One of the most important considerations in the treatment of your cancer is deciding on a doctor. You can find a board-certified oncologist, or cancer specialist, by asking your primary care physician, managed-care representative, or contacting the oncology department at the hospital. Besides experience, there are other qualities that your doctor should have, which may require a little more research on your part.

You must feel that your oncologist is competent and up-to-date, and that he sees you as a partner in your cancer treatment. Your doctor should be willing to listen to your concerns, offer support, and explain treatment options and side effects in language that you understand.

It is important to include your primary care physician in decisions about your treatment and medical care. Think of your primary care physician as your gatekeeper, the doctor who has good knowledge about your overall health and who can refer you to other health professionals, when needed. Other members of the health care team, such as the nurse, dietitian, physical therapist, radiation therapist, and social worker are also excellent sources of information and explanations for various aspects of your treatment. So be sure to ask questions.

The Office Visit

It is very common to feel anxious when initially visiting an oncologist. One way to remove some of the anxiety of a first visit is to bring a list of questions with you. Paper and pencil or a tape recorder may also help, so you can remember the answers given.

You might want to bring a family member or close friend with you for support, especially if you are feeling overwhelmed or upset. Some individuals, however, feel more comfortable speaking privately with the doctor. A good compromise may be for the friend to accompany you, but remain in the waiting room while you are with the doctor.

Good communication is critical to a doctor-patient relationship. Your initial meeting will help you gauge how comfortable you feel with this particular doctor. If your interaction is not satisfactory, you may want to seek another referral from your primary care physician, or you can call the oncology department of your local hospital for a list of names of local oncologists who treat your type of cancer.

Following is a list of questions you may want to ask about your treatment. Remember, if you do not understand the medical terminology at any time, be sure to ask.

Questions To Ask Your Physician and Other Health Care Providers About Your Treatment

• What is your experience in treating this type of cancer?
• What kinds of treatment do you recommend and why?
• What are the chances that the treatment(s) you suggest will be successful?
• How long is treatment typically?
• What are the side effects of the treatment?
• How do you determine if symptoms I am experiencing are normal or adverse responses to the medications or other treatment?
• What will my quality of life be during and after treatment?
• Are clinical trials or investigational agents an option for me?
• Who is available for medical questions when you are not?
• Is a nurse or other health care professional available to deal with phone inquiries?
• What is the schedule for follow-up and post-treatment?
• When do you generally return phone calls?
• What is the cost of treatment and is it covered by my health plan?

Getting a Second Opinion

A second opinion can give you confidence in the information and recommendations you have already obtained, or it may offer a different approach to treatment. If the second physician disagrees with the initial consultation, you may even want to seek a third opinion. The important thing is that you receive the best state-of-the-art diagnostic tests and treatment, and that you have confidence in the care you are receiving.

You may ask your primary care physician for a referral for a second opinion, or you can ask the oncologist that you have already seen. You should not be uncomfortable asking for this referral. Many physicians welcome the additional input and reassurance provided by a second opinion. It is your right as a patient to obtain this information. If this request is met with resistance, give some extra thought to whether you wish to continue with this doctor.

Most insurance companies will pay for a second opinion; some require it. Check your insurance policy or ask about second-opinion coverage.

Keep Asking Questions

For many cancer patients, the first few days and weeks following a diagnosis of cancer are filled with a blur of appointments, tests and new information, often in a language that isn’t quite clear. No one can be expected to remember everything the first time around. Your nurses and physicians know this and should encourage you to continue asking questions –– even the same questions two or three times.

There’s no need to feel embarrassed if you don’t understand the medical terminology being used. Ask to have the information explained in simpler language, and paraphrase the answers to make sure they’re clear to you. This information will affect important treatment and care decisions you’ll have to make. Being an involved, active participant in your treatment means asking questions to get the answers you need for those decisions.

Understanding Treatment Options

“I know that the treatment of cancer is pretty complicated – I don’t feel in control of what’s happening unless I feel capable of making some choices.”

Methods of Treating Cancer

Modern medicine has developed several methods of treating cancer. The most common are surgery, radiation therapy, and chemotherapy. Other cancer treatments include hormone and investigational therapies. Complementary/alternative medicine (sometimes referred to as “integrative medicine”) is becoming more integrated into mainstream medicine.

