Question everything. If you or your loved one are being prescribed a medication [especially chemotherapy], ALWAYS ask to see the statistical studies and warning labels which are required to be read by physicians. Obviously, they don’t have the time to study them all. Do not be surprised if the oncologist blows you off, or becomes short with you. He is usually just repeating what his Pharmaceutical Sales Reps have told him. You MUST make the time.
Here are 20 questions we recommend asking your oncologist.
1. Is it alright if I record this conversation?
When life and death decisions are at stake, conversations with oncologists and other physicians take on enormous importance. In addition, sometimes these conversations take place when the doctor is very busy. Given the subject, the hurried bedside manner of some physicians, and the emotional intensity for the patient and family, it can be very hard to listen, understand, and ask appropriate questions.
Tape recording important conversations with your doctor(s) about treatment options is an excellent way to provide a record so that you can: 1) concentrate on listening; 2) do not have to worry about taking notes; 3) can focus on your questions; 4) can replay and review the conversation in a less stressful environment such as your own home to fully comprehend what the physician communicated. It is always a good idea to use the first few seconds of the recording to have all the parties acknowledge that the meeting is being recorded with their permission.
2. Did you send my pathology to another Doctor for a second opinion?
The pathology of your tumor cells tells pathologists whether you actually have cancer and what kind. Having a second look/opinion by another pathologist from another hospital helps ensure that you have been properly diagnosed. There have been unfortunate situations when patients have been treated inappropriately because the wrong kind of cancer was diagnosed. In many hospitals it is standard practice to “send the slides out” for a second opinion. You may want to check to ensure this step was taken in your case and find out who rendered the second opinion and what they concluded.
3. How many patients have you treated with my diagnosis/type of cancer? Which treatments did you use? Are any of the patients still alive? How many have survived more than 5 years? 10 years? 20 years? Can I speak with some of them to see what the quality of their lives has been like – during and post-treatment?
You want to get a good idea of what the oncologist’s experience is with the various treatments being recommended. You should find out how many patients (your age with the exact same cancer) they have treated with each therapy. Ask if you can speak to these other patients. Other patients (like you) who have been administered the same therapy by the same oncologist(s) can provide valuable insight into what to expect.
4. What is your treatment plan for me?
5. What evidence can you provide that shows success with your treatment plan for me?
6. Can you show me where the survival information comes from? Is it reported in the peer-reviewed published medical literature? Can you give me a copy of the article(s)?
Monthly medical journals provide survival information that your doctors should be familiar with. The oncologist should be able to support any survival/prognosis claim they may make with data or published studies that they can share with you. Be wary, if they can not support their claims of a potential cure with medical studies or with examples of other patients they have treated.
7. Did any patients have side-effects from the treatment? What were they? What was the worse side-effect? Did anyone die from the treatment, not the cancer?
Some patients do not die from their cancer, but die from the treatment. You should ask questions to learn how toxic the therapy is.
8. Are these drugs FDA approved for treating my cancer?
Many cancer drugs are not FDA-approved for the use for which they are prescribed. (This is called “off-label” use.) In fact, some drugs that are widely used for a particular cancer may never have been approved for safety or efficacy for that use by the FDA. It is valuable to know if any of the drugs the oncologist intends to prescribe would be used “off label” and if so, why the oncologist is comfortable with that use.
9. What percentage of your patients with my diagnosis/type of cancer have been cured?
10. Do you have any financial or research interest in this treatment you are recommending? For example, are you being paid by a drug company when you prescribe these drugs? Do you consult for the drug company that makes these drugs?
Some oncologists have financial arrangements with various drug makers or other financial incentives that could be construed as a conflict of interest. You should find out whether your doctor(s) has any financial or research interest in recommending a certain treatment.
11. If you order a CT scan, MRI, tests, or a chemotherapy drug, do you get a commission, rebate, or kickback? How much do you get?
12. Before the treatment, will I be required to sign a waiver that releases you or the hospital from any harm caused by the treatment?
13. What legal solutions are available to me if the procedures administrated to me by this hospital hurt me?
14. How much will my treatment cost me?
15. How much profit will the hospital make from my treatment?
16. How much profit will you make from my treatment?
17. If you were me, would you take the treatment that you are recommending?
18. Were you aware that chemotherapy was shown to be 97% ineffective in the treatment of adult onset cancer by a study published in the Journal of Clinical Oncology in 2003? see:
19. So if it’s 97% ineffective, why are you recommending that I do it?
20. What is my prognosis with no treatment?
Comparisons are very seldom made between the results of a clinical trial and those patients who received no adjuvant treatment (i.e. no therapy beyond surgery). When survival and quality of life comparisons are made, they are usually made between two or more treatments, not between treatment and no treatment. It is very difficult, therefore, for an oncologist to objectively answer the question of how long did the treated patients live and what was their quality of life compared to those who received no adjuvant therapy. Nonetheless, it may be of interest to ask your doctor for a reference/study that discusses this. Be advised that such studies may not be available.
Remember, if a drug or regimen has not been proven to cure, significantly prolong actual survival, or improve the quality of life — if it only temporarily shrinks tumors, with a probable loss in well-being — then it is at most entirely experimental and unproven, and should not be represented as anything else. At worst, it could be not just ineffective, but painful, destructive — or even fatal.