For an oncological patient, the correct diagnosis and the establishment of treatment as early as possible are of crucial importance. And they are reached through teamwork. Because, say Dr. Cătălin Iacobradiotherapy primary physician, medical oncology specialist within MedLife Brașov Oncology Hospital, it is very difficult to say that this result is only from one good doctor. Patient care is the result of teamwork. But beyond the specialists, throughout this journey, the patient remains the most important decision-maker in his scenario. This is because the decision to follow one treatment or another belongs to him, in the end. The important thing is that this decision he takes is an informed one.
Dr. Catalin IacobPhoto: MedLife
Lately, oncologists have started talking about cancer as a chronic disease. The new methods of medical investigation, the appearance of new treatment molecules have allowed not only the survival of oncological patients, but also a better quality of their life. But for a precise diagnosis and a well-managed treatment, the collaboration of doctors from different specialties is needed.
“Currently, it is very difficult to work alone. In fact, it is impossible. Those who say they work alone, in fact, do not. It is very difficult to say that an oncology patient is treated by only one good doctor. In fact, there is a whole team of well-trained doctors behind it”, emphasizes Dr. Cătălin Iacob.
There are many explanations for the multidisciplinary approach in medicine, but especially when it comes to oncology. One of them is the explosion of medical information and research in the field of oncology – a doctor cannot simply accumulate all the new data and become an expert in all areas of cancer. “I’ll give just one example: when I started – in the 1990s – there were, I think, 30 cytostatic molecules. Today, there are hundreds and counting. And it is very difficult to manage them, to choose the best one. In immunology, in the 1990s there were 200 articles a year, now, last year, there were almost 25,000. I return to the discussion about the team: surely, in the end, the responsibility rests with the attending physician, the one who applies the treatment. But until that treatment is reached, the path is not so long as it is very bushy, and that is why collaboration with other colleagues is essential, in order to offer the best care to the patient”.
The most accurate diagnosis and treatment of cancer patients depends on taking into account all medical data. And that’s what medical teams do, both formal and informal, which are very important, points out the doctor.
Until a case is presented to the Oncology Commission, discussions take place in informal committees, in pre-commissions, where the oncologist consults with the hematologist, the imaging specialist, and the pathologist. “And when the case has been outlined to me as close as possible to what I think I would do, I go and propose it to the Commission. This consists of oncologist, radiotherapist, surgeon, pathologist, imager, geneticist, psychologist and so on. And what the Commission does is issue a medical recommendation based on the experience of each of its members. Experience that they must support with evidence and arguments. It is not possible to say: “I would do that”. You must also say why, what are the arguments. And they are always debatable. Everyone comes with their own knowledge in making a decision. In the end, the recommendation has a certain degree of uncertainty, it is important that this margin of uncertainty be as small as possible.”
The most accurate diagnosis attracts the establishment of a treatment as close as possible to what the patient needs.
The path of the oncological patient
In Romania, in the absence of cancer screening programs, most of the time, the patient comes to the oncologist by chance. “A patient can go for varicose vein surgery, and after the pre-operative assessment, he can end up discovering a lung tumor. Then the investigations begin: bronchoscopies, computed tomography, immunohistochemistry profile. All these data reach the oncologist quite quickly. Then, the oncologist conducts investigations to establish the diagnosis. After that, the case is presented to the Commission I was talking about above, constituted at the level of the medical institution”.
Dr. Iacob adds that these commissions include both young doctors, with a lot of enthusiasm and fresh knowledge, as well as those with more experience. Very good decisions result from these harmonisations, says the doctor. “Every one of us learns from these commissions. We learn from every case, even those considered very clear. Let me give you another example: years ago I participated in the opening of an oncology clinic. The coordinator of this clinic was and is the best prostate specialist in our country. And he told us that all the cases that will enter the clinic will be discussed in this oncological board. And I asked: how, you come and ask me or another colleague if your proposal to treat a prostate is correct? To which you replied: Yes! Because there is always human error. Maybe you’re tired and you let slip a detail that makes the difference. But someone else notices and changes the treatment decision. So that’s why these discussions are so important. Most of the time, the patient does not know what is behind a medical recommendation. There is much unseen work. The patient knows that he was operated by the surgeon, but without the anatomist-pathologist, he could not do anything, his work is very important”.
The patient has the last word
The discussions of the specialists in the oncology committee materialize in a medical recommendation. The oncologist managing the case explains the benefits and risks of the therapy to the patient in detail and in his understanding. “The situations are complex. There are patients who say: I don’t want to have surgery. I think that every patient has certain phobias, certain anxieties for a certain type of treatment. Some say: “I do what you say, but I don’t do chemotherapy”. Or: “I accept this, but I don’t accept the other”. There are different situations. And then we discuss, we explain to them. If we manage to convince them, fine, if we don’t, we move on to the second treatment option – also discussed in the committee – explaining to the patient that the success rate is lower. And we have to make sure that he understood that.”
After the oncology commissions, there are the technical boards of each specialty, adds Dr. Iacob: “I receive a recommendation from the Commission that the patient undergo radiotherapy. Then the radiotherapy technical board where I discuss with colleagues how to target the tumor, without attacking the surrounding organs too much. I have to compromise sometimes. So we have these large commissions of diagnostic and therapeutic indications, after which the implementation actually takes place. In our hospital, we have developed mechanisms for verification, reverification, independent triple verification of plans, to minimize the risk of error”.
Establishing the right treatment can sometimes take more time
As for patients, more and more – especially young people – are becoming aware of the importance of early cancer detection. “Romania is the only country in Europe that does not have screening for bronchopulmonary cancer. Even Bulgaria and Albania have, albeit at a minimal level. Young people learn from social media what they should do. I, as an oncologist, when the patient arrives at my office, I also give the relatives advice for their health. Because, in oncology, the genetic component is very strong. And the success rates in cancer therapy are higher the earlier you diagnose it. And this is true for all cancers”.
Many times, the doctor also says, patients diagnosed with cancer are in a hurry to start treatment and do not really understand the purpose of certain investigations. However, it is important to institute the correct treatment, points out Dr. Iacob: “I’m interested in starting as well as possible, and that can take time.”
For its part, the state, through public health policies, should identify risk groups – people who have cancer patients in the family – and establish early detection programs. The results can be seen over time, but they will be unmistakable, says Dr. Iacob.
MedLife Brașov Oncology Hospital, an innovative concept of integrative medicine
Inaugurated in 2012, the MedLife Brașov Oncology Hospital is a modern platform for oncological diagnosis and treatment, based on an innovative concept of integrative medicine, which starts from the diagnostic phase and covers the entire period of specific active therapies. In addition, it covers the entire range of oncology treatment.
In the year 2023 alone, in the MedLife Brașov Oncology Hospital, more than 1,200 cases were discussed in the oncology committee, more than 18,000 imaging investigations, more than 10,000 chemotherapy sessions and more than 15,000 radiotherapy sessions were performed.
“An oncology hospital must be a place of hope, trust, optimism, rebirth. We are dedicated to healing our patients, because they are special. We have to learn every day, to be constantly informed, because any new information means a new bud of hope, it can mean the chance of healing. Medical oncology, Hematology and Radiotherapy are medical specialties in continuous development. Medicines, devices and new techniques are constantly appearing, more effective, more precise, with fewer side effects. We consider it our duty to make them available to patients, to prove to them that the disease they suffer from can be cured”, says Dr. Szekely Zsolt, Medical Director of the Hospital.
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