Suddenly faced with a cancer diagnosis, patients may find themselves confused and overwhelmed by treatment decisions. With careful consideration and answers to the right questions, though, patients can tackle treatment with confidence, says Robert Figlin, M.D., the Arthur and Rosalie Kaplan Professor of Medical Oncology and acting director of City of Hope Comprehensive Cancer Center.

A leading oncologist specializing in kidney cancer and chair of City of Hope’s Division of Medical Oncology & Therapeutics Research, Figlin understands that patients want the best treatment — quickly. He recently spoke with eHope about helpful tips for these new patients.

EHope: Once a doctor diagnoses cancer and suggests treatment, what should a patient ask?

Robert Figlin, M.D.: The first questions I’d ask are what type of cancer is it and what is its stage. Is the treatment recommended specific for the type and stage of cancer that I have? That’s true whether you’re talking to a surgeon about a surgical procedure, a radiation oncologist about radiation therapy or a hematologist/medical oncologist who’s giving recommendations about systemic therapy.

EHope: What if the doctor recommends more than one type of treatment? Should patients try to get opinions from the physicians who will provide those treatments?

R.F.: Cancer is mostly a multidisciplinary disease: Any single health-care provider may not be the only member of a patient’s cancer health-care team. It’s appropriate to ask your doctor if there is another member of the team whom you should visit with, such as a radiation oncologist, in anticipation of treatment.

Members of your team may suggest that you first need surgery, then you may need to receive local radiation, and then you should consider systemic therapy to prevent recurrence, for example. Keep in mind that this multidisciplinary approach is very different from a second opinion, where the health-care provider is trying to answer the question for each of the approaches recommended.

EHope: How so?

R.F.: A second opinion is specific to the type of recommended treatment. For example, if a surgeon recommends a certain procedure, but there are other procedures that could also be options, you might want to ask if you should seek out a second opinion to make sure the procedure your doctor is recommending is the same one that other doctors might recommend.

A good illustration is prostate cancer. Many places perform standard radical prostatectomies, while at City of Hope, we are experts in a new procedure, robotic prostatectomy. If you went to another institution and were recommended to have a standard radical prostatectomy, you could also talk to a City of Hope physician to find out the role of a robotic prostatectomy.

Seeking out a second opinion means you understand the questions you want asked and answered before you identify the doctor to ask and answer them for you.

EHope: Who should provide these second opinions?

R.F.: Generally, with a new diagnosis, if cancer is localized — confined to an organ — the surgeon is the first person making recommendations. The person you’d seek a second opinion from would be a surgeon, as well.

There is one thing that people should recognize: There are professionals who specialize in oncology within various fields. Surgical oncologists are people who have done their general surgical training and then became specialists in cancer and surgical procedures. That’s true whether it’s a breast surgeon, thoracic surgeon or urologic surgeon. All of them offer specialists in cancer care.
 
Generally, when you seek out a second opinion, you want to talk to someone who’s experience either matches or exceeds the recommendations from your primary care physician. So, if your first opinion was with a general surgeon, your second opinion should be with a surgical oncologist, for example. And if the first was with a thoracic surgeon, the second opinion should be with a thoracic oncologist. It holds true not only for surgery, but also for radiation and medical oncology.

EHope: Should patients start treatment right away or delay it to get these second opinions?

R.F.: Although cancer has a very scary name, and decisions should be made in a timely fashion, one doesn’t have to rush to make a decision: it is better to take the time to make the right decision than to rush to make a decision.

What that means is that often there’s sufficient time to seek and obtain a second opinion to make sure you’re following the proper path of treatment. Oftentimes, people are getting very good advice from their physicians and they don’t feel the need to seek out a second opinion, and that is appropriate.

EHope: How do patients approach their own doctor about a second opinion and find physicians to provide one?

R.F.: Most physicians who are cancer experts acknowledge that part of the process of caring for cancer patients is the role of a second opinion. What a patient must be careful about is obtaining too many second opinions that delay therapy and cloud their ability to make good decisions for themselves. What you need is a second opinion to satisfy your conscience, and your family, that you’ve thought about your treatment options and can make an informed decision.

The best way to get information about physicians who might offer second opinions that are substantially different than what you would get from physicians in the community is to go to the Web and identify a National Cancer Institute-designated Comprehensive Cancer Center. Identify the people at that institution who are experts in the disease you are struggling with, and seek an opinion from someone whom other people consider to be a leader in that area.

Another thing to remember is to make sure the physician you’re seeing is board-certified in the area you’re consulting him or her about.

EHope: Are there any helpful tips you would give to someone seeking out other opinions?

R.F.: One other thing I always recommend is to include family members in consultations with physicians. It’s important that many people hear the discussion and that you have support in making those decisions. Also, it ensures that you’ve heard answers to the questions that you’ve asked.

Also, it’s always best to go into the second opinion with a series of questions you want to make sure are answered to satisfy your desire to pick a treatment choice. Most of the time, the physician will answer those questions long before you ask. But when that doesn’t happen, in the intensity of the moment, make sure you have those questions ready.

EHope: What do patients need to take with them?

R.F.:  Physicians need to review your medical records to be able to provide an expert opinion. That includes the pathology report, the recommendations of prior physicians, the radiologic review and all pertinent pathology and laboratory tests performed.

EHope: Should people turn to the Internet to learn more?

R.F.: Information technology has both been a help and hindrance to cancer care. The most important thing is that when you go to the Web, you ask questions that specifically relate to you. Learn about the kind of cancer you have, the stage you have and the treatments that have been recommended for you — not information that doesn’t apply to you.  Actually, part of the benefit of expert doctors is that they take everything that’s out there and customize all of that information to your case.

EHope: What if clinical trials are an option?

R.F.:  Oftentimes treatment options that are best for patients include participation in clinical research trials that ask important questions comparing existing therapy to novel therapy. Any discussion with a physician should always include asking whether any clinical trials are available to you, and how to learn more about them.

That’s true whether it’s surgical, medical or radiation treatment. And it’s true regardless of the stage of the cancer.

At the end of the day, clinical trials are about improving care, improving results and offering future generations better care than we have today.