There is no “best” method of treating cancer. In deciding on a specific type of treatment, the physician must consider a number of factors, including the type, stage, and location of the cancer, as well as the health and age of the patient.

An individualized plan of care will generally fit into one of three categories:

• It is very clear, based on the scientific literature, what should be done to treat your cancer. In many cases, clinical practice guidelines will direct your doctor to use these established practices.
• It is not clear what to do, but there are several promising alternatives (e.g,. radiation vs. surgery). Your doctor will have a balanced discussion with you about the various options. You will be asked your preferences based on your cancer and your lifestyle.
• It may be unclear what treatment to use. In this case you may wish to participate in a clinical trial of a promising new treatment.

A combination of treatments is commonly used to treat a specific cancer. Regardless of the type of treatment, the goal is the same –– to stop the uncontrolled growth of the cancer cells. Surgery does this by attempting to remove all the cancer cells. Radiation and chemotherapy work by destroying the cancer cells.

Your physician should be willing to discuss each of the treatment options or combination of treatment options under consideration, including the advantages and disadvantages, and complications or side effects of each type of treatment.

You will find a much more detailed discussion of the specific treatment options in the cancer-specific section, which is part of this CancerResource package. That information, drawn from the Physician’s Data Query system of the federal government’s National Cancer Institute, provides a detailed overview of the various treatment protocols for specific types of cancer.

Below is a brief description of the various treatment methods and their side effects.

Surgery

Surgery removes the tumor and any nearby tissue that may contain cancer cells. Sometimes, healthy tissue may have to be removed from around the tumor to help keep the cancer from spreading.

Cancer cells can spread by traveling through the bloodstream or the lymphatic system, which carries lymph fluid through the body. Surgeons often remove lymph nodes that are near the tumor to see if they contain cancer cells. This information contributes to treatment decisions. The location and extent of surgery determine the long- and short-term side effects.

Radiation Therapy

In radiation therapy (also called X-ray therapy, radiotherapy, cobalt treatment, or irradiation), high-energy rays are used to damage cancer cells so they are unable to grow and multiply.

Radiation therapy may be used before surgery to shrink the tumor or after surgery to destroy any cancer cells that may remain in the area. Most often, the radiation is delivered as a series of treatments using a machine that directs high-energy rays at the cancer. In some cases, however, radioactive material may be implanted at the tumor site to give continuous treatment over a period of time.

Even though radiation therapy is directed only to the area where treatment is needed, it can cause side effects. Most of the side effects are not permanent. The most common side effects of radiation therapy are fatigue, skin rashes or redness in the area being treated, reduced appetite and gastrointestinal upset. In some cases, radiation therapy may cause a decrease in the type of blood cells that help protect the body against infection, bleeding and anemia.

Chemotherapy

Chemotherapy, or treatment with anti-cancer drugs, is used to destroy cancer cells by disrupting their ability to grow and multiply. The type and stage of cancer determines which drugs are used, and often more than one drug is used during a single course of treatment.

Chemotherapy drugs poison the cancer cells. That action, as well as the toxic effect they may have on some normal, healthy cells can produce a wide range of temporary side effects. The most common side effects of chemotherapy include nausea and vomiting, hair loss, loss of appetite and fatigue. Other side effects include an increased chance of infection, bleeding and anemia.

Hormone Therapy

Some types of cancer depend on hormones for their growth, while other types of cancer may be suppressed by high doses of hormones. For these reasons, doctors may recommend therapy that either prevents cancer cells from getting the hormones they need to grow, or supplies amounts of hormones that limit the growth of cancer cells.

Hormone therapy is most commonly used to treat cancers of the breast, prostate and other hormone-responsive tissues. Drugs may be used to block the body’s production of hormones, or surgery is performed to remove hormone-producing organs.

Hormone therapy can cause a number of side effects, depending on the specific drug or surgical procedure. In some cases, the treatment interferes with the body’s normal production or use of hormones. For example, women taking tamoxifen may experience some symptoms of menopause, such as hot flashes. Patients may have nausea and vomiting, swelling and weight gain. Since some hormones cause an increase in appetite, they are occasionally prescribed for this purpose.

