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CATEGORIES [ TREATMENT, GENERAL ]

With rare cancers, information and support can be hard to find

BY GUEST BLOGGER | FEBRUARY 24, 2014

Les Mahler

Most any diagnosis of cancer is filled with worry and bad thoughts, but when the cancer diagnosis comes with the words that it's a rare cancer, the words are more than devastating, they're horrifying and nerve-racking.

How rare, what's the prognosis, why me, what did I do, what can be done and what are my odds or chances on recurrence and dying?

At least that was my reaction when I was told in 2007 that the tumor behind my right eye was adenoid cystic carcinoma; the more difficult part was the pronouncement by the oncologist that the cancer was incurable and fatal. "You will certainly die because of the cancer."

Wow, could it have been told in a gentler way, without the windows closed and dark curtains drawn all around?

After the surgeons and oncologist left, I took a half hour to myself and cried, uncontrollably. I needed that time to understand the magnitude of what had been said to me, and then I straightened up, took a deep breath, looked around and realized I was still alive and the cancer was just a disease like any other disease. All I had to do was find out more about the cancer and try to live life as best as possible.

The problem was gathering information about adenoid cystic carcinoma is that there's such scant information out there. Plus, what information is out there is sometimes so outdated and wrong.

For example, how many people are diagnosed each year with ACC, is it 1,200 or 1,500 or a lesser number? And what are the survival rates in terms of years? Different sites, different information. I wondered should I just pick my own numbers.

The other problem was finding an oncologist who had at least some experience with this type of cancer. The first one put it very bluntly, "30 years as an oncologist and you're my first ACC patient; I can't help you."

The second oncologist put it more mildly, "I know nothing about your cancer. I'm flying blind and learning as we go along. You probably know more about this cancer than I do."

My third and current oncologist hasn't said what he knows about this cancer, which I guess is good. During a visit, I did ask him if he's treating me like any other cancer patient, wondering if this cancer is different than other cancers.

It sure looks as though he's treating my cancer like any other cancer, with the standard six months between tests and check-ups.

I did pick five years as the starting number for survival rates; that sounded good but by 2012, a new tumor had been found pushing against the brain. It actually started growing in 2011 but it was missed, even with the MRI and contrast.

My oncologist gave me the bad news, there's nothing that can be done, surgery is out because the tumor had grown around a major blood vessel. If we tried surgery, I would die on the table. Oh, not good.

Chemotherapy has never been and was not an option with ACC because the cancer is so relentless.

It was almost as though the oncologist didn't have an answer; that he was at the end of the rope: and then, one last hope, radiation. But how much and how long, and would it be safe considering I had had radiation in the same general area in 2007; plus, this time there would be radiation to the brain. Thank God for Stanford.

Their recommendation, eight weeks of daily radiation and all will be good to go. Of course, with this cancer there is no good to go, ever.

On Jan. 2, news came that a growth had been found in the left lung; for now it's all observation and then a fine needle biopsy (I had that done for the eye in 2007, so no worries there).

What I've discovered in my cancer journey is that there is no ready-set information about adenoid cystic carcinoma. Yes, it is a rare cancer, and as such, there is little information out there on how to treat it and what to expect.

Also, there is little research being done leaving ACC patients to wonder why? Is it because this cancer affects so few? I know many ACC patients feel like we're the pariah, the black sheep of the family. I have noticed that ACC patients themselves have started their own websites for information on this cancer; only we understand what we're going through so it would stand to reason that we'd reach out to help each other.

We have several sites on Facebook, where we exchange information and often support each other as we fight this cancer; the sad part is so many new people are joining these sites and then there are the ones we say goodbye to...too often and too many. As for me, I am spending time with childhood cancer patients and helping raise funds for research.

Les Mahler is a journalist, copy editor, song writer, children's story writer, photographer, and an adenoid cystic cancer survivor since 2007. He's on his third fight against ACC.

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CATEGORIES [ TREATMENT, GENERAL, BREAST CANCER ]

Silicone implants and a pouty lip

BY GUEST BLOGGER | FEBRUARY 20, 2014

Carrie Corey

No, I'm not a celebrity – I'm a breast cancer patient.

For people living with metastatic disease, oftentimes medicine side effects are worse than the symptoms of the cancer itself, and such is the case for me today.

Two weeks ago I started taking a new drug (Afinitor) that studies have shown can dramatically increase patients' response time to my current medication (exemestane). As with any new drug, my medical team went over the side effects before writing the prescription; I admit I've somewhat started tuning that part out – it makes me feel like I'm watching a TV commercial for an erectile dysfunction drug. "Yuck!!! Who would want to take that?"

