Pediatric Cancer Care Team

When a child has cancer, they need a team of experts who can provide care from diagnosis to treatment and beyond. This team includes doctors, nurses, and other health specialists.

The care team members may change depending on your child’s needs and treatment plans. Your child may have many specialists as part of their care team or may have only a few.

Core care team

Your child’s primary care team will likely have a doctor (attending physician), an advanced practice provider, and a nurse to coordinate care.

• Pediatric oncologist or pediatric hematologist/oncologist: treats childhood cancers. This physician directs and manages your child’s cancer treatment.
• Registered nurse (RN): provides a wide variety of nursing care. Responsibilities include monitoring and assessing patients, giving chemotherapy and other medicines, watching over daily needs, and providing patient and family education.
• Advanced practice providers (APPs): work with the physician to help care for your child. There are 2 kinds of APPs:
  • Physician assistants (PAs) are licensed health care professionals who help plan care, assess patients, prescribe medicines and treatment plans, and perform certain procedures.
  • Nurse practitioners (NPs) are registered nurses who have advanced education and training. They may do physical exams, give tests, and prescribe treatment.

Care team during diagnosis and treatment

Each patient has different needs based on their diagnosis and treatment plan. Care team members will work with your child to meet their specific needs.

Radiology team members specialize in doing imaging during diagnosis and treatment, as well as using radiation therapy to kill cancer cells. This team may include:

• Radiologist and/or interventional radiologist (physician): diagnoses diseases using medical imaging methods such as x-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), positron emission tomography (PET), nuclear medicine tests, and ultrasound.
• Radiology or imaging technologist (also called a tech or radiographer): uses x-ray, CT, MRI, PET, nuclear medicine tests, and ultrasound to create images of the body
• Radiation oncologist (physician): treats cancer with high-energy radiation that can shrink tumors and kill cancer cells during treatment

If your child needs surgery for diagnosis or treatment, several specialists will provide surgery, sedation, and anesthesia. These specialists may include:

• Surgical oncologist (physician): performs surgery or procedures to diagnose and treat cancer
• Surgical specialist (physician): does specific types of surgery. For example, a neurosurgeon performs operations on the nervous system, including the brain and spine. An orthopedic surgeon specializes in surgery of the musculoskeletal system, including bones, joints, and muscles.
• Anesthesiologist (physician): gives anesthesia to prevent or relieve pain and monitors patients during surgery or other procedures.
• Certified registered nurse anesthetist (CRNA): prepares patients for sedation or anesthesia, gives anesthesia medicines, monitors patients during procedures, and does other tasks to assist the anesthesiologist. A CRNA is a registered nurse with advanced training in anesthesia.

Your child may also have other specialists, such as a:

• Pathologist (physician): diagnoses disease by looking at tissue and cells under a microscope and performs other tests. After a biopsy, a pathologist will study your child’s tissue sample to find out if the tumor is cancerous and, if so, what kind of cancer it is. The pathologist is assisted by lab technologists.
• Medical oncologist (physician): uses medicines such as chemotherapy, immunotherapy, and targeted therapy in cancer treatment. This person may also be a child’s main doctor (pediatric hematologist-oncologist).
• Clinical pharmacist: prepares and dispenses medicines. Pharmacists educate patients and families on the proper use and side effects of prescribed drugs. They also help keep track of medicines and determine their doses.
• Infectious diseases specialist (physician): works to prevent, diagnose, and treat infections that can occur in children having cancer treatment. They may help treat patients with unexplained fevers or signs of serious infection.

Physical support

Your child may need help from other health professionals depending on their type of cancer and treatment. These specialists help with recovery and overall well-being:

Rehabilitation specialist: helps your child with movement, hearing, speech, communication, and daily activities. Your child may see specialists in physical therapy, occupational therapy, speech therapy, audiology, and learning.

Clinical nutritionist or registered dietician: offers nutrition care and education for healthy eating habits, special diets, and therapies.

Palliative care specialist: focuses on improving your child’s quality of life. They treat symptoms such as anxiety, pain, or loss of appetite during medical procedures or treatments. The palliative care team may include other health care providers to meet physical, emotional, social, and spiritual needs.

Psychosocial support

Chaplain: supports you and your family with religious, spiritual, and emotional needs due to your child’s illness or other challenges

Child life specialist: uses play, art, and other activities to help your child cope with cancer and prepare them for treatments and procedures using age-appropriate, child-friendly methods

Psychologist: helps you and your child cope with emotional, behavioral, social, and cognitive concerns. Psychologists provide mental health resources that include psychological assessment, counseling, behavioral interventions, and stress or pain management.

Social worker: provides counseling and support for different stages of the cancer journey. Social workers can also help you find resources to help with challenges such as family education, financial concerns, and housing.

Other specialists on the care team

Your child may need extra support and care during treatment and recovery. These professionals can help assist your child with specific needs:

• Fertility specialist (physician or nurse practitioner): helps patients with reproductive health needs. Certain cancer treatments may affect your child’s ability to have children in the future. A fertility specialist can help you understand risks and potential options to preserve fertility.
• Genetic counselor: interprets genetic test results, evaluates the risk of an inherited medical condition, and provides guidance to help you understand hereditary conditions
• Hospice care provider: offers compassionate care to control symptoms and improve quality of life if no cure is available. Care may be provided in a variety of settings, including the hospital or home.
• Orthotic or prosthetic practitioner: designs and fits orthopedic braces if your child has physical rehabilitation needs. A prosthetist provides patient care related to custom-made artificial limbs (prostheses).
• Pain management specialist: assesses and treats pain, either with medicines or using techniques that do not involve medicines. This person is part of the pain management team, led by a physician with advanced training in treating pain.

Other members of the care team may help provide care during treatment. These include physicians and medical students completing training, providers who help families during cancer treatment, and others who improve the experience for patients and families.

Communicating with your care team

Cancer care is complex, so good communication among care team members, patients, and families is important. To help with communication, you should:

• Be honest and open.
• Ask questions when you do not understand. Write down your questions so you do not forget.
• Take notes and keep good records of medical information including tests, treatments, medicines, and appointments.
• Write down the names of your care team members, what they do, and how to reach them.
• Talk with your child about their experience that is at the right level for their age (age-appropriate). Doing so helps build good relationships with the care team and gives your child a sense of control.

It is also important to have fair expectations:

• Of yourself. This is a stressful time. Do not expect to understand or remember everything. Ask for help and use the resources that are available to help meet your needs.
• Of your care team. Your doctors and nurses will not always have the answers. Often decisions are not simple. Communicating with a team of people can sometimes make communication more difficult.

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