Children Diagnosed With Cancer: Understanding the Health Care System

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Who are the members of the comprehensive health care team?

Experts from different disciplines (medicine, nursing, social work, and many others) are part of the cancer care team that helps patients and families. They may be involved from the days before diagnosis through the months and years following the end of treatment.

Team members offer different services and programs. They work together to figure out what each patient and family needs in order to best cope with cancer and its treatment. They design and coordinate a personal plan for care. While in the hospital, patients and families will see some team members every day. Others will only come when their help is needed with certain issues. During clinic visits the same or even more team members may be available. When patients are at home, team members generally stay in touch. They might offer help by phone or arrange community care.

Every treatment center is unique, so teams will have different members in different settings. Just before or just after diagnosis, parents are usually told about, or introduced to, all members of the cancer care team. All teams have doctors, nurses, and social workers. Teams may also include psychologists or psychiatrists, recreation therapists or child life workers, teachers, and chaplains. Most teams think of parents as team members and want them to have an active role in caring for their child. The patients, whether they are children or teens, also are part of the team if they are mature enough.

Next are some lists of team members you might meet. They are in order with those most commonly seen at the top of the lists.

Types of doctors who help care for children with cancer

Pediatric oncologist: a doctor who specializes in cancers of children. (Pediatric means dealing with the health of children. Oncology means cancer.) They generally are board-certified (have passed written national exams). They plan and direct cancer treatment. In teaching hospitals they serve as the doctor in charge. There might be more than one on the team, in which case they might rotate (switch places from one day to the next).

Pediatric hematologist: a doctor who specializes in diseases of the blood and blood-forming tissues of children (Hematology means blood disease.)

Pediatric hematology or oncology fellow: a pediatrician training to become a hematologist or oncologist

Pediatric resident: a doctor training to become a pediatrician. They are in teaching hospitals, usually doing a rotation on the hematology or oncology service.

Medical students: although not yet doctors, third and fourth year medical students in teaching hospitals are assigned monthly rotations on the hematology or oncology services and help care for patients

Radiologist: a doctor with special training in diagnosing diseases by reading x-rays and other types of imaging studies, for example, CT scans and MRIs

Pediatric surgeon: a doctor who treats medical problems in children with surgery

Thoracic surgeon: a doctor who operates on the chest cavity

Neurosurgeon: a doctor who specializes in operations on the brain, spine, or other parts of the nervous system

Neurologist: a doctor who treats problems of the nervous system

Ophthalmologist: a medical doctor who specializes in eye diseases

Orthopedic surgeon: a surgeon who specializes in diseases and injuries of the bones

Pathologist: a doctor who specializes in diagnosing and classifying diseases by lab tests, such as looking at tissue and cells under a microscope. The pathologist decides whether a tumor is cancer, and, if it is, the exact cell type and grade.

Psychiatrist: a medical doctor who specializes in mental health and behavioral disorders. Psychiatrists prescribe medicines and can also provide counseling.

Urologist: a doctor who specializes in treating problems of the urinary tract in both sexes, and of the genital area in males

Endocrinologist: a doctor who specializes in diseases related to the glands of the endocrine system, such as the thyroid, pancreas, and adrenal glands

Gynecologist: a doctor who specializes in women’s health and the female reproductive system

Anesthesiologist: a doctor who specializes in giving medicines or other agents that prevent or relieve pain, especially during surgery

Other doctors in the medical center and its clinics may play a part in caring for the child or teen with cancer, depending on the diagnosis, treatment plan, or symptoms that develop during the course of treatment. All work closely with the basic cancer care team to coordinate care.

Other professionals who may help care for a child or teen with cancer

There are many professionals and specialists other than doctors who may work with your child or family. Here are just a few more you may meet as your child is treated.

Nurses: like doctors, nurses have different roles and titles based on their education and training. Nurses help care for and treat children and teens with cancer. They play an important part in teaching the patient and family about cancer and its physical and emotional effects. They also help set up care for the patient in his or her home community when referrals are made to home health agencies.

Teams of nurses may include:

    Oncology Clinical Nurse Specialists (OCNS; may also be called Advanced Practice Registered Nurses or APRNs in some states): registered nurses with a master’s degree in oncology nursing who specialize in the care of cancer patients. Oncology clinical nurse specialists may prepare and give treatments, monitor patients, prescribe and provide supportive care, and teach and counsel patients and their families.

    Nurse practitioners (NP; also called Advanced Practice Registered Nurses or APRNs): registered nurses, usually with a master’s or doctoral degree, who have passed a national certification exam. Certified nurse practitioners diagnose and manage illness and disease, usually working closely with a doctor. In nearly all states, they can prescribe medicines.

    Certified Pediatric Oncology Nurses (CPONs): registered nurses who specialize in working with pediatric cancer patients, and who have passed a national exam

    Registered nurses (RN): nurses with associate or bachelor degrees who are licensed by their states to practice nursing. They give medicines (often including chemo), start and monitor IV medicines, take vital signs, and provide other hospital and clinical care. They also provide patient and family education.

    Licensed practical nurses (LPN): nurses who have completed training in a vocational school or community college program and have passed a state licensing exam. They do many skilled tasks for patients at the bedside or in clinics.

Oncology social worker: this person has a master’s degree in social work and is an expert in coordinating and providing non-medical care to cancer patients. The oncology social worker provides counseling and assistance to people with cancer and their families. They can help you and your child talk with the cancer care team and they can speak up about issues that are important to you. They can also help with issues like financial problems, housing (when treatments must be given at a facility away from home), and finding child care.

Recreational therapists or child life workers: these team members encourage children and teens to take part in play activities designed to maintain and improve physical and mental health. Such activities also provide distraction and help relieve stress and anxiety during treatment, tests, and procedures. These experts work closely with social workers, team psychologists, and psychiatrists. They generally have advanced college degrees.

School teachers: teachers often are part of comprehensive care teams and must have the same training, credentials, and state licenses as public school teachers. They bridge the gap between the hospital and school, and teach students based on plans outlined by the patients’ teachers in their regular schools. They are usually available in both inpatient and outpatient settings.

Dietitians: experts in the area of food, nutrition, and diet. A registered dietitian (RD) has at least a bachelor’s degree and has passed a national exam

Radiation therapists: people with special training to work the equipment that delivers radiation treatment

Pharmacologists: professionals trained in understanding the properties, dosing, and uses of drugs. They may consult with your cancer team about the uses, reactions, and interactions of drugs used to treat cancer and manage symptoms.

Pediatric psychologists: psychologists generally have doctoral degrees and are licensed to practice after passing a written exam. Some psychologists specialize in oncology. They are also part of many comprehensive care teams. They help patients understand and talk about their cancer. They are skilled in helping young people use a variety of techniques to get through surgery, radiation treatment, chemo, nausea, pain, IVs, shots (injections), procedures, scans, and other tests.

The psychologist also may work with patients, parents, and other team members to look at educational needs and help with school issues. They evaluate a child’s mental and emotional state and provide counseling to children and teens to help them cope with their illness. They often refer patients to mental health providers and services in the family’s home community. There usually is a fee associated with their professional services, but insurance may cover at least part of it.

Chaplains or pastoral counselors: these counselors help care for the spiritual needs of the patient and family and are available in most medical centers. They often coordinate their efforts with a family’s pastor or spiritual caregiver. Along with a divinity degree and other advanced degrees, chaplains often have had special training in working with the ill and dying. Pastoral counselors have special training in counseling, as well as in divinity or theology. In teaching hospitals they may be involved in teaching and training.


Last Medical Review: 07/02/2012
Last Revised: 07/02/2012