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Monday, January 30, 2012

What is Great Cancer Care?

By Richard Frank, MD

I remember meeting Mr. Albert and his wife about four years ago. In their 70’s, they had been married for nearly 50 years and still couldn’t bear to be apart for very long. He was seeing me because he had recently been diagnosed with lung cancer. A persistent cough led to an X-Ray and then a CAT scan. The tumor in his chest was large and could not be surgically removed. I had reviewed his records in anticipation of seeing him and was prepared to talk about the treatment of stage III lung cancer, which involved chemotherapy and radiation given concurrently.

Bert took his position on my examination table; his wife Margie sat close by. He wore an anxious but resolute expression; she had her heart in her mouth and was very scared about what I was going to say. Still, she was hopeful, had a great deal of faith in God and told me they would make it together, whatever the challenges. I then took his medical history and examined him. I explained the diagnosis, the different stages of lung cancer and that while stage IIIB is not the most advanced stage (which is stage IV, when the cancer has spread to another part of the body) and that some patients may be cured, many unfortunately are not. “But there is a chance?” Margie asked as tears streamed down her face. “Yes, absolutely,” I replied.

Just then, Bert said, almost in passing, “You know, I forgot to mention that I have been getting headaches. They don’t bother me much but I never got them before.” I immediately developed a sinking feeling in my stomach. “I see…I think we should have Bert get an MRI of his brain. I know he had a CAT scan that showed no cancer but I just want to be sure.” A look of shock broke over Margie’s face as she considered, just for a moment, an even worse scenario than the one they were already trying to come to terms with.  I immediately did two things: 1) led them into the office of one of our oncology counselors for emotional support and 2) ordered an MRI to be done stat.

Bert went for the MRI while Margie was comforted by Michelle Dailey, LMFT, an experienced family therapist who would ultimately support them through years of battling lung cancer.  Meanwhile, in another office, I received the result I feared:  Bert’s cancer had spread to his brain, meaning that he had stage IV cancer and the plan we had discussed would have to be changed: he would first need brain radiation. This finding also meant that Bert’s cancer was not curable. I had to somehow deliver devastating news and avoid Margie’s collapse.

I led them back into my examination room and girded for the very difficult conversation ahead. This also meant having Michelle at their side so that they would not have to leave my office overwhelmed and feeling helpless. I told them the new findings and the new strategy and answered their questions about the prognosis. They cried and hugged and we talked it out, trying to be realistic and hopeful at the same time.

Bert lived nearly three years, mostly with an excellent quality of life. They traveled and lived life to its fullest. But what made their cancer care great was not the quality of the medical care they received, not the chemotherapy or the radiation. What made it great was that they felt cared for by their cancer care providers throughout their experience. They had individual counseling, attended patient support groups and after Bert died, Margie attended our bereavement group; all of these without charge as they are services provided at our center.

Great cancer care is about much more than surgery, chemotherapy or radiation. It is beyond “the best” hospital and “the top” doctor. It is about being cared for and feeling supported emotionally throughout the most difficult time in one’s life. That is the most challenging part of delivering great cancer care. But it is not advertised and it is not sought after initially. In fact, many cancer patients never receive the emotional support they need and do not even know what they are missing.

How did you feel about your (or a loved one’s) cancer care? Did you feel like you got the emotional as well as the medical support you needed? What do you wish the doctors and other medical professionals had done differently? Share your thoughts in the comments below or in our Cancer community.

Posted by: Richard C. Frank, MD at 11:47 am

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