|
How can I make Informed Decisions?
MAKING DECISIONS ABOUT TREATMENT | Second Opinions
The ultimate result of the process of cancer diagnosis and staging is a recommendation of a treatment plan. You will need
to decide whether you will accept that recommendation and, ultimately, where you will be treated and by whom. Some basic questions
to ask yourself before beginning treatment are listed in Box 6-1 .
| Box 6-1 |
|
QUESTIONS BEFORE MAKING A TREATMENT DECISION
- Do I need any more information before I begin treatment?
- Do I have confidence in the diagnosis?
- Do I have confidence in my doctors?
- Do I have confidence in the facility?
- Do I understand what will happen before, during, and after treatment?
- How far from home am I willing to travel to be treated?
- Do I want what is the “standard of care,” or am I interested in participating in a clinical trial?
|
ADJUVANT THERAPY: A treatment given after surgery (radiation therapy or chemotherapy).
Making an informed decision about whether or not to undergo adjuvant therapy can be a difficult. Before you make a decision,
please Read the Essential Information about Adjuvant Therapy compiled by our multidisciplinary team.
|
FACING TREATMENT CHALLENGES
The best treatment results are obtained if surgery can be included as part of the treatment when pancreatic cancer is found
at an early stage, before it has spread. Despite the great increase in research into pancreatic cancer, however, early detection
is uncommon. When diagnosed, people usually are older than 55, and most often are older than 65, and co-existing conditions may limit treatment options. Disease-related side effects may make patients very ill, again limiting treatment options. Even
so, treatment aimed at controlling symptoms and preventing additional harm may increase patients’ quality of life. 1,2
GETTING A SECOND OPINION
Keep in mind that the diagnosis and staging of cancer is a complicated process and that cancer is different in every person.
“Every person with cancer – even two people with cancer at precisely the same stage – differs from every other.” 3 It may feel much safer and simpler to take the advice of the doctor who diagnosed your cancer, but getting a second opinion
by an expert in your type of cancer may be a wiser choice.
| A SECOND OPINION FOR ALL PATIENTS WITH CANCER |
The National Cancer Institute (NCI) recommends that all patients with cancer get a second opinion for two reasons:
(1) to confirm the diagnosis and
(2) to review the proposed course of treatment. 4
|
You may want to obtain a second opinion for peace of mind. You may want to confirm that your diagnosis is correct and that
you will be receiving the most up-to-date treatment. You may want a second opinion because your doctor is not experienced
in your type of cancer. You may have read about a treatment your doctor does not know about, and may wish to pursue such a
treatment.
If you decide to get a second opinion, it may be best to go to an expert who is not affiliated with your doctor and to a hospital
that is not affiliated with your hospital. This is so that you can obtain an unbiased review of your individual case.
CHOOSING A TREATMENT CENTER
Today, more than 60 cancer centers across the United States are designated by the NCI as Comprehensive Cancer Centers or Cancer
Centers. A list of these centers with contact information is provided in the Appendix. You can get a second opinion or be
treated at one of these centers. Most have patient information services that will help you.
 Kimmel Cancer Center
at Jefferson
The Kimmel Cancer Center is proud of its status as a National Cancer Institute-designated Cancer Center. The NCI-designated cancer centers were established to be national leaders in cancer treatment, research, and education.
|
There are many advantages to receiving treatment at a large cancer center. A center that treats a high number of patients
with cancer will have more experience in every aspect of your care: diagnosis, staging, surgery, and managing side effects
and complications. More experience usually means more expertise, which can improve the results of your treatment. For example,
at an NCI-designated Comprehensive Cancer Center you may be able to have a type of surgery for pancreatic cancer that a small
hospital may not be able to offer. (See Question 7 on Treatment.) Or another hospital may offer the procedure, but not many are performed there. You want a facility that treats many patients
with pancreatic cancer.
A list of questions to ask when you are looking for a treatment center is given in Box 6-2 . A list of components of quality of care is given in Box 6-3 .
Many Americans live a manageable distance from a major cancer center. At one Comprehensive Cancer Center as many as half of
patients are seen for only a single visit. Doctors at top cancer centers often can plan patients’ treatments then refer them
to doctors closer to home who will carry out those treatments. 4
| Box 6-2 |
|
SOME QUESTIONS TO ASK WHEN LOOKING FOR A TREATMENT CENTER 4,5
- Has the facility been rated by state, consumer, or other groups for its quality of care?
- How does the facility check on and work to improve its quality of care?
- Has the facility been approved by a nationally recognized accrediting body, such as the American College of Surgeons (ACS)
and/or the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)?
- Does the facility explain patients’ rights and responsibilities? Are copies of this information available to patients?
