Learn about cancer care options
Q: My mother was just diagnosed with breast cancer, and we’re confused by the med-speak that the doctors are using. They keep asking Mom what she wants to do, but how can she (or her family) know what’s best for her? — Kathy G., Orlando
A: You’ve pinpointed a big problem: Cancer diagnoses and treatments have gotten so complex that it’s difficult to know exactly how to choose a course of treatment. It seems these days that every patient and/or family needs to take a crash course in being a great self-advocate and managing the stage of cancer that’s been diagnosed. Only then is it possible to fully participate in patient-centered communication and shared decision-making with the doctors.
Unfortunately, many doctors still don’t bother to ask the patient what he or she wants to do. And when they do, the collaboration doesn’t always result in “informed medical decisions.” That may be why some studies show that only half of cancer patients rate their care as excellent.
Here’s where to start learning about Mom’s best options:
The National Comprehensive Cancer Network — an alliance of 25 of the world’s leading cancer centers — offers free, detailed guides to all diagnoses and treatment options for breast, colon, esophageal, pancreatic, prostate and ovarian cancers, as well as chronic myelogenous leukemia, malignant pleural mesothelioma, melanoma, multiple myeloma and non-small-cell lung cancer. You can access them at nccn.org (or buy a printed copy at Amazon.com). Chemocare.com and Cancer.net offer advice on navigating cancer care. The American Cancer Society’s Understanding Your Diagnosis offers step-by-step advice, at cancer.org.
And remember to ask as many questions as you like. Insist on answers that you and/or your mom can understand. And don’t hesitate to bring in the cancer treatment center’s patient advocate to help you get the information you want.
Q: I have arthritis in my knee, and my doctor gave me a prescription for physical therapy, starting with the stationary bike for 10 minutes each time. But pedaling hurts! He says if I do the PT, I will have less pain. How is that supposed to work? — Bob D., Charlotte, N.C.
A: Without knowing more about your condition, it’s tough to say exactly what will benefit you, but we know where your doc is coming from. It may seem counterintuitive to move an aching joint to reduce pain, but in general it’s good advice.
A recent study of 206 people with osteoarthritis of the hip and/or knee was released by the American College of Rheumatology; the findings may apply to you. One group of participants did their usual care plus exercise and manual therapy (that’s having your afflicted joint moved and manipulated by a physical therapist); one group did their usual care and only exercise; one did their usual care and only manual therapy; and one did whatever they’d been doing. After two years, it turns out that all of people in the study who did exercise and/or manual therapy showed improvement in both pain and function. Folks who relied only on their usual medical care didn’t improve as much as the other people in the study!
Dr. Mike is a board-certified anesthesiologist, and he knows just how innovative the latest arthritis-painmanagement techniques are. But even with all of the innovations, one basic tenet still applies: You have to move it to make it better. Improved circulation encourages improved muscle strength and dispels inflammation (ice your knee when you’re done exercising), and that means less pain.