Multidisciplinary Team (MDT) Specialists
General Practitioner | Gynaecological Oncologist | Specialist Gynaecological Oncology Nurse | Gynaecological Pathologist | Medical Oncologist | Radiation Oncologist | Pain Management Clinician | Palliative Care Physician | Palliative Care Nurse | Colorectal Surgeon | Stomal Therapist | Urologist | Support Co-ordinator | Community Nurse | Psychologist | Sexuality Counsellor | Social Worker | Familial Cancer Specialist / Genetic Counsellor | Physiotherapist | Pharmacist | Dietitician | Occupational TherapistThe following clinicians work together to determine the best possible outcomes for women with a gynaecological cancer. Some may work outside the specialist Gynaecological Oncology Unit.
General Practitioner
The General Practitioner will be closely involved the patient's care and will be kept up to date on what is happening and what is planned for continuing care. They will have been the first point of medical contact and usually have started the investigations leading to diagnosis. The General Practitioner is someone who can immediately be contacted if there are acute symptoms in addition to the other acute service providers in this list. The General Practitioner is also often well acquainted with the patient's home and social circumstances and may be very helpful with issues in this regard.
Gynaecological Oncologist
Specialist surgeon who is responsible for the overall management of women with a gynaecological cancer, from diagnosis throughout their treatment including after care
The role of the gynaecological oncologist is firstly at diagnosis, identifying the nature of the disease, locating any possible metastatic disease and confirming the nature of the tumour with a biopsy as appropriate. Once all this information is gathered, these results are presented to the patient with all her options for treatment with their pros and cons. Covering all the possible risks and complications has become an even larger part of our work in the last 20 years. If surgery is the best treatment for a patient, this is performed with the intention of removing all primary and if necessary metastatic disease. In some circumstances this may be in conjunction with other surgical colleagues.
When the pathology results are known, decisions about adjuvant therapy are made and there is close consultation with our radiotherapy and chemotherapy colleagues. With the completion of treatment, the patients are invited to attend for regular review with the hope of detecting recurrent disease earlier rather than later. Interestingly some patients find this very confronting, reminding them of their past invasive treatments (and are not keen at all) whereas others find it highly reassuring and do not wish to cease their regular review even after many years.
Specialist Gynaecological Oncology Nurse
Undertakes the nursing procedures related to the particular treatment regime, offering support and assistance at all stages
Gynaecological cancers affect women of all ages from adolescents to the elderly, and women must live with the sequelae of the disease and its treatment. Gynaecological cancer presents a woman with many challenges and can impact on body image, fertility, sexuality, relationships and life roles. The gynaecological oncology nurse is in the prime position to be able to support women through this journey.
As a member of the multidisciplinary team, the gynaecological oncology nurse contributes to the holistic care of the woman with gynaecological cancer. From preoperative education and support, postoperative surgical nursing care, education and provision of adjuvant treatment, follow-up care, to palliative care, grief and bereavement the gynaecological oncology nurse has a multi-faceted role.
The gynaecological oncology nurse is in a privileged position in which they form a close relationship with both the woman and her family and significant others. She is able to support them through some very difficult decisions and challenging times. The relationship between the gynaecological oncology nurse and the woman often extends for many years after completion of treatment and can continue with family and significant others as a support after death.
Gynaecological Pathologist
Analyses the nature and extent of the cancer to assist in determining appropriate treatment plan
Malignant uterine tumours are varied, and each is associated with a particular profile of risk factors that affect patient management and outcome. The pathologist's roles, by microscopically examining biopsy material or surgically excised tissues, are principally to assist the surgeon in carefully defining those risk factors specifically relating to each tumour (such as type of tumour, grade of malignancy and stage of disease) and to advise on the likely outcome for the patient. This information is then used to tailor a treatment plan best suited to the individual patient's needs and circumstances. As part of the multidisciplinary team approach, this role should continue for the duration of the patient's treatment and follow-up and the pathology material should be available for review and reassessment at any time the patient's changing circumstances deem it advisable.
Carefully detailing the features of each tumour and interpolating the results into the large published data bases, allows standardization of the reporting of these risk factors so that the pathology report becomes a vital part of the patient's medical record. The report is, therefore, structured to survive changes in venue and personnel caring for the patient and represent an enduring link between the original reporting pathologist and the various clinical management teams.
Medical Oncologist
Prescribes and co-ordinates the course of chemotherapy.
The medical oncologist is responsible for prescribing and overseeing patients during their chemotherapy treatment. The consultation with the medical oncologist to discuss potential chemotherapy treatment generally takes place following surgery, once a definitive diagnosis has been made and confirmed at the gynaeoncology multidisciplinary meeting.
