Treatment options and second opinions

Many people with pancreatic cancer want to take an active part in making decisions about their medical care. They want to learn all they can about their disease and their treatment choices. However, the shock and stress that people may feel after a diagnosis of cancer can make it hard for them to think of everything they want to ask the doctor. Often it helps to make a list of questions before an appointment. To help remember what the doctor says, patients may take notes or ask whether they may use a tape recorder. Some patients also want to have a family member or friend with them when they talk to the doctor-to take part in the discussion, to take notes, or just to listen.

Cancer of the pancreas is very hard to control with current treatments. For that reason, many doctors encourage patients with this disease to consider taking part in a clinical trial. Clinical trials or studies are an important option for people with all stages of pancreatic cancer.

Such trials are a type of research study that uses volunteers to test new methods of screening, prevention, diagnosis, or treatment of a disease. The trial may be carried out in a clinic or other medical facility.

(The National Cancer Institute hosts a web site with a detailed discussion of what goes into a clinical trial and what a patient should consider. Here's a link to it: Taking Part in Clinical Trials: What Cancer Patients Need To Know. For the world's largest listing of clinical trials for pancreatic cancer, click here: Searchable Pancreatic Cancer Clinical Trials Database, compiled by Pancreatica.org.

At this time, pancreatic cancer can be cured only when it is found at an early stage, before it has spread. However, other treatments may be able to control the disease and help patients live longer and feel better. When a cure or control of the disease is not possible, some patients and their doctors choose palliative therapy. Palliative therapy aims to improve quality of life by controlling pain and other problems caused by this disease.

The doctor may refer patients to an oncologist, a doctor who specializes in treating cancer, or patients may ask for a referral. Specialists who treat pancreatic cancer include surgeons, medical oncologists, and radiation oncologists. Treatment generally begins within a few weeks after the diagnosis. There will be time for patients to talk with the doctor about treatment choices, get a second opinion, and learn more about the disease.

Getting a second opinion

Before starting treatment, a patient may want a second opinion about the diagnosis and the treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if the patient requests it. Gathering medical records and arranging to see another doctor may take a little time. In most cases, a brief delay to get another opinion will not make therapy less helpful.

There are a number of ways to find a doctor for a second opinion:

• The doctor may refer patients to one or more specialists. At cancer centers, several specialists often work together as a team.

• The Cancer Information Service (1-800-4-CANCER) can tell callers about treatment facilities, including cancer centers and other programs supported by the National Cancer Institute, and can send printed information about finding a doctor.

• A local medical society, a nearby hospital, or a medical school can usually provide the name of specialists.

• The American Board of Medical Specialties (ABMS) has a list of doctors who have met certain education and training requirements and have passed specialty examinations. The Official ABMS Directory of Board Certified Medical Specialists lists doctors' names along with their specialty and their educational background. The directory is available in most public libraries. Also, ABMS offers this information on the Internet at http://www.abms.org. (Click on "Who's Certified.")

Preparing for treatment

The doctor can describe treatment choices and discuss the results expected with each treatment option. The doctor and patient can work together to develop a treatment plan that fits the patient's needs.

Treatment depends on where in the pancreas the tumor started and whether the disease has spread. When planning treatment, the doctor also considers other factors, including the patient's age and general health.

People do not need to ask all of their questions or understand all of the answers at one time. They will have other chances to ask the doctor to explain things that are not clear and to ask for more information.

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