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Making Treatment Decisions | |
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| Choosing a Doctor and Hospital | |
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Once you have learned you have cancer, your next concern is to make sure you have the best possible medical care and treatment. Choosing your doctor and treatment center is one of the most important decisions you will make. There are many excellent cancer care centers throughout the United States, but how do you know where to look? Here we will give you some things to think about as you choose your doctor and hospital. Determining cancer care quality When you or a loved one first learns about a cancer diagnosis, there are many things to think about. Most people with cancer are not experts on cancer treatment. You probably don't feel as if you have the time, energy, or resources to figure out how to get "quality cancer care." You will need some help. The doctor who found your cancer is the first person you should ask: "If you found out that you (or someone you loved) had cancer, which doctor would you see for treatment?" Often a doctor will go ahead and suggest another doctor anyway. If your doctor isn't sure of your diagnosis, but thinks there's a chance you might have cancer, you can ask: "If you were in my situation, which doctor would you see first?" Try to get at least 2 or 3 names, and find out what these doctors' specialties are. Find out if they practice at cancer treatment centers. Then later you can find out more about the treatment centers and the doctors. Know that you can get help with this. The organizations listed next work with cancer treatment centers and know a lot about quality cancer care. They can point you to centers that offer only the best in cancer care. Commission on Cancer The Commission on Cancer (CoC) is a program of the American College of Surgeons. The goal of this group is to improve the care of patients with cancer, while keeping it as close to home as possible. Through their cancer treatment facilities approval program, the CoC approves hospitals or facilities that have committed to provide the best in cancer diagnosis and treatment. Its list of approved facilities includes more than 1,400 cancer centers throughout the United States. A good way to judge the quality of cancer care at a treatment facility is to find out if it has been approved by the CoC. If it has, you know it meets certain standards and offers a range of cancer care services. No matter its size or location, its ability to deliver quality cancer care is constantly being surveyed by the CoC. CoC-approved cancer programs are found in many different kinds of hospitals or facilities. They may be in major treatment centers, community hospitals, or other diagnostic and treatment centers. Approved programs must provide state-of-the-art diagnostic and treatment services. They have many different specialists available to treat patients, they take part in a cancer registry that collects all kinds of information on cancer, and they can give you information on clinical trials and new treatment options. CoC-approved cancer programs also must offer life-long follow-up care to people with cancer. This gives patients ongoing long-term care so that any problems, such as late side effects, recurrences, or new cancers, are found and treated as soon as possible. If you would like to find a CoC-approved center near you, see our Treatment Center Locator. Or you can call us at 1-800-227-2345. National Cancer Institute The National Cancer Institute (NCI) is part of the U.S. National Institutes for Health. The NCI is dedicated to better understanding, diagnosing, treating, and preventing cancer for all people. Its goal is to support and enhance the quality of clinical cancer research. The NCI works with more than 60 cancer treatment centers in the United States. It recognizes 3 levels of cancer treatment centers, ranging from a comprehensive cancer center to the more basic cancer treatment center. These facilities are often housed at universities and research is a large focus. You can get a list of the NCI-designated Cancer Centers and read more about the NCI by visiting the NCI Web site at www.cancer.gov. You can also learn more about your cancer and treatment options at the NCI Cancer Information Service, available at www.cancer.gov/cancertopics/factsheet/Information/CIS. Children's Oncology Group The Children's Oncology Group's mission is to cure and prevent childhood and adolescent cancer through scientific research and comprehensive care. Over 90% of children with cancer in the United States are treated at a center that is a member of the Children's Oncology Group (COG). COG has nearly 250 affiliated centers that are linked to a university or children's hospital. To find a listing by state of COG institutions, go to their Web site at www.curesearch.org/resources/cog.aspx. Choosing your doctor Going through the process of choosing a doctor can take time, and many people are tempted to rush through it to start their treatment sooner. Keep in mind, though, that most people with cancer have enough time to be sure that they get the best care possible. Ask the doctor who found your cancer whether you need to take action right away or if you can take a short but safe amount of time to check out all your options. Carefully choosing the doctor you need now (such as a good surgeon, radiologist, and/or oncologist) will pay off for years to come. Your relationship with this person will probably last through treatment into long-term follow-up care. Decide what you want and need in a doctor Before you start looking for a doctor, think about the qualities you want your doctor to have. A few ideas are listed below, but you may want to add others.
