Senior doctor examining and pointing to a patient's x-ray while consulting with his medical team

The Complete Radiotherapy Care Team Breakdown

Bradley T. McCall, MD | SERO Doctors | Novant Health, NC
Written by Bradley T. McCall, MD

Cancer and life-changing diagnoses requiring radiotherapy are terrifying. The sudden jolt of uncertainty is overwhelming, and the chaos of treatment leads to even higher levels of stress. While radiotherapy treatments have improved over time, the complexity of a care team may lead to confusion. Between your primary care physician (PCP), nutritionist, oncologist, physical therapist and other care team members, understanding the role of your doctor only grows more confusing.

Depending on your diagnosis, surgical options may be combined with targeted radiotherapy treatment, or a radiotherapy-exclusive treatment may be optimal. In addition, the person in charge of radiotherapy treatment is only one part of the multidisciplinary care team, working to provide comprehensive care for your body, mind and soul. In creating a comprehensive treatment plan, the title, “doctor,” may be applied across numerous professionals beyond a traditional Medical Doctor (MD). That’s excluding an entire group of other professionals, including radiation specialty nurses, social workers, dietitians and psychologists, that may be involved in devising and implementing the best treatment plan possible.

To help you navigate the complex process of planning for, receiving and following up after radiotherapy, let’s take a closer look at different professionals that specialize in radiotherapy, where they may work, who they work with as part of the care team and what to expect.

Who Forms the Multidisciplinary Care Team?

Members also include specialist nurses and those with advanced training in the care of those with a cancer-like diagnosis. Moreover, the provider performing the radiotherapy treatment—operating the machine—may differ from the prescriber. A physicist may work together with the care team to determine dosage levels and more. Meanwhile, managing the side effects of radiotherapy may involve other physicians and specialists in radiotherapy.

In general, notes the American Society of Clinical Oncology (ASCO), the doctors involved in radiotherapy include these specialists:

  • Radiation Oncologists. The radiation oncologist oversees each person’s care. They determine if radiotherapy is appropriate, review side effects and benefits, develop a treatment plan and ensure treatment is given at the proper dose and location. They are the catch-all provider throughout treatment, almost a PCP for cancer care. They do work closely with other physicians and the radiation oncology care team. They must attend four years of college, four years of medical school and an additional period of specialty residency training for radiation oncology. In addition, they must be certified by the American Board of Radiology.
  • High-Specialty Radiation Oncologists. High-Specialty radiation oncologists fulfill the same criteria and practices as a radiation oncologist. However, they take on additional roles in treating specific demographics or cancer types. For example, pediatric radiation oncologists treat childhood-cancers and hematologist-oncologists treat cancers of the blood.
  • Radiotherapy-Trained Pathologists. Pathologists are responsible for reading laboratory tests and depending on their skills, they may double as diagnostic radiologists. In addition to the initial treatment, radiotherapy-trained pathologists focus on the potential tissues surrounding a targeted area and its side effects from radiotherapy. Meanwhile, diagnostic radiologists use x-rays, MRI, CT scans and ultrasound to read imaging results.
  • Therapeutic Medical Scientist. The therapeutic medical physicist typically holds a doctorate in particle physics and oversees the dose planning and targeting aspects of treatment. They tailor each treatment to the unique properties of a person’s tumor. In addition, they take precise measurements of the tumor, plan beam intensity and conduct safety tests. In addition, they must be certified by both the American Board of Radiology and the American Board of Medical Physics.

Of course, PCP and other specialists in charge of your care will play a role in ensuring comprehensive care, considering any other chronic or unique health conditions affecting treatment planning and progress.

Group Photo of the SERO Staff and Board-Certified Physicians and radiotherapy staff
SERO Radiotherapy Care Team

Characteristics and Personal Traits of Caregivers Working with Radiotherapy.

