It’s the diagnosis no one wants to hear: That lump or mysterious pain is cancer, and it needs to be dealt with right away. It’s an emotional blow, but one that’s also immediately followed by a slew of decisions and a need to meet with several different doctors in quick succession. Among those doctors is one who will likely take the lead in organizing your cancer treatment: the oncologist.
The oncologist specializes in treating cancer, and there are three primary types of oncologists: medical oncologists, surgical oncologists and radiation oncologists. The National Cancer Institute defines the medical oncologist as “a doctor who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy, and targeted therapy. A medical oncologist often is the main health care provider for someone who has cancer,” and will also give “supportive care and may coordinate treatment given by other specialists.” Because many cancer patients also need radiation therapy and/or surgery to treat their cancer, you may also see a surgical oncologist or a radiation oncologist — doctors who specialize in using surgery or radiation treatments to treat cancer.
[See: 10 Questions Doctors Wish Their Patients Would Ask.]
So how do you find the oncologist who’s going to be so integral to managing your care? It’s not always a straight-forward process, says Dr. Karen Reckamp, associate professor of medicine and medical director of thoracic oncology at City of Hope Comprehensive Cancer Center in Duarte, California.
“It’s shocking [to get a cancer diagnosis] and [patients] want to be seen by the smartest person as fast as they possibly can. But it’s a very personal issue to pick a doctor when you have a serious disease that leaves you very vulnerable,” she says. Making sure the doctor you’re working with has the skills, experience and knowledge to help you is important, and she says one of the first things patients should do is determine whether or not the oncologist they’ve been referred to or are considering seeing is board-certified.
“In choosing an oncologist, everyone wants to go to someone who has all the knowledge and can help them find the right treatment options and is up-to-date,” Reckamp says, and board certification is a signal that a specific doctor prioritizes “studying on the more current treatment options that are coming up.”
Staying up-to-date is critical when treating cancer specifically, Reckamp says, because it’s such a rapidly evolving field. “Having been in the field for over a decade — most of the things we did 10 to 15 years ago might be actually the wrong things to do today,” she says. “Not even just subtly, but absolutely wrong, so it’s really important to stay up-to-date.” Reckamp is board-certified in thoracic oncology, meaning she treats cancers in the thorax, primarily lung cancer. She also serves as a member of the American Board of Internal Medicine Medical Oncology Board.
Holding board certification in a subspecialty area may signal that the oncologist you’re seeing has even more expertise with your specific form of cancer. If you have lung cancer, for example, seeing a thoracic oncologist makes sense, as he or she may have more specific expertise than an oncologist who’s a generalist, seeing patients with any type of cancer. Subspecialists are typically found at comprehensive cancer centers, and these larger treatment hospitals, often attached to university research centers, offer cutting-edge technologies and expanded treatment options. (The National Cancer Institute currently designates 49 Comprehensive Cancer Centers around the country that may be a good place to start your search for a top cancer center.)
Michael J. Greenberg, a radiation oncologist with Geisinger Health System in Danville, Pennsylvania, says the “number one thing that makes a good oncologist is experience.” He says expertise and maturity should also factor into your judgment of whether an oncologist is right for you, and that patients should consider whether the doctor they’re seeing understands “how to take care of specific problems and makes good decisions. I think someone who can listen to patients and hear their concerns and also the problems that they’re having,” is also important. “It’s easy to just look at the tests, but often they don’t tell the whole story, and we find out a lot by listening to the patient,” he says.
In preparing for your first appointment with an oncologist, Greenberg says patients should make sure the doctor has received all the information and test results that may have been previously gathered. “Make sure they have a copy of all the pathology reports and previous information, and that they have the X-rays, CAT scans and MRI scans. The last thing you want to do is get to the consultation and find out that the information is not all there.”
[See: HIPAA: Protecting Your Health Information.]
He also recommends coming in with a list of questions about which treatments are going to be recommended, their side effects and how they will affect your life. “How’s it going to affect your family? What’s the recovery period? What’s the plan of action? Do I need any more tests first? When do I start, and what’s the plan for after I finish treatment? How long will it all take, and when do I get tested after treatment ends?” are all good questions you should discuss with your doctor, Greenberg says.
Cost may also enter into the conversation, and you should find out which treatments are covered by your insurance. Although the oncologist may not be able to answer the cost question specifically, other members of the care team, such as a social worker or patient navigator, should be able to help you get that information so you can make informed decisions about the direction of your care.
When meeting with a new oncologist for the first time, Greenberg recommends considering how the doctor interacts with you. Is his approach one that makes you comfortable? Cancer has a long treatment timeline, and while you’re in active treatment, you’ll be seeing your oncologist frequently. But even after you’ve been discharged from active treatment, your oncologist will need to see you regularly for “restaging studies, CAT scans, PET scans, MRI scans at specific intervals every six weeks or three months. We’ll see patients very regularly in the first and second year after treatment concludes and then begin to taper off. After five years, I see them annually,” a routine that continues indefinitely for many cancer patients to check for recurrence.
In other words, your relationship with your oncologist is likely going to be long term, so you want to be sure you’re comfortable with this person, Greenberg says. “Just be very honest with them and make sure that you mesh with the person that you select. You’re going to be putting your total trust in them, so make sure there’s a good communication back and forth. If there’s not, that’s not a good match,” and it’s time to look for someone else, he says.
[See: 14 Things You Didn’t Know About Nurses.]
Reckamp agrees that finding a doctor you’ll be comfortable working with long term is important, and you shouldn’t feel bad if the fit isn’t there on the first try. “Patients often have a feeling that, ‘I’m going to insult this person,’ and they don’t want to stack the deck against themselves, so they keep going with something that may be less than satisfactory for them.” But she says that’s not the case, and any decent doctor will understand if you want to move on.
That said, she cautions against seeing “10 different doctors and delaying treatment. There’s a balance between” finding a good fit and getting treatment started quickly. “Many times, the info you get [from the oncologist] is not what you want to hear, but that can’t be the reason to get a new doctor every time. Still, you need to be able to ask questions. You need to be able to communicate. And you need to be able to be heard. That’s something that takes a little time and effort to go through.”
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How to Find a Top Oncologist originally appeared on usnews.com
