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A Review of Considerations to Guiding Patients Through a Cancer Diagnosis

Issue: July 2009

By: Patricia Seid, M.D.

The complex thoughts and emotions that run through patients’ minds when they hear that they have cancer is unimaginable. The fact that treatment modalities have advanced to the point where there are millions of cancer survivors means little to a person who is hearing a diagnosis of cancer from a physician.

Those of us who have chosen to work in cancer care see first-hand the fear that ensues when the diagnosis is mentioned. In the days and weeks to come, patients are asked to digest the emotional impact on themselves and their families, as well as be a partner in making complex treatment decisions. It is during this tumultuous time that we are able to offer our specialized knowledge and support.

The Diagnostic Process

Fortunately, a large percentage of cancers are detected when patients undergo routine screening tests ordered by their primary care physicians. Screening studies such as pap smears, mammograms and prostate-specific antigen (PSA) testing are typically done when patients are asymptomatic. When an abnormality is detected, or when patients have symptoms that may suggest cancer, the first step is determining if a malignancy is present, usually by obtaining a biopsy.

Once a diagnosis is made, there is usually a period of active investigation to determine the stage of disease. This may involve imaging studies such as CT scans, MRIs, and PET scans. I have often heard from patients that the waiting period is the most unsettling time for them, so every effort should be made to expedite the careful collection of information and initiate treatment.

While the waiting period can be frightening and frustrating, it is imperative that accurate information is collected regarding the extent of the disease and that information is provided to patients and their families. Only then can a thorough discussion take place regarding the applicable treatment options and prognosis.

Treatment goals can vary from curative intent to palliation of particular symptoms, and may sometimes involve both goals concurrently. The majority of treatments are given with curative intent. However, even when a cure is not possible, long-term control of disease and successful symptom control can be offered.

Treatment Options

When discussing treatment options with cancer patients, we follow a process that always starts with education. Surgical options and post-surgical treatment are discussed. While most people have heard of chemotherapy and radiation, few have an in-depth understanding about these treatment modalities, so it is important to discuss the benefits and potential side effects, as well as reasonable goals for treatment.

Typically, chemotherapy occurs in two- to three-week cycles depending on how well patients tolerate treatments. Oncologists have been able to deliver more intensive and effective cycles in recent decades, mainly because of dramatic improvements in the control of side effects. For example, great strides have been made in minimizing nausea and in supporting the bone marrow.

Radiation therapy, which may occur alone or in concert with chemotherapy, has also significantly advanced in the last several decades. It has always been a goal to eradicate tumors while involving as little healthy tissue as possible, and we’re more successful than ever at doing that. Many of these advances have been made possible because of improvements in diagnostic radiology, allowing us to localize the tumor with more precision. Our ability to deliver radiation treatments with more precision has also dramatically improved, allowing us to better account for individual variability of tumor movements during and between radiation treatments.

Radiation treatments usually take about 15 minutes and are typically delivered once a day for a period of several weeks. As a radiation oncologist, my job is to select patients who will benefit from treatments; discuss the treatment logistics, risks and benefits; plan the radiation treatments themselves; and monitor patients closely during the treatment process and beyond.

Patients frequently have misconceptions about chemotherapy and radiation that include deep-seated fears resulting from seeing friends or family have unpleasant experiences. While focusing on the advances that have been made in the delivery of these treatments, we also note that when it comes to treating cancer, it’s impossible to compare any two cases. There’s no way to know if complications occur as a result of treatment or the disease itself.

Being Informed

While receiving a diagnosis of cancer is going to be deeply troubling, there are things that patients can do to give themselves very necessary emotional strength. The most important thing is to ask questions of their primary care physician, surgeon, medical oncologist and radiation oncologist to ensure they’re informed about their condition, treatment options and treatment goals.

Patients should be careful about where they get their information since they may find inaccurate or misleading data. As physicians, we can often direct them to the most reputable Web sites or other sources of information. The American Cancer Society website (www.cancer.org) has lists of suggested questions as well as treatment decision tools.

Patients are also cautioned against taking too much from cancer survival statistics, since it’s hard to apply them to individual cases. Their treatment teams will be the best source of comprehensive information relevant to their situation.

Patricia Seid, M.D. is a board certified radiation oncologist at Sutter Solano Cancer Center in Vallejo.

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