- Does the treatment facility offer support services to help with day-to-day obstacles such as providing assistance to obtain
medical equipment and supplies, arranging transportation for treatment, or handling the emotional, psychological, or financial
issues that go along with having cancer?
|
| Box 6-3 |
|
SOME QUALITY-OF-CARE COMPONENTS OF A CANCER TREATMENT CENTER 4,5
- Experience in diagnosing and treating pancreatic cancer, for example, a specialized center within a cancer facility that is
dedicated to the evaluation and treatment of patients with pancreatic cancer
- Experience in managing the symptoms and side effects of pancreatic cancer
- On-site, advanced techniques and technology, such as a state-of-the-art dual-phase helical CT scanner
- An on-site laboratory
- Access to investigational treatments for pancreatic cancer, such as in clinical trials
- Services for pain management and palliative care
|
Multidisciplinary Clinics Dedicated to Pancreatic Cancer
More and more today, cancer centers are opening multidisciplinary clinics specifically dedicated to pancreatic cancer. The
goal is to provide the highest quality of care. Patients who have suspected or known pancreatic cancer may receive a comprehensive
evaluation that incorporates all of the resources available at these clinics for the diagnosis and treatment of pancreatic
cancer. Because highly experienced pancreatic cancer clinicians and specialists are available at these clinics, the most advanced
treatments are offered. These clinics also provide patients with the infrastructure, coordinated services, and team approach
needed to carefully walk them through all phases of treatment. 6
CHOOSING A TREATMENT TEAM
One doctor will be in charge of your care, but an entire team may be involved in creating and implementing your treatment
plan. The team approach is a way to benefit from the expertise and experience of many people. It is called multidisciplinary care. 3
Treatment teams for patients with pancreatic cancer may include doctors such as surgeons, medical oncologists, radiation oncologists,
pathologists, endocrinologists, gastroenterologists, genetic counselors, and experts in pain management. Oncology nurses,
physician’s assistants, and oncology social workers also may be part of your team.
JEFFERSON CENTER for PANCREATIC, BILIARY and RELATED CANCERS
Our multidisciplinary team consists of more than 30 clinicians and scientists. The team integrates surgery with oncology, pathology, pharmacology, gastroenterology,
pain management, palliative care, genetics and nursing.
The co-directors of the center are Charles J. Yeo, MD, Donald Mitchell, MD, Agnes Witkiewicz, MD, Kowalski, MD, and Jonathan
Brody, PhD.
|
| Medical oncologists |
Medical doctors who prescribe anticancer medications. |
| Radiation oncologists |
Medical doctors who specialize in treating cancer with radiation. |
| Endocrinologists |
Medical doctors who specialize in disorders of glands of the endocrine system. |
| Gastroenterologists |
Medical doctors who specialize in disorders of the digestive system. 3 |
| It is important to seek specialists who have experience in pancreatic cancer and work together to plan your treatment. |
| Physician’s assistants |
Medical professionals who are trained in an accredited program and certified by an appropriate board to perform certain duties
of a physician, under the supervision of a licensed physician. Some of the duties include history-taking, physical examination,
treatment, and certain minor surgical procedures.
They also have special training in managing the treatment and care of patients with cancer. Among their duties are giving
chemotherapy drugs, helping manage side effects, and providing patient education. 7 |
| Oncology nurses |
Medical professionals who have special training in managing the treatment and care of patients with cancer. Among their duties
are giving chemotherapy drugs, helping manage side effects, and providing patient education. 7 |
| Oncology social workers |
Oncology social workers are professionally trained to counsel patients who have cancer and help provide practical assistance.
These professionals can help find support groups, locate community services, and help with financial assistance. 7 |
Patient Advocacy
Patient advocacy has changed with treatment advances and a greater appreciation of the daily needs of patients with cancer
and their families. From diagnosis to recovery, the best cancer care requires far more expertise than any single healthcare
provider can give. The person with cancer is best served by a multidisciplinary team, led by a professional team leader. All
team members have the same goal: to offer services that provide the highest quality of life and extend survival. 3
REFERENCES ! Click reference number to return to text.
1. American Cancer Society. Pancreatic cancer. http://documents.cancer.org/ 116.00. Accessed April 15, 2007.
2. McKenna S, Eatock M. The medical management of pancreatic cancer: a review. The Oncologist. 2003;8:149-60.
3. Eyre HJ, Lange DP, Morris LB. Informed Decisions: The Complete Book of Cancer Diagnosis, Treatment, and Recovery. 2nd ed.
American Cancer Society–Health Content Products. Atlanta, GA; 2002.
4. Teeley P, Bashe P. The Complete Cancer Survival Guide. New York: Doubleday; 2000.
5. National Cancer Institute. How to find a doctor or treatment facility if you have cancer. www.cancer.gov/cancertopics/ factsheet/Therapy/doctor-facility.
Accessed April 15, 2007.
6. Johns Hopkins Pathology. Pancreas cancer. www.pathology.jhu.edu/pancreas. Accessed May 23, 2007.
7. CancerCare InformTM. Your health care team: your doctor is only the beginning. www.cancercare.org/pdf/fact_sheets/fs_ healthcare_team.pdf.
Accessed April 12, 2007.
|