For me, when we're talking about LIFE-SAVING medicine, the benefit will almost always outweigh the negative side effects. I don't mean the debilitating side effects, I mean the manageable ones: I've lost my hair twice, I've had black fingernails, lost toenails....blah, blah, blah... diarrhea or constipation? Fatigue, aches and pains? You know the drill. If the drug works and gives me the quality of life to enjoy being a wife and a mom, I'm in. And so we start down the new path.

Now, when cancer drugs say you might get mouth sores or a rash, they don't mean an annoying cold sore or an itchy hand like "normal" folks might complain about. They mean painful, fire-breathing mouth sores and a rash that makes you want to scratch your skin off. While I don't have the rash on this one, I am not exaggerating about the mouth sores. The sore is inside my mouth, but my bottom lip is so swollen it looks like I was punched in the face.

Seriously.

When I dropped Henry off at school this morning, Chris was paranoid the teacher would think he is an abusive husband. It is HUGE. I am talking with a lisp, and I can't even sip my morning coffee without dribbling all down my shirt. Good times!

Like most aspects of cancer, there's also a mental battle going on here. My pride tells me I can do anything I want to do – that cancer doesn't have a hold on me. So I am determined to keep taking a good drug, even if it means dealing with some annoying side effects.

But I can hear the words of my oncologist's nurse, reminding me I can easily land myself in the hospital if side effects get out of control. Or worse, have to discontinue the medicine for good.

There's a thin line separating "deal with it" from "call your doctor."

Whereas last week I thought I could power-through, today I cried mercy. This morning's count was eight mouth sores, which makes me not want to eat, drink or talk! Darn it. I called my doctor, who gave me a few days off meds to let my mouth clear up with the help of some prescription goodies. Hopefully next week I can try it again.

I'm going to enjoy my weekend, pouty lip and all. Since I refuse to be a hermit, I will likely encounter strangers who ask what happened. There's no way to quickly explain how breast cancer caused my fat lip, so I need to come up with a better story or else I'll end up telling my life story to the checker at the grocery store. Right now I have three good options.

1. My two-year old Henry threw a ball and hit me in the face.
2. I just started taking a kick-boxing class.
3. You should see the other guy!

What do you think? Any suggestions?

Carrie Corey was diagnosed with stage 2 breast cancer at age 29 and with a stage 4 recurrence in 2012 at the age of 31. She is a wife and new mom living in Dallas, and will be reporting frequently on her cancer experiences.

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CATEGORIES [ GENERAL ]

All dogs go to heaven

BY KATHY LATOUR | FEBRUARY 10, 2014

Kathy LaTour blog image
I was reminded last week of the value of pet therapy when I lost my sweet labradoodle Edith (Edie). What was to have been surgery to remove some kind of blockage in her stomach, which we all decided was a sock, turned into an inoperable condition from which she could not recover.

I haven't cried that hard in years, and it reminded me just how much of a family member Edie was. She was my girl, my buddy, my confidant. And more than anything she was the source of unconditional love of the kind you only get from your mother -- if you were lucky.

I have always had dogs, both growing up and in my adult life. My Irish Setter Erin lived with me through my 20s and was such a great guard dog that the plumber came, fixed the sink and didn't know there was a dog in the house until the plumber came out from under the sink and met Erin eye level for a big sloppy kiss. I guess that was her way of saying, "I got my eye on you."

I rescued Edie three years ago as a 1-year-old who was full of life and fun. She had never been abused and was ready to get on with the business of living. I found out she was an F1 labradoodle at the dog park when one of the folks in the casual discussion group I was standing in asked me what kind of dog she was.

I said she was a labradoodle. Well, he snorted, "I don't think so,"as he pointed toward a huge black dog (His). "That's a labradoodle." OK, so what, I thought, I really don't care. That's what they said she was on the site where I found her. I learned later that he had a designer labradoodle, and I had the first iteration, meaning one or the other of Edie's parents was a poodle and the other a Labrador. Edie could care less. She just wanted to win the ongoing dog chase where all the dogs chased her. She would collapse on the back seat on the way home, deliriously happy that once again she had outrun the crowd.

The studies that have come out on the power of our animal friends have been compelling evidence that we all need one. Heart attack patients who owned pets lived longer than those who didn't, petting your dog lowers your blood pressure and increases oxytocin.