All healthcare professionals have common traits. They must understand the trials of illness, how to help people in emotional turmoil and demonstrate a commitment to serve others. The same traits are integral to effective radiotherapy care team members. However, the nuances of such treatment mean healthcare professionals in this setting must amplify their skills to ensure the safety and effectiveness of treatment. It’s not as simple as administering a medication; the slightest miscalculation could result in adverse effects. 

  • Innovative thinking. While radiation may produce life-saving results, the standard treatment is not always the most effective. In addition, poor planning could lead to serious side effects. As a result, they must be ready to respond to any change in condition up to, including and after administration of treatment. This level of innovative thinking sets healthcare professionals that work in radiotherapy apart from their peers.
  • Considerate of others’ opinions and needs. While radiation is much safer today than history reveals, it is still a cause of apprehension. Those working with radiotherapy need to take the full consideration of others’ opinions, including those in need of treatment.
  • Willing to work with the person in need to create the best-case scenario. Even those prepared and ready to receive radiotherapy may have unique needs, such as special protectors for metallic body implants or other medical devices. Radiation Specialists need to work with each person to consider their physical and mental needs, and if something does not mesh well, it may warrant a complete overhaul of the treatment plan.
  • Helpful, aiding with referrals and information to obtain funding for treatment. Another critical component of these caregivers goes back to financial responsibility. Regardless of insurance availability, no one should be refused treatment without any course of action. Even centers that do not accept self-pay patients may have resources available to help prospective patients apply for and obtain coverage. Of course, such services may vary widely, so it is up to each patient and family members to determine their financial responsibility needs prior to arrival.
  • High-quality communication skills. Any practitioner is only as good as their ability to communicate with verbal and nonverbal skills. Since radiotherapy is still a technology-of-concern for patients and family members, body language will speak volumes about their trust in the treatment plan of care. Also, radiation specialists must break down complex principles to help people make an informed decision.
  • Experience in working with radiotherapy across the scope of cancers. As radiotherapy has advanced, the knowledge to make an informed decision for treatment has grown. Meanwhile, numerous cancer types exist, further complicating the process. As a result, doctors that specialize in radiotherapy need to understand how a specific type of radiation will affect each cancer, as well as share these expectations with those in need.

Additional physicians may be involved in the care process as well. These physicians may have extensive training for treating a specific type of cancer, such as a specific sub-set of cancers of the liver or lungs. Although these professionals would fall under the highly specialized group, they may vary widely and by the facility. Furthermore, the policies of individual facilities may require additional assessment, diagnostics and treatment planning that go beyond the pre-determined care plan.

Such activities further ensure the planned treatment provides the best result and minimizes the risk of severe side effects.

Of course, there is much more that goes into treatment than physicians, including those responsible for providing care during and after treatment, especially when illness necessitates hospitalization.

What About Radiotherapy Nurses and Direct Caregivers Involved in Treatment?

Nurse and elderly man spending time together

Nurses are heavily involved in radiation treatment as well. Traditional registered nurses (RNs) may serve as a charge nurse, making them responsible for overseeing a unit and multiple nurses that provide direct care. Those providing direct care may include RNs, licensed practical nurses (LPNs) and certified nursing assistants (CNAs). In addition, nurses may complete additional training, set forth by state-specific and facility-specific requirements prior to working with radiotherapy patients.

For example, a hospital may require nurses that work with patients receiving this therapy to complete a course prior to engaging with patients on their own.

In outpatient clinics, nurses may fulfill other roles, assisting with patient mobility, positioning and assessment, as well as administering medications, establishing IV access and preparation for the procedure. As explained by the American Cancer Society (ACS), advanced practice nurses (APN or APRN) that complete the state-mandated requirements—either a master’s or doctoral degree, as well as a specialized certification in a given care setting, may fulfill additional roles. They may supervise staff, work with doctors to develop care plans, conduct nursing research, offer education to patients and help them navigate the course of treatment.

Integrative and Complementary Health May Be Appropriate, Resulting in Additions to the Care Team.

