PERSONALIZING THE APPROACH TO CANCER TREATMENT

How You Are Your Own Best Champion

All cancer diagnoses are daunting, but every patient is unique. While cancer drugs and treatment regimens are generally prescribed based upon large swaths of the patient population, the key issue in oncology today is determining how to personalize or individualize treatment. After hearing the words “you’ve got cancer,” most patients are given a drug or combination of agents according to guidelines or standards of care. These treatments, in the oncologist’s best judgment, are considered most likely to work based on the results of clinical studies in patients with similar tumor types.

However, cancer patients often require several courses of drugs and regimens before doctors can identify the optimal therapy. In the meantime, precious time is lost; patients may suffer unpleasant side effects while tumors may continue to grow and mutate. Eventually tumors can become resistant to therapies, further reducing the future effectiveness of other anti-cancer agents. Current cancer drugs are also increasingly expensive; when patients undergo several essentially ineffective courses of therapy, costs mount unnecessarily.

Given the toxicity and side effects of certain treatments, and that only a fraction of patients may benefit from these drugs, an informed patient is his or her own best champion. In the performing arts, the saying goes that the best actors are the best listeners. In medicine, too, listening is one of the most important skills a physician can develop. Working with patients over the years—hearing them air their questions, concerns, and fears—has enabled me to identify five important steps any recently diagnosed cancer patient should take:

Step 1: Establish an Advocate

A patient advocate, who acts as a witness and recorder of events, helps the patient to recall information whenever necessary, and to identify areas where more information or clarification is needed.

Step 2: Keep Good Records

Many patients feel overwhelmed upon first hearing their diagnosis. Maintain thorough notes and records from your first diagnosis forward. It is difficult to remember everything one hears in a doctor’s office, much less to process and understand it all.

Step 3: Ask Questions

Patients should ask questions in terms of their specific diagnosis or situation and ask about alternate options. Questions should be written down ahead of time, as they might be forgotten upon meeting with the physician. In fact, patients should keep a running list of any questions they might have. Patients should prioritize this list starting with the most important questions to ask in case time with the physician is limited. Patients should also ask to consult with other physicians and gather as many opinions as they feel necessary. Some basic questions you will want your doctors to answer include:

* What are the cell type, grade, and stage of my cancer? What does that mean in my case?

* What treatment options are there? What do you recommend for me? Why?

* What is the goal of this treatment?

* Based on my cancer as you see it, what are my chances of survival? How long would you expect me to survive?

* What are the risks or side effects that I should expect? What can be done to mitigate these?

* What are the chances my cancer will return with the treatment we have discussed and what would be the next step?

* What should I do to ready myself for treatment? Should I follow a special diet? A special exercise regimen?

* How much will this treatment cost me out of pocket?

* Are there clinical trials available for my cancer?

* What cutting edge therapies are available?

* What complementary and alternative treatments would be potentially beneficial for me?

Step 4: Stay Informed and Empowered

Newly diagnosed cancer patients must remember that they are the decision maker, not the physician. There are things a doctor may not know. For example, the information required may not be readily available to him or may not fall within the treating physician’s specialty or field of expertise. There are many treatment options to evaluate, and advances in multiple disciplines that patients and physicians will want to consider.