10 things to look for in a cancer doctor
Since Richard Nixon declared the “War on Cancer” in 1971, billions of dollars have been devoted to cancer research. Over that time, we have learned a great deal about cancer, how it develops, and how it can be treated. According to the American Cancer Society, the death rate from cancer in the United States has decreased during the past two decades. We have seen a 23 percent decline in the cancer death rate since the early 1990s when it was at its peak.
Despite the progress made, we are still losing the war on cancer – and we are losing it badly. According to “Cancer Statistics, 2016,” published in CA: A Cancer Journal for Clinicians, a total of 1,685,210 new cancer cases and 595,690 deaths from cancer are expected to occur in the United States in 2016. Approximately 1 in 3 Americans will be diagnosed with cancer during their lifetimes, and that number is quickly approaching 1 in 2. In addition, many of the treatments employed today cause significant side effects.
Dr. Jonathan Stegall — founder of the Center for Advanced Medicine, one of Cancer Tutor's verified clinics — practices integrative oncology, which involves combining the best of modern medicine with natural therapies.
• Center for Advanced Medicine
• Dr. Stegall on Cancer Tutor
The treatment of cancer in the 21st century is at a crossroads. Many patients find themselves confused as to where to turn for the most advanced, up-to-date treatment recommendations. Thankfully, the internet has allowed patients and their family members to have access a wide variety of information about cancer treatment. I believe that a more informed patient is a better patient. However, the amount of information available can be quite overwhelming, and some of it is incorrect or misleading. The result is people being more confused than ever about cancer treatment options.
When you go to your conventional oncologist, they are typically going to recommend chemotherapy, radiation, and surgery, or some combination of these. All three are proven and effective therapies, but the downside is that they frequently damage the body’s healthy cells. Surgery causes local inflammation, a risk of infection, and can impact the function of surrounding structures. Radiation disrupts cellular genetic material (DNA) and creates harmful free radicals. Chemotherapy at the high doses used by most oncologists causes significant unintended damage to the body. With continued collateral damage to your healthy cells, several things happen:
- Energy levels decrease because the cells cannot make ATP (the body’s energy currency) as efficiently.
- The body’s immune system becomes weaker.
- Increased risk of side effects such as fatigue, nausea, vomiting, headaches, digestive disturbances, infections, gastrointestinal complaints, and decreased quality life.
We have a lot of research supporting surgery, radiation, and high-dose chemotherapy, and there are certain occasions when I recommend these therapies if I feel that they are the best approach for patients and their cancer. We must also recognize that these treatments are not without risk, and for many patients relying solely on these therapies they might not be the best option.
More importantly, these therapies are only a small part of what I believe is an extensive and well-equipped toolbox to fight cancer. Sadly, most cancer doctors stop with the three treatments. The reality is that we have many more tools at our disposal! Extensive knowledge of these treatment tools, whether their origin is in modern medicine, natural medicine, or ancient healing, is crucial in treating cancer optimally. That is what I do with my patients every day.
I see patients in my office from all over the country who are seeking an integrative approach to their cancer. I define integrative medicine as an advanced form of healthcare that combines the best of modern medicine with the best natural therapies. Integrative oncology applies these principles to cancer care. These treatments are hand-picked for each patient, based on each patient’s unique physiology and biochemistry. Thus, we combine both the science of medicine and the art of patient care.
To assist patients and their families in the daunting process of navigating their cancer treatment, I have assembled a list of the 10 things I feel you should look for in a cancer doctor. Review this list carefully, and look for these traits in the cancer specialist you have chosen. If your cancer doctor does not fulfill most of these criteria, I would strongly consider looking for a new one.
1. Thorough understanding of the body’s biochemistry and physiology
Cancer, as we all know, is a very complex disease. All medical schools in the United States teach its aspiring physicians about cancer, including how cancer cells form, grow, and flourish. This study of cancer requires many hours of learning about cancer across various disciplines, including anatomy, biochemistry, histology, pathology, physiology, immunology, and pharmacology. These principles are then applied to direct patient care in the hospital and in clinics. Once a medical student graduates from medical school – at which time the M.D. degree is awarded – he or she must choose a specialty. Those who ultimately plan to specialize in cancer treatment in adults must first complete a three-year residency in internal medicine. These grueling years of training, which include long hours and sleep deprivation, provide the necessary foundation for becoming an expert on the care of patients with a wide variety of illness and disease. After this training is complete, advanced training in oncology takes place where further specialization in cancer treatment occurs.
I feel strongly that cancer treatment should be primarily managed and conducted by a physician. This means that he or she must have attended medical school and earned an M.D. or D.O. degree, completed residency training (preferably at a top institution), and obtained the necessary advanced training and experience in the treatment of cancer. There are plenty of other healthcare practitioners such as chiropractors, naturopaths, acupuncturists, and nutritionists who see cancer patients, and while I feel that they offer valuable treatment modalities, I do not feel that they should be the ones primarily managing a disease as complex and aggressive as cancer. Proper management of cancer requires the extensive hours of study and patient care only possessed by a physician.
