Here are important questions you should ask your Surgeon.

Question everything. If you or your loved one are being prescribed surgery, ALWAYS ask to see the statistical studies and risks which are required to be disclosed by physicians. Do not be surprised if the surgeon blows you off or becomes short with you. He is usually just repeating what his Professors taught him. You MUST make the time. It’s a sure sign that you’ve jumped into a circle of dogma when the very act of asking intelligent questions is no longer allowed. 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 conversation 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 this operation?

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

4.) Do you have experience with Immunotherapy?
If your surgeon speaks against Immunotherapy, find out why since it’s now the gold standard for treatment in the U.S. Understand that if he doesn’t perform surgery, he doesn’t earn income.

5.) What is the goal of the operation?

6.) Is this intended to be a curative, debulking or palliative surgery?

  • Debulking is the reduction of as much of the bulk of a tumour as possible.
  • 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 and is this operation the best option for me?

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

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 actually having 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 surgeon’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 treatment plan for me pre and post op?
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?

a.) Is it reported in the peer-reviewed published medical literature?
b.) Can you give me a copy of the article(s)?

Monthly medical journals provide survival information that your doctors should be familiar with. The surgeon 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 surgery and protect my body during treatment?

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 surgery?

a.) What were the side effects?
b.) What was the worst side effect?
c.) Did anyone die from the treatment and not the cancer?

Some patients do not die from their cancer but from the treatment. You should ask questions to learn the risks of the procedure.

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

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

20.) (For breast cancer) Since mastectomies have been largely abandoned in most 1st world countries in favor of lumpectomies for nearly 30 years, why are you recommending it for me?

21.) (For prostate cancer) Since “watching and waiting” has been shown to be a better approach than surgical removal of the prostate for the vast majority of cases, why are you recommending the surgery to me?

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

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

24.) Do you have any financial or research interest in this treatment you are recommending?

a.) For example, how much are you earning to perform this surgery?

Some surgeons have financial arrangements 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.

25.) If you order a CT scan, MRI, tests, or any other procedures, do you get a commission, rebate, or kickback?

a.) How much do you get?

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

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

28.) How much will my treatment cost me?

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

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

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

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

33.) How will this treatment change the cancer environment: will it only remove some of the cancer cells and leave me vulnerable when the cancer stem cells go on to create more cancer?

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

35.) What is my prognosis with no surgery?
Comparisons are very seldom made between the results of a clinical trial and those patients who received no treatment at all. 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 any surgeon to objectively answer the question of how long treated patients lived and what was their quality of life compared to those who received no surgery. 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 procedure has not been proven to cure, significantly prolong actual survival, or improve the quality of life — if it only temporarily debulks 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.

oncologic-ethicsOncologic ethics

is-stage-4-cancer-curable-using-chemotherapy-radiation-or-surgeryIs Stage 4 Cancer curable using Chemotherapy Radiation or Surgery (8:04)