Expert, ease


Finding a specialist is the most critical aspect of cancer survival

The term 'life expectancy' often accompanies a cancer diagnosis. Simply put, it is how long the person will live after the diagnosis, and is derived from statistical evidence and the prognosis of the type of cancer.

I often meet people who have lived for 10 to 15 years longer than they were given. For instance, when Shiela was first diagnosed with leukaemia and dialysis dependent kidney failure, she was given three months to live. However, she beat the average life expectancy prognosis and has survived for eight years.

“In my mind, dying wasn’t an option,” says Shiela. “When you are facing cancer, you want answers, you want hope. I wanted someone board-certified in haematology. My initial oncologist was not. When it came to challenging questions, such as drugs perhaps causing secondary cancers, it was evident that his general area of expertise of medical oncology had not prepared him for the question. I never got a straight answer from him. That was not necessarily his fault; haematology just wasn’t his speciality. I wanted someone who, by training and by interest, would be keeping up with the very latest in the world of leukaemia and other blood cancers.”

While one aspect of Shiela’s progress is related to her disease type and her physical response to drugs, a lot of credit goes to the level of care she got. Her doctor was trained in oncology as well as haematology, and was abreast of the latest treatments and techniques.

One multiple myeloma (plasma cell cancer) patient I know said the local oncologist never suggested any options. Instead, he insisted that a newly diagnosed myeloma patient get an allogeneic (donor) stem cell transplant, which is typically saved as a last resort. Yes, this is an extreme example, but I have heard a number of stories where obvious options were not discussed.

There is nothing more critical to cancer survival than the selection of a cancer specialist. Studies and surveys show that cancer patients treated by specialists tend to survive longer. Says Dr Lalit Kumar of All India Institute of Medical Sciences, New Delhi: “There is ample data showing that the outcome for patients treated by specialists is better than the outcome for those treated by generalists. There have been careful studies in gynaecological cancers, colorectal cancer, brain tumours and sarcomas, which show that compliance to treatment and completeness of surgery are better when treated by specialists.”

But why is it so? Well, cancer surgery can be challenging, involving techniques not routinely encountered by generalists. For example, in early stage ovarian cancer, data shows that women operated on by trained gynaecological oncologists get better results than those operated on by general gynaecologists.

In addition to finding a specialist oncologist, it is equally important to find the right cancer centre. “Even for rare cancers, the outcome is better if treatment is done in a centralised treatment facility,” says Kumar. In rare cancers like mesothelioma (cancer caused by exposure to asbestos), finding a right cancer treatment centre may not be an easy task, but it could well be the most important one. Making the right choice could add those extra years to your life.

At a specialised cancer centre, you have a team of interdisciplinary health care professionals working together to manage your care. A team of nurses manages your tests and medications, and the primary care physician works with specialists to coordinate care.

The first resource is always and obviously your current medical oncologist. You can ask him for references of specialists whom you may consult for a second opinion. The next step would be to spend some time looking for centres that specialise in your cancer type. Ask your family, friends and other patients for recommendations. Even if the centre cannot accommodate you, most of them have affordable boarding facilities nearby.

Having a surgeon, oncologist and assorted therapists in your medical team should be the rule and not the exception.

Priya V. Menon is scientific media editor at TrialX/Applied Informatics Inc. She manages and hosts CureTalks, an international online radio talk show on cancer research and health care.

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