2. Spends plenty of time listening to you
The unfortunate reality of healthcare today is that most physicians are diagnosis- and treatment-focused, rather than patient-focused. The difference here is subtle but significant. All physicians must have the goal of being excellent diagnosticians and providing outstanding treatment, but I would argue that the patient-focused physician goes a step beyond and does these things in a way that honors, respects, and values each patient. This is because the patient-focused physician puts the patient and his or her needs first.
When I conducted research at Harvard Medical School on the doctor-patient relationship, I sought to learn more about the sacred bond between doctor and patient, and the effect this can have on the ultimate treatment outcome. There are several ways in which you can evaluate any doctor to determine if he or she is appropriately focused on you during the encounter:
- The doctor first asks you how you are doing or feeling.
- You are given an opportunity to express any concerns at the outset of the encounter.
- You are asked about your treatment goals.
- The doctor’s treatment recommendations are clearly communicated and thoroughly explained.
- You are given an opportunity to share your thoughts.
- You are allowed time to have all your questions answered.
I believe that the physician-patient encounter should be a respectful dialogue. The days of a doctor-dominated conversation, where the patient is not given adequate time to talk or ask questions, are over. If you are talked over or interrupted by your doctor, you should find another one as soon as possible. Ultimately, the job of your physician is to support you in receiving the treatment you prefer which best meets your needs and wants.
3. Obtains advanced lab testing
One of the best ways to monitor cancer treatment is through lab testing. When cancer is first diagnosed, lab tests called tumor markers are analyzed through a blood test. Some examples include CEA, AFP, CA 15-3, CA 19-9, CA 125 and CA 27.29. These each correspond to one or more types of cancer, and they are obtained at regular intervals to evaluate response to treatment. While these lab tests are important and should be used, they should not be our only way of evaluating a patient’s cancer through blood work.
4. Shows genuine compassion
Most doctors care about their patients, but some show more of a humanistic side than others. It is one thing for a doctor to be pleasant while reviewing your medical records and recommending treatments, but it is another to truly become invested in your care. Unfortunately, insurance regulations have limited the amount of time doctors spend with patients. The unfortunate result is that the scientific and technical aspects of care take priority, leaving the all-important emotional components of care deemphasized or ignored altogether. Here are some questions I have for you:
- How much does your doctor know about you?
- Does he or she know where you grew up and/or where you are from?
- Has your doctor asked about your spouse, family, children, and loved ones?
- Does your doctor know what your hobbies and interests are?
I make it clear to my patients that I am their advocate. They have someone who is going to lock arms with them and do their best to work toward a positive outcome. I tell patients that they will be treated like family when they are in my office. I decided early on to take this approach because I went into medicine to care for others. Make sure your doctor has this quality because you will need his or her compassion, support, and devotion during the course your treatment.
5. Creates personalized treatment protocols
A one-size-fits-all approach to medicine does not work. Under no circumstances do I support the idea of practicing “cookbook medicine,” where one type of cancer automatically gets a specific treatment without taking other factors into consideration. Doctors who merely look at a patient as a list of diagnoses that must be treated in a rigid and specific way are not going to be nearly as successful as doctors who look at each patient individually. This is because every patient is different.
Let’s imagine that we take two patients with the same cancer, and give them the same treatments. Do you think they will have the same exact response to treatment? Of course not! This is because the two patients have different internal environments. Each person’s internal environment is a result of:
- Pre-existing medical issues
Basically, your body’s unique biochemistry and physiology are the results of the cumulative effect of everything you have been exposed to from the time you were born until now. These exposures also affect how your body responds to treatment. In essence, our internal environments are like snowflakes – no two are alike. So, it only makes sense that no two patients should be treated exactly alike either.
This is why it is so wonderful that we have so many tools in our toolkit. For example, in my office, we have many great therapies from which to choose, including:
- Fractionated (low dose) chemotherapy, which allows us to safely give chemotherapy more often without the side effects typically seen with high dose chemotherapy;
- Insulin potentiation therapy (IPT), which is a delivery system for providing chemotherapy in a more targeted way;
- Intravenous nutrition, including high dose vitamin C, minerals, and antioxidants;
- Supplements, including herbs, vitamins, and other nutraceuticals;
- Nutrition, which is specific for cancer treatment;
- Mind-body medicine, including prayer, meditation, and proper mindset.
The therapies chosen are based on a thorough review of each patient’s cancer diagnosis, medical history, test results, and treatment goals. This is why we call it personalized medicine.
As Sir William Osler stated, “The good physician treats the disease; the great physician treats the patient who has the disease.”
