Arun Kalra, M.D.
Oncologist/Hematologist

GETTING CANCER TREATMENTS TO GIVE BEST RESULTS

1.   Ask your doctor if any mutations were reported in the cancer pathology report that would influence the type of chemotherapy to be chosen for you. This clinical practice called 'personalization of therapy' leads to better treatments for certain cancers. These treatments are more effective and with fewer side effects. Some common mutations have been named: ALK, ROS and EGFR in Lung cancer; K-ras, N-ras and B-raf in colon cancer, and B-raf in Melanoma. More of of such mutations are being discovered. This development will change how cancers get treated in the near future.

2.   Ask if the intended chemotherapy has been recommended by National Comprehensive Cancer Network (NCCN) and if this was well rated (such as a rating of 2A or above). NCCN is a network of most of the cancer treatment experts in the world and they frequently revise the best treatment recommendations for different cancers. They rate their own recommendations as 1, 2a, 2b and 3, in decreasing order of preference. They are also beginning to make recommendations based on Effectivity, Adverse Effects, Consistency of data, Quality of data and affordability of cancer treating drug combinations.

3.   Ask if the Oncologist has written treatment plans for the cancer that you have. These plans give a timeline of various planned interventions such as chemotherapy administration and intervening intervals, timing of lab and Xray tests and duration of treatment programs. These plans come highly recommended by American Society of Clinical Oncologists. These can help plan your life around the treatment.

4.   Make sure your Oncologist gets all the information about your illness before you go to the office. Keep duplicate copies of all your information and carry it during the office visits. Whenever possible, keep the multipage documents together with paper-clips. Minimum essential information includes pathology-biopsy report, surgical-pathology report if surgery has been accomplished after the initial biopsy, and all radiologic imaging reports pertaining to the diagnosis. It is ok to take older radiology reports if that helps to compare the old with the new. A clinical visit note from the referring physician helps with the details and avoids duplication of questions. Do carry information on past therapy of the cancer if you have already received some.

5.   Write down all your questions and group them under headings like ‘type of therapy’, ‘length of therapy', ‘cost of therapy', ‘what studies are done to monitor disease improvement’, 'what studies are done to monitor toxicity’.

6.  Beware of life threatening toxicities of chemotherapy and how to look for them. Be aware of the remedies to the toxicities and ask the Oncologist to advance prescribe them, such as nausea medications, Look for plan B if the first remedy is not working. Call the doctor sooner than later. And call again if necessary.

7.  Carry a list of all the medications you take, including the chemotherapy drugs. Carry it where an Ambulance crew can also find it.

8.  Make sure your Oncologist knows the other serious illnesses you may have, such as heart failure, kidney disease.

9.  Ask the Oncologist if special cancer emergencies can happen in your cancer, such as blockage of an organ, bleeding, obstruction of circulation, such as obstruction of superior vena-cava, loss of walking ability due to sudden pressure of a cancer mass on the spinal cord,  (this is the sensitive nerve-tissue inside the spine) or kidney failure due to chemicals released by dying cancer cells (Tumor Lysis Syndrome).

10.  Try not to delay the chemotherapy due to social reasons like vacations, as schedule and dose intensity are important to your Cancer management. Dose intensity is the amount of chemotherapy delivered to the cancer in a certain length of time.
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