Dogs are helping with veterans who have PTSD and doing lots of other good stuff that you can read about at the Research Center for Human/Animal Interaction. And anyone who has loved a dog will tell you that they know when you are upset.

Edie was not allowed on the bed, but on those nights when I was struggling with something, I could always count on turning over to see her big brown eyes looking at me. "It's OK, Mom, I am here. Go back to sleep," they said. And I did.

Rest in Peace, Edie.

Edie

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CATEGORIES [ GENERAL ]

Whatever it takes

BY GUEST BLOGGER | JANUARY 9, 2014

Carrie Corey

For those of you who aren't familiar with the "whatever it takes" style of parenting, it's basically doing whatever it takes to keep everyone alive, well and happy. It's when you swore you would never give your child candy yet you're stashing suckers in your purse. I have (on more than one occasion) actually had to place a banana peel on the grocery store conveyer belt. Yep, I just paid for a banana peel, but it kept my child from screaming in the produce aisle...whatever it takes, right?

A friend with muscular dystrophy told me she often feels judged at her daughter's preschool when making her toddler walk inside the building, instead of carrying her like the other moms. When you have health issues – be it MD, cancer or something else – you have physical limitations other people don't understand. So what if you make your child walk into the school herself or teach your toddler how to climb into his own car seat.

Do whatever it takes to keep going.

And that includes ignoring guilt about not being the perfect parent and nasty looks from people who think such a creature exists. As a wife and mom living with cancer, I have started applying the whatever it takes theory to other areas of my life as well. While a "normal person" might say he/she has a lot on their plate, some of us have plates the size of a turkey platter. My day to day can be pretty heavy, so I give myself a pass on the little things like laundry to fold or dishes to wash.

I went in for my last PET of the year, and while overall I am still doing well, my cancer is starting to resist my current medication. Which means a new drug (but not back in the chemo chair yet!) and surgery. Instead of thinking about the big picture of what this means or the number of medications I haven't crossed off the list yet, I keep my sanity by taking the tactical approach. After all, I am a list maker.

1. New drugs? Researching new side effects.
2. Surgery? Scheduled as soon as possible.
3. Two week without driving? Time for a long visit from Mom.
4. Six weeks without lifting my 2-year old? Teaching Henry how to climb in and out of the car seat

Let's do this thing. I'll do whatever it takes to keep everyone alive, well and happy...including me.

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CATEGORIES [ GENERAL ]

Top 10 CURE blogs of 2013

BY ELIZABETH WHITTINGTON | JANUARY 2, 2014

Elizabeth whittington blog image
Looking back on 2013, we've compiled CURE's Top 10 blogs of the year. We based the ranking on the number of views for each posting, and noticed that triple-negative breast cancer was a top read this year, along with fear of recurrence and metastatic cancer. There also appears to be a few popular posts from past years that continue to make the list.

What do you think? Did the one that impacted you the most last year make the list?

1. Fear of recurrence like no other fear

It's not hard to imagine why this one topped our list. The fear of cancer returning is a common emotion in survivors after treatment ends. Kathy LaTour describes her own experience with recurrence fears after her diagnosis 27 years ago, and how she overcame it.

2. Finally, good news about triple-negative breast cancer patients!

This post was originally published in 2009, when news of PARP inhibitors as a potential treatment for TNBC excited everyone who had knowledge of the disease. While the original research didn't pan out, there is new "good news" in the field. You can read the latest in our Fall 2013 article "Divide and Conquer."

3. A recap of triple-negative breast cancer research from San Antonio

Continuing on with the TNBC coverage, many of our readers were interested in Patricia Prijatel's account of TNBC research from the 2012 San Antonio Breast Cancer Symposium. Patricia, a survivor of TNBC and a patient advocate, provided a great update that spanned various treatments and the biology of the disease. I wouldn't be surprised if our guest blogger from the 2013 Symposium, Michelle Esser, makes the list next year. Michelle wrote an update from this past year's meeting.

4. When the unexplainable happens

Oncologist Richard Frank shares his experience in treating a family friend, a patient with metastatic liver cancer.

5. Do you need a baseline mammogram?

While this post was originally published in 2012, we're understanding more and more that screening, treatment and follow-up is not a "one-size-fits-all." As for guidelines, and whether many physicians follow them, we'll be covering that topic later this year.

6. The dreaded conversation: Telling friends your parent has cancer

Maya Silver was 15 when her mother was diagnosed with breast cancer. Writing about her own experience and other teens facing a parent's diagnosis, she offers helpful advice on how to share the information with friends and receive the support teens need during this time.

