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ASK THE DOCTOR: Cancer care - Make informed treatment decisions
By Dr. JIM MITTERANDO
The Patriot Ledger

Too often the word ‘‘cancer'' is falsely linked with death. Most cancers are not death sentences and can be treated. Here is some advice to help you make decisions regarding you or a loved one:

Knowledge is control

Learn as much as you can about cancer and its treatment. The more you know, the more you can control the situation. This knowledge can help you and your family members talk to your doctors about what to expect and which treatment is right. Try these resources:

Do not rush

One of the first things to know about cancer is that, most of the time, it is NOT an emergency. Many people panic when they first find out and rush to make a decision to start treatment as soon as possible. Almost everyone with a new diagnosis has time to look for information and make careful, thoughtful decisions.

Awaiting tests

Waiting for test results is the hardest part. After the initial diagnosis, further testing is needed to give doctors a more accurate prognosis (outlook) from which to proceed.

The pathology report will microscopically examine a biopsy to not only diagnose the type of cancer but also determine the aggressiveness of the cancer. X-rays, CT-scans, MRIs or bone scans determine if the cancer has spread (metastasize). Oncologists or surgeons need this information to discuss prognosis and treatment options with you.

The health care team

Most people have a team of doctors and nurses that will include your primary care doctor and an oncologist. The oncologist is a cancer specialist who often quarterbacks the care while you are undergoing treatment. Oncologists provide statistics on the chance of cure or remission, lifespan and help you to weigh the risks and benefits of various treatments such as surgery, chemotherapy, hormone therapy and radiation treatments. Often a surgeon and a radiation oncologist are also involved and can provide different viewpoints on treatment.

Your primary care doctor can arrange consultation with an oncologist and help expedite appointments and tests. People often believe they should go to a cancer center such as Dana Farber, Sloan Kettering or Mayo Clinic to get the best care. In fact, most oncologists in your community are part of broad treatment network involving multiple centers. They provide excellent care, locally. For more rare or unusual cancers you may be referred to a specialty clinic. Oncologists can also put you in touch with clinical trials, if appropriate.

To get the most out of your doctor's visits:

  • Ask as many questions as you need to
  • Write down your questions in case you forget them
  • Don't worry if your questions seem silly or don't make sense
  • Take someone along to provide emotional support, ask questions and help to remember what is said
  • Take notes
  • Find out the success rate and risks of each treatment option
  • Do your homework

Additional support

Being diagnosed with cancer and going through treatment is difficult and you often will feel overwhelmed, frightened and alone. Even with the support of family members and friends, many people need additional help. Support groups are designed to offer an atmosphere where you can talk about your feelings and share information with other people who are going through a similar experience. Support groups are also available for the family members of people who have cancer. Your doctor, a hospital or the local chapter of the American Cancer Society can provide you with a list of support groups.

Stay organized

Lastly, it is important to organize your health information, tests and insurance information to ensure your best care and to avoid misunderstandings or billing problems.

Consider using a three-ring binder or file folders. Contact your insurance company to make sure treatments are covered. Make sure insurance referrals are made in advance of appointments to avoid future payment problems or bills.

Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright 2004 The Patriot Ledger
Transmitted Tuesday, March 16, 2004