6. Emphasizes the importance of nutrition
I am amazed at the number of patients who tell me that their oncologist told them that nutrition doesn’t matter. I suspect that this is the result of nutrition being under-emphasized in medical training. However, for doctors who claim to practice evidence-based medicine, it amazes me how so many fail to recognize the abundance of research showing how important nutrition is.
I view nutrition as the foundation of any good cancer treatment protocol. We know that cancer cells have unique behaviors not found in normal, healthy cells. Proper cancer nutrition will target these specific characteristics of cancer cells, while also providing healthy cells with the nourishment and protection they need.
I also view supplementation as a component of nutrition. While the things we eat and drink are vital, they are not sufficient to treat cancer. By strategically adding physician-grade nutraceuticals such as vitamins, minerals, herbs, plant extracts, and antioxidants to cancer protocols, we are giving the body what it needs. It is a requirement that these supplements be the highest quality supplements. Simply buying something you find online or on the store shelves is not adequate, and could even be harmful.
7. Views himself or herself as a consultant
Is your cancer specialist a consultant? Does he or she provide you with the details of your cancer treatment, including why each treatment was chosen and what it is intended to do? Are you provided with potential outcomes, including possible side effects? Are you informed of all your options?
Armed with this information, you should be at the center of the decision-making process. I always tell patients that I will provide my recommendations in an honest and straightforward way, but that the treatment plan is one that we come up with together.
Patient empowerment is crucial, especially when dealing with cancer. Although I am an expert in this field, it is not my job to demand that you undergo certain treatments. Rather, my job is to provide as much information as possible to allow you to make informed decisions which you feel are best for you and your treatment goals.
8. Tends to your spiritual needs
Has your cancer physician asked you if you have any religious or spiritual beliefs? If not, it is a shame because there is a lot of evidence showing that patients who have a spiritual practice have better outcomes than those who do not. I feel strongly that your spiritual practice, whatever it is, should be a meaningful part of your cancer treatment journey. It should bring you hope and peace, and should ideally be supported by those who are closest to you.
For example, I am a Christian and pray for all my patients. I am also happy to pray with my patients and do so regularly. For those patients who share a different belief, I do my best to support them in their beliefs by making sure that they are connected with others in their lives who provide them with spiritual guidance.
Spiritual health cannot be separated from your overall health, as it is an important component along with your physical, mental, and emotional health. Find a doctor who treats the “whole person” and supports you in your spiritual practice.
9. Recognizes the importance of having a good support system
When it comes to cancer treatment, you cannot go it alone. From the moment you hear those three life-changing words “You have cancer,” having others support you in your journey is essential. It is my hope that anyone going through cancer will have at least one advocate, whether it be a spouse, sibling, parent, adult child, relative, or close friend. This advocate should ideally be available to:
- Accompany you to appointments (especially those appointments involving a review of test results and specific treatment options)
- Spend time with you
- Show you affection (this can be as simple as giving you a hug or holding your hand when you need it)
- Lend a listening ear or shoulder to cry on
- Celebrate your successes
My office staff and I pride ourselves on being an integral part of our patients’ support system. We like to say, “Let us do the worrying for you.” It is our job to take care of the little details regarding your cancer treatment, and I have structured my office environment accordingly. I feel that this is very important. Look for a doctor who supports you and encourages you, rather than gets upset with you. Look closely at the office staff, and see if they look like they enjoy their jobs or not. Ask yourself if those who are caring for you are service-oriented. Seek out an office with a pleasing, calming environment rather than a cold, sterile one.
10. Has a plan for proper follow-up
Cancer is an extremely aggressive disease. Even when certain treatments are effective in killing cancer cells, the remaining cancer cells are always looking for a way to continue to survive and grow. Therapies that have been effective might not continue working over time, as cancer cells can change forms (a process known as mutation). Thus, continued monitoring is essential.
There are several ways in which we should monitor cancer treatment effectiveness, including:
These are lab tests run by virtually all oncologists, which reflect the activity of cancer cells. The tumor marker(s) measured will depend on which type of cancer a patient has.
The best way to measure cancer cell activity is via a PET scan. It uses radiolabeled glucose, which causes the most glucose-loving cells (i.e., cancer cells) to light up. Other forms of imaging might be used as well, including MRI scans, CT scans, X-rays, and ultrasounds. The risks versus benefits of radiation exposure must be weighed against the need to see pictures of what is going on inside the body.
Follow-up testing through the Research Genetic Cancer Centre
I use testing from R.G.C.C. in Greece to not only obtain a baseline level of circulating tumor cells but also to monitor the changes in these extremely important cells in response to the integrative therapies all top oncologists should be using.
I tell my patients that cancer is a lifelong diagnosis, even when we ultimately achieve normal blood work and imaging results. The moment we let our guard down is the moment cancer can once again obtain a foothold.
As you can see, a lot goes into proper cancer treatment and management. You owe it to yourself to find a cancer specialist who has the training, knowledge, and treatment protocols to meet the needs of you or your loved one. In fact, you deserve it!