7. Would you date a cancer survivor?

Would you? A lot of survivors have weighed in since the post was originally published in 2009.

8. Six tools you need to reinvent yourself beyond cancer

"When cancer happens to us it's common to feel completely out of control. We go from our "normal" lives to something we reluctantly call the "new normal." The problem is that it doesn't feel normal at all because we are changed suddenly and forever." Debbie Woodbury shares her tips on how to take control over the new normal.

9. Young and living with metastatic breast cancer

This year, Kathy LaTour introduced us to Carrie Corey, a young wife and mother living with metastatic breast cancer. Carrie has become a regular guest blogger with CURE, sharing her experiences including a first beach trip with young son, Henry. You can read her first guest post at "Young, a new mother and metastatic."

10. CURE's "beat cancer" playlist

What song describes your cancer experience the best or helped you with treatment? Our readers gave their best "fighting cancer" songs, and we compiled them for you.

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CATEGORIES [ GENERAL ]

What will you do to pay it forward after cancer?

BY SUZANNE LINDLEY | NOVEMBER 20, 2013

suzanne lindley blog image
I've mentioned the Synergy 2013 meeting in a couple of my blogs now. It was great to see so many brilliant physicians, nurses, treatments and thoughts coming together. It was a learning experience for me, a time to see some old friends, and to also meet some new ones.

On my last day in Florida, Dr. Andrew Kennedy brought Dr. Jim Caridi over to the YES booth and introduced us. It was the most profound moment of the entire meeting for me. Dr. Caridi is a very gifted interventional radiologist of whom I've often heard reference. What I didn't know is the story that follows, taken with permission from his website (OneIAMClub.com).

"As a physician, his efforts were to allay the fears of the patient and make them more comfortable in their situation. He has an uncanny ability to put himself in others shoes and would attempt to lessen the discomfort of the situation. Jim would enter the hospital every day and passing patients, would think to himself "as long as I am on the other side of the glass, I am OK."

On August 10th, 2011, the glass shattered and he entered the other side. Our world stopped when we received the deafening news--Jim had bone cancer. A year has passed and we have been through the emotional roller coaster that all cancer patients and their significant others endure. Though we have not achieved remission, Jim has fought this battle with the same passion and finesse that made him successful in his career and life in general."

Here is a link to his speech at Synergy presented to his peers...from his perspective as a patient.

His talk ends with a quote from Jimmy V, "A good day is when you laugh, you think, and you cry." Jim says he gets two or three of these most of the time and eloquently added two additional thoughts to Jimmy V's quote. You need to dream and be passionate about your dream and you need to pay it forward.

You might ask what do you mean: "pay it forward?" All of you in this room have the ability to pay it forward...I can name 30 people in this room who have emailed me, called me, given me this opportunity. It's simple to do and can make such a difference in people's lives."

I hope you enjoy the video. I hope you are inspired. AND I hope you "Pay it Forward." Truly, it's quite simple! What will you do?

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CATEGORIES [ GENERAL ]

Using integrative therapies to cope with side effects

BY ELIZABETH WHITTINGTON | SEPTEMBER 11, 2013

Elizabeth whittington blog image
In the fall issue of CURE, we look at how patients can prevent common treatment-related side effects, including pharmaceutical strategies and integrative therapies.

We asked our Facebook fans, "Did integrative therapy approaches help you in dealing with side effects from cancer or treatment?"

We received many responses, and they were all across the board.

From yoga and acupuncture to laughing and music therapy, patients and survivors shared what integrative therapies helped them deal with side effects and the psychosocial issues in dealing with cancer and its effects. Many large cancer centers and hospitals offer integrative therapies, and several now have their own dedicated departments and staff.

However, not everyone was quick to answer. Some patients said it was hard to find integrative therapies, especially if they were not offered at the location they received their cancer treatment. If integrative therapies aren't offered at your clinic, there are several non-profit groups that offer support, information and services.

Here are a few tips to find integrative therapy options:

1. Talk with a dietitian. Foods that boost immunity, lower fatigue and have the right amount of calories may help reduce certain side effects. Many insurance plans and Medicare cover nutrition services if it is prescribed by your physician. You can get a referral from your medical team. You can also find registered dietitians at eatright.org. Use your ZIP code and refine your search to "expertise: oncology, cancer nutrition."

2. Ask your medical team and fellow survivors about fitness programs geared toward survivors, including those at gyms, yoga studios and other local hospitals. LIVESTRONG at the YMCA is a twelve-week program that helps survivors increase their health and fitness, but also aims to reduce the severity of side effects. The program is available at certain YMCAs across the country.

