"is naturally going to be an anxiety provoking experience. I’ll talk a little about the first visit for a newly diagnosed patient contemplating the benefits of hormonal or chemotherapy after surgery for breast cancer. (Patients with metastatic disease we’ll address at a later time).
A medical oncology office can be a frightening place at first - some of the patients in the waiting room LOOK sick, and most patients doubt they would end up visiting us.
The reason for the visit is to learn how you can maximize your chances for cure. By this time you have likely seen a surgeon and most likely had surgery (unless you are consulting for neoadjuvant therapy - for women with large breast masses where therapy can shrink the mass to make surgery easier and/or make a lumpectomy possible).
Radiation therapy is for optimal local control. The medical oncologist’s goal is to help you control your disease systemically and to see that you are doing okay psychologically and socially. The medical oncologist is also the person you can turn to at any time, who traditionally coordinates your care.
Here are some suggestions to make that first visit go smoother:
Consider doing some background research on breast cancer, if you have the interest. Besides the HealthCentral Web site, here are three others I like - from each home page you can find very good information on breast cancer: www.plwc.org, www.cancer.gov, www.oncolink.edu
If you can, bring a friend, spouse, or significant other with you to the first visit. It might help relieve some of the stress you’re feeling to have a supportive person with you. In addition, when you’re anxious about the visit it’s hard to remember what was said, and the person you bring with you can help with this.
You very well may go over history that should theoretically be "in your file." Sometimes this is because the records are not complete. Mostly it is to go over your history to tease out other things that may have relevance to your particular case. It’s also a standard - a history, a physical examination, and then discussion. Plus it allows the oncologist to gauge how you are doing emotionally and psychologically as you discuss your diagnosis and what has happened to date.
Ask about clinical trials - often a clinical trial is the best treatment option available. For example, the clinical trials testing adjuvant herceptin with chemotherapy showed that women who received herceptin had a 50% lower chance of relapse - for several years that option was only available as part of a clinical trial. Even if you’re not eligible for a clinical trial or decide you’re not interested it is also a way to gauge the quality of the practice - clinical trials take a lot of time and effort to conduct, and usually lose money for an oncology practice. Having an active program shows dedication on the part of the doctors.
Ask any question that comes to mind - even though your doctor may have some recommendations, we ultimately let the patient decide what treatment she would like and support that decision. If something is not clear, ask for an explanation or clarification.
Decide if you like your doctor. I have always worked with groups so that if patients desire they can see a different doctor in the group and over the years some patients have switched to me, and some have switched from me. Sometimes personalities just don’t mesh, and we want you to feel comfortable with your oncologist.
If you need to, you should schedule a follow-up appointment before making a final decision - particularly if you are having a hard time deciding if adjuvant chemotherapy is for you. The initial consultation covers a lot of ground and it’s a complicated, emotional visit. About 20 percent of my patients end up having a second visit - it gives them time to absorb the information, and another chance to ask questions and sort things out before deciding their treatment program.
Kevin Knopf is a hematologist in San Francisco, California and is affiliated with California Pacific Medical Center. He wrote for HealthCentral as a health professional for Breast Cancer.