The world has experienced a shift in the perception of alternative and integrative health as an extension of traditional healthcare. According to the National Center for Complementary and Integrative Health (NCCIH), the use of conventional a non-conventional treatment measures, such as using natural products, chiropractic manipulation, massage, special diets and guided imagery, may be a part of the care plan. This is largely dependent on each person’s needs and wants.

Based on personal preference and the type of tumor present, patients may wish to explore integrative health measures to increase their chances of remission. Although debate still exists over the efficacy of some non-conventional measures, studies support the use of complementary health approaches in managing treatment side effects and increasing remission chances. However, the NCCIH, operated by the National Institutes of Health (NIH), notes that each consideration must be taken seriously. Some herbal supplements and activities could exacerbate health condition, lead to the worsening of symptoms or even contribute to other illnesses.

At the same time, other types of non-conventional treatment bear the same points as traditional care. For example, improving diet may reduce the severity of symptoms and overall health, placing less strain on the body during treatment. Even in this case, sudden dietary changes could be off the table for those with unique health problems, including diabetes, high blood pressure, kidney disease or other metabolic conditions. Therefore, the only safe option is to discuss non-conventional treatments with the oncology multidisciplinary care team before taking a chance that may prove harmful.

Nutritionists and Registered Dietitians Will Also Work to Enhance Outcomes.

Diet plays a significant role in health. It affects weight and ability of the body cells to perform their functions. When a tumor develops, the right balance of nutrients may slow or augment its progression. In other words, diet may directly affect the exacerbation of cancer cells.

Other reasons to consider dietary changes when receiving treatment go back to the type of treatment and its possible side effects. For instance, nausea is among the most reported side effects across radiation therapy. Eating a small meal prior to treatment may reduce its incidence and vice versa. The types of foods consumed may also lead to an increased or decreased risk of side effects.

As another example, spicy foods increase the product and release of acids within the stomach to enable digestion. Among people with gastroesophageal reflux disorder (GERD), more commonly known as chronic heartburn, the foods eaten in the days leading to treatment should avoid spicy items and those that trigger a person’s stomach to release higher levels of acids. Moreover, taking a duration of proton pump inhibitors or H2 antagonists during the days before treatment may reduce the likelihood of severe nausea.

These issues highlight the need to work with a nutritionist or registered dietitian before and after treatment. Dietitians also help increase positive treatment outcomes by reducing the adverse effects of dietary choices on overall health. For illustration, decreasing sodium (salt) intake will reduce strain on the kidneys and heart. This can mean the difference between taking additional medications to control kidney function and blood pressure or suffering through more pills.

A healthy diet also helps the body fight infection and reduce inflammation. This is achieved through an improved mix of compounds in the blood, stimulating the production of proper hormones, metabolism of complex carbohydrates and sugars and more. As body weight decreases, the body spends fewer resources trying to maintain homeostasis, allowing for the diversion of nutrients and amino acids necessary to promote healing.

It is a very complex process, but it boils down to a simple principle: Healthier diets mean a healthier body mass index (BMI).

A healthy BMI is a protective factor against certain cancers, the onset of other illnesses and decreased lifespan. In fact, according to an analysis of study data of diet and breast cancer risk among more than 22 million people, published by the National Library of Medicine, those that embrace a healthy diet experience a reduction in breast cancer risk. Meanwhile, those that exhibit precancerous cells or other risk factors, including past incidence of breast cancer, can utilize improved dietary choices to reduce their risk of recurrence.  

Social Workers and Psychologists Will Take Part Too.

Another group of professionals involved in care includes social workers and psychologists. Social workers perform multiple tasks, ranging from counseling to assistance with locating and applying for financial assistance. Meanwhile, psychologists and psychiatrists will help those suffering with cancer prepare mentally for the challenges ahead. Yet, their skills are not limited to helping those with a diagnosis; they extend to the support system for each patient. In other words, they work the family members and friends of those in need of treatment.

