July 29, 2007
The New York Times

What You Should Know
Push Hard for the Answers You Require

By DENISE GRADY

How can people with cancer make sure they are receiving the best treatment?

"The advice I would give every patient is to take the time to find help," said Dr. Richard C. Wender, president of the American Cancer Society and chairman of the department of family and community medicine at Thomas Jefferson University in Philadelphia. “Get more than one opinion.”

But how to do that? Picking a doctor out of the phone book or going down the hall to a colleague of the first doctor may not accomplish much.

"If you’re going to get another view, use it wisely,” Dr. Wender said. “Go to a higher-volume site."

Even if it requires traveling, make the trip, Dr. Wender said. "You’re in a fight for your life, and it’s worth the inconvenience," he said.

If there is a disagreement, the opinion of the cancer center that is more expert, which may reflect the judgment of multiple doctors, carries more weight.

"Frankly, if you have a less common cancer, or a more common one at an advanced stage, if you can get an opinion from a place doing more of it, there is value, in many cases," Dr. Wender said. He said patients should ask how many cases like theirs a doctor has seen.

If the operation or therapy is complex, treatment at the highest-volume hospital may be the best choice. But in some cases the more specialized center may confirm what has already been recommended, or provide advice that can be followed by a hospital closer to home.

There are several ways to find expert centers, Dr. Wender said. One is to look for a hospital that has been designated for excellence by the National Cancer Institute. The list is online at cancercenters.cancer.gov/cancer_centers/cancer-centers-list.html or can be obtained by calling 1-800-4-CANCER.

The American College of Surgeons also has a Commission on Cancer that evaluates cancer treatment programs and lists approved ones at www.facs.org/cancerprogram/howto.html. The American Cancer Society (cancer.org) has a 24-hour help line (1-800-ACS-2345) that can locate accredited programs. Advocacy groups for specific diseases may also know which centers treat the most cases and have the best track records.

Rules about paying for second opinions vary from one insurer to another.

Once treatment begins, Dr. Wender said, another good strategy is to ask one doctor to be “captain of the team,” the person who receives all the test results and reports, and helps the patient make treatment decisions and coordinate care. The captain can be a primary care doctor or one of the cancer specialists treating the patient.

"If you’re feeling rudderless as a cancer patient, you should not allow that to occur," Dr. Wender said. "Cancer patients have too much on the line."

Lack of money, insurance and education can block access to cancer care. According to a report by the Institute of Medicine, in 2002, “Uninsured cancer patients generally have poorer outcomes and are more likely to die prematurely than persons with insurance, largely because of delayed diagnosis.”

Being unable to afford treatment is one of the main reasons that people call the 24-hour help line set up by the cancer society, Dr. Wender said. “State by state, we are able to help 20 percent who call to get the financial resources they need for treatment,” he said. “We are unable to help 80 percent.”

He went on: "In cancer, people often ask, why haven’t we found a cure? We have, in many. But you have to find it in one patient at a time. A cure a person can’t afford is not a cure at all."