Having an Open Dialogue With Your Physician

Transcript: Philippa Cheetham, M.D.: We’ve talked already about the kinds of questions that patients should be asking, obviously the treatments, the side effects of treatments, the benefit of treatments, and of course all the other concerns that patients bring to us about, exposure to children if they’re having chemotherapy, radiation therapy, whether they can work. Do you think there are obvious questions that we know that patients should ask us that may not necessarily be at the forefront of their initial discussion with specialists like yourself?

Edward Kim, M.D., FACP: It is always very intimidating for patients to be in a doctor’s office. We show up with our teams, they’re sitting down, we’re standing there. There’s never enough seats for all of us to sit, so we’re standing over them. They might be sitting on the gurney or maybe they’re sitting in a chair. They need to make sure and call time out, and I’m going to look right in the camera, let’s use this one and tell patients, look, if things are going too fast, then slow it down. Ask the questions.

Every doctor is busy, they want to get to their next appointment they have, they’re overbooked. They’ve got all these things to do, but take your time. Ask the questions that you need answered and expect it. And if they need to send somebody else in like we talked about, an ACP [advanced care provider], a pharmacist, a nurse navigator to help, then absolutely. But get the answers. You don’t want to get home and say, gosh, what just happened? How am I going to get these answers? And then go to the internet and then some bad things can happen when you read things on the internet, as we talked about.

So I really think it’s important to ask about the treatment. What are the options? Are there clinical trials available? Not every doctor knows every approved drug out there. And so if you have someone who is more of a specialist in lung cancer, just as you’re a specialist in GU [genitourinary] malignancies, one sees, we know what’s out there. We know what people are doing. If you’re a general oncologist, it doesn’t mean you have less IQ or anything like that, you just have to cover all the different tumor types. There’s no way I could do that. It’s way too much information.

Philippa Cheetham, M.D.: It must be quite difficult when you know that you’re working in a center of excellence and you can offer this whole treatment package, the evidence-based with excellent outcomes. And then the patient says, well, that’s great, Doc, but it’s really not convenient for me to do the two-hour trip, particularly for radiation and chemotherapy where it’s not a one-off. It’s much more convenient for me to get treatment close to home where I can get transport to and from the hospital. Of course, we know that cancer has a huge financial as well as emotional burden for patients. Do you counsel patients about the fact that care closer to home may not necessarily result in the best outcome, or is it possible for you to guide clinicians closer to home in the community, so that patients can get the best of both worlds?

Edward Kim, M.D., FACP: It’s easier for me as I’m just a simple medical oncologist. We don’t have the same sophistication as our radiation or surgical colleagues. And so I will, even when I was in Houston at [The University of Texas] MD Anderson [Cancer Center], I would tell people, get your chemotherapy close to home. As long as we’ve got a board certified medical oncologist, they know how to give infusions, their infusion unit knows how to do that. But I do think the decision-making points when we restage and we need to think about whether we continue or we change therapies, you do want to have somebody who is a specialist to help make those decisions. Part of the reason why I moved to Charlotte to be at Levine Cancer Institute to help start this new institute was our motto is “A cancer center without walls.” We actually have 26 locations throughout North and South Carolina, and we use pathway-driven, evidence-based software to help people deliver that local care.

Philippa Cheetham, M.D.: So it’s standardizing care across those states, basically. It’s great. It’s really important for patients to know that.

Transcript Edited for Clarity