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What to Expect From Your Cancer Doctor

MEDICAL CARE

Your relationship with your doctor is one of the most important factors in managing your illness. You will need to depend on his or her knowledge and skill to keep your illness under control. One doctor should coordinate your care. Your doctor may consult with other specialists, but you should feel confident that one person is in charge. If this doctor happens to be your family doctor, you can take comfort in knowing that he or she knows you best. If your family doctor refers you to a cancer specialist, he or she will keep in close touch with the specialist. This is important because many people like to use their family doctor as an anchor, especially when dealing with so many specialists. Your family doctor can also help you sort out new information that may be confusing.

AVAILABILITY

Your cancer doctor should be available to you. There will be times when this is more important than others -- for example, at the point of diagnosis, or if there is a change in your condition or treatment. These times may seem like crises and you will find it difficult to understand everything. Most doctors know this and are willing to give you more time so that you fully understand what is happening. Naturally, doctors cannot be available 24 hours a day. But your doctor should have a coverage or on-call system so that you will always be able to reach someone if you have a question or medical problem.

TREATMENTS

The primary goal of cancer treatment is to cure. If cure is not possible, treatment is often still possible and appropriate to achieve long term control of the illness and to manage the symptoms associated with cancer. Your physician may use one or more of the following cancer treatments: 1) surgery, 2) radiation therapy, and 3) drugs such as chemotherapy as well as newer agents called biological response modifiers which enhance your body's defense against cancer. Your doctor may also prescribe other treatments, such as anti- anxiety medicines, nutritional supplements, pain medicine, etc. to help relieve your symptoms.

Cancer therapy consists of both standard and experimental treatment. Standard treatment means the kind of therapy that any doctor who treats a person with cancer is expected to deliver. Standard treatment is developed by doctors and researchers and is tested scientifically, usually by a method called a "clinical trial." Once a treatment has been found to cure a large number of patients, it becomes "standard," meaning that all patients with a particular cancer are expected to receive this treatment.

Standard treatment offers you the best hope of obtaining a cure. Because not every person with a particular type of cancer will be cured by standard treatment, medical researchers are constantly seeking improvements and testing experimental treatments. Your doctor should be knowledgeable about what is standard for your particular cancer. He or she should also inform you of the expected results of that treatment. Not every doctor has access to experimental treatments, but you should have the option of being referred to another doctor who does.

You should feel confident that your doctor knows what is available in other centers and is willing to refer you if you are interested, especially if standard care doesn't seem to be working. (See INVESTIGATIONAL TREATMENTS for suggestions about how to discuss this with your doctor.) Asking for a second opinion about treatment options does not mean that you don't like or trust your doctor. Doctors know that patients have to feel that every possibility for cure is being explored. This is what a "partnership" with your doctor means. It's a cooperative effort geared to helping you get the best care possible. Mutual respect between you and your doctor means that you should understand all of the treatment options. Once you and your doctor have fully discussed these options, you should feel confident about the recommended treatment.

COMMUNICATION AND SENSITIVITY

Many years ago, before cancer was considered curable, patients and their families sometimes asked their doctor to withhold the truth about the diagnosis. Now that cancer is no longer "hopeless," it is considered poor medical practice to withhold information from a patient. In only a few situations will a physician not relay a cancer diagnosis to a patient. These may include small children and mentally incompetent adults. To withhold information about the diagnosis results in a poor doctor/patient relationship. Coping with something unknown is extremely difficult for all of us. You and your family need to share information about your diagnosis and treatment. Because of this, you should try to include a trusted loved one in the first discussion with your doctor. Remember that you have the right to include or exclude anyone else in these discussions.

Besides your doctor's medical skill, his or her ability to communicate with you is important. Doctors differ in the amount of information they give to patients and their families, and patients vary in the amount of information they need or want. It will be up to you to tell your doctor if he or she is giving you too much or too little information. Doctors are not mind readers. They will take their cues from you as the person in charge of your life and health. You should have the feeling that your doctor is interested in you as a person, and how you and your family are coping with the problems you face with cancer.

