Receiving a cancer diagnosis can leave patients feeling dazed, dismayed and deluged. While these reactions are natural, cancer patients must play a major role in their own treatment. Asking the following questions is an important first step.
Q: What’s the cancer type and stage?
A: Cancers are identified by the organ where they originate. In other words, breast cancer that spreads to the lungs is still breast cancer. This is very important, as breast and lung cancers, for example, have different root causes and are treated differently.
Cancers are staged one through four, one being the earliest stage. However, the consequences of a more advanced cancer vary with the cancer. Testicular cancer can spread throughout the body and be completely cured. Stage four pancreatic cancer has a very poor prognosis.
Q: How was the cancer diagnosed?
A: Most often, cancer is diagnosed with a biopsy, which is interpreted by pathologists. Patients should get the pathology report. This will help them better understand the type of cancer, whether it has spread to lymph nodes, and other important information. They should also keep track of what tests were done — mammograms, CT, PET — and get copies of these reports. They should ask about molecular tests (diagnostics that determine which mutations are driving the cancer). Knowing the genetic underpinnings of the tumor can influence treatment.
It never hurts to get a second opinion, and having all the reports will expedite this process. But patients should proceed quickly. Once treatment has begun, it’s often difficult to take a different course.
Q: What are the treatment goals and options?
A: There are three basic forms of treatment: surgery, radiation and chemotherapy. Depending on the type and stage, an oncologist may recommend one or more.
Patients should know the treatment goals. Is the team working to cure the cancer or slow it down? Sometimes treatment may prolong life but will not eradicate the disease. Also, some treatments, such as Gleevec for chronic myelogenous leukemia, work to transform cancer from a deadly to a chronic disease, much like diabetes.
Clinical trials are often available, however eligibility criteria vary, and not every patient will qualify. Nevertheless, patients should ask their physician about clinical trial availability.
Q: How will it affect quality of life?
A: Cancer treatments may have debilitating side effects. However, newer treatments can be less toxic. Patients should understand the consequences of treatment: The long- and short-term side effects, whether home care will be needed, how much medical leave might be required. Will transportation be needed and, if so, are shuttles available?
On the business end, will treatments be covered by insurance? Co-pays can add up, what will the out-of-pocket expenses be? A case worker or business office staffer can help with these and other financial issues.
Q: Who’s on the treatment team?
A: Cancer patients should know their medical team: medical oncologist, surgeon, radiation oncologist, nurses, case workers and others. Even more importantly, who is going to be the quarterback, coordinating care, ensuring nothing falls through the cracks and providing long-term monitoring?
These issues provide a starting point and basic framework for gathering key information, which will help patients make knowledgeable care decisions.
Dr. Michael Kosty is the medical director of Scripps Cancer Center at Scripps Green Hospital.
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How to wage a smart cancer fight
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