QUESTIONS TO ASK YOUR ONCOLOGIST?

Here are important questions you should ask your Oncologist.

Question everything. If you or your loved one are being prescribed a medication [especially chemotherapy], ALWAYS ask to see the statistical studies and warning labels which are required to be read by physicians. Obviously, they don’t have the time to study them all. Don’t be surprised if the oncologist blows you off or becomes short and ill-tempered with you. He is usually just repeating what his Pharmaceutical Sales Reps have told him. You MUST make the time. He MUST make the time. Please have your goals of treatment in mind and written down. This is one of the most important conversations you may ever have. No question should be off limits.

1.) Is it alright if I record this conversation?
When life and death decisions are at stake, conversations with oncologists and other physicians take on enormous importance. If the doctor objects, this is a big red flag. In addition, sometimes these conversations take place when the doctor is very busy. Given the subject, the hurried bedside manner of some physicians, and the emotional intensity for the patient and family, it can be very hard to listen, understand, and ask appropriate questions. Recording important conversations with your doctor(s) about treatment options is an excellent way to provide a record so that you can:

  • concentrate on listening;
  • not worry about taking notes;
  • focus on your questions;
  • replay and review the conversation in a less stressful environment such as your own home to fully comprehend what the physician communicated. It is always a good idea to use the first few seconds of the recording to have all the parties acknowledge that the meeting is being recorded with their permission. In the Philippines there are legal ramifications if permission is not obtained for recorded conversations.

2.) Why do I need the chemotherapy?

3.) Why aren’t we considering Immunotherapy instead of chemotherapy?

4.) Do you have experience with Immunotherapy?
If your oncologist speaks against Immunotherapy, find out why since it’s now the gold standard for treatment in the U.S. Understand that chemotherapy is how the majority of oncologists earn their income.

5.) What is the goal of the chemotherapy?

6.) Is this intended to be a curative or palliative treatment?
Palliative treatments are intended to provide relief from the symptoms, pain, physical stress, and mental stress of a terminal illness. Their role is not to cure or prolong life.

7.) Are there other treatment options for me and is chemotherapy really the best option for my situation?

8.) What are the risks, benefits, and possible complications for the chemo?

9.) How often do your patients experience any problems?

10.) Did you send my pathology to another Doctor for a second opinion?
The pathology of your tumor cells tells pathologists whether or not you actually have cancer and what kind. Having a second look/opinion by another pathologist from another hospital helps ensure that you have been properly diagnosed. There have been unfortunate situations when patients have been treated inappropriately because the wrong kind of cancer was diagnosed. In many hospitals it is standard practice to “send the slides out” for a second opinion. You may want to check to ensure this step was taken in your case and find out who rendered the second opinion and what they concluded. I have encountered countless patients who came to me after being treated with cancer when there was never ANY evidence of cancer.

11.) How many patients have you treated with my diagnosis/type of cancer?

a.) Which treatments did you use?
b.) Are any of the patients still alive?
c.) How many have survived more than 5 years? 10 years? 20 years?
d.) Can I speak with some of them to see what the quality of their lives has been like – during and post treatment?

You want to get a good idea of what the oncologist’s experience is with the various treatments being recommended. You should find out how many patients (your age with the exact same cancer) they have treated with each therapy. Ask if you can speak to these other patients. Other patients (like you) who have been administered the same therapy by the same oncologist(s) can provide valuable insight into what to expect.

12.) What is your specific treatment plan for me?
Find out how many times they have used this plan before on a patient.

13.) What evidence can you provide that shows success with your treatment plan for me?
This is critical to find out. How many patients survived the treatment and were able to resume a normal life.

14.) Can you show me where the survival information comes from? Is it reported in the peer-reviewed published medical literature? Can you give me a copy of the article(s)?
Monthly medical journals provide survival information that your doctors should be familiar with. The oncologist should be able to support any survival/prognosis claim they may make with data or published studies that they can share with you. Be wary, if they cannot support their claims of a potential cure with medical studies or with examples of other patients they have treated. Be very wary if they do happen to produce articles that are industry funded without secondary scientific verification.

15.) What lifestyle and dietary changes will I need to make to improve the outcome of the chemotherapy and protect my body during treatments?

16.) Since the vast majority of cancer is shown to be a direct result of lifestyle, what are some of my specific lifestyle risk factors that contributed to me getting cancer?

17.) Did any of your patients have side effects from the treatment?

  • What were they?
  • What was the worst side effect?
  • Did anyone die from the treatment, not the cancer?

Some patients do not die from their cancer, but from the treatment. You should ask questions to learn how toxic the therapy is.

18.) How can you help me with the side effects of this treatment?

19.) Do you have patients who have gotten worse under your care? Why? What happened?

20.) Are these drugs FDA approved specifically for treating my cancer?
Many cancer drugs are not FDA-approved for the use for which they are prescribed. (This is called “off-label” use.) In fact, some drugs that are widely used for a particular cancer may never have been approved for safety or efficacy for that use by the FDA. It is valuable to know if any of the drugs the oncologist intends to prescribe would be used “off label” and if so, why the oncologist is comfortable with that use in your body.

19.) What percentage of your patients with my diagnosis/type of cancer have been cured?

20.) What are my chances of being cured? How did you come up with that number?

21.) Do you have any financial or research interest in this treatment you are recommending? For example, are you being paid by a drug company when you prescribe these drugs? Do you consult for the drug company that makes these drugs?
Some oncologists have financial arrangements with various drug makers or other financial incentives that could be construed as a conflict of interest. You should find out whether your doctor(s) has any financial or research interest in recommending a certain treatment.

22.) If you order a CT scan, MRI, tests, or a chemotherapy drug, do you get a commission, rebate, or kickback? How much do you get?

23.) Before the treatment, will I be required to sign a waiver that releases you or the hospital from any harm caused by the treatment?

24.) What legal solutions are available to me if the procedures administrated to me by this hospital hurt me?

25.) How much will my treatment cost me?

26.) How much profit will the hospital make from my treatment?

27.) How much profit will you make from my treatment?

28.) If you were me, would you take the treatment that you are recommending?

29.) Were you aware that chemotherapy was shown to be 97% ineffective for cancer in numerous scientific articles, especially in the treatment of adult onset cancer in a study published in the Journal of Clinical Oncology in 2003? see: http://www.ncbi.nlm.nih.gov/pubmed/15630849 and http://www.icnr.com/articles/ischemotherapyeffective.html

30.) So, if it’s been shown to be 97% ineffective, why are you recommending that I do it?

31.) Do you have a plan to address my circulating tumor cells?

32.) How will you support my immune system during treatment?

34.) What is my prognosis with no chemo?
Comparisons are very seldom made between the results of a clinical trial and those patients who received no adjuvant treatment (i.e. no therapy beyond surgery). When survival and quality of life comparisons are made, they are usually made between two or more treatments, not between treatment and no treatment. It is very difficult, therefore, for an oncologist to objectively answer the question how long the treated patients lived and what was their quality of life compared to those who received no adjuvant therapy. Nonetheless, it may be of interest to ask your doctor for a reference/study that discusses this. Be advised that such studies may not be available.

Remember, if a drug or regimen has not been proven to cure, significantly prolong actual survival, or improve the quality of life — if it only temporarily shrinks tumors, with a probable loss in well-being — then it is at most entirely experimental, unproven and should not be represented as anything else. At worst, it could be not just ineffective, but painful, destructive — or even fatal.

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