Lung Cancer: Questions to ask the doctor

What to Ask About Lung Cancer
Published in the New York Times

Confronting a new diagnosis can be frightening — and because research changes so often, confusing. Here are some questions you may not think to ask your doctor, along with notes on why they’re important.

What type of lung cancer do I have, and what is its stage?
Treatment strategy will depend on the type of cancer you have and how far it has spread, indicated by its stage (0 to IV). Depending on the type and stage of your cancer and your general state of health, combinations of surgery, radiation therapy, chemotherapy and established or experimental targeted drugs, antibodies or vaccines might be indicated. Find out your doctor’s rationale for what he or she is recommending.

What risks and side effects are common with different treatments and experimental protocols?
In some cases, different treatment options might be equally effective, with the major differences being in the likely side effect or risk profiles. Let your doctor know if avoiding or minimizing particular side effects is especially important to you. Remember that patients and their families are their own best advocates and that no patient need suffer in silence. Do not shy away from seeking the information you need to make informed decisions about managing your cancer.

Am I eligible to participate in a clinical trial?
It is important to ask about clinical trials as early as possible, because undergoing certain treatments can affect eligibility. To learn more:

Do you know of a Comprehensive Cancer Center where I might get a second opinion?
While there is much to be said for the convenience of being treated at a medical office close to home, lung cancer treatments are changing rapidly. It is a good idea to consult with one or more experts keeping abreast of the latest developments. The National Cancer Institute has designated dozens of Cancer Centers across the country that are actively engaged in the latest cancer research. To locate one:

If I will be undergoing surgery to remove my tumor, could I also benefit from chemotherapy?
Several major studies recently showed that chemotherapy after surgery improves survival for some patients with tumors that were formerly treated with surgery only. Make sure your doctors know about these studies and whether they apply to you.

Am I a candidate for less invasive forms of surgery?
Some medical centers offer video-assisted thoracic surgery, or VATS, a new and less invasive form of surgery employing a thin tube mounted with a miniature camera. Though the procedure is not appropriate in all cases, it may offer significant advantages, especially in older or frail patients with early-stage lung cancer. Benefits include greatly decreased recovery time compared with open chest surgery.

Can my tumor or blood be tested for markers that might indicate I would respond better to certain treatments than others?
Many oncologists believe that this type of testing will become standard practice for lung cancer in the coming years, as it has for breast cancer. Some centers already offer testing for E.G.F.R. (for epidermal growth factor receptor) mutations, which are associated with excellent responses to drugs like Tarceva. Patients can also opt to allow their tissues to be used in research aimed at developing therapies tailored to different lung cancer tumor types.

Should I get a CT scan to check for early lung tumors?
The vast majority of lung cancers are currently caught late, when there is little chance of curing the disease. Screening with spiral CT scans can pick up small lung spots in healthy people, but often the lesions turn out to be benign and patients are subjected to needless worry as well as follow-up tests, procedures and even major surgery. Doctors are divided on whether the benefits outweigh the risks. If you do choose to be scanned, have it done at a reputable laboratory where workers follow guidelines from the American College of Chest Physicians that help differentiate harmless lesions from dangerous ones.

What smoking cessation treatments do you recommend?
Smoking is the leading cause of lung cancer, and the risk of the disease declines with time after stopping. Smoking also puts others at increased risk of lung cancer through secondhand smoke. Useful online resources include the National Cancer Institute’s site and the U.S. Surgeon General’s Tobacco Cessation — You Can Quit Smoking Now site.

Publish date: 2/15/08