Dan Labriola ND
No one is prepared for a cancer diagnosis. The words “you have cancer” are a life changing moment you never forget. You must now make decisions for which no one is prepared; choosing doctors, selecting treatments and managing life issues that are suddenly front and center such as financial survival, personal responsibilities, relationships, quality of life, your dreams and plans for the future and, in some cases, survival. And if that wasn’t enough, you must do this while navigating medical and insurance systems that are less than user-friendly.
When you receive the diagnosis you will likely be referred to a conventional oncology physician who will outline a course of treatments or treatment options but it is not uncommon for daunting questions to remain: Is this the best treatment? Is this the right doctor? Where do I look to learn more about the diagnosis and treatments? How do I pay the rent, get transportation to doctor appointments or deal with side effects? If you consult the internet, chances are you will be even more confused.
What you need is a plan that enables you to answer these questions and guide you through the cancer experience with the confidence that you’ve made the best decisions. Such a plan will also restore control of your life.
You don’t want to go this alone. Taking advantage of the training and experience of knowledgeable cancer treatment and support providers will result in the best plan so we begin with a strategy for choosing your cancer team including doctors, other providers and institutions. These are the experts you will rely on to provide the information necessary to make treatment decisions and, in most cases, deliver the treatment. We will start with choosing your team.
Depending on your particular circumstances, the treatment selection process can involve multiple choices that may also include clinical trials, complementary and alternative medicine, other supportive therapies or doing nothing. In the second part of this series we will look at ways to evaluate these choices and tailor your treatment to meet your unique needs.
The third and final installment will address the services and resources that can be critically important in addition to killing cancer cells such as reducing side effects, maintaining quality of life, finances, psychological issues, diet, prevention and much more. These services have a name, cancer survivorship, and can remarkably improve your life and outcome.
Choosing your care team
Cancer is not a single disease but actually many diseases with a few characteristics in common. Each kind of cancer acts differently, has different treatments and in many cases different kinds of treating doctors.
At this moment in science conventional medical oncology programs have the best diagnostic tools and treatment effectiveness and are the place to start. Even if you are considering using alternative medicine, you can take advantage of the very credible evidence and experience available from the conventional cancer world and then apply the same criteria for evaluating benefits and risks that I have listed below for all of the treatments you are considering. Knowledge brings clarity.
The first step I recommend is to identify the specific kinds of medical specialists that treat your cancer. Referrals are especially valuable from someone you trust such as your family doctor or the provider who delivered the diagnosis. Top Doctor surveys are useful as well but there are many excellent docs that don’t make it into Top Docs. Be cautious of blogs and sites that may be influenced by just a few opinions. If it’s colon, lung or breast cancer, for example, you will likely start with a surgeon or medical oncologist but may need a radiation oncologist (not to be confused with radiologists who read diagnostic studies such as x-rays). For prostate cancer you will probably start with a urologist or radiation oncologist. Medical oncologists, the doctors who administer chemotherapy, also frequently act as quarterback even if you’re not receiving chemo.
Once you have narrowed your choices down to a few, the easiest next step is to schedule an appointment and evaluate your experience with the help of the guidelines below. You can also request a meet and greet to see if a prospective doctor is a good fit but the experience will not be as complete as a formal visit. If the first doctor is a home run you’re set. If not, then seek out more referrals and try again. There are many excellent cancer docs and institutions who would be honored to be your provider. You will be working with this person for some time so it’s worth the effort now to get the doctor that meets your needs.
Here is a checklist you can use to evaluate prospective doctors:
1. Familiarity and experience treating your diagnosis.
Board certification is a must. Doctors increasingly sub-specialize in specific cancers and specific patient cohorts such as pediatric, adolescent and young adult and others.
2. Covered by your insurance.
Insurance can be tricky. There are different levels of coverage depending on whether the doctor is in network, out of network, preferred etc. The right doctor may be worth a difference in cost but ask the question at the beginning to avoid a nasty surprise later.
3. Has an acceptable disciplinary record.
Log on to your state department of health website to see the doctor’s history, www.doh.wa.gov for Washington State.
4. Practices at a hospital that is highly rated for safety and has all of the other services you may need.
Check reputable hospital ratings such as Leapfrog Group, www.leapfroggroup.org. If you have heart disease, for example, you will want an organization that can also care for your heart issues especially in an emergency.
5. Communicates effectively.
You want a doctor whose communication style and demeanor are consistent with yours, who is approachable, provides clear information and works well with your decision-making process. Be clear about your preferences to give the doctor a chance to meet them.
6. Office staff that is friendly and cooperative.
Front desk, nursing and other support staff are there to meet your needs. They should be approachable, responsive and make you feel like a priority, not an interruption. Today’s healthcare world is pretty lean so keep your expectations reasonable.
7. Is in the same healthcare delivery system as your other medical specialists and hopefully your primary care doctor.
Modern communication has made care coordination much easier but having doctors who are all in the same electronic medical record or otherwise connected will make your care coordination more seamless.
8. The doctor’s gender is not as important as the other items.
We all tend to be modest but doctors have seen thousands of whatever it is you are modest about. The other criteria above will have a greater effect on your satisfaction.
If you belong to an HMO or other restricted plan your choices are different but you can still interview doctors in the oncology group and, in some cases, be treated at affiliated cancer centers.