As an interior designer, Pam Newton knows the importance of preparation and attention to detail. So even before a biopsy last year confirmed that she had early-stage breast cancer, she was researching cancer treatment options and interviewing oncologists and surgeons in the greater Washington area, where she lives. Then Newton, 63, learned about a newer method of radiation, involving a shorter course of treatment and special protective measures to shield vulnerable organs from the damaging effects. Trouble was, many of the local doctors she consulted about it after her cancer surgery were hesitant to move away from the standard of care. "But I learned that major cancer centers were doing these different approaches," Newton says—and she promptly joined a clinical trial of the therapy at New York University's Langone Medical Center. After less than a month in New York, she was back under the care of her own oncologist.
Newton discovered what every cancer patient should know: that the country's major cancer centers are a rich resource even for people who can't or don't want to receive all of their care there. That's particularly true of the cancer centers specially recognized by the National Cancer Institute and funded by taxpayers to support research into the disease.
There are a number of ways to take advantage of the expertise concentrated at the big centers, says Mark Fesen, an oncologist in Hutchinson, Kan., and author of Surviving the Cancer System, published earlier this year. One of the simplest: get a quick "curbside" consultation. "Without your doctor leaving the examination room, he can call down to the sarcoma or brain tumor expert," says Fesen. True, many specialists won't give specific advice about a patient they haven't seen. But an informal exchange of information can be a quick way for your doctor to check whether he's on the right track. Second opinions or in-person consultations are routinely available and often are covered by insurance. If you have a straightforward, early-stage disease with a standard course of treatment, a local second opinion can suffice. But if your case is complicated, advanced, or unusual, a research center can give you the reassurance that your treatment plan is the right one for you.
One way: by reviewing your pathology reports, the biological details of your cancer obtained by biopsy or surgery. The precise nature of the tumor can play a huge role in how cancer is treated, so an expert opinion is helpful in complex cases or where the precise diagnosis can be difficult to pin down, as with leukemia and lymphoma.
You also can tap into the wisdom of an expert tumor board, where specialists from all aspects of cancer care convene to "ask, 'What's the diagnosis? What's the right approach—should treatment be prior to or right after surgery? What about radiation? When do the cosmetic aspects of treatment come in?' " says Robert Figlin, professor and chairman of the department of medical oncology and experimental therapeutics at the City of Hope Comprehensive Cancer Center in Duarte, Calif. The focus, he says, is the "care of the whole person." Such boards regularly discuss second-opinion cases as well as those of people who come for care, says William Carroll, director of NYU's Cancer Institute. Fesen advises, however, that you not agree to a tumor board's suggested treatment plan unless you have spoken face to face with all the specialists essential to your case.
Once you have a diagnosis and a plan, it's often perfectly fine to head back home for your care. But anyone with a complex case may find it worthwhile to seek out cooperative care, in which a tag team of specialists, at home and at the center, works together. Mike Rutter, 39, was diagnosed with advanced melanoma last fall. He had two surgeries in his hometown of Bristol, Tenn., after which his oncologist advised him to seek out experts at the Duke Comprehensive Cancer Center for another operation and an ongoing treatment plan. His Duke oncologist, Amy Abernethy, put Rutter on interferon treatment, which starts out with an intense month of once-daily IV transfusions before easing off to self-administered injections a few times a week. But Rutter didn't have to spend that time at Duke. His local doctor "took the recipe that Duke gave and administered it to me," he says. "It would have been next to impossible to spend 30 days at Duke," he says. "I would have had to stop everything else in my life." Abernethy, who directs Duke's Cancer Care Research Program, says about a third of her patients come intermittently for check-ins and services not available at home, like PET scans. "Frequently, their doctor has them come see me as another pair of eyes," she says. "The local oncologist feels confident carrying out the plan but wants to make sure it's going to work."