6 Things to Ask Your Doctor When You Learn You Have Lung Cancer
A diagnosis of lung cancer can send a patient's brain into a whirl. Here are a few questions that can be brought along to the initial consultation with an oncologist. These questions may help offer some clarity about treatment options, life changes, and generally what to expect (or not expect) in the future. If possible, bring a friend or family member along to take notes, act as an objective ear, or just as moral support -- if you want it.
#1: What is my specific cancer and stage?
The fact is that "lung cancer" is not a singular thing. There are three primary categories of lung cancer and several fairly rare types. Inside the largest category, non-small cell lung cancer, there are multiple types of cancer. Additionally, each patient has unique genetic variations, making it very clear that understanding the specifics of the cancer is key to understanding how to treat it. The "stage" of the cancer is based on a combination of tumor size and whether it has spread to the lymph nodes or other parts of the body. It is increasingly common to request a genetic profile of the tumor cells in order to check for "actionable mutations," or certain protein markers. This combined information will affect the choice of treatment options.
#2: What are my treatment options?
This is one of the most important questions that a patient will ask. Understanding the answer(s) fully is important, especially when it comes time to ask a second opinion. Depending on the stage of the cancer and where it is located, surgery and radiation may or may not be options. Each patient's physical status will be fully evaluated, including age and overall health, before making final decisions on any treatment.
With all forms of treatment, the oncologist and patient need to consider the risk to reward ratio. Generally, the reward should outweigh the risk as much as possible. The treatment landscape is changing rapidly, and sometimes it might be appropriate to attempt therapies with the potential for a very high reward even when the risk potential is also high, but only after the positive and negative aspects are carefully reviewed and fully understood. This will answer whether you might be a candidate for chemotherapy, targeted therapy, or immunotherapy.
#3: What side effects might occur?
Dealing with side effects is almost always an issue, regardless of the type of therapy. But side effects vary greatly from patient to patient, even for the same treatment being used for the same type of cancer at the same dose or rate. Some patients report very low side effects while others have more dramatic reactions, whether these are nausea, rash, sleeplessness, hair loss, fatigue, neuropathy, or a host of other treatment-specific issues. Fortunately, there is medication and other forms of palliative care available to help with most side effects. Knowing what a patient should be on the lookout for can be helpful, and knowing the probable side effects of any treatment will also be important when getting a second opinion if that is desired before starting treatment.
#4: Should I consider a clinical trial?
While clinical trials are not always available, being aware of what trials are currently being conducted is a good idea. Sometimes, even if a patient cannot participate in a current trial, ongoing research may inform the direction of a patient's treatment. Ask your oncologist about this and determine whether any treatment options today will help or hinder participation in upcoming trials. Be aware, however, that there are often many factors that determine eligibility for clinical trials, and genetic testing is often required prior to consideration.
#5: What other support is available?
Most clinics and hospitals should have a social worker available to help the patient navigate the process of dealing with public resources, including filing for disability and issues related to patient rights. An increasing number of facilities also utilize nurse navigators, a unique professional who will help solve problems for the patient with regard to scheduling appointments, communicating with insurance companies to get approvals, and often ensure that the patient gets good answers to complicated questions.
There may also be local support groups available for both the patient and caregiver. If there are known concerns, whether they relate to cost of treatment, transportation, or mental health, it is important to raise them and ask where support is available.
#6: What can I do to help myself?
This one is going to be different for everyone, of course, because all patients are individuals. But a few things should always be looked at, such as diet and exercise and the physical goals for the patient before and during treatment. Some patients find counseling or seeing a therapist to be helpful, some patients consult with a nutritionist, others merely continue leading the healthy lifestyle they already had.
This is also a time to talk with the oncologist about other palliative options and so-called "complementary" care. These choices are often outside of the range of medical treatment, such as yoga or massage, but work well to help make the process of treatment easier. Always consult an oncologist prior to partaking of any herbal or "natural" remedies, or engaging in any use of "alternative medicine" of any sort, because there are often bio-active aspects of such treatments that might react adversely with traditional medical therapy or otherwise prove more toxic than helpful.
Remember...knowledge is power
When it comes to the personal care of a cancer patient, knowledge is power, and the oncologist is a great resource that should be exploited thoroughly. Bring this list of questions, and do not be afraid to bring it again. After all, even for the best questions, answers often evolve. And if the answers don't change much, the questions most certainly will. Ask again. Ask often.
Editor's Note: We are extremely saddened to say that on October 21, 2018, Jeffrey Poehlmann passed away. Jeffrey’s advocacy efforts and writing continue to reach many. He will be deeply missed.
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