Radiotherapy Specialty Clinics, Hospitals and Outpatient Centers: Where Will Treatment Take Place?

Two nurses with a patient demonstrating external beam therapy
External Beam Therapy

The final aspect of understanding the type of healthcare professionals that specialize in radiation treatments is the simplest. It is the type of facilities and care settings that conduct such treatment. Depending on each person’s unique tumor growth, location and needs, treatment may be available on an outpatient or in-patient basis. The type of facility hinges on the current health of the person in need of treatment.

Someone with limited resources or receiving around-the-clock care in an in-patient facility may need to receive treatment at the facility or be sent to a nearby facility for a scheduled visit.

Those receiving treatment on an outpatient basis will also need to consider the unique factors affecting each dosage.

For example, those traveling distances greater than an average commute may consider staying in a local hotel or guesthouse to reduce the burden of traveling immediately after administration. Meanwhile, some facilities may work with partnering hotels to offer lower per-night rates, as well as ensure a nearby location to the treatment center.

Of course, treatment may also be available at radiotherapy specialty clinics maintaining the appropriate equipment and personnel. In this respect, everyone working in the facility, including scheduling coordinators, maintenance professionals, custodians and others, become an extension of the care team. Everyone has a common goal; provide a treatment that will help.

What to Expect from Your Care Team Before, During and After Treatment.

radiation oncologist talking to a senior man prior to treatment

The process for receiving radiotherapy is complex. Prior to treatment, a confirmation of your diagnosis will be obtained through diagnostic imaging or other tests prescribed by your PCP or oncologist. Depending on the preferences of your PCP and location, your initial referral may be to a SERO-partnering provider or clinic. Upon such referral, care team members will work to obtain all medical records and begin treatment planning.

The type of cancer, size and location will affect the type of radiotherapy best suited to achieve remission with the fewest side effects possible. The diagnostic radiologist will begin the initial planning phase, deciding what type of radiotherapy is recommended and verifying the presence of tumors susceptible to treatment. If surgical options are considered, as well as if biopsies are needed, a radiation pathologist will begin working to determine how treatment may affect the tumor and its surrounding tissues. Such actions are crucial to minimizing side effects and unnecessary tissue damage.

Depending on your age group, a highly specialized radiotherapy oncologist, such as pediatric radiotherapy oncologist or a surgical oncologist, may be involved in choosing a combination of radiotherapy, chemotherapy or surgical options.

After the Therapeutic Medical Scientist and other providers determine treatment needs and plans, the process moves through the administrative tasks. In other words, it may be necessary to schedule a follow-up visit to answer questions about the proposed treatment, consider insurance or payment plans, if applicable, and ensure everyone understands what to expect during treatment.

Some treatments may be available on an outpatient basis, and others may require hospitalization to prevent potential infections. As with any type of radiation treatment, it reduces the efficiency and effectiveness of the body’s immune system. Therefore, hospitalization may be necessary to avoid potential cross-contamination and manage side effects. In addition, radiotherapy nurses will conduct assessments to identify potential risks and side effects. They also work directly with the doctors involved in your case to prevent the worsening of symptoms with medication management. Since the period represents an increased emotional state, counselors and psychologists may visit to review your mental health and how you feel about treatment.

Even during follow-up appointments and treatment sessions, expect to see these people. Although they are not necessarily MDs, they understand the relationship between body and mind. They can help you come to terms with treatment and maintain physical and emotional comfort.

Choose an Experienced Radiotherapy Team for Your Care.

No one wants to think about the doctors involved in caring for cancer and ailments requiring radiotherapy. However, knowing what to expect and understanding the responsibilities of the multidisciplinary care team empowers people to make an informed decision. Even though the diagnosis is heart-breaking and stressful, knowledge is power.

Make an informed decision about your care by receiving care at Southeast Radiation Oncology Group, P.A., for your radiotherapy consultation and administration. Schedule your consultation online today.