Breast Cancer Treatment Options: Get the Facts
You arrive home from the doctor's office overwhelmed with the news that you have breast cancer. The surgeon's nurse has set up more tests and said she will call tomorrow with an appointment for you to meet with an oncologist.
Clicking on the television, you see a woman talking about how wonderful her cancer hospital is. She stands with her husband in front of a large building saying it is worth traveling any distance to find a hospital that offers hope and options. You start wondering if you should just take your surgeon's recommendation for an oncologist or if you should check out the hospital in the advertisement.
Competition for your medical dollar is strong. Everyday I see ads from both local hospitals and medical centers up to three hours away from my home telling me how wonderful each medical facility is. A recent study looked at ads for cancer centers and found that they were long on emotions and short on facts.
The National Institutes of Health funded a study of 409 magazine and television advertisements. The ads for 102 cancer centers were strong on testimonials of patients who had successful outcomes and who were happy with their treatment, but they rarely mentioned overall outcomes or costs. The best comprehensive cancer centers were just as likely to run highly emotional ads as other hospitals.
So what should you do if you are just diagnosed? You have already made some decisions about medical providers by now. If you like and trust the surgeon who did your biopsy, you may be inclined to follow his or her recommendation for an oncologist and any further medical care. However, in the long run, you will probably feel more confident in your medical care if you are more active in making the choices. Here are some factors to consider:
Nearby facilities. For many people there is only one nearby hospital and not many oncologists to choose from. In that case, your decision is whether to stick with your local facilities or to travel to a big cancer center. For most people with breast cancer, the local hospital will be fine. Breast cancer is common, and doctors everywhere are experienced in treating it. However, if you have a rare form of breast cancer or complications with other medical issues, finding a doctor at a Comprehensive Cancer Center (CCC) might be a good idea. CCC's offer high quality care because they treat a high volume of cancer patients, which means their doctors have more experience. They also recruit the most highly trained oncologists and have to pass careful monitoring to maintain their CCC certification.
If you live in a metropolitan area with several choices, consider factors like parking and traffic as well as the medical staff. You are going to be going to this facility when you are tired and in pain. A long walk from the parking lot to the doctor's office will seem much more tiring when you are going for daily radiation. You may need to ask people to give you a ride to this hospital, and it will be easier to beg a favor if the hospital isn't all the way across town. Convenience isn't the most important factor, but it is a significant one.
Your medical personality. Are you more comfortable with a small practice near your home, or is it important to you to have doctors who are engaged in the latest research? How crucial is bedside manner to you? Are you going to feel intimidated in a big hospital where you might not see the same people on each visit? It is important to keep in mind that competence outweighs a pleasing personality, but you want to find doctors you feel comfortable enough with that you can ask questions.
Hospital and doctor facts. You will need to go beyond emotion in making your final decision. You need to be asking some questions. Read the bios provided about the doctors you will be seeing. Where did they go to school? What are their research interests? Your best friend may sing the praises of her doctor, but when you find out that her doctor specializes in triple negative breast cancer, you need to think twice if you are triple positive. You want a doctor with plenty of experience prescribing hormonal and targeted therapies.
You might find a health care services ranking website helpful. I checked out one from Medicare.gov. When I typed in my zip code, I was able to compare up to three hospitals at a time on all sorts of criteria. A person needn't be on Medicare to find this information useful.
You also need to know what your insurance covers. Most of the time, you will need to choose from specific doctors and hospitals in a network. If you feel you need to see a specialist out of the network, you will have to offer your insurance company facts about why the network facilities aren't sufficient and get pre-approval or you may find yourself with a huge bill that you didn't expect. None of the ads in the recent study even mentioned insurance--a crucial factor for most people.
Your type of cancer. Sometimes the decisions for treating cancer are clear cut. If you have an aggressive cancer that has spread to your lymph nodes, chemo may be clearly called for. But suppose you are on the borderline for whether chemo is advisable? Then a second opinion at a Comprehensive Cancer Center from a doctor who won't be treating you might be a good idea. If your cancer has already metastasized to your lungs (lung mets), then you need to see a doctor with experience treating breast cancer lung mets. You want the latest drugs and treatment methods, and it is worth traveling to find that facility. Hospitals that are designated as Comprehensive Cancer Centers by the government are the ones you want to seek out. You might end up deciding to be treated nearby with your local oncologist working with the specialist, but you need input from an expert.
Although I had a rare aggressive cancer, I chose to stay with my local doctors in a small city, and have a second opinion with a doctor at a big cancer center. That turned out to be the right decision for me, but it might not be the way you should go. As you see ads for treatment centers, pay attention to what they say and what they don't say. Every hospital has at least one feel-good success story to tell, but you want to know how many success stories they have. You need facts, not emotions.
Colwell, J. Study: Cancer Center Ads Long on Emotions, Short on Facts. CancerNetwork. May 30, 2014. Retrieved from http://www.cancernetwork.com/practice-policy/study-cancer-center-ads-long-emotions-short-facts Jan. 16, 2015.
Hamel, PJ. Are You Getting the Best Possible Care? January 12, 2010. HealthCentral. Retrieved from http://www.healthcentral.com/breast-cancer/c/78/100691/care
Johnson, P. Picking a Breast Cancer Doctor or Surgeon: Neighborhood Oncologist or Big Cancer Center? HealthCentral. April 1, 2008. Retrieved from http://www.healthcentral.com/breast-cancer/c/9692/23654/big-cancer Jan. 16, 2015.