How To Talk With Your Doctor About Cancer

How Can You Partner With Your Doctor?

Author: Dr. Stephen Chaney

CancerFew things in life are more devastating than a cancer diagnosis. One day life is going on smoothly. The next day everything is in doubt. And before you know it, you are listening to your cancer doctor recommend a frightening treatment protocol.

Because of my 40-year career in cancer drug development at the University of North Carolina, people who are newly diagnosed with cancer often contact me for advice.

Let me start by making it clear that I am not a medical doctor, much less an oncologist or radiologist. Thus, I am not qualified to give medical advice on cancer treatment.

However, I worked with many oncologists and radiologists during my career at UNC, so I can offer perspectives about the advice your doctor is giving you and counsel you on what questions to ask your doctor(s).

I love helping people. But rather than have all of you calling me, I thought it would be best to put my advice in writing and send it to all my “Health Tips From the Professor” subscribers.

Is Your Doctor Being Honest With You?

doctor advising patientThe complaint I hear most often is, “I don’t feel my doctor is being honest with me. I feel that he or she is overselling the benefits of cancer treatment, whether it is chemotherapy, radiation, surgery, or some combination of them.”

There is some truth to that perspective, but you need to understand why that is. There are four reasons, and I will save the two most important reasons for last.

  1. People go into medicine to cure disease. Doctors are action oriented. They will recommend the best treatment available, even if its success rate is low because they feel the alternative is unthinkable. The idea of letting cancer run its course is abhorrent to them.

2) Cancer doctors focus on the cures, not the failures. In my time at UNC a couple of oncology residents rotated through my lab to gain some research experience. I was amazed that they were able to remain so positive when they had many patients who were dying. Then it hit me. They comforted the patients they weren’t able to help and took their joy from the cures they were able to obtain.

3) The worst thing a doctor can do is to take away a patient’s hope. Our minds are powerful. If a patient is to have any chance of defeating cancer, they first must believe it is possible.

4) Cancer is a fearsome opponent. There are spontaneous remissions. There are miraculous cures. But left untreated, the cancer usually wins. And that is your doctor’s greatest fear.

How To Talk With Your Doctor About Cancer

QuestionsSo, how do you find out the truth about your doctor’s treatment recommendations. You could Google it, but Dr. Google’s medical advice is often unreliable.

There is a simpler way. Your doctor(s) will be honest with you if you ask them the right questions and assure them you can deal with the answers they give. That last point is key. You should only ask these questions if you can accept whatever the answer may be.

If bad news would devastate you, you shouldn’t ask these questions. And your doctor may not feel he or she could be honest with you.

Before I give you the questions, let me share some definitions you need to know. These definitions give you a more precise definition of success of the cancer treatment your doctor is suggesting. Any treatment your doctor recommends will be supported by multiple clinical trials that provide data for each of these definitions.

Partial Remission is a decrease in the signs and symptoms of cancer. Your tumor has shrunk, but it is still detectable.

Complete Remission is a disappearance of all signs and symptoms of cancer. However, some cancer cells may remain.

Duration of Remission is the average time between the end of treatment and the return (recurrence) of the cancer.

Cure is usually defined as a complete remission that lasts 5 years or more.

With these definitions in mind, here are the questions to ask (only if you want to know the answers).

  1. What percentage of patients undergoing this treatment achieve remission? Is the remission partial or complete? How long does the remission last on the average? If the cancer does recur, can it be treated successfully a second time?

[Even if remission is relatively brief, it may give a chance to put your affairs in order and check a few items off your bucket list. This knowledge is important for many cancer patients.]

2) What percent of patients are cured?

[Every patient receives this information differently. But at least you, rather than your doctor, are making the choice of whether likelihood of being cured is worth the downsides of the treatment.]

3) What are the side effects of the treatment? How much does the treatment cost?

4) What is the prognosis if you do nothing? How long will you live? What will your quality of life be like?

[Sometimes the quality of life if you do nothing is better than the quality of life during treatment because of treatment side effects. This can be an important factor for treatments that have a short duration of remission and/or a very low cure rate.]

As you can appreciate, the answers to these questions can lead to some heart wrenching decisions. That’s why I caution you to only ask these questions if you can handle the answers.

Finally, it is important to remember that the answers your doctor gives you represent the average response of thousands of patients. None of us are average. Your response to treatment and your response to doing nothing depend on your age, overall health, lifestyle factors, genetics, and factors that none of us understand. That makes your decision even more difficult.

How Can You Partner With Your Doctor?

Doctor With PatientThe second most common complaint I hear from patients going through this process is that their doctor isn’t listening to them. They would like to explore treatments with fewer side effects or alternative therapies with no side effects. But their doctor refuses to even consider those possibilities. He or she will say there is no proof those treatments work. It’s their way or the highway.

If you search the internet, many alternative health gurus will tell you this is because:

  • Big Pharma has doctors in its pocket. It spends a lot of money convincing doctors their drugs are the best treatment available.
  • The medical profession is prejudiced against supplementation and alternative therapies.
  • The AMA controls what treatments doctors can and cannot recommend. It can yank the medical license from doctors who dare recommend anything except the AMA-approved treatment.

There is some truth to each of these statements. But there are two other factors that are overlooked by most of these “health gurus”:

  • The proof is much greater for conventional treatment than for alternative therapies. Conventional treatments are supported by multiple clinical studies involving thousands of patients.

This is the standard of proof for conventional treatments. But this kind of proof can cost millions of dollars. Pharmaceutical companies can undertake these kinds of studies because they can recover that cost with a successful cancer drug. But there is no financial incentive to provide that level of proof for alternative therapies.

  • As I said before, cancer is a deadly foe. More importantly, left untreated it can rapidly progress from a highly treatable stage to a stage where any treatment is unlikely to be successful.

This is the greatest fear of your cancer doctor. If you tell them you want to explore an alternative therapy, they are worried that they won’t see you again until your cancer has become untreatable.

With that in mind, let me suggest how you might partner with your doctor.

  • Start by stating that you would like to try an alternative therapy or a less aggressive medical treatment before you try the treatment your doctor recommended.
  • But also tell your doctor that you would like him or her to monitor you on a frequent basis to determine whether your approach is working.
  • And if your approach isn’t working, you will consider again the treatment your doctor recommended.

This is what partnership with your doctor looks like. And it allays their greatest fear that they won’t see you again until your cancer has become untreatable.

If your doctor says no, listen very carefully to their reasoning (You may want to bring a relative or friend with you because they may hear your doctor’s response differently than you do). For example, it could be that your kind of tumor is so aggressive it doesn’t allow a window of opportunity to explore other options.

However, if you are unsatisfied with your doctor’s answer, that is what second opinions are for.

The Bottom Line 

Few things in life are more devastating than a cancer diagnosis. One day life is going on smoothly. The next day everything is in doubt. And before you know it, you are listening to your cancer doctor recommend a frightening treatment protocol.

You are being asked to make the most important decision of your life.

I spent 40 years of my life working on cancer drug development. I’m not a medical doctor. I can’t tell you what to do. But in this article, I tell you:

  • What questions to ask your doctor, and…
  • How to partner with your doctor…

…to help you navigate the most difficult decisions of your life.

For more details, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Health Tips From The Professor