Chemotherapy may be prescribed prior to surgery, known as neoadjuvant therapy, more often for ovarian cancer. It may also be given in combination with radiotherapy particularly to treat cervix and vaginal malignancies. Used in this way the chemotherapy acts as a radiation sensitizer and is given in a weekly low dose. The medical oncologist is responsible for the care of the patient receiving chemotherapy, managing side effects and supervising haematological results. In general patients will be reviewed by their medical oncologist prior to each cycle of chemotherapy.
Following completion of treatment the medical oncologist forms part of the team involved in patient follow-up, in general alternating visits with the surgeon and radiotherapist.
Chemotherapy and also hormonal therapy may be prescribed to treat symptomatic recurrences in those patients where the tumour has recurred. Treatment is aimed at reducing tumour burden and improving quality of life, and is done in consultation with the radiotherapist and palliative care physician.
Radiation Oncologist
Prescribes and co-ordinates the course of radiotherapy.
The radiation oncologist is part of the multidisciplinary gynaecology oncology team. They review the pathology of patients together with the gynaecology oncologist to select appropriate patients for radiotherapy treatment. They oversee the process of radiotherapy which can take up to 6 weeks to deliver. Radiotherapy for gynaecological cancers can be given externally or internally into the vagina, cervix and uterus with special applicators (brachytherapy). On completion of treatment, the radiation oncologist shares follow-up of patients to check for recurrence, provide support and monitor for late toxicities of radiation therapy.
Up to 35% of all patients with gynaecological cancers will need radiotherapy at some point. In about half these cases, this will be given post-operatively (adjuvant radiotherapy) because of high-risk pathological features. Curative radiotherapy (with or without chemotherapy) is used for cervix and vaginal cancers. Radiotherapy is also a useful palliative modality especially in the treatment of bone pain, brain metastases and bleeding.
Pain Management Clinician
Implements a multidisciplinary approach in the management of chronic pain, including prescribing medications to relieve pain and its associated problems, such as sleep disorders, anxiety and depression.
Palliative Care Physician
Prescribes drugs to assist in the control of pain and can offer other options to assist a woman, her family and friends to cope with the symptoms associated with cancer.
Palliative care is an approach that aims to improve quality of life for people with life-limiting illness through the assessment and management of symptoms that may be physical, social, spiritual or psychological. A team approach is used, with high level evidence available to support that contact with palliative care teams is an effective way to improve symptom control and satisfaction with care whilst reducing anxiety. Furthermore, people are more likely to spend less time in hospital, and are more likely to achieve their desired place of death.
Palliative care has become synonymous with terminal care, but this is in direct contradiction to the World Health Organization's definition of palliative care that states that referral is appropriate at any stage during a person's illness and should be based on need rather than prognosis.
Women with gynaecological malignancies are at risk of numerous symptoms, and palliative care may be beneficial for those who are carrying a symptom burden that interferes with their ability to live well.
Palliative Care Nurse
Palliative Care services have specially trained Palliative Care nurses attached who have a community role.
Often in rural settings the palliative care nurse has a strong coordination role as a conduit between primary health care providers and specialist services. They are dependant on a team approach, particularly for women with gynaecological cancers who are commonly travelling between home, regional centres and/or metropolitan treatment centres.
This role includes providing nursing assessment of patients and their carers and recommending a plan of care to primary health care staff, inpatient staff and the patient's GP that aims to effectively manage symptoms, be they physical, social, spiritual or psychosocial. Their role extends into the provision of bereavement support.
Due to the geographical location of many patients the palliative care nurse is reliant on an 'extended team' which includes the GP and nurses in the patient's town, generalist and specialist allied health providers where available, oncology colleagues both nursing and visiting doctors, palliative care physicians who commonly visit on a regular basis and specialist gynae-oncology services in metropolitan treatment centres.
Colorectal Surgeon
An expert in the surgical and nonsurgical treatment of colon and rectal problems which can be associated with gynaecological cancer.
Stomal Therapist
Assesses the patient's needs and assists the nursing staff to care for patients with stomas, draining wounds, fistulas, pressure ulcers and skin trauma due to incontinence.
Urologist
Specialises in treating urinary tract problems which can be associated with gynaecological cancer.
Support Co-ordinator
Provides information about local support services to women close to their home; could be a Cancer Care Co-ordinator, Gynae Oncology Specialist Nurse, Palliative Care Nurse, Community Nurse or Social Worker.