Doctors, like people in general, vary in their sensitivity to the emotional impact of cancer. This sensitivity will be more important to some patients than to others. Nevertheless, you should feel that you and your doctor are partners, both working toward the same goal of getting you well. As with all human relationships, this will take work, but it is well worth it if it results in your trusting and having confidence in your doctor, as well as feeling in control of what is happening to you.

QUESTIONS ABOUT YOUR TREATMENT PLAN

The most important issue to be discussed is your treatment plan. Before accepting your doctor's recommendation for treatment, you will want to discuss certain basic information. This includes the following:

  • Has the diagnosis of cancer been established without any doubt?

  • What is the goal of treatment -- cure or control of your symptoms?

  • How will your doctor know that your treatment is working?

  • How long will your treatment last, and how often will you need follow-up visits?

  • How will your lifestyle change regarding work, family relationships, and recreation?

  • If there is a chance that your cancer may recur, how will you know it?

  • If several specialists are to be involved in your care, who will coordinate your entire treatment program?

  • Have all your concerns, no matter how minor, been satisfied after your initial talk with your doctor?

  • What financial responsibilities will you have? Most doctors are generally pleased to discuss fees and other financial arrangements. You should feel free to bring up these matters.
In talking with your doctor about treatment, it may be difficult to remember all that he or she is saying. It may be helpful to take notes, and to take along a family member or friend to help you remember everything. You may also want to prepare a list of questions before the meeting so you don't forget to ask about something important.

QUESTIONS ABOUT SPECIFIC TREATMENTS

The following questions are commonly asked about specific treatments, such as chemotherapy, surgery, BRMs (biologic response modifiers), and radiation therapy:

What are the benefits and risks of the treatment suggested for me?
Applicable to: Chemotherapy; Radiation therapy; BRMs; Surgery

What are the names of the drugs I will be taking?
Applicable to: Chemotherapy; BRMs

Why do I need a blood test before treatment, and how often will a blood test be given after treatment?
Applicable to: Chemotherapy; Radiation therapy; BRMs

What if I miss a treatment?
Applicable to: Chemotherapy; Radiation therapy; BRMs

What are the possible side effects of treatment, and which side effects should I report to my doctor right away?
Applicable to: Chemotherapy; Radiation therapy; BRMs

What other medicines or treatments may I have to take?
Applicable to: Chemotherapy; Radiation therapy; BRMs

May I drink alcoholic beverages?
Applicable to: Chemotherapy; Radiation therapy; BRMs; Surgery

Are there any special foods I should eat, and are there any I should avoid?
Applicable to: Chemotherapy; Radiation therapy; BRMs; Surgery

If I don't feel sick, does that mean the treatment is not working?
Applicable to: Chemotherapy; Radiation therapy; BRMs

Will I lose the ability to conceive and bear children after treatment is completed?
Chemotherapy; Radiation therapy; Surgery

Will I lose my hair?
Applicable to: Chemotherapy; Radiation therapy

QUESTIONS ABOUT PROGNOSIS

Many patients and some doctors may want to discuss prognosis in terms of time. ("Doctor, how long do I have to live?") But prognosis ultimately depends upon the effectiveness of your treatment, so it's better to focus on the immediate issue of getting through treatment and understanding its results rather than worrying about survival. Statistics about survival are really meaningless because no one knows how you as an individual will respond to treatment. A prognosis should be discussed only on an individual basis, and only after you know the results of your initial treatment.




News
Early Palliative Care in Lung CA Focuses on Coping, Symptoms

Jan 31, 2013 - Early palliative care clinic visits, integrated with standard oncologic care for patients with metastatic lung cancer, emphasize symptom management, coping, and psychosocial aspects of illness, according to research published online Jan. 28 in JAMA Internal Medicine.



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