How to make an informed cancer treatment decision

If you or someone you care about has been diagnosed with cancer, there are several decisions you need to make about what treatment plan to follow and what physician and hospital you’d prefer to provide your care. To help you understand what information you need to make these important decisions, we talked with Robert G. Mennel, MD, FACP, FASCO. Dr. Mennel specializes in medical oncology at Baylor University Medical Center. Trained at the Johns Hopkins School of Medicine, he is also a professor at the Texas A & M Health Sciences Center and Medical Director of the Baylor Precision Medicine Institute. His clinical interests focus mainly on sarcoma, breast cancer, gastrointestinal cancers, and the carcinoma of unknown primary.

Q: What are the first steps that someone should take after being diagnosed with cancer?

Robert G. Mennel, MD (RM): First, you should have an in-depth discussion with the oncologist who will be caring for you. The answers you receive from that discussion will help you decide if you’re comfortable with that physician’s experience and how he or she interacts with you. The questions you should ask during that initial discussion should include finding out what stage the cancer is, because the staging determines what the proper treatment options are.

Q: Can a second opinion provide useful information?

RM: Ask your doctor who’s reading the pathology that your diagnosis is based on, if the doctor knows what the pathologist’s qualifications and experience are, and how sure the pathologist is of the diagnosis. A second opinion on pathology can be very valuable if your diagnosis isn’t definitive or if you don’t feel confident in the answers you’re getting from your physician. A second opinion about the suggested therapy is always warranted if you are uncomfortable with your oncologist or the therapies suggested to you.

Q: What information do you need to make an informed decision about which treatment option to follow?

RM: A lot goes into an informed decision. One question many people don’t ask but should is what is the likelihood of being cured of this cancer? Ask the physician what the natural history of the group of patients with this disease and stage is. You should also ask how long treatment will take, how aggressive it is, what side effects you may experience, and how they may impact your quality of life. Taking all that information into account, what you want to think about is how you want to balance quality and quantity of life. Your decision about what treatment option you choose will also likely be affected by your age and how healthy you are. For example, a younger person may be willing to undergo aggressive treatment and its side effects to add five years to his or her life. But someone who’s 85 and is in poor health may not want to undergo the same treatment.

Q: What experience and characteristics should you look for in the oncologist and medical center that will provide your treatment?

RM: In general, if the hospital has a good reputation for its cancer care and treats a large number of patients, those are good signs. In terms of the physician, the most important factor is board certification. He or she should be board certified in Oncology or Hematology and a member of the American Society of Clinical Oncology or the American Society of Hematology. You can also look for red flags about the quality of care provided, for example, whether there have been any disciplinary actions or malpractice suits. How comfortable you are with the physician is also important. Is this a caring, compassionate person and does he or she give you the time necessary to answer your questions?

Q: Are there any resources that can be helpful when making treatment decisions?

RM: The National Comprehensive Cancer Network (NCCN) has some very good resources on the patient portion of its website. They have guidelines for patients based on type of cancer, as well as information to help you understand your diagnosis, what treatment is like, and topics like personalized medicine, targeted therapies and biomarker testing.

You can also find evidence-based information to help you make cancer treatment decisions by talking with a health advisor. In addition, an advisor can connect you with experienced oncologists who have expertise treating the type of cancer you face.