Complex Cancer Care Explained

Cancer is one of the top 3 diagnostic categories for employee health plans.

If you are a patient or if you work in health insurance, employee benefits or as a vendor in these areas, then you MUST understand cancer care.

Learn the path of cancer care: diagnosis and treatment by 1) Medical Oncologists, 2) Surgeons and 3) Radiation Oncologists.

Cancer Diagnosis

Somewhat counterintuitively, cancer doctors are not generally involved in the diagnosis of cancer. Rather, they are involved after a diagnosis of cancer has been confirmed.

Typically, a person with suspected cancer presents with a sign such as a mass (e.g. in the breast or abdomen) or symptom (e.g. unexplained dramatic weight loss and night sweats). A person then undergoes a CT scan and/or MRI that identifies possible cancer on an image. Then, a biopsy of the suspected cancer is necessary. The biopsy must be examined by a pathologist and it is the PATHOLOGIST that makes the diagnosis of cancer.

Other medical conditions such as infections or inflammatory conditions can ‘look like’ cancer on imaging, but the biopsy and the pathologist’s examination of the tissue is what allows cancer to be distinguished from these other diagnoses.

Therefore, only AFTER the pathologist makes the diagnosis do cancer doctors become involved.

Medical Oncologists

Cancer doctors that prescribe medications, including intravenous (IV) chemotherapy infusions, are medical oncologists. Some cancer treatments today come in pill form, but many cancers are still treated by IV chemotherapy that causes side effects such as hair loss and severe nausea and vomiting. 

The medical oncologist will also prescribe medications to treat these side effects.

Medical oncologists are a sub-specialty of internal medicine and most are trained in hematology (the study of blood disorders).

Surgical Oncologists

Surgery for cancer is especially confusing. Many cancers (breast, colon, lung, etc.) are treated in part by surgical removal of the tumor. Different types of surgeons can operate on tumors.

• Breast Cancer Surgery:  A surgeon for breast cancer could be a surgical oncologist, a gynecologic oncologist or a general surgeon.
• Colon Surgery:  A surgeon for colon cancer could be a surgical oncologist, a colorectal surgeon or a general surgeon.
• Lung Cancer:  A surgeon for lung cancer could be a surgical oncologist or a thoracic surgeon.
• Prostate Cancer: A surgeon for prostate cancer is a urologist.

As you can see, there is an overlap regarding which type of surgeon may operate on a particular cancer.

The most qualified surgeon in your area could be in any of these specialties. An important area you would want to research on the surgeon is how many patients with cancer similar to yours have they operated on in the past year?

Radiation Oncologists

Radiation treatment is used for certain types of cancer. Treatment for breast cancer, colon cancer, lung cancer and other cancers can all potentially involve radiation therapy depending on the stage of the cancer.

A patient typically does not ‘choose’ a radiation oncologist. Typically, the medical oncologist or surgical oncologist will refer the patient to the radiation oncologist associated with the hospital where he or she practices.

Radiation treatment typically involves going in for 10 or more sessions of treatment with a high-powered radiation focused closely on the tumor. Each session is brief and often three sessions per week are performed.

Order of Treatment

The order of treatment—chemotherapy, surgery, radiation—is very important.  Different cancers at different stages have different orders. For example, if the colon cancer is small, a person may have surgery first and then chemotherapy second. However, if the tumor is large, the patient may have radiation or chemotherapy first to ‘shrink’ the tumor and then surgery to remove the tumor once it is smaller.

Given that cancer is a matter of life and death, involves care that costs hundreds of thousands of dollars and has the potential to bankrupt a person with out-of-pocket cost, even if they have insurance, it is vital that employee benefits professionals understand cancer care to better help their plan members.

Coupe Health helps with cancer care by providing quality scores for doctors so people are not left ‘guessing’ when it comes to the expertise of different providers. Coupe also offers $0 deductibles and only copays for services so plan members can know in advance exactly how much a service will cost them. There are no surprises.

Cancer is scary and complicated enough. Health insurance coverage for cancer should not add to that fear and complexity.