Patient Basics
What does it mean to be diagnosed with cancer?
Cancer is here. It's part of our world now. We desire to live longer, we will have cancers. The longer you live, the weaker your immune system gets, the more likely you will develop a cancer. It is not the end of the world. It is a nasty thing to deal with but it can be dealt with. It does not mean death. It does not mean no-hope. It does not mean it is impossible to treat. So, people should not walk into the office or walk out of an office thinking 'I'm dead'. That's not the case. What they should do is get ready for a fight. Get ready for, to reroute their energy and get ready to rise to the occasion and they should make sure that they are dealing with a surgical team or a medical team, whoever their providers are, that they have that mentality as well that 'wow, we are here to win, we're not here to lose'.
What questions should I ask my doctor first if I am diagnosed with cancer?
Once you find out you have cancer, when you're first diagnosed, the next question you always want an answer to is how far along is this cancer? Is this an early finding? Are we finding this late? So essentially, what stage is my cancer? And the next step would be, obviously, what other diagnostic tests should I be doing before starting any treatment? What other specialists do I need to see before starting treatment? The critical statement I try to tell all patients is, "Do all your research before you start treatment. "Many people, they run into treatment too early. They just want to do something. This is a time when you should step back and get all the information you could possibly get. Ask your physician, "Where can I read about my cancer?", "Where can I get objective information about my cancer?", "What patients can I speak to who have had my cancer, who have made different treatment options, and may I talk to them to see?", "Would they do it again?", and, "How did it go for them?" These are the kinds of things that I think you want to try to leave that office with, once you finally find out what the actual problem is. Once you get that diagnosis, try to ascertain these things first.
Who should I have on my cancer support team?
I think you should, Number 1 get your family as a Cancer Support Team, because they're going to ultimately be the support group that's going to be there the longest and be there at three in the morning when you really need them. From the medical side In regards to Cancer Support Team, most people usually need at least two out of the three different types of oncologists. And when I say three, I mean Surgical oncologist, which is what I am. Those are people who remove Cancers using surgery. There are Radiation oncologists, and these are people who treat Cancers with radiation. And then there are Medical oncologists, and these are people who treat Cancers using different types of chemo-therapy agents. Most people will have at least two; some people will need all three.
What's the best way to tell my loved ones about a cancer diagnosis?
In general, being open is a good approach. Of course, your family structure, your culture, your religious beliefs, that may not be the approach for everyone.I find that most patients feel fairly comfortable just bringing their family in because they are looking for support. That is ultimately where the structure of the support is going to invaribly lie, is with their family.If you have difficulty doing it yourself, most people are able at least to bring a family member along with them to the doctor's office. And in general, I think physicians are willing to break the news to their family for the patient if they are unable to do it themselves.
What does it mean to be proactive in my cancer care?
For some people, proactive just means I showed up to the doctor's office on time; I did my part. For other folks, it means they are going to search the Internet and research every procedure and every medication to the fullest. They are going to look into clinical trials. They are going to try to assist the physician in making the decisions that are going to ultimately affect their life and their outcome. I don't know which one is going to apply and work best for any one particular person. I do know that being proactive on whatever level you deem or feel you have the ability to be proactive is going to give you a sense of empowerment and a sense of being a part of the team that ultimately I think it's going to improve your outlook and your outcome overall.
What is a 'clinical trial'?
Clinical trials are the mechanism in which oncologists and researchers in cancer, or in other diseases, define a treatment and define whether or not a treatment is effective in the treatment of a disease. I think the most important aspect of clinical trials that patients must understand is the differentiation between Phase I, Phase II, and Phase III clinical trials. Let's start with Phase I. So Phase I clinical trial is really a dose finding study and what do I mean by that? Means that it's probably the first time, or one of the first times, where this drug or agent has been used in a human, in a person, and it's probably been investigated for years in the laboratory. It's probably been investigated for years in animals, but it's the first time to be used in humans, in human subjects with cancers. And the point, and I guess the real endpoint and goal of a Phase I trial, is to define the dose that would work best and cause the least side effects when it comes to treating a particular cancer. Phase II trials, which is the next one up, are, well it's been tested. It's been tested in humans. We know the dose to proceed with, but now lets take a bunch of people, lets take a group, take 20, 25 patients, 50 patients and give it to patients with particular diseases that we think this drug will work in and decide whether or not it works. And these are the trials that are pretty much the trials that most people get enrolled into in this country. Phase II trials are easy to enroll into. They don't have very strict eligibility criteria and are available in lots of institutions and research institutions and community practices all across this country. The most data and the most important research we can do are Phase III studies in which we take a new therapy that has such promise, worked very well on patients, worked very well in the laboratory, and very well in animal models and compare it against the current standard of therapy. And if we can compare it against the current standard of therapy and prove that it is better than the standard, then it now becomes the new standard. And that is the strongest type of evidence we have to proceed with therapies.
How do I find out about the latest research and newly approved drugs for my cancer?
I would say that the best way to find out about the newest and the greatest thing for your particular disease is to ask your physician. And you would hope and we all hope that all clinicians are staying up-to-date on the latest and the greatest in their particular field of medicine. It's a particularly difficult task for a generalist, a general hematologist oncologist, for example, that treats leukemias on one hand and prostate cancer on the other where you have many, many cancers you are treating and you don't have really the ability to keep up on every single aspect of every new drug. However, if you go to physicians that have a more specific I'd say expertise or an interest in particularly breast cancer or a specific other cancer then you can assume and I hope you can assume that those physicians are keeping up-to-date on the latest and greatest research, new drugs available for patients in this field.