How Treatment Is Planned and Scheduled

To plan and schedule cancer care and treatments, a lot of information must first be collected. This information often needs to be shared with different specialists, as well as with patients and their caregivers, to help decide what treatment option is best. Once a treatment is decided on, care can be customized for a patient's situation. It can be a very involved process.

Although treatment and care decisions are mostly made by patients and their cancer care teams, communication with others is very important. Sometimes, though, patients and caregivers might find themselves being the ones having to do most of the communicating. For this reason, it's important for patients and caregivers to understand the work that goes into planning and scheduling treatment, how communication is handled by their cancer care team, and how they might need to be involved.

Who is involved in planning cancer treatment and care?

Depending on the type and stage of cancer, cancer patients often need care from many health professionals who are involved in providing cancer care. Some of these might include a surgeon, pathologist, medical oncologist, radiation oncologist, rehabilitation (rehab) specialist, palliative care specialist, pharmacist, nurse, dietitian, social worker, and case manager. You can learn more in Health Care Professionals Associated With Cancer Care.

Besides the cancer care team, there are others who need to know what care is being planned and given. These people include your primary care doctor and any specialists who manage other health problems you might have. It's also important to look at how work and family schedules play a part in planning and scheduling treatments. You might need certain community resources, and sometimes transportation or finding lodging is a concern. Your insurance coverage must also be verified and out-of-pocket expenses need to be figured out. In some cases, you might also want to get a second opinion before your treatment plan is created.

How treatment plans are created

Once a treatment is decided on, a treatment plan can be customized for a patient's situation. This is a step-by-step process that involves both planning and scheduling.

• Treatment planning involves figuring out the exact doses of the treatment that will be given and how long it will last.
• Treatment scheduling involves working out the best timing and schedule for getting treatment.

How complicated your plan is and how difficult it is to figure out the right doses and schedule will depend on the type of treatment you're getting.

Doctors follow certain guidelines when planning treatment doses and combinations of treatments. These guidelines are based on research studies that are specific for the type and stage of cancer you have and the treatment you've chosen. If you want to learn more, you can ask your doctor what guidelines are being used to help put together your treatment plan, and you might also ask where you can learn more about the guidelines. You can also read about how cancer care teams help patients plan and schedule specific types of treatment in Surgery, Radiation Therapy, Chemotherapy, Hormone Therapy, Targeted Therapy, Immunotherapy, Stem Cell Transplant, and Clinical Trials.

At most cancer clinics or treatment centers, your cancer care team will explain your treatment plan during one of your regular appointments or a special teaching session. During this visit or session, your doctor and other members of the cancer care team will sit down and talk through the treatment plan with you and your family or caregiver. Some centers might offer classes for new patients, too.

Throughout this process, make sure any questions you have are answered, and ask for information to be written down as well as explained. Research has shown that having both verbal and written communication about your treatment plan can lower your stress level and help you and your cancer care team work together better.

Your cancer treatment plan

Many experts recommend having a written cancer treatment plan. A cancer treatment plan is kind of like a roadmap because it helps to lay out the expected path of treatment. It is a document that is created by the cancer care team and given to the patient and others that may need to know the planned course of care. The plan helps with communication because it keeps everyone informed. Sometimes treatment plans list who is responsible for the patient's care at different times.

Not all treatment centers use written cancer treatment plans. Even if your treatment center does not use treatment plans or does not give you one, you can ask for as much information in writing as possible. This will help you remember what's been told to you, which can be hard to do when you're given a lot of information at once. Either way, having things in writing is helpful. You and your caregiver can refer to the written information if a problem comes up when you're at home or traveling.

If a written cancer treatment plan is used, it might include some of the following information. If you're not given a treatment plan, these are some things you can ask about getting in writing:

• Your exact cancer diagnosis and stage
• Special test results, such as imaging (x-rays), blood tests, tumor marker tests, genetic testing, or biomarker tests done on the tumor
• Your planned treatment, its doses, the schedule for getting it, and how long it is expected to be given
• Common and rare side effects that might be expected, along with how they can be managed
• Expected long-term effects of the treatment
• Supportive treatments or therapies that might be needed, such as pain medicine, physical therapy, oxygen, or medical equipment
• Who will be responsible for helping you with problems or answering questions about your care
• Resources for emotional support, mental health issues, or social concerns
• Disability and financial concerns, if needed, and how they can be managed
• Advance directives you may have (living will, durable power of attorney for healthcare, do not resuscitate orders) and your care preferences

Written cancer treatment plans should be changed when there's new information. This might happen because the response from a treatment wasn't as expected, if side effects are too severe, or if you want to try a different treatment option or choose to stop treatment. When treatment ends, a survivorship care plan can be used to help manage care.

