Diagnosed with cancer? Seek expert medical second opinion. Multidisciplinary Team must treat all cancer patients. 6
Cancer diagnosis becomes ever more precise. Cancer treatment becomes more sophisticated. Dr. Anton Titov, MD. My mother was diagnosed with the lung tumor. I had a deeply personal experience. Two highly knowledgeable and experienced thoracic surgeons gave a completely different assessments of her situation. One was this. “Nothing you can do. She is elderly patient. Another surgeon said. We could do a curative surgery now. We were able to identify what would be the best treatment in her particular situation. We did it by searching the medical literature. Dr. Anton Titov, MD. We found best therapy by asking for opinion our professional network. May cancer patients are not being treated by the best-fitting experts for their particular diagnosis! Dr. Bruce Chabner, MD. Yes, yes. Of course, it’s true in cancer. But it is true not just in cancer. How important is it to seek a review of a situation by the expert who is knowledgeable in that exact medical problem that the patient has? Dr. Anton Titov, MD. How important is it to get second medical opinion? Especially when a new diagnosis of cancer is made or suspected? Dr. Bruce Chabner, MD. It is important. Unfortunately, medical expert opinion is not always available. In the United States we spend so much money on healthcare. But we still have patients in rural hospitals in the countryside. They don’t have easy access to an expert opinion. Cancer patients often do not have access to a cancer center. So that’s ideal. If you live in Boston, you have three or four hospitals that have very large faculties who sub-specialize. So it’s not only lung cancer. Dr. Bruce Chabner, MD. But it’s in the little subsets of lung cancer. It’s a non-small cell lung cancer. It’s small cell lung cancer. It’s squamous carcinomas. It’s neuroendocrine tumors. It’s the expertise that’s available in a place like this hospital. Or it is in our partner hospitals, the Brigham and Women’s Hospital, and the Dana-Farber Cancer Institute. We are unusual and different than what you would find in a rural setting. So, unfortunately, not everybody has access to this cancer therapy expertise. It’s an issue. Then even beyond cancer treatment in the United States. I work in outreach efforts in Africa. They would be thrilled to have even what’s available to us here in cancer diagnosis and treatment. What we already have in our more remote hospitals in the countryside. It’s a problem. The distribution of cancer treatment expertise is not even worldwide. Cancer therapy expertise certainly might not even be even within the top academic communities in Boston. Dr. Anton Titov, MD. Because medicine is so much siloed. My mother’s situation actually developed in Boston. It took a literature search to find who is the patient. We had to find who’s really dedicated his professional life to that particular type of lung tumor. That’s how we got the better tumor treatment result. That’s correct! You did a very good job, obviously. Dr. Bruce Chabner, MD. You’re in a sense lucky that you were living in this community. Sometimes you’ve been living in some much more remote area. Where there was no expertise, how would you know? You’d have to travel 500 or a 1000 miles to find out about the best cancer therapy. It’s not easy. Many patients can’t afford that. So it is a real problem. The variability of cancer therapy expertise that’s available to patients. I guess, in general, the other thing is this. For a very serious kind of cancer you have to get expert medical opinion. In cancer, a patient’s life is at stake. Often the initial decisions have to be taken fast about what to do. How to treat a cancer patient. It is always reasonable to seek a Second medical opinion. Dr. Anton Titov, MD. Sometimes you need a third expert medical opinion! Well, yeah! Sometimes you find conflicting expert medical opinions from the first two opinions. Then you may want to go to a third opinion. Of course, you don’t want to waste too much time. Dr. Bruce Chabner, MD. Because in some cancer diagnoses time is extremely important. Getting cancer treatment fast and taking care of it is crucial. That’s why the multidisciplinary approach works best. You have to do expert medical opinions in parallel. You have to use the panel of experts. Each medical expert might evaluate the cancer situation independently. This could be one option. Dr. Bruce Chabner, MD. You bring out one other important aspect of going to a cancer center. When we see a patient here with prostate cancer or pancreatic cancer, it’s not just one doctor that sees the patient. It is a multidisciplinary team. It’s a medical oncologist, surgeon, radiation oncologist, radiologist, the pathologists. Radiologist takes the X-rays and interprets them. All of oncologists and experts have to work together to come up with a reasonable cancer therapy plan. What is best for that particular patient with cancer. Dr. Anton Titov, MD. Because in prostate cancer the factor that determines the type of prostate cancer treatment is the type of specialist that the patient sees first. Prostate cancer is treated with surgery or radiotherapy or watchful waiting even. Dr. Anton Titov, MD. There’s an expert that I discussed it with in London. That’s correct! If you first see the surgeon, you may be advised to have surgery for prostate cancer. It is best that you see the group of medical expert together. It is a multidisciplinary team. This is what we do here. They’re called multidisciplinary clinics. They have at least one expert from each of the relevant oncology fields. You may get a consensus opinion how to treat cancer. This is very different from the opinion that a surgeon would offer or a medical patient or radiation therapist. If they see the patient by themselves only. That is the value of multidisciplinary assessment of every cancer patient. Dr. Bruce Chabner, MD. Yes.
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