I just spent a very busy month on the inpatient medical oncology service and thought I would share some insight about what medical oncologist see and do in-house.
Navigating the healthcare system can often feel like a maze, particularly when a loved one is admitted to the hospital and under the care of multiple specialists. If you or a family member is seeing a medical oncologist during an inpatient stay, understanding the specifics of the process can offer some peace of mind. Here are ten important points to consider:
1. Different Settings, Same Expertise:
The medical oncologist you see in the hospital may be different from your outpatient oncologist, but rest assured they both possess the same expertise. They collaborate and communicate to ensure continuity of care. I specifically focus on cutaneous/connective malignancies and yet most of the patients we see in the hospital are usually one of the big four tumor types: lung, colon, prostrate, breast cancers.
General oncology is rather straight-forward. We need tissue to make a diagnosis in most cases with the most accessible tumor biopsy. This can be done via bronchoscopy for chest tumors, endoscopies for most gastrointestinal malignancies, and/or image guided biopsies with the interventional radiologist.
While pending a biopsy, we will often complete all staging scans to confirm local, locally advanced or metastatic disease. Complete case review can be discussed with the treating medical oncologist that the patient will meet in the clinic and/or at the cancer specific tumor board before the patient is seen in the clinic.
2. Purpose of Consultation:
An inpatient consultation might be due to a new cancer diagnosis, a complication of ongoing treatment, or for symptoms that need urgent management. It’s essential to understand the specific reason for the consult.
Medical oncology is fortunately an outpatient field where most patients are managed and treated in the clinic by a village of healthcare providers. Unfortunately, if a patient is admitted with a known diagnosis of cancer, they often are coming in for severe symptoms due to their underlying cancer or significant toxicities of the treatment they were receiving outpatient. For some patients, treatment with chemotherapy must be given inpatient under direct nursing observation for several days.
3. Communication is Key:
Ensure that there’s a clear channel of communication between the patient, family, and the medical team. Use this opportunity to ask questions, clarify doubts, and understand the treatment plan. Many times, patients are coming in for other medical issues completely unrelated to their cancer diagnosis. Infection, pneumonias, stones, gastrointestinal bleeds, etc.
We often notify the treating physicians regarding no major changes in their cancer care or quite possibly the opposite, the overall prognosis of the patient may dramatically change how aggressive or conservative the other treating physicians can be.
4. Multidisciplinary Approach:
Inpatient care often involves multiple specialists working in tandem. The medical oncologist will collaborate with other physicians, nurses, and healthcare professionals to ensure holistic care. Prognosis, treatment options, sequence of therapies are discussed constantly depending on the status of the patient from a overall health and performance standpoint.
5. Treatment Modifications:
Hospitalizations might result in modifications to cancer treatments, such as delaying a chemotherapy session, continuation of oral therapies that patients were taking outpatient, or even complete discontinuation of all therapies with a plan for more best supportive care. This is done keeping the patient’s best interests in mind.
6. Understanding Side Effects:
Some treatments can have side effects that need hospital care. Be proactive in discussing potential side effects and the measures taken to manage them.
With many new therapies now available for patients, patients and healthcare providers may think the patient’s inpatient healthcare issues are unrelated to treatment but with collaboration may be surprised to find out about new toxicities concerns.
A great example of this issue is with immunotherapies that cause pneumonitis instead of pneumonia, colitis requiring steroids instead of chemo induced diarrhea treated supportively or immune related myocarditis as opposed to more commonly diagnosed heart attacks.
7. Role of Trainees:
Teaching hospitals will have medical trainees, including residents and fellows. They play a vital role in patient care under the supervision of senior oncologists. Remember, these are doctors-in-training who bring fresh perspectives and are up-to-date with the latest medical knowledge. I truly think this is an advantage for a hospital to have as it maintains the clinical acumen of attendings to stay up to date. Also, patients are often seen by the medical students/residents/fellows in the morning and again by the main attending later in the day. That’s basically two physician visits in one day and allows patients to voice concerns that they may have missed with the first visit.
8. Discharge Planning:
The ultimate goal is to stabilize the patient and plan for discharge. Engage with the oncologist and the broader medical team to understand post-discharge care, follow-up appointments, and any modifications to the treatment plan. I constantly remind the treating medical team, what is the initial medical complaint that brought the patient to the hospital and does the patient need to stay in the hospital. Certainly get as much done in the hospital as we can but it is always more preferable to have patients seen and managed in the clinic if feasible.
9. Psychosocial Support
Hospitalization can be stressful. Many institutions offer psychosocial support, including counseling, during inpatient stays. If you or your family member feels overwhelmed, don’t hesitate to ask for assistance. Nutrition, psychosocial, financial support services are typically available at most institutions.
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10. Always Advocate:
As a patient or family member, always advocate for the best care. If something doesn’t feel right or isn’t clear, speak up. The medical team is there to support and guide you through the process. Your hospitalist or main physician can consult medical oncology at any time and we are always happy to stop by and answer questions!
A hospital stay involving an inpatient medical oncology consultation can be daunting. However, understanding the intricacies of this specialized care and actively engaging with the medical team can lead to the best outcomes. Remember, the entire healthcare team is there to ensure the patient’s health, well-being, and comfort.
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About the author
Dr. Sajeve Thomas is a distinguished medical professional and a compassionate guide in the field of oncology. With over a decade of dedicated experience as a board-certified medical oncologist/internal medicine specialist, Dr. Thomas has become a trusted expert in the treatment of melanoma, sarcoma, and gastrointestinal conditions. Currently practicing at the renowned Orlando Health Cancer Institute, he brings a wealth of expertise to the complex and challenging world of oncology.
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