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1994-05-14
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13 STEPS TO WORLD CLASS CANCER CARE
(C) National Kidney Cancer Association. 1994.
Eugene P. Schonfeld, Ph.D.
President and Chief Executive Officer
National Kidney Cancer Association
1234 Sherman Avenue
Evanston, Illinois 60202
708-332-1051
Your doctor says you have cancer. Your mind whirls with emotion. Your spouse
starts crying. You are in the middle of a health crisis. Now, more than ever,
you need to think clearly despite strong emotions.
I know the feeling. Five years ago, I was diagnosed with cancer.
Over 1.1 millions Americans will be diagnosed with cancer this year. Over half
of them will survive more than five years. Here's how you can get world class
cancer care and increase your odds of surviving:
1. Do not rush into surgery or treatment without getting some basic facts
about your specific type of cancer. Your doctor and your emotions may be
telling you to act quickly. But your tumor has been part of you for months,
perhaps even years. Not all types of cancer are fast growing. Take your time
to get a few basic facts so you can make informed decisions. Time is
important, but it is more important to get great care than to save a few days
or a week.
2. Start information gathering by calling 1-800-4-CANCER. The Federal
government operates the Cancer Information Service. You can call and get
information on any type of cancer. There are over 200 types of cancer. Each
type of cancer is treated differently. Ask for the "state-of-the-art
statement" for your type of cancer. There are two types of statements, one for
patients and one for physicians. Ask for both. The physician statement
contains more details and technical information. The statements will be mailed
to you. Ask the Cancer Information Service for phone numbers of cancer patient
organizations for your type of cancer.
3. Find out if there is a patient or research organization which specializes
in your type of cancer. Y-Me serves breast cancer patients (800-221-2141).
US Too serves prostate cancer patients (708-985-5255). The American Brain
Tumor Association (800-886-2282) and the National Kidney Cancer Association
(708-332-1051) serve patients with these types of cancer.
These organizations have information which can be helpful to you. For example,
the National Kidney Cancer Association publishes a 56-page booklet which is
free to kidney cancer patients.
Visit a medical school library. Read medical journals if you have a technical
background. Or get your local public library to do a computerized literature
search for information on your disease. Many libraries will search for you
free of charge. You can get abstracts of articles. You can see which doctors
are doing the most research and have them treat you.
4. Get a second opinion from a doctor who specializes in your type of cancer.
Your doctor may be an excellent physician. But some types of cancer are very
rare so your doctor may not see enough cases to be good at treating your
disease. In medicine, practice makes perfect.
You can find an expert doctor by asking the Cancer Information Service or
cancer patient organizations for the names and phone numbers of experts in your
area. Call one or two expert doctors and make appointments to see them.
Sometimes, these "super doctors" are very busy and you may need a referral from
a cancer patient organization. Ask for this help.
5. When you get a second opinion, bring your CAT scans, X rays and other
medical records with you. You don't want to waste time repeating tests. If
your doctor or hospital refuses to give you X-rays or records, call your
lawyer. These records belong to you, not to the doctor or hospital. But do
not be surprised if the doctor asks you to sign a receipt for your X rays or
charges you for copying documents. A receipt is simply a written record that
you were given the materials you requested.
Do not worry about offending your doctor if you get a second opinion. Your
doctor gives second opinions himself. Really competent doctors are not worried
about losing patients to other physicians. In fact, they will often recommend
patients to specialists. In any case, your doctor works for you. He is your
consultant and advisor, and you pay his bill. Remember, you are his boss.
6. Get the most qualified physician to treat you. Do not confuse "bed side
manner" with true expertise. You want to be cured, not charmed.
You are more likely to find a physician expert at a comprehensive cancer center
associated with a university medical center, particularly for a rare type of
cancer. However, there are many excellent physicians in community hospitals.
Do not hesitate to be treated by them if they have experience with your type of
disease. Simply ask your doctor how many patients with your type of cancer he
has treated in the past 12 months. If the answer is less than 12 or 15, find
another doctor who has more experience.
Some medical centers are famous. However, when it comes to rare cancers, a
less well known cancer center may offer more advanced care and have more
doctors who are experts in your type of cancer. For example, the Cleveland
Clinic in Cleveland, Ohio is a "power house" in kidney cancer.
7. If surgery is done to remove any tumor, ask your doctor what will happen to
your tumor. Your tumor is extremely valuable. It contains information about
your disease. You want your tumor to be analyzed to get its secrets.
Your tumor can be tested to determine if it is resistant to certain drugs. If
you need chemotherapy, you will want to avoid these ineffective drugs. Your
tumor can be turned into a vaccine to treat a recurrence of your cancer. The
lymphocytes (white blood cells) in your tumor can be grown in a laboratory and
put back into your body to fight any cancer left behind after surgery. For
some cancers, genetic testing is possible. Your tumor can be frozen and saved
for future testing or use in gene therapies. You must talk with your doctor
before surgery and arrangements must be made if you are to get the benefits of
these scientific advances.
