Dear Doctors Column
August 13, 2007
Cancer Care: Informed Decisions Lead to Best Care
Question:
I’ve recently read about how difficult it is to sort out treatment options when faced with a diagnosis of cancer. Can you offer any advice?
Answer:
If you are diagnosed with cancer, actively seeking out information and carefully weighing your options for care, which include choosing a treatment plan, health care facility, and doctor or doctors, can significantly impact your health. Scientists have made many advances in the treatment of cancer, and the complexity of care has increased along with rapid progress. Not all physicians have access to the latest or most effective therapies, and studies have shown that people aren’t always offered the best treatment options for their disease.
Optimal care may require treatment from multiple specialists, including an oncologist (a doctor with expertise in the use of medical and chemotherapeutic cancer treatments), a radiation oncologist (physicians with specialized training in the use of radiation for cancer), and a surgeon.
For certain cancers, a surgeon with additional specialized training (beyond general surgery) may improve your chances for a good outcome. If you need surgery for ovarian cancer — a disease for which an optimal surgical procedure can significantly prolong your life — you should see a gynecologic oncologic surgeon (a surgeon who specializes in cancers of the female reproductive system).
In addition, for cancers that can affect physical appearance or function, consulting with a plastic surgeon often is appropriate, but physicians may not always discuss this option. If you’re having a skin cancer lesion removed from your face or must undergo mastectomy, for example, you should consider asking your physician about referral to a plastic surgeon if this option isn’t offered.
A diagnosis of cancer is a devastating event and at such a time navigating the many alternatives can be overwhelming, but there are resources that can help guide you through the complicated system.
In March 2007, a group of leading cancer organizations, including the American College of Surgeons’ Commission on Cancer, the American Society of Clinical Oncologists, and the National Comprehensive Cancer Network, released the first set of nationally accepted quality measures for treatment of breast and colon cancer. The measures are intended to give patients a tool to help evaluate the quality of care offered by hospitals. For example, the measures for treatment of breast cancer note that patients who have certain types and stages of disease should receive postsurgical, or adjuvant, treatment with tamoxifen or an aromatase inhibitor — drugs proven to reduce the risk of disease recurrence and lengthen life spans.
Before you can make a decision about a treatment plan, however, you must first choose a physician and health care facility. The National Cancer Institute’s (NCI) fact sheet, “How to Find a Doctor or Treatment Facility if You Have Cancer” is loaded with links to valuable resources that can guide your evaluation of a doctor’s education and training as well as the experience of various hospitals.
Studies have repeatedly shown that finding a physician and hospital that treat a large number of patients with particular types of cancer produce better outcomes for those diseases. Experience plays an even larger role for cancers that are advanced, rare, or require complex surgery.
People just diagnosed with cancer rarely have to begin treatment immediately. In general, waiting a few days to a few weeks will not affect the outcomes and provides time to consider all the options.
The NCI suggests meeting with several doctors before making a decision and considering these questions:
Ø Does the doctor have the education and training to meet my needs?
Ø Does the doctor use the hospital I’ve chosen?
Ø Does the doctor listen to me and treat me with respect?
Ø Does the doctor explain things clearly and encourage me to ask questions?
Ø What are the doctor’s office hours?
Ø Who covers for the doctor when he or she is unavailable? Will that person have access to my medical records?
Ø How long does it take to get an appointment with the doctor?
If you need surgery, the answers to following questions can help you make an informed decision:
Ø Is the surgeon board-certified?
Ø Has the surgeon been evaluated by a national professional association of surgeons, such as the American College of Surgeons (ACS) or the American College of Obstetricians and Gynecologists?
Ø At which treatment facility or facilities does the surgeon practice?
Ø How often does the surgeon perform the type of surgery in question?
Ø How many of these procedures has the surgeon performed? What was the success rate?
It’s important to note that your insurance plan may limit your choice of physicians. Your insurance company can provide you with a list of participating physicians.
Once you’ve decided on a doctor and he or she has discussed and recommended treatment options, you may also want to consider getting a second opinion. Doctors are rarely offended by their patients’ seeking a second opinion — it’s a standard practice, and many physicians appreciate additional professional input. In some cases health care plans require a second opinion.
When choosing a hospital, the NCI advises considering:
Ø Has the facility had experience and success in treating the condition?
Ø Has the facility been rated by state, consumer, or other groups for its quality of care?
Ø How does the facility check on and work to improve its quality of care?
Ø Has the facility been approved by a nationally recognized accrediting body, such as the ACS or The Joint Commission?
Ø Does the facility explain patients’ rights and responsibilities? Are copies of this information available to patients?
Ø Does the treatment facility offer support services such as social workers and resources to find financial assistance if needed?
Ø Is the facility conveniently located?
You may wish to seek treatment at an NCI-designated cancer center, institutions with proven track records of excellence in clinical care and research. The NCI has two designations: Cancer Centers, which conduct a variety of laboratory and clinical research (these centers may offer patient care only through participation in clinical trials), and Comprehensive Cancer Centers, which conduct a wide range of research and provide patient care and education.
The bottom line: take charge of your care. Making the most informed decision and seeking out the best treatments can profoundly affect your medical outcome. In a complex health care system, you are your own best advocate.
To help make the task more manageable, enlist the help of friends and family to conduct research and accompany you on doctor’s visits, where they can take notes and ask questions you may not think of.