Make a list of doctors who might be a good fit One of the best ways to choose a doctor to treat your cancer is to get referrals from people you trust, like your primary care doctor. You might also try to speak with others in your area who have been treated for the type of cancer you have to see who treated them. Some hospitals and communities also have physician referral services available by phone or online. These allow you to learn more details about the doctors in your area, such as their areas of expertise, medical certifications, office locations, languages spoken, and so on. You can find these referral services through many hospitals by calling their main number or visiting the hospital Web site. Or you can ask your primary care doctor about them. If you are in a health plan, you can begin by checking their list of doctors. This is usually available online or by calling the member services hotline. You will still want to find out more about each doctor before you decide. Call the doctors' offices and make appointments: The first visit Once you've found doctors that seem like a good fit for you, call their offices and ask whether they are covered by your health plan and are taking new patients. You may also want to find out which hospitals they work in and have admitting privileges for. The next step is to schedule appointments with a few doctors. The most important question to ask them is how much experience they have in treating your type of cancer. If you are meeting with surgeons, find out how often they perform the type of surgery you need, how many of these surgeries they have performed before, and what their success rate is. Along with finding out your doctor's medical experience and credentials, notice how comfortable you feel with him or her. One way to measure this is to ask yourself these questions after your appointment.
Trust yourself when deciding whether this doctor is right for you. Keep in mind, though, that relationships take time to develop and you may need more than a single visit before you and your doctor really get to know each other. Some of the questions about the doctor you may want answered include: Is the doctor board certified? Doctors who are board certified have had extra training in special treatment areas, such as medical oncology (cancer care), hematology (diseases of the blood), or gynecologic surgery (female reproductive system). They have taken and passed certification tests given by doctors in their field. To keep their certification, doctors must continue their education and keep up with advances and changes in their specialty area. Not all doctors who are specialists are board certified. Doctors do not need to be board certified to be excellent caregivers. Still, more than 85% of doctors become board certified in at least 1 specialty. To find out if a doctor is board certified, contact the American Board of Medical Specialties (ABMS) at www.abms.org. The ABMS has a list of board certified doctors who subscribe to the ABMS service. You can search for all doctors in a certain specialty by state. Or you can type in the name of the doctor you have questions about to learn about their specialty. Information on doctors who have extra training and certification may also be available at your public library. Ask for the Official ABMS Directory of Board Certified Medical Specialists, or get your librarian to help you. What is the doctor's experience? Find out how long the doctor has been in practice. Ask how many people with cancer she has treated. If you are thinking about surgery or special procedure, you may want to ask about the number of these procedures she has performed. How many patients is the doctor currently treating? How many are cancer patients? How much experience does she have with your type of cancer? Along with finding out about the doctor's experience, you may also want to find out who the leading authorities in the field are. A visit to a medical library may be useful. You can do research on the Internet, too. You can start with us, or go to other respected Web sites like www.cancer.gov, healthfinder.gov, or medlineplus.gov. Look for the names of doctors who have written about the cancer you have and whose work is most often quoted. If your doctor has done research and had it published, you may ask to see copies of those articles at the library. By doing so, you will learn more about her approach to cancer treatment. With what hospitals is the doctor affiliated? Where you will get inpatient cancer care is determined by where your doctor practices. Find out where you would go for surgery or other care. Check with your health insurance company, to see which doctors and hospitals your insurance plan covers. Is the doctor affiliated with any medical schools? Teaching affiliation (association) with a respected medical school may suggest that a doctor is a leader in her field. Doctors who teach and who also practice medicine often are in contact with medical experts from around the country. They may know more about the latest treatments. Other questions to ask:
It's helpful to ask around about a doctor's reputation, but in the end, trust your gut. You should feel comfortable not only with your doctor's ability to treat your cancer but also with how she treats you as a person. Can you talk with this doctor? Does she listen to you? If it doesn't feel right, keep looking. The American Medical Association (AMA), on the Web at www.ama-assn.org, represents many doctors in the United States and offers a doctor locator service called "Doctor Finder." You can find information about doctors, such as their contact information, medical school, residency training, and specialty area(s). Another source of information is the American Society of Clinical Oncology (ASCO), on the Web at www.asco.org. This is an international medical society representing cancer specialists involved in clinical research and patient care. They provide an oncologist directory, which is a database of ASCO members called the "Membership Directory." You can sign in using a guest username and password to access this database. You might also contact the nearest cancer centers and ask for doctors who are specialists in your type of cancer. Consider asking family, friends, nurses, and other doctors in your community. Most hospitals have a doctor referral service, too. You could also call medical schools or medical societies in your area. Once you have come up with some names, you might begin getting the answers to some of the same questions you asked before, for example, board certification and experience. Second opinions Even after you have chosen your doctor, you may want to get a second opinion. This is an especially good idea if you feel uncertain about the proposed treatment. For example, if you have prostate cancer and a urologist has recommended surgery, you may want to see a radiation oncologist to learn about non-surgical treatment. Consider getting a second opinion when:
Before you begin looking for a second opinion, contact your insurance company to find out what your policy covers. You may even have to get a second opinion from another doctor who is part of your health plan before the plan will pay for your treatment. Tell your doctor you plan to get a second opinion. It is common for patients to do this, so most doctors are comfortable with the request. You may want to ask your doctor to recommend someone. You may also want to look at the above section, "More ways to find a doctor," for suggestions. Once you have decided who you will see for your second opinion, ask that your medical records, original x-rays, and test results be shared with the referral doctor. You will need to sign a release of information form. Or you may want to take copies of your medical records to the new doctor yourself. Be sure to take all of your medicines (including vitamins and supplements) with you on your first visit. The new doctor will review your medical history, prior test results, do a physical exam, and maybe do other tests, too. Choosing a good hospital Most doctors who treat cancer work with hospitals that are good at cancer care. Ask other doctors and nurses for their opinions on hospitals in your area. Cancer experience is also important for hospitals. For example, larger hospitals may have more experience with different kinds of cancers and offer more services for cancer patients. If you live in a small town, you may need to travel to a larger city to find a center with enough cancer experience. This might be especially important if you have a rare type of cancer or if you have something unusual occur along with your diagnosis. Larger institutions will have more experience in treating less common cancers. This experience advantage may be the key to getting the best possible treatment and be well worth any extra travel or inconvenience to you in the short-term. You may also go online to find out if nearby hospitals meet certain quality standards and are accredited by The Joint Commission at www.jointcommission.org. Keep in mind, though, that accreditation does not necessarily mean the hospital has expertise in cancer care. Online, The Joint Commission's Quality Check allows you to check on the performance of your local health care facility. From their home page, select "Quality Check," then search for your health care organization by its name, zip code, or state. If you don't have Internet access, ask your local public library staff if they can help you, or call the Quality Check help line at 630-792-5800. Additional resources More information from your American Cancer Society We have selected some related information that may also be helpful to you. You can order these materials from our toll-free number, 1-800-227-2345.
Books The following books are available from the American Cancer Society. Call us at 1-800-227-2345 to ask about costs or to place your order. National organizations and Web sites* Along with the American Cancer Society, other sources of information and support include: Finding doctors: American Board
of Medical Specialties (ABMS) American Medical
Association (AMA) American Society
of Clinical Oncology (ASCO) Treatment center and hospital information: CureSearch
National Childhood Cancer Foundation (NCCF) Joint
Commission, The National Cancer
Institute (NCI) *Inclusion on this list does not imply endorsement by the American Cancer Society. No matter who you are, we can help. Contact us anytime, day or night, for cancer-related information and support. Call us at 1-800-227-2345 or visit cancer.org. References American College of Surgeons. Accessed at www.facs.org/cancer/ on May 27, 2009. American Medical Association. Doctor Finder. Accessed at www.ama-assn.org/ on May 29, 2009. American Cancer Society. About the Commission on Cancer. Accessed at www.cancer.org/docroot/FTC/content/ftc_1_2.asp?sitearea=ETO on May 27, 2009. American Society of Clinical Oncology. Find an Oncologist Database. Accessed at www.cancer.net/patient/Diagnosis+and+Treatment/Finding+Quality+Care/Find+an+Oncologist/Find+an+Oncologist+Database on May 29, 2009. Eyre HJ, Lange DP, Morris LB. Informed Decisions: The Complete Book of Cancer Diagnosis, Treatment, and Recovery. 2nd Ed. Atlanta, GA: American Cancer Society. 2002. Hewitt M, Simone JV (Eds), National Cancer Policy Board, Institute of Medicine, and National Research Council. Ensuring Quality Cancer Care. Washington DC, National Academy Press, 1999. Accessed at www.nap.edu/catalog.php?record_id=6467 on May 27, 2009. National Cancer Institute. The National Cancer Institute Cancer Centers List. Accessed at http://cancercenters.cancer.gov/cancer_centers/cancer-centers-names.html on May 29, 2009. Ross JA, Olshan AF. Pediatric Cancer in the United States: The Children's Oncology Group Epidemiology Research Program. Cancer Epidemiol Biomarkers Prev. 2004;13:1552-1554. The Joint Commission. About Quality Check. Accessed at www.jointcommission.org/QualityCheck/06_about_qc.htm on May 29, 2009. The Joint Commission. Quality Check™. Accessed at www.qualitycheck.org/consumer/searchQCR.aspx on May 29, 2009. Last Medical Review: 06/11/2009 |