8. If you are treated surgically, do not believe your doctor if he says "I got
it all." What he really means is that he removed all the tumor which he could
see. If didn't see it, he didn't remove it.
Some tumors have many blood vessels. Tiny bits of tumor or even a few cancer
cells can drift off in the blood stream and settle elsewhere in your body.
Years after your primary tumor is removed, these cells can form new tumors and
kill you.
You will need regular check ups such as CAT scans, bone scans, and blood tests.
If a new tumor starts up, you want to catch it early and treat it promptly.
Never let your guard down. Make sure you get follow up care.
9. Join a cancer patient organization which specializes in your type of
cancer. Many organizations provide emotional support for cancer patients. But
don't settle for emotional support. You want to beat cancer, not just feel
good emotionally. If you read popular books on cancer such as Bernie Siegel's
books, remember the real message about emotional support: "Good mental health
is necessary for good physical health." But do not expect tumors to just
disappear because you have engaged in "imaging" or some mind technique.
The best organizations have ongoing information programs for patients. For
example, the National Kidney Cancer Association publishes a quarterly
newsletter and holds an annual convention for patients and physicians. It also
operates a free computer BBS (708-332-1052) with information for patients.
Science is making tremendous progress in many types of cancer. Stay informed.
Get involved. Meet other informed patients. Meet the doctors and scientists
who are true experts in your type of cancer. If you have a recurrence, you
will know what your treatment options are and who can give you the best care.
Be an activist, support the patient organization so it can support you. Act in
your own self-interest.
10. Interact with doctors in a professional manner. Before you go to see your
doctor, send him a letter or FAX telling him about any changes in your medical
condition since your last visit. Include new symptoms such as pains, bleeding,
any new illnesses such as colds, and any crises in your life such as getting
fired. Then, include your questions.
You will be prepared to meet your doctor. Your doctor will be prepared to
answer your questions. This business-like approach will make your doctor
respect you. It will also set the tone for your patient-doctor relationship.
Your doctor will also like you because you won't waste his time. You will get
better care than other patients who are less professional.
If your doctor will not answer your questions, fire him and get another doctor.
You are entitled to clear communications.
11. Appeal any insurance claim that is rejected. Your ability to get state-
of-the-art care can be influenced by your insurance coverage. If a claim is
rejected, resubmit it. Another claims reviewer at your insurance company may
evaluate your claim differently and authorize payment.
Every insurance company has a claims appeal process. If a claim is rejected,
appeal it. If it is still rejected, contact your state insurance commission
and patient organization for assistance. Sometimes, a call to an insurance
company medical director from a patient organization can get you payment of a
claim. You can sue your insurance company as a last resort, but you must have
a legitimate case.
Be reasonable. Do not expect your insurance company to pay duplicate claims,
fraudulent claims, claims which are not covered by your policy, or claims for
"snake oil" treatments. As a policyholder, your insurance company pays claims
with your money. You want your insurance company to have a fair review process
but not a stupid one.
12. Don't take vitamins or other medications without talking to your doctor.
Many patients want to help themselves. However, large doses of some vitamins
can interfere with some chemotherapy drugs or radiation therapy. Do not
medicate yourself unless you are a physician.
Do not throw away money on treatments which have no medical justification.
Some alternative therapies are based on sound theories. However, without
scientific knowledge and investigating details, you will not be able to tell
which ones have some validity and which are exploiting vulnerable patients.
If your cancer does not respond to the first treatments you try, move on to the
next one. There are many valid therapies for every type of cancer. New ones
are being developed constantly.
13. Continually seek information. If a doctor tells you a tumor is
inoperable, get a second opinion. Call the Cancer Information Service to get a
list of clinical trials for your type of cancer. When you get the list, review
it with your doctor. Ask why his proposed trial is best for you. Talk with
other patients who have had any proposed therapy so you know what to expect.
If there are side effects, remember not all patients get every side effect.
Ask your doctor what he can do to control side effects.
When you get cancer, you are a big time health care consumer. It pays to be a
smart shopper. Here's a true story to prove it.
Herm Singer was diagnosed with kidney cancer. His tumor and kidney were
removed surgically. One year later, his tumor came back where the old kidney
was. He was treated again with surgery and with four different drugs. Nothing
worked. Finally, at a meeting of the National Kidney Cancer Association, he
heard an expert doctor talk about surgery as a treatment for advanced disease.
He went to see this doctor who operated on him for twelve hours. He has been
cancer free for over two years.
What if he hadn't gone to the meeting? What if he gave up after his first
failure? What if he didn't get new information and expert care? Your ability
to think clearly is your best weapon against cancer.