Investigational Therapies

Investigational therapies are new treatment approaches that are being tested in clinical trials. There is not yet sufficient data to make the therapy a standard method of treatment. Biological therapy and gene therapy are considered investigational therapies.

Biological Therapy

Biological Therapy(sometimes called immunotherapy or biological response modifier therapy) uses the body’s immune system to fight cancer or to lessen some of the side effects of cancer treatment. This therapy may suppress or alter cancer cell growth, boost the killing power of immune system cells, or enhance the body’s ability to repair or replace normal cells damaged by other cancer treatments. Examples of biological therapy include interferon, interleukin-2, monoclonal antibodies, colony-stimulating factors, and vaccines.

Cancer vaccines are a form of biological therapy with potential to encourage the immune system to recognize cancer cells. They may help the body reject tumors and prevent them from recurring. Unlike other types of vaccines, cancer vaccines are injected after the disease is diagnosed. They are being studied for their possible use with other biological therapies and as a treatment for melanoma and many other types of cancers.

The side effects and severity of biological therapy depend on the type of treatment. It may cause flu-like symptoms, including fever, chills, nausea, vomiting and fatigue. Muscle aches and rashes at the site of injection may occur. Interleukin-2, in high doses, can have more severe side effects and is usually administered in the hospital where the patient is closely monitored.

Gene Therapy

Initiated in the 1990’s, gene therapy replaces an active cancer-causing gene, or oncogene, with a normal gene. It might also involve removing bone marrow from a cancer patient, inserting a “designer” gene, and then returning bone marrow to the patient.

At present, there are a number of serious obstacles to the complete success of gene therapy. These need to be overcome before this process is routinely available.

Clinical Trials

Researchers use clinical trials to find out whether investigational therapies are safe and effective. These carefully controlled studies often compare the new therapy with standard treatment methods. In a clinical trial, some participants are given the best known treatment along with the investigational therapy, and some are given the best known treatment alone. This is at minimal or no cost to patients. The participants are randomized by chance to determine who will receive the investigational therapy and who will not. Sometimes the investigational therapy is not helpful, but other times it can lead to significant improvements in treatment and quality of life.

Patients who participate in clinical trials make an important contribution to the advancement of medical science and cancer care. For more information on clinical trials and how to participate in them, see AICR’s “Cancer Information: Where to Find Help” brochure, under Investigational Treatment.

Complementary and Alternative Medicine

Complementary/alternative medicine (CAM) can be described as diagnosis, treatment and/or prevention that complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine. CAM is now also referred to as “integrative medicine.”

Complementary and alternative therapies include, but are not limited to:

• Acupuncture
• Botanicals/Herbals
• Dietary Supplements and Antioxidants
• Mind/Body Therapies
• Macrobiotic Diets

While certain complementary/alternative therapies for cancer may appear to help some people, scientific evidence proving their effectiveness is often lacking. If you are already using or want to try complementary therapies, it is important to tell your doctor what you are doing. Some of these therapies may be harmful or may interfere with conventional treatments. There is often little information available about how herbal therapies and supplements interact with prescription drugs. In addition, many botanicals and herbals are poorly standardized, so it is not known exactly what is in them and in what amounts.

Always approach unconventional, alternative cancer therapies with caution. Keep in mind that just because a therapy is “natural” does not guarantee that it is harmless. Complementary therapies should complement, but never replace, traditional medical approaches to cancer treatment. For your own well-being, always inform your physician about any complementary therapies you are using.

AICR – American Institute for Cancer Research

The American Institute for Cancer Research is the nation’s third largest cancer charity and focuses exclusively on the link between diet and cancer. The Institute provides a wide range of consumer education programs that have helped millions of Americans learn to make dietary changes for lower cancer risk. AICR also supports innovative research in cancer prevention and treatment at universities, hospitals and research centers across the U.S. The Institute has provided over $50 million in funding for research in diet, nutrition and cancer. Visit the Institute online at www.aicr.org

American Institute for Cancer Research
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Washington, DC 20009
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