Have you ever stopped and asked your doctor, “Wait, but are you sure about that?” Whether you have doubts about a recommendation or you just want some extra peace of mind, it can be intimidating to challenge medical professionals. But according to Dr. David Palma, it’s absolutely vital that you do. Especially when it comes to cancer.
In his new book Taking Charge of Cancer, the London, Ont.-based radiation oncologist and cancer researcher provides concrete advice for navigating each and every step of a cancer diagnosis. He breaks down medical jargon, runs through questions to ask at consultations, deciphers medical reports and writes about how doctors can be biased between surgery, radiation and chemotherapy.
Chatelaine talked to Palma about the most common mistakes made in cancer treatment — both by patient and doctors — and why he encourages people to research their diagnoses as much as possible (and yes, that includes doing some Googling).
I think many of us feel like it’s hard to question doctors because they have medical training and we don’t.
Hopefully that attitude is changing. When you look at medicine in the ’70s and ’80s, it was very paternalistic. People were expected to be good patients, listen to their doctors and do what they were told. Now we have more of a shared decision-making approach where we realize we’re all partners in this.
Someone told me this analogy recently: When you buy a car, you’ll research the cars, see the dealership, negotiate with them and really make sure you’re getting a good quality car. People spend so much effort on that yet not enough on something way more important, which is getting good quality cancer care treatment.
What’s the biggest mistake patients are making?
The quality of treatment really does vary from place to place. It’s not like when you go to any grocery store to buy Kraft Dinner — whether you buy it here or there, it’s going to be the same. Patients assume treatment is a product like that, but that is not the case.
Why does quality of care vary so much?
It depends on the level of expertise at a specific centre. If you go to a centre that treats your kind of cancer very frequently, things are much more streamlined — they’re used to treating that type of cancer, they’ve seen the complications before, they can anticipate things better and often they’ll have procedures in place to help make sure mistakes are avoided or caught — because mistakes do sometimes happen. Patients are sometimes not diagnosed the right stage, for example, and that can lead to the wrong treatment.
How do people make sure they’ve been assigned the right stage?
Many people ask their doctor “What is the stage of my cancer?” already, but [they should] follow that with: “How certain are you of my stage, and are there any uncertainties that we need to look into, and any tests that are missing that we need to do?” Ask why that stage has been assigned and what it means. Make sure the stage is rock solid. It tells us where a cancer is and how far it’s spread. Sometimes tests are inconclusive and need to be followed up on.
It’s comforting to think patients can be a part of the decision-making.
What I say to patients is, it’s like we’re on a road trip together: You’re driving, I’m in the passenger seat with the map and I can tell you to go straight or turn left and here’s where you’ll end up. It’s up to them to make the final decision.
What are the biggest misconceptions when it comes to cancer care?
It’s not so much around the treatment doctors and hospitals are providing. But there are a lot of misconceptions around alternative treatments and there are a lot of alternative health care providers who aren’t providing honest information.
So many patients have pursued vitamin C treatments. Vitamin C has been studied in humans and the human studies have not shown that it fights cancer. Yet some alternative health providers are charging patients for IV vitamin C at a cost of several hundreds of dollars per week.
Other myths are around big dietary changes that can fight cancer. Only a very small set of patients with dietary changes have shown any promise. But people are being told to cut out all sugars or carbohydrates — those strategies are all unproven, and weight loss in the setting of cancer treatment can be very dangerous. We hear a lot about cannabis oil, which doesn’t fight cancer. And some people are told they can fight cancer by changing the acidity of their diet, which is completely not true.
It makes it very difficult for patients to really know who to believe and who not to believe. Sometimes patients come in skeptical of me because they’ve been told that “doctors are hiding a cure,” which is a crazy idea. We all lose family members and loved ones to cancer. If my child has cancer and there’s a cure hidden up in my office, am I really going to hide it?
Is seeking additional advice from alternative health providers common in cancer patients?
The large majority of patients pursue the recommended treatments in order to cure their cancer. But on occasion, I have seen catastrophes where patients will pursue an alternative treatment [instead of the one I recommend] because they’re misinformed by alternative practitioners, and the cancer grows, as it would be expected to, and they miss the chance of cure because it’s spread to other parts of the body.
What in your life has shaped your thinking about how to treat cancer?
Having more experience with family members and friends diagnosed with cancer has really changed my practice. Once you see what it’s like to be on the other side of the discussion as a patient, you really become aware of the fears and the anxieties patients go through — things like waiting for your first appointment and how badly you want it booked as soon as possible. One of my close friends was diagnosed with cancer. He was a radiation oncologist and, ultimately and unfortunately, he passed away. He said, “If I had known what it was like to be a cancer patient, I would have practised totally differently.” That has really stuck with me.
How would he have practised differently?
He said he would have been more attentive toward concerns about pain, symptoms and emotions. I think there’s been an approach in the past to treat the cancer and focus on the cancer. Now we’re realizing that symptoms, quality of life, pain control, emotional support, financial and social support are incredibly important.
All author royalties from Dr. Palma’s book are being donated to the London Health Sciences Centre.