3. Investigate whether your insurance company offers discounts or coverage on health programs, acupuncture, massage or other non-traditional therapies.

[Questions to ask if your massage therapist is qualified]

4. Reach out to local support groups and non-profits that may offer integrative therapies. Organizations such as the Cancer Support Community offer onsite support and classes, including yoga and meditation.

Where did you find your integrative therapy services? Did it help alleviate side effects?

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CATEGORIES [ DIAGNOSIS, NEWS, GENERAL ]

Redefining the word "cancer"

BY DEBU TRIPATHY | AUGUST 2, 2013

Debu Tripathy blog image

Can a simple act of a few individuals change how we think about cancer?

Well, not a few, anymore, but a growing choir of voices are now redefining the term "cancer." We have known for a long time that there is a continuum from benign to cancerous growth. We even have names for some of these, such as borderline malignancy of the ovary. In the case of ductal carcinoma in situ of the breast (DCIS), the survival of patients is equal to the general population, but it is often treated with surgery, radiation and tamoxifen.

The Institute of Medicine has called for not just a redefinition of names, but a realignment of the cancer culture of "detect and eradicate." A recent article (Overdiagnosis and Overtreatment in Cancer: An Opportunity for Improvement) in the Journal of the American Medical Association highlights this problem in cancer screening, where the knee-jerk reaction for any cancer is to treat low- and high-risk cancer with many of the same treatment, therefore exposing everyone to side effects and complications while many derive no benefit--because their chance of dying or having their life affect by their "cancer" was minimal.

Solutions proposed in this article include getting rid of the word "cancer" and using terms like "indolent lesions of epithelial origin"--this may alter behavior both on side of the medical team and the patient. Of course, one cannot just declare a new system into existence.

The medical system must provide safeguards that truly dangerous cancers will be diagnosed and treated appropriately. Even some cases of DCIS can recur as invasive cancer, which can then potentially spread and lead to death. This means more research on prognostic tests – a huge ongoing needed in oncology that involves molecular/biological assays and large follow-up studies to validate these tests. We have a long way to go on redefining cancer, but perhaps starting with labeling changes is at least a symbolic start – but hopefully will be followed by both a scientific and cultural shift.

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CATEGORIES [ FEATURED, GENERAL, YOUNG ADULTS, BREAST CANCER ]

Surrogacy: Becoming a parent after cancer

BY GUEST BLOGGER | JULY 11, 2013

Jennifer Nassar
In 2010, Lindsay and Tony Giannobile returned from a vacation in Italy, their last "hurrah" before starting a family, but the life-changing news they received wasn't what they were planning for.

At 28 years old, Lindsay received a diagnosis of stage 3 HER2-positive breast cancer. Listening to Lindsay talk about her struggles and determination to not let a cancer diagnosis stop her from becoming a mother, I was inspired. Her story could give other cancer patients and survivors hope of having or continuing to have a family.

"It was our dream to have a family," Lindsay says. Unfortunately, like many other young adults with a cancer diagnosis, Lindsay learned infertility was a risk with her treatment.

From what I've learned, not all patients are given upfront information about potential fertility risks before therapy. If I had treatment and learned, after it was too late, that I could've done something to be able to have children of my own one day, I would feel denied the right and ability to have biological children.

With chemotherapy, the possibility of infertility may depend on age, type of drug and drug dose. Ifosfamide, chlorambucil and cyclophosphamide are a few drugs that can damage eggs. High doses of radiation therapy can also lead to premature menopause by destroying eggs in the ovaries. Even radiation not aimed at the reproductive organs can still cause damage by bouncing rays inside the body. Several options are available for women who want to plan for a family after treatment, including egg or embryo freezing, using an egg donor, surrogacy and adoption, to name a few.

[Read "What to Expect When You're Not Expecting"]

The couple chose to freeze embryos before Lindsay started chemotherapy in late 2010 with the hope that she might be able to carry them after her year-long treatment of chemotherapy, radiation and surgery.

"We're very blessed that I had babies on the brain," she says. "That really was our only chance at the time."

The Giannobiles' plan for Lindsay to complete therapy, be finished with cancer and have a child was derailed when, a year after starting treatment, she learned the cancer had spread to her bones. The cancer, now stage 4, ultimately means she will stay on treatment indefinitely.

