In our webinar with board-certified hematologist, medical oncologist, and author of The Cancer Journey Dr. Chadi Nabhan, Dr. Nabhan emphasizes the significance of communication after a cancer diagnosis. Uncover the importance of open dialogue and gain insights on how to have productive conversations with your care team in the full webinar replay, included below.
Keep reading for some key questions transcribed from the discussion.
The following questions and responses have been lightly edited for grammatical purposes.
Q: Patients are sometimes given choices with their treatment options which can be hard to navigate after a new diagnosis. How do you recommend patients manage all the information available on cancer treatments?
A: We refer to that as shared decision-making. What you’re going to hear from me is straight talk. Imagine I am asking you to make a decision when you’re very overwhelmed and you’re making a very complex medical decision about a serious disease without ever being trained in oncology. I mean, I spent years and years of school to at least feel comfortable, making decisions and helping patients make that decision. Shared decision-making should have different components.
Number one, what are the patient’s values? What do they aspire to? What are the things that they want? What do they not want? The physician has to decide on what is appropriate or not and then the patient has to say yes or no. Let me give you an example.
Let’s talk about breast cancer as an example. There are many situations in breast cancer where the patient may or may not require chemotherapy. I should be the person who is deciding whether chemotherapy is needed or not because I should counsel the patient and say, “Based on the information that I have for you, chemotherapy is absolutely recommended. You can deny it, or decline it, and this is what could happen. You could accept this and this is what could happen.”
But where’s the decision shared? Decision-making is if I have several types of chemotherapy regimens that I could prescribe to this patient. I say, “These are the three regimens that I could prescribe. Let’s talk about the side effects of each regimen. Let’s talk about your lifestyle and maybe we can figure out the type of regimen that is most suitable for your lifestyle. Maybe you travel a lot, so an oral pill is better. Maybe some of the chemotherapy regimen could cause tingling and numbness in the fingers and toes, so maybe we should avoid that. Take another regimen that could have fewer things of that nature.”
I don’t think it’s fair to tell the patient “Should you get chemotherapy or not?” That decision is based on facts and training. The shared decision-making happens after where you sit together and say, “These are the facts, let’s make the decision together.” It’s pretty complex.
Q: How can patients go about seeking a second opinion?
We absolutely should embrace second opinions. The reason patients and families don’t get second opinions is the fear that they’re going to offend their oncologist. Are they going to treat me differently when I go for a second opinion and then come back?
I think we all should empower patients and families to do this, and I’m a big proponent of it. Actually, I did not wait for the patient to tell me. Literally every single new patient I saw, I always ended up saying “I know you are thinking about getting a second opinion.”
I just literally put it out there. I don’t even wait for them to tell me and I say, “That is totally okay. It is totally fine. It is normal. If you want to get a second opinion in the Chicago area, let me tell you who I would see, so I could help you do that.” Then I can actually help that patient get a second opinion as opposed to them struggling with it and we can copy the records and things of that nature.
Universally, it’s as if a burden falls off their shoulders because you know they were thinking about it. They just don’t want to appear they’re doubting you because patients who have dealt with cancer are the nicest people in the world. I have a lot of family members who are affected by this disease and it really keeps us grounded and humbled.
I really advise everyone to just be vocal about it and just simply ask. It does not mean you’re going to leave your doctor. It just means you just want to get confirmation of the care that you are receiving.
Q: What are complementary therapies and how can patients safely incorporate them?
A: Complementary therapy is anything in addition to the core treatment of the actual cancer. There are many of these complementary therapies that are actually over the counter that you do not need a physician to prescribe whatsoever. This includes vitamins as an example, there’s so much data on vitamins that you hear about. Not all of the complementary therapies are drugs or pills. I mean music therapy, pet therapy, massage therapy, yoga, and meditation are complementary approaches to the way we deal with cancer.
But yes, you can go into any drugstore or a pharmacy and have all these available and you could just buy anything you want. I think it’s very important to tell your doctor or your medical team what you are taking. In general, I have no issues if somebody says, ”I want to take these 2 vitamins.” I would say, “Well, let me know about them, and I will investigate that, but it’s unlikely to hurt,” but you want to know what the patient is taking for two reasons.
Number one is to manage expectations. If somebody is taking a vitamin because they think that the vitamin is going to replace a particular treatment of the cancer, I think it’s important to sit down and talk and counsel that patient. That’s not the case. You could take the vitamin, but it does not replace the treatment that you need to get for the cancer.
Number two, certain components of these over-the-counter complementary therapies may interfere with some of the medications that a person is taking for the treatment of the cancer. An example of this many years back is St. John’s Wort, which is a particular herbal medication that is available without a prescription. It could interfere with the concentrations of tamoxifen in the blood of women who are taking tamoxifen for breast cancer. So that’s important information, right? If somebody is taking something that contradicts the medication that the person is taking.
So please communicate with the healthcare team. There are some rare situations where they can affect the blood counts, the platelets, and the white cells. There are other situations where they could actually also affect the concentration of medications.
Lastly, setting expectations. I feel strongly about that. Are you taking this because it makes you feel good? I’m fine with that. Are you taking this because you think it’s going to prevent cancer forever? I’m not fine with that, because I don’t want you to be disappointed. Let’s just sit down and talk about the data on that.
To view the entirety of Dr. Nabhan’s Ask the Expert webinar, click here.
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