Cancer is a complex health problem that requires the expertise of many healthcare professionals from various disciplines working together in partnership. Oncology teams – be they local, regional or supra-regional – call upon these professionals based on their needs and the types of cancer being treated. They have both similarities and differences. Here are descriptions of the roles of some of the professionals you may encounter during your cancer care journey.
 
Other hospital or community professionals:
 

Professional	Role
Medical Oncologist or Hemato-Oncologist	Doctor specialized in cancer treatment, more specifically chemotherapy.
Surgical Oncologist	Medical specialist who performs surgery to diagnose cancer, remove tumours or repair damage.
Radiation Oncologist	Doctor specialized in the use of radiation therapy to treat cancer.
Oncology Pivot Nurse	Resource person for patients and their family throughout the course of the disease. Evaluates their needs, provides support, gives information and participates in the coordination of care.
Oncology Pharmacist	Pharmacist who prepares chemotherapy. Provides information on the treatment, its potential side effects and ways to alleviate them.
Nutritionist/Dietician	Professional who evaluates a person’s nutritional status and creates a tailored nutrition plan.
Social Worker	Professional who evaluates social functioning. Provides support and psychosocial treatment services. Identifies available community resources and refers people to them.
Psychologist or Psycho-oncologist	Professional who conducts evaluations and provides psychological counselling tailored to the needs of patients. Helps people adapt to illness and maintain their quality of life.
Rehabilitation Specialists (Physiotherapists, occupational therapists, speech therapists, etc.)	Professionals who conduct evaluations and recommend treatments adapted to different patient needs. Develop and implement personalized rehabilitation programs.
Gynecologic Oncologist	Obstetrician gynecologist who specializes in the treatment of gynecological cancers, who performs surgical operations to diagnose cancer, remove a tumor and gives treatments with chemotherapy.
Spiritual Care Professionals	Professionals who evaluate spiritual and religious needs. They accompany people in their search for meaning and provide moral support to loved ones.

• Family doctor
• Chemotherapy clinic nurse
• Liaison nurse
• Research nurse
• Radiation oncology technician  
• Medical specialist
• Dentist
• Sex therapist
• Community pharmacist
• CLSC nurse
• Community organizations
• Etc.

The best way to reach your oncology team is to contact the oncology pivot nurse (OPN). OPNs play a central role in the care team. During your first meeting with your OPN, she will give you her contact information. 

Not everyone with cancer has access to an oncology pivot nurse.  If you need to reach your oncologist, ask to speak to his or her secretary. Your message will be passed on to your oncologist, along with your file to make sure he or she has all the information needed for your phone call. You can also ask your oncologist directly how to get in touch if a problem arises.

Many professionals of the oncology team hand out their contact information so patients can get in touch with them if needed. Carefully store all this information in a single place (e.g. your Oncology Passport).

An Oncology Passport is a special health booklet for people with cancer. It is a great tool to help you understand your treatment program, follow its course and actively participate in it. It is also your “calling card” if you ever need to go to the emergency room, since it will inform healthcare personnel that you are undergoing active cancer treatment (hence its name “Oncology Passport”).

The document contains many helpful sections, including:

• A listing of useful information, such as emergency telephone numbers.
• Information on symptoms that need immediate assistance and a special chart to help you better track and manage your side effects.
• Spaces reserved to record your appointments, healthcare professionals, prescription drugs and overall state of health. 

The Oncology Passport is designed to foster a sense of partnership between people with cancer and healthcare professionals and to promote better disease self-management

Publication du MSSS (2008), Oncology Passport
Order online if the document was not submitted by a member of the oncology team

The Direction de la lutte contre le cancer (2011) defines the oncology care continuum as being made up of four periods: investigation, diagnosis, treatment and follow-up.
 
The investigation period involves the onset of cancer symptoms and the wait for screening and investigation test results.

The diagnosis period is the announcement of the cancer diagnosis and the wait for treatments.   

The treatment period corresponds to the start of treatments or their modification if the cancer returns.   

Finally, the follow-up period signals the end of treatments and the transition to survivorship, when medical follow-up and monitoring tests will need to be performed.

Two more periods – palliative care and end-of-life care – may also be added.   

Diagram: The Oncology Care Continuum

Source: Lise Fillion, R.N., Ph.D., Chantal Vézina, M.Ps. U.L.
 

Cancer treatment plans are based on the unique situation of each person with cancer. Your oncologist, in partnership with your care team, will continue to adapt it to your situation, based on your disease and health.

Treatment plans are made according to established recommended best practices in keeping with the most up-to-date scientific knowledge. They are based on internationally recognized medical practice guidelines.

Cancer Therapy Committee

Oncology teams discuss and make decisions on treatment plans as an interdisciplinary committee. The ultimate goal of these meetings is to determine the best possible treatment for each person with cancer.

The suggested course of treatment is then discussed with the patient. During this consultation, the oncologist provides information on the characteristics of the cancer, recommended treatments, expected benefits and potential side effects.

It is best for patients to be accompanied by a loved one for this consultation. It is important for patients to take the time to ask any questions they have and make sure they understand what is at stake, so that they make an informed decision about their treatment. Sometimes, people will need time to think before making a decision. Do not hesitate to ask about this.

Therapeutic Options

In some cases, there may be more than one therapeutic option available. This means that two or three different treatments have been recognized as equally efficient. It is then up to patients to decide on the most suitable treatment for them.

Clinical Trials

In other cases, the oncologist may propose a clinical trial.

The purpose of clinical trials is to evaluate new cancer treatments. In other words, before introducing new treatments to all patients, they need to be tested for efficiency and tolerability. It is not always possible to participate in a clinical trial, since specific criteria have to be met in order to be eligible.    

Participation is free and voluntary. Even before agreeing to take part in a clinical trial, you are free to leave at any time. Your oncologist will then recommend another treatment avenue. This decision will in no way affect the medical team’s commitment to treating you.

Single-drug or combination treatments

Some cancer cases require a single treatment drug. In other cases, a combination of drugs can be used to better control and treat the disease.

When more than one drug is used, they can be administered together or at different times, depending on the type and stage of cancer.

Curative Treatment or Palliative Care

Curative treatment includes all treatments administered for the purpose of curing a disease or bringing about prolonged remission.

“Curative treatments seek to cure people of disease, which may or may not be life threatening, by using all reasonable diagnostic and therapeutic means available. They also aim to preserve the quality of life of patients and their loved ones by preventing and treating the consequences of the disease and its related suffering without undermining the possibility of a cure.”  (Translation from CA GRASSPHO NOV 05) 

According to the World Health Organization (WHO) (2002):

“Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness: through the prevention and relief of suffering by means of early identification and impeccable assessment; and the treatment of pain and other problems – physical, psychosocial and spiritual.” 

Receiving a cancer diagnosis is extremely difficult and it is perfectly normal for people to want to act fast when they receive the news. Having to wait for services, test results and the start of treatments can be very stressful.

The ministère de la Santé et des Services sociaux du Québec (MSSS) has made timely access to care and services one of its policy priorities.
 
In its 2016-2017 Action Plan, the Direction générale de cancérologie states that:

“Access to medical services within a reasonable time frame is essential to ensure the health, quality of life and survival of people with cancer. The cancer care and service continuum must be organized in a way that promotes better access to screening tests, investigations, diagnoses and curative or palliative treatments.” 

To learn more about the objectives and actions taken to improve accessibility to cancer care and services, consult the Plan d'action en cancérologie 2016-2017 (in French only).