Making decisions about cancer treatment

By Jeanne SatherAbout two years ago, a British man was diagnosed with terminal pancreatic cancer and told he would probably only live for a year. The 62-year-old man went on a spending spree: he quit his job, spent his savings on vacations and eating out, and gave away most of his possessions.Then, a year later, he was told that the diagnosis was wrong.Now he is healthy, but broke. And he may sue the hospital that misdiagnosed him, according to Reuters.So, if your doctor says you have cancer, my first recommendation is to get a second opinion on the diagnosis, before you even consider making treatment decisions. Stories like this one are rare, but misdiagnoses do happen--those are human beings reading your slides, after all, and people make mistakes. Take some timeSome 1.4 million people in the United States will be diagnosed with cancer this year. If you are one of them, the first thing you should know is that you do not have to rush to make a decision.Unless your doctor tells you otherwise, you can take several weeks or even longer to consider your options and get a second opinion--even a third opinion--to help you choose the right treatment for you. Your health insurance should pay for second and third opinions.First, take a deep breath and spend time processing the fact that you have been diagnosed with cancer. Start to deal with the emotions that surround that diagnosis (fear, for example). Then, when you are ready, talk to your doctor or doctors about treatment options. My experienceWhen I was diagnosed with breast cancer almost 10 years ago, I got a second opinion, and then a third. I've always been glad I did. The doctors I consulted for my third opinion, at the University of Washington Medical Center, confirmed my diagnosis, but they also offered me a surgical procedure-- sentinel node biopsy--that was not available anywhere else in Seattle at the time.During this procedure, doctors removed three lymph nodes from my armpit for biopsy. Having this procedure along with a mastectomy spared me the lifelong complications of lymphedema, which can include swelling and risk of infection in the arm.The UW doctors also offered me a multidisciplinary team approach that worked marvelously well. All the specialists I needed--including a surgeon, radiation oncologist, and medical oncologist--participated in my initial consultation and then worked closely together throughout my treatment. Although this team approach is now common at major medical centers, it was new in 1998.In December 2001, my cancer metastasized to my bones, and I have been in almost continuous treatment since that time.Now, a team of handpicked doctors manages my care. The team includes a radiation oncologist at Swedish Hospital in Seattle, a medical oncologist (who sees me most often and manages my chemotherapy and other cancer drugs) at Northwest Hospital in Seattle, and the medical oncologist who treated me from the time of my first diagnosis, but who has relocated to Tucson, AZ.I see this doctor about twice a year, for what is essentially a second opinion. He is the one I trust most, because he's cared for me the longest.Another point to consider: You can put together your own medical team, and they don't all have to be at the same cancer center. You can have surgery at a major cancer center, and then return home for the follow-up treatment, which might be chemotherapy or radiation, or both. The follow-up treatment can be planned by the doctors at the major cancer center, who will be specialists in your type of cancer and up-to-date on the latest treatment options. How to make the right decisionIt is tough to make a decision about treatment when you are still reeling from the diagnosis, but here are some suggestions that I hope will help. Don't rush into a decision, and don't let others--doctors or family members--push you to make a decision. Take your time. Consider making an appointment at a major cancer center for a second opinion. You will probably be presented with several treatment options. Focus on choosing the right treatment for you. Consider the impact the treatment will have on your life. Radiation therapy usually means daily trips to the cancer center for a period of five or six weeks, for example. Ask someone you trust to go with you to doctors' appointments and tests to take notes, help keep track of your questions, and provide emotional support. Do research but be aware of information overload. Too much information can confuse and frighten you. You may need to stop researching on the Internet for awhile. Talk to other people who have or have had your kind of cancer--but remember, the treatment these people received may not be right for you. All cancers are not the same. Check your health insurance coverage, or have someone do it for you. Rally support. Friends and family will want to help, but you need to tell them what kind of help you need, whether it's doing research for you, or driving you to doctors' appointments. Jeanne Sather is an outspoken advocate for the cancer patient's point of view and writes at The Assertive Cancer Patient.  Read full story >