The Importance of Proper Diagnosis

Like most cancers, lung cancer is best treated when diagnosed early. There are several types of lung cancer, and it is crucial that your lung cancer be diagnosed accurately because your treatment depends upon careful identification of the type and stage of your lung cancer.

Since a biopsy is key to the diagnosis, it is important that you receive the appropriate type of biopsy and that the tissue sample is evaluated by a pathologist (a doctor who specializes in studying disease through the evaluation of body tissue). Preferably this pathologist should specialize in lung cancer. You may need to seek out a clinical cancer center or academic medical center to ensure that you have access to a qualified pathologist, especially if your local doctor does not see many lung cancer patients.

Where do I find a Lung Cancer Specialist?

Lung cancer specialists have a particular focus on the diagnosis and treatment of lung cancer. You will want to seek care from a medical oncologist who specializes in lung cancer. A lung cancer specialist will most likely be on the forefront of lung cancer care and will read articles and attend scientific meetings about the newest treatments. These doctors are members of professional societies such as the American Society of Clinical Oncology (ASCO) and the American Association for Cancer Research (AACR). In many cases, your primary care physician, sometimes with the help of your insurer, will refer you to a lung cancer specialist.

The Importance of a Second Opinion

It is important that you feel confident that you are receiving the best possible treatment for your cancer. Even if you have a good relationship with your doctor, before you begin therapy, you may want to seek a second (and sometimes a third) opinion about your diagnosis and treatment plan. Keep in mind that some insurance programs require second opinions, and many will cover a second opinion if the patient requests one. Most doctors expect and understand that because of the seriousness of cancer, patients will seek a second opinion.

Do not be afraid that you will hurt your doctor's feelings or that he or she will treat you differently.  Your doctor will most likely appreciate that you are gathering vital information that will help you make informed decisions about your treatment.

Some important times you may wish to seek another doctor's opinion are:

• If you have been told that there is no further treatment available that can help you.
• If there is something uncertain about your case or your initial diagnosis.
• If you are receiving treatment at a small hospital that normally does not treat many patients with your type of cancer.
• If you are on a managed care plan that you feel is limiting your treatment options.
• If you just want to be sure that you are on the right course.

Many oncologists are associated with a tumor board, which is a group of several kinds of cancer specialists who have different experience and backgrounds. At a tumor board meeting, your doctor may present information about you and your disease, and the other doctors will then be able to offer their opinions and ideas. If you are interested, you may want to ask your doctor to present your case at a tumor board. However, you may prefer to get the opinion of a different oncologist, one not affiliated with the doctor who made the primary diagnosis. Consider having your second or third cancer consultation in a multidisciplinary setting at a major cancer center or university hospital, if possible.

Your general practitioner or insurance company can often recommend an oncologist or lung cancer specialist whom you can visit to get a second opinion. If you do seek another doctor's opinion, remember that it is best to have a complete copy of your medical records, including original x-rays, pathology slides, laboratory results, scans, and medical reports.

It is best to get copies of all of these materials and deliver them yourself. A second opinion is not considered adequate unless another pathologist, preferably a lung cancer expert, reviews the tumor sample. You may want to bring a friend or family member to the appointment to help take notes, ask questions, and provide support. Also, you may want to bring a tape recorder and ask the doctor if you may tape the conversation.

If you receive a recommendation that is different from your original one, you may be confused.  You should discuss the reason why a different treatment plan is being proposed with either your original doctor or at the second opinion visit. You may feel that you need a third opinion. Because so much is at stake, it is important that you ask questions and discuss your medical care fully so you can make the decision that you think is best.

Remember that getting a second or third opinion does not mean that you have to change doctors. You can take the information you learned back to your initial doctor and discuss what treatment options are right for you. Many people with cancer have shared that they feel better and more in control when they have talked to another expert about their disease. Then, when they continue treatment with their doctor, they feel more confident that they have explored every possible avenue to receive the best available care.

Also, keep in mind that going from doctor to doctor, searching for a "magic" cure is not necessarily productive for your disease or your mental health. Some patients make it even harder on themselves by getting opinion after opinion and feeling immobilized because they cannot figure out what to do. If this is happening to you or someone you care about, talk to your physician, an oncology social worker, or oncology nurse to explore some of the fears and anxieties you may have about making a decision, starting or ending treatment, and finding the right treatment team for you.

Some Advice for Communicating with your Health Care Team

Finding out that you have lung cancer can frighten and overwhelm you. It can make talking (and listening!) to your doctor, nurse, other members of your health care team, and even your family very difficult. Fortunately, there are several things you can do to make communicating with your doctor easier. Studies show that clear communication between you and your health care team can help you feel better about your choices and may even improve the quality of your care.

Make sure that you understand what is being discussed. When you talk with your doctor, use "I" statements. For example, the phrase "I don't understand..." is much more effective than "You're being unclear about...". Also, be assertive. If you don't understand a word or a treatment option, say so. Make your questions specific and brief and come to your appointment with them written down on a list to review with your doctor. If there is something you don't understand, ask your doctor to discuss it in more detail. Finally, if something seems confusing, try repeating it back to your doctor; for example, "You mean I should...". If you think you will understand better with pictures, ask to see x-rays or slides, or have the doctor draw a diagram.

Here are some questions that you may want to ask your doctor or nurse:

• How much experience does this doctor have in treating cancer and specifically lung cancer?
• Is the doctor board-certified as an oncologist? Surgeon? Pulmonologist?
• How does this doctor stay up-to-date on the latest lung cancer treatments?
• Do the doctors at this clinic/hospital participate in clinical trials?
• What kind of radiation and surgical services are available at this clinic?
• Is the doctor or clinic associated with a major medical center, medical school, or National Cancer Institute-designated cancer center?
• Does this physician or hospital accept my insurance?
• What types of professional organizations is the doctor a member of?
• Is there an oncology nurse and/or oncology social worker that would be available for my treatment, education, and support?
• What other support services are available at this clinic for patients and families?
• When/how can I contact my health care professionals?