Community Nurse
Community nurses are an integral part of the care team, aiding patients after discharge and caring for chronic symptoms when appropriate.
Psychologist
Provides ongoing emotional and psychological support to women, their families and friends involving stress management and relaxation.
Sexuality Counsellor
Concerns about sexual function and even psychosexual disturbance is very common after a diagnosis of gynaecological cancer. Sexual counsellors are an important part of care for some patients and patients should be aware that they are available. Patients may suppress their concerns in this area and should be encouraged to see counsellors as appropriate.
Social Worker
Provides ongoing psychological emotional support and practical assistance to cope with the impact of the diagnosis, including linking women to relevant support organisations.
The diagnosis of any gynaecological cancer imposes a significant burden on both patients and caregivers. Beyond the immediate questions about survival, women may have many other concerns including: short and long-term side-effects of treatment, talking to children about cancer, maintaining employment, financial assistance, menopause, fertility and changes to sexuality. For many women, the diagnosis of cancer will be a major life crisis in the context of an otherwise happy and functional life; for others, this new crisis represents yet another catastrophe in a life characterised by difficulties such as poverty, abuse and physical or mental health problems.
The role of the Social Worker within the Gynaecological Oncology multidisciplinary team is to work with and empower patients and families to negotiate the challenges presented by the cancer diagnosis and treatment. Ideally, Social Work contact will begin at the time of first presentation, and should continue throughout the treatment trajectory: surgery, adjuvant treatments, recovery and resumption of life roles, recurrence, survivorship and bereavement follow up for surviving family members.
Social Work interventions may include the provision of counselling to patients, couples and families, information about statutory entitlements and benefits, referral to community-based support services for practical assistance and emotional support, and advocacy where gaps in services are identified. Support groups are a valuable source of information and support for people with cancer, and Social Workers may lead or co-facilitate support groups with other health professionals.
In addition to direct service provision to patients and caregivers, the presence of a Social Worker as an integral part of the gynaecological cancer team enables involvement in qualitative research, policy, resource and program development.
Familial Cancer Specialist / Genetic Counsellor
Provides information to those with a strong family history of cancer. Not all cancers are associated and these practitioners clarify what is significant for patients and what is a random event. It is not necessary for all patients and not all patients with a family history wish to have this type of investigation.
The Familial Cancer Service representative can assist patient care within the GO MDT. As each case is presented by the clinician, the known family history of cancer is also reported. Sometimes other team members (nurse, social worker, psychologist) may have gathered additional details about the family history. The personal and family history combined with detailed pathology reports (sometimes including tumour immunohistochemistry) can be assessed for a possible genetic predisposition to gynaecological and other cancers. Although genetic testing is not an immediate consideration at diagnosis (in that results would not usually alter management), it is wise at that time to flag patients for a future visit to the Familial Cancer Service. This assures that appropriate referrals eventually occur at a time when the patient is ready. The Familial Cancer Service will extend and verify the family history before offering genetic counselling and testing.
Now that targeted therapies are being developed eg. the PARP inhibitors for treatment of BRCA-related breast and ovarian cancers, it is important for the team to know the results of genetic tests for their patients. In addition, relatives of gene mutation carriers can be referred by the team for predictive genetic testing. Finally, the GO team plays a vital role in the management of women at genetic risk of gynaecological cancer. Apart from the offer of risk-reducing surgery, the team provides the necessary psychosocial support for women considering such options.
Physiotherapist
Assists in addressing the physical side effects from surgery including lymphoedema.
Pharmacist
Dispenses drugs and advises physicians and other health practitioners on the selection, interactions and side-effects of medications.
Dietitician
Provides advice on healthy nutrition and special diets during and post treatment.
The role of the dietitian is to provide an appropriate nutrition assessment and nutritional care intervention service to patients undergoing treatment for gynaecological cancer. Dietetic input is essential throughout the patient's journey to:
• assess patients nutritional needs
• evaluate how different treatments will impact on the patient's nutritional status
• aim for weight maintenance
• recommend the most appropriate short and long term nutrition interventions
• negotiate with the patient specific practical dietary changes to meet nutritional and/or therapeutic goals
• assist individuals to undertake dietary change
• maintain or improve quality of life
This is obtained through early intervention with clear and precise education, communicating with the patient and their families as required. It is further enhanced by being a nutrition advocate and having a close working relationship with all members of the multidisciplinary team (MDT).
Occupational Therapist
Assists in developing techniques and strategies to help women maintain their normal daily routine including assessment of the home for modification or equipment.
This web page is managed and authorised by Greater Metropolitan Clinical Taskforce. Last updated: 16 March, 2009