Oncology Teamwork

A unique hallmark of comprehensive cancer care is treatment delivered in well-organized teams. Most comprehensive cancer centers organize care around multidisciplinary provider teams that center on the disease rather than the training or professional background of the providers. Most oncology patients can identify multiple clinicians who are part of their cancer care team. Most guidelines in oncology, and certainly the NCCN Clinical Practice Guidelines in Oncology, invariably describe integrated, multidisciplinary management.The number of sub-specialists involved in caring for a single patient can be legion: surgical, radiation, and medical oncologists; radiologists; pathologists; pain or palliative care specialists; geneticists; psychologists, social workers, and counselors; oncology-specialized treatment and symptom-control nurses, nurse practitioners, and physician assistants. A patient with newly diagnosed cancer who is embarking on a multidisciplinary treatment program might encounter literally dozens of health care providers—each with his or her own business card, email address, and pager number—who will weigh in on the treatment plan and goals. Further, all these clinicians must communicate with each other and work together to deliver the type of seamless care that patients deserve. Sometimes the entire cancer care team works in the same building at a single institution; other times, the members may be joined in a loose confederation or work at entirely different cancer clinics.This brings up many questions. How are teams created and sustained? How is com-munication facilitated and enhanced? Although easily recognized as an important goal incancer care, the fully integrated team of cancer specialists is not an easy creation. Medical...

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Harold J. Burstein, MD, PhD, editor-in-chief of JNCCN, is an Associate Professor of Medicine at Harvard Medical School and a medical oncologist at Dana-Farber Cancer Institute and Brigham & Women's Hospital. He is a clinician and clinical investigator specializing in breast cancer.

Dr. Burstein attended Harvard College and earned his MD at Harvard Medical School, where he also earned a PhD in immunology. He trained in internal medicine at Massachusetts General Hospital and was a fellow in medical oncology at Dana-Farber before joining the staff.

Dr. Burstein's clinical research interests include novel treatments for early- and advanced-stage breast cancer and studies of quality of life and health behavior among women with breast cancer. He has written widely on breast cancer in both traditional medical journals and on the web, including New England Journal of Medicine and Journal of Clinical Oncology. International committees focusing on cancer treatments that he has or continues to participate in include the NCCN Clinical Practice Guidelines Breast Cancer Panel, St. Gallen Breast Cancer Panel, CALGB Breast Cancer Committee, ASCO Health Services Research and Clinical Research Committees, the National Quality Forum Breast Cancer Technical Panel, and other ASCO expert panels.

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