10 things to discuss in your first meeting with your Oncologist- Dr Rahul Kulkarni

Dr.Rahul Kulkani-Oncologist | OncoWin Cancer Clinic

When someone is suspected or diagnosed with Cancer, there are lot of questions which arise in the mind of patient as well as the relatives. Also there is lot of anxiety and patients are desperate to start treatment at the earliest. However many a times patients and relatives start the treatment without getting clear understanding or information about the cancer, its stage and complete overview of cancer treatment plan.

This may lead to lot of misunderstandings later or may also compromise further treatment plan as well. Hence it is most important that you get all the realistic information about your disease right at the start of treatment. Here are some important points which you should know and discuss with your oncologist and get things clarified before you start your treatment:

 

 

The first thing you need to understand is what is the exact diagnosis: is the cancer confirmed beyond doubt or we need to do anything else to confirm it? Generally diagnosis of cancer is confirmed after a proper biopsy which confirms the diagnosis of cancer.

 

After the diagnosis is confirmed, you should know what type of cancer is it and what is the organ of origin- There are more than 100 types and many more subtypes of cancer  and treatment of each and every cancer and its subtype is different. This is very important because many patients and their relatives don’t know the exact type of cancer which they are suffering from and then they compare their outcomes with other patients which may be having completely different  type of cancer and then they get confused and deviated from their treatment.

 

Except blood cancers, treatment of all other cancers is based on stage of cancer. Your oncologist will be advising you some scans which may include CT scans/MRI or sometimes PETCT scan which will help to know at what places the cancer has spread. This will help to stage the cancer from Stage 1 (earliest) to stage 4 (most advanced).

 

 

Cancers diagnosed in Stage 1 to stage 3 can be treated with Curative intent. However the modality of treatment used to maximize the chances of cure may differ from patient to patient and as per the type of cancer. Generally stage 4 cancers cannot  be completely cured and will be treated with palliative intent i.e to control the disease and reduce the symptoms. But with advances of cancer treatment, now even some stage 4 cancers which are spread to limited sites can be cured with incorporation of multimodality treatment like chemotherapy/targeted therapy, radiation and surgery. However this is possible in selected cases and this requires treatment planning in multidisciplinary tumour board right at the beginning of treatment. On the other hand, hematological cancers like lymphomas can be cured even in stage 4 with chemotherapy and targeted therapies. So it is very important for you to know the intent of treatment before starting the treatment- Curative /potentially curative/palliative.

 

It is a common observation that many patients are not aware of further treatment plan or sequence of treatment which is required for best outcomes of their disease. This may lead to dropout or compromise in their treatment and ultimately benefit achieved by earlier modality of treatment is nullified.

 

For eg: Stage 3 breast cancer generally is best treated with chemotherapy followed by surgery followed by radiation. However all modalities of treatment are equally important and cannot be omitted. On the other hand, stage 1 breast cancer requires surgery first followed by further treatment as per indications and pathology report. Similarly Stage 3 advanced Esophageal Cancer may require initial Chemotherapy + radiation followed by surgery or if surgery is not possible then only high dose radiation and chemotherapy. So get your entire treatment plan clear right at the beginning so that you get a clear idea about the type of treatment and duration of treatment.

 

 

Have an open discussion with your oncologist regarding the likely complications and risks involved in surgery or chemotherapy or radiation. However probability of these complications may be very less and this information should not lead to unnecessary fear and avoidance of treatment. Generally if the intent of treatment is curative, the chances of benefit and long term cure outweighs the chances of complications. Also you should understand that cancer is a deadly disease and if we don’t treat it appropriately due to fear of complications, it will eventually spread and will be life threatening. However if the patient or family is not willing to accept the risks for the best treatment suggested  by all means, then please discuss with your oncologist regarding alternate second best treatment options.

 

 

Due to recent advances in cancer treatment, there may be multiple treatment options in all fields of Medical Oncology, Surgical Oncology and radiation Oncology. It may happen that certain plan of treatment may not be possible in your patient due to patient’s general condition/comorbidities or due to financial constraints. In that case alternative chemotherapy drugs or schedules, surgical and radiation techniques may help you to customize treatment according to your needs and still retaining the best possible outcomes.

 

 

It is extremely important to have a rough idea of approximate cost of entire treatment plan right at the start of treatment. This may include approximate expenses of different modalities like surgery, chemotherapy and radiation and also likely complications. This will help you to organize your finances accordingly and you will not be financially burdened all of a sudden. If you have any financial constraints or issues then please discuss suitable alternatives which can reduce the treatment cost as per individual priorty without compromising much on treatment outcomes. Some newer treatment options are ideal as per recent guidelines but not always must and treatment can be tailored to suit patients capabilities. The most important thing in cancer treatment is that you complete the entire multimodality cancer treatment as planned. Leaving the treatment half way due to financial issues will ultimately nullify the benefit of previous treatment and will be indirectly a waste of your money. Your oncologist  can be your best guide in helping you to tailor the best possible plan as per your budget.

 

 

With the advent of technology and internet, accessing information has become very easy. However interpretation of that information and application of those treatments in right indication and right patient requires years of rigorous training and experience and that can be best done by a trained oncologist. Many patients or relatives already read about the cancer and treatment options on the internet before meeting the oncologist. Also it may happen that you already have taken opinion from another cancer specialist and you are meeting for a second opinion. In some cases the opinions may vary as per individual treatment approaches and institutional practices. In that case you can openly discuss regarding the rational for one particular approach and its pros and cons over the other. Your oncologist can help you to understand the treatment recommendations and National and International Cancer treatment guidelines based on which the treatment plan is recommended.Do not take treatment decisions solely on emotional grounds and try to understand the scientific evidence and rationale behind it.Also understand that the cancer treatment planning needs multimodality approach and involves specialist from all fields i.e Medical Oncologist ( For deciding chemotherapy/targeted therapy and planning of treatment), Surgical Oncologist ( for planning of Cancer Surgery) and radiation oncologist ( for planning of radiation therapy).

 

 

This is a very common situation wherein many a times relatives don’t want to disclose the diagnosis of cancer to the patient. However as a part of ethics, we need to take patients consent before starting any cancer treatment. Hence it is recommended that patient should be given a fair idea of the disease and nature of treatment which he is likely to undergo. At the same time it is important to boost the morale of the patient as the diagnosis of cancer can develop a lot of stress. Oncologists are trained in dealing with such situations and can help the patient understand things in a step by step fashion.

 

This discussion generally takes place when cancer is diagnosed at advanced stages. Though now with newer treatment options, chemotherapies, targeted therapies and immunotherapy, many cancer patients can live a good quality of life for many years, it is important to have a realistic information about the prognosis and likely course of disease. This can help the family to take important decisions, prioritize their important family events and emotional adjustments. Ultimately the entire objective of cancer treatment in advanced stages focuses on maintaining the quality of life and helping patient to spend maximum quality time with their near and dear ones and to help them fulfill their life goals.

 

After you have a clear idea about all these important points,begin your cancer treatment with lot of positivity and trust on your oncologist.Remember that cancer is like a battle and you are not alone.Your oncologist will always be there with you in this fight to help you conquer it!! 

 

Together We CAN WIN !!!