Your treatment schedule

As noted above, a treatment schedule is included as part of a written treatment plan. If you don't get a written treatment plan, you can ask for a treatment schedule to be written out for you. A treatment schedule includes:

• The type of treatment that will be given, such as radiation therapy, chemotherapy, targeted therapy, immunotherapy, hormone therapy, etc.
• How treatment will be given, such as how radiation will be delivered, or if a treatment drug will be given by mouth, injection, or infusion.
• How often treatment will be given, such as once a day, once a week, or once every 3 weeks.
• If there are breaks between cycles, courses, or types of treatment, and how long the breaks will be.
• The expected length of time for each type or course of treatment.

Your treatment schedule may be fairly easy to figure out, but some schedules are more complicated. It's important to remember that treatment schedules are based on research and what has been shown to work best. The outcome of your treatment might be affected if the schedule is disrupted or if delays happen. But, while treatment guidelines need to be closely followed to get the best treatment outcomes, your wishes and choices are important.

Here are some things you'll want to discuss with your cancer care team if you think they might affect your treatment schedule or if you wonder about being able to finish the treatment as planned.

• How soon treatment needs to start
• How much you need to stay on the planned schedule
• Your work or school schedule
• What vacation time you have available, if you need to take time off
• Spouse, partner, and family schedules
• Religious or spiritual rituals or schedules
• Transportation problems
• Travel plans you may already have
• What might happen if your treatment gets disrupted

Keeping your health care team informed

If your treatment center uses a written treatment plan, it's a good idea to ask your cancer care team how that plan will be communicated to other health care professionals involved in your care. If you don't have a written treatment plan, you might want to ask how your primary care doctor and other health care specialists or professionals will know about your treatment plan and how often they will get notes about your treatment and care. Sometimes electronic medical records can help, but sometimes the electronic systems can't connect or "talk" to each other. You may find that you need to ask about this, or that you need to make phone calls or send emails to be sure your treatment information is being communicated to other members of your health care team.

If you need to take a break from cancer treatment

It's important to talk to your cancer care team about things that might interfere with your treatment schedule before treatment starts. But sometimes things come up during treatment that might make it difficult to continue or complete your treatment as scheduled. Sometimes taking a break is recommended by the cancer care team, and that's OK. It might be due to side effects, to do more tests, because of a holiday or special event, or because of other health problems. But some patients who are actively on treatment might wonder if they can take a break for personal reasons. Maybe they want a break from some of the side effects. Maybe they have travel plans. Maybe a family or life situation has come up that they need to deal with or take care of.

Here are some important things to think about if you're getting ready to talk to your doctor about taking a break from treatment.

• Make a list of the reasons why you are thinking of taking a break. List the pros and cons the break would have for you, in your own words.
• Think about the goal of your treatment. There is a difference between treating to cure the cancer, control the cancer, or make symptoms of the cancer better.
• Know that the order and type of treatment may make a difference. Staying on course with treatment might be very important in getting the best results, but this can vary depending on the type and stage of cancer you have.
• If side effects are a problem, be sure to track and report them so they can be managed. If your cancer care team isn't asking about side effects, speak up and tell them. If what's offered to manage side effects isn't helping, tell your doctor so something else can be tried. 

Questions about if it's OK for you to take a break from treatment need to be answered by your cancer care team, because they know your situation best.

Questions to ask your cancer care team

It's important to remember that each person with cancer has a different situation. Some questions you have need to be answered by your cancer care team because they know your situation best.

In the sections above called "Your treatment plan" and "Your treatment schedule," you'll find lists of information you should ask about if not provided in a treatment plan for you. In addition, here are some questions you might want to ask about your treatment plan or schedule:

• Are there guidelines you use to help figure out my treatment dose and schedule? Is there a website or place where I can find more information?
• How soon does treatment need to start?
• Other than what you've already told me about my treatment plan, is there other information that I need to have?
• What happens if I can't stay on the schedule?
• Do you think my treatment plan will change? If so, how and why?
• How will my other doctors be notified of my treatment plan?

When getting verbal information, you might want to ask if it's ok to record the visit or session so you can listen to it or review it later. You might also want to have your caregiver or a family member or friend with you to take notes. If you have a different primary speaking language than your doctor, ask for a translator or to be connected with a translation service.

If you are not getting the information you need or if you think others on your health care team need more information than what's being given to them, talk to your cancer care team about what can be done to improve communication.