"Tony kept saying, 'God will make it so that we can be parents'," Lindsay says, but at this point, the couple had very few options of starting a family. Surrogacy was their first choice. They would have tried adoption, but Lindsay was told by multiple sources that they wouldn't qualify to be adoptive parents because of her cancer diagnosis. "We wanted our biological baby, and we believed that God's plan for us was just that since we were able to freeze embryos successfully," she says.

Their first order of business: find a surrogate.

Lindsay and Tony reached out to surrogacy agencies and sent emails to friends and family, asking if they knew anyone who might be willing to carry their child.

The Giannobiles received a response from Kristen Keighley, who she met during treatment.

"She said, 'I can do this, I want to do this for you,'" Lindsay says. "We got things started from there."

Lindsay and Tony Giannobile with their surrogate, Kristen Keighley

Surrogacy is one of the most expensive options for women unable to conceive. It can cost anywhere from $10,000 to $100,000, which includes doctor appointments, embryo transfer, surrogate compensation and legal fees. Most costs are not covered by health insurance.

[Read "The Price of Parenthood"]

To help them finance the surrogacy, friends of the couple held fundraisers. Lindsay's friend, Matt Russo, raised $1,000 for every mile he ran in a Columbus, Ohio, marathon. The final total neared $30,000.

On May 15, Lindsay and Tony's son, Rocco, was born via caesarean section. Lindsay says words can't describe the experience of watching Rocco come into the world. It is something she and Tony will always "vividly remember."

Tony and Lindsay Giannobile holding their son, Rocco

"To think our baby was frozen for about two years, then developed in someone else's body is just an absolute miracle," she says.

Lindsay describes their surrogate as a "selfless, selfless person." Kristen, a single mom, works and attends school full-time. "And to add one more thing to her plate, she carried our child."

Lindsay isn't ashamed of her decision to use a surrogate and feels surrogacy isn't talked about enough.

"I think our generation has gotten better with talking about cancer, but surrogacy is a different story."

Lindsay encourages others to not give up on the dreams they had before cancer. "Look at the things that you thought your life would consist of before cancer" she says. "I think that is so important."

For more information on requirements, costs and support for surrogacy, here are a few resources:

> All About Surrogacy
> Circle Surrogacy
> The National Infertility Association

You can read more about family planning with cancer in CURE's Summer issue article, "Managing Expectations."

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CATEGORIES [ FEATURED, ASCO, GENERAL ]

Do you talk to your doctor about cost of care?

BY ELIZABETH WHITTINGTON | JULY 8, 2013

Elizabeth whittington blog image
Cost is one of those "difficult conversations" between a patient and a physician, right up there with end-of-life discussions. Does that surprise you?

An article posted online from the Journal of the American Medical Association addresses the issue of medical cost in "First, Do No (Financial) Harm."

"... seemingly simple decisions that physicians make about testing could directly lead to thousands of dollars in out-of-pocket costs," the authors write, noting that physicians shouldn't assume that high medical costs are a known and unavoidable fact of life for all patients. The article encourages physicians to optimize care for individual patients in regards to cost, a strategy used commonly to treat cancer. The article is geared toward a general medical audience, not specifically cancer, so the examples it provides may not apply. However, the overall theme is that physicians should have a financial conversation with their patients, including if patients are worried about cost and are understanding the financial ramifications of screening and treatment.

"Too often physicians choose less than ideal options for their particular patients not due to a lack of caring, but rather a lack of knowing. This includes not prescribing generic or other insurance-covered drugs when appropriate. Lack of awareness about the opportunities to provide higher-value care should no longer be an allowable excuse."

While the article is geared toward physicians having that financial conversation with their patients, this should also encourage patients to initiate the discussion. Asking for lower cost treatment alternatives, generics or making sure their doctor works within their insurance plan are conversations that patients shouldn't be ashamed to have with their physicians.

At the annual meeting of the American Society of Clinical Oncology this year, a study examined how likely insured patients were to talk to their physician about treatment cost. Nearly half of the 119 patients surveyed expressed a desire to discuss the issue, but only 21 percent had actually done so. Of that 21 percent, half felt the discussion helped lower their treatment costs.

In another study of women with breast cancer, 94 percent believed cost should be discussed between patient and physician, but only 14 percent reported ever having the discussion.

"To provide truly patient-centered care, physicians can live up to the mantra of 'First, do no harm' by not only caring for their patients' health, but also for their financial well-being," the authors conclude.

Do you discuss cost with your physician? And does cost affect your treatment decisions?

Stay tuned for more on this subject. CURE is producing a supplement on the cost of cancer care later this year, which will include tips and resources to help manage the financial burden of cancer.

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