some concept of radiation so the question remains, what do medical oncologists do? Quite a lot it turns out.

As the responsibility for cancer patients shifts from their primary care physician to the cancer specialists, the medical oncologist must assume the role of quarterback, calling the plays as he or she sees them. Medical oncologists coordinate diagnostic work-ups, laboratory analyses, referrals to sub-specialists and provide care in the form of pain management, hydration, nutritional support, hospitalization and, where needed, end-of-life counseling.

So emotional can the relationship become that one of my co-fellows at Georgetown described oncology as “psychiatry with a stethoscope”. But is that it? Are medical oncologists nothing more than good doctors with a kind demeanor?

Cancer therapy has become increasingly complicated as the options have become more numerous. It is now necessary for Medical oncologists to step out of the role of chemotherapist and expand their understanding of cancer biology, developmental therapy, drug toxicity even drug costs to navigate patients through the treacherous shoals of cancer medicine.

Making a Difference for Cancer Patients

Richard Bloch co-founder of H&R Block is an instructive example.

Diagnosed with lung cancer at the age of 52, he was given a death sentence.

Unwilling to accept his terminal prognosis, he sought out the care of experts until he found a group who combined treatment modalities to provide him a cure, surviving cancer–free to the age of 78.

He and his wife Annette then committed their lives to providing every cancer patient the guidance they needed to make informed decisions.

They started the Cancer Hotline and promoted the PDQ (Physician Data Query) for the National Cancer Institute. Millions of patients have since benefited from their efforts.

A Good Oncologist Should Be A Guide

This is the role that every oncologist should aspire to fulfill.

Not a treater but a teacher. Not a chemotherapist but a guide who steers each patient through the obstacle-field of therapy to the best possible outcome. Each drug, combination or modality brings risks and hazards with uncertain benefits.

The knowledgeable physician must maneuver through this minefield to avoid toxicity and maximize response. At their best the oncologist should see the patient through, even if they themselves cannot offer the therapy that is needed.

The role that I have defined for myself is to look beyond the standard regimens, NCCN (National Comprehensive Cancer Network) guidelines and protocol therapies to pursue those options that meet the needs of each individual.

With a knowledge of cancer biology I use all sources of information to drill down onto “actionable” findings at the cellular level. In our 3-dimensional tissue cultures (EVA/PCD functional profiling assay) we can interrogate tumors and force them to give up the information that informs our drug selections.

These laboratory tests are a valuable adjunct to my role as a guide.

But not every patient has an assay nor does every assay lead to a winning combination. Nonetheless, every patient that I treat gets the best possible therapy that I can find, wherever I need to look.

I am reminded of the Blochs when I consider my own role as an oncologist.

I am a guide, there to assist my patients through an unfamiliar maze of cancer therapeutics using all the resources at my disposal. Whether it is a knowledge of molecular biology, an understanding of metabolomics, an interest in natural therapies or my own laboratory platform, all of these insights are applied toward the greatest good for each patient.

As always, I appreciate your thoughts and comments.

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