Prepare for Your First Visit

One of the first physicians you may speak with after a cancer diagnosis is a medical oncologist. 

These doctors specialize in treatment with medications, such as chemotherapy, targeted therapy or immunotherapy. (Surgical oncologists, meanwhile, treat cancer by performing surgical procedures, and radiation oncologists use proton therapy, brachytherapy, and other types of radiation therapy to treat it.) 

So, what should you ask your physician to get the most out of your first visit? We spoke with Eric Singhi, M.D., a medical oncologist who treats thoracic cancers at our Texas Medical Center Campus and MD Anderson West Houston. Here are the top five questions he recommends asking your medical oncologist during your first appointment. 

1. What type of cancer do I have?

The answer to this question may seem obvious, but it’s not. Or, at least, not always. That’s because many cancers don’t start causing problems until they’ve metastasized — or spread — to other areas of the body.  

Lung cancer, for instance, may only come to your attention because it’s affecting the nerve that controls your vocal cords. A malignant growth near the end of your large intestine, meanwhile, is most likely one of three diseases that tends to develop there: anal cancer, rectal cancer or colon cancer. And, what appears at first glance to be salivary gland cancer may turn out to be a skin cancer that started on your scalp. 

“Don’t assume you know what type of cancer something is based solely on its current location,” says Singhi. “Ask your doctor for an exact diagnosis.” 

2. Where is the cancer in my body?

Cancers are grouped based on their place of origin. Once you know the specific type of cancer you have, the next step is to determine its stage. The stage indicates how far the cancer has spread, including its location, size and whether it has grown into nearby tissues, lymph nodes or other parts of the body.  

Early-stage cancers that form solid tumors are generally confined to the same places they started, and typically involve surgery, although radiation and chemotherapy treatments may also be used. But later-stage cancers, by definition, have already spread beyond their original locations. So, they may involve both larger tumors and other organs or tissues, making their treatment more complex. 

This is different from blood and bone marrow-based cancers such as leukemia and lymphoma, which are often first detected through abnormalities in lab tests rather than the presence of lumps or abnormal growths. 

“It’s important to clarify just how advanced your cancer is and all of the places it’s located,” Singhi notes. “Accurate staging determines which treatments you’ll be offered and why. And, sometimes, even a slight difference in staging can make a big difference in the treatment recommended.”  

Your care team will use a combination of physical exams, body scans and lab tests to find out the full extent of the disease. 

3. What are my cancer treatment goals?

This is probably the most important question to ask. Knowing your treatment goals can affect both how you feel during treatment and when — or if — it ends.  

“With early-stage cancers, the goal of treatment is usually removing all evidence of disease,” says Singhi. “But it could be more nuanced. With later-stage cancers, for instance, the goal might be to prolong someone’s life by slowing the cancer’s growth or to reduce and manage their symptoms.”  

Sharing your goals for treatment and what matters most to you with your care team is extremely helpful. For some people, living long enough to mark a particular milestone may be a priority. For others, maintaining a high quality of life in the time they have left is what matters most. 

“Whatever is most important to you and what you hope to achieve with treatment, we want to know about it,” Singhi says. “The things you find meaningful are a significant part of the equation to us. We’re partners in your care.” 

4. Who else is on my cancer care team?

MD Anderson’s team approach to care means you have many experts in your corner, including, but not limited to: physicians, advanced practice providers, registered nurses, patient access staff, patient service coordinators, case managers, dietitians, occupational or physical therapists, pharmacists and social work counselors.  

Knowing who to talk to when questions arise is a vital aspect of good cancer care. So, take time to find out exactly who your providers will be and how to reach them quickly if you need to. 

Most cancer patients’ care teams will also involve a combination of oncologists: 

• a medical oncologist 
• a surgical oncologist and/or 
• a radiation oncologist.  

If you’re diabetic, you may need an endocrinologist, too. Or, if you have heart problems, you may need an onco-cardiologist. Clinical trial participants may also have a research nurse assigned to them.  

Regardless of how many specialists are involved in your care at MD Anderson, though, they will all work together to give you the best possible experience during your cancer treatment.  

“Solid communication is what keeps things running smoothly,” says Singhi. 

5. What are the next steps for my cancer treatment?

Once you’ve established the basics of your diagnosis, it’s time to start looking ahead. So, what needs to happen next?  

Here are some questions to consider asking during your care: 

• Will I need any additional tests before you can start treatment?  
• What are my treatment options?  
• Do I need to schedule surgery or set up regular appointments for chemotherapy infusions? 
• If I need radiation therapy, how many days a week will it be, for how many weeks, and how long will each treatment last?  
• Can my treatments be scheduled around my job or other obligations?  
• What kind of side effects can I expect, and what can be done to decrease their impact?  
• How will treatment or surgery affect my daily activities, like the ability to work, exercise and have sex?  
• What other lifestyle changes can I expect? 
• If I need surgery, how long will it take me to recover after the procedure? How long will I stay in the hospital? What should I be looking for in case there is any complication after surgery? 
• Who can I contact if I have a question and what’s the best method of reaching them? 

“Asking all of these questions can help you determine where and how you’re going to be spending your time receiving cancer care over the next few weeks or months, so you can start working out logistics and making concrete plans,” says Singhi. 

If you need a certain number of chemotherapy infusions, for instance, ask if they can be handled on an outpatient basis, or if you’ll need to be hospitalized for each one. Make sure you’re getting information from your insurance provider, too, and find out what pre-authorizations will be needed. Find out how long it might take for you to recover from surgery, and if the clinic location closest to your home or job can provide any of the other services you might need. 

“A cancer diagnosis can be really overwhelming,” notes Singhi. “So, having the right tools to start the conversation is critical. And getting the answers to these — and any other questions you might have — will help you stay better informed and more empowered in your cancer care.” 

Review new patient information and resources at MDAnderson.org/FirstVisit. Check out the First Visit Guide to learn what to expect during your first appointment with us, learn about members of the care team and review questions to ask during your first appointments. 

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

Any time you see a new doctor, one of the first things they’ll ask about is your medical history. That’s because everything from the aftermath of childhood diseases to the side effects of current medications can influence which treatments you’re offered for new conditions and how effective they might be.

But what actually makes up your “medical history,” and what are the most critical things to share with your doctor? Are there any areas of particular importance that cancer patients should mention?

We went to Amy Hassan, M.D., chair of General Oncology, for answers. Here are six things she wants every cancer patient to share with their doctors.

1. Chronic health conditions

Some cancer patients may think that if their diabetes or high blood pressure is well-controlled – whether through medication or lifestyle choices – then they don’t even need to bring it up. But that is not the case. Five underlying conditions you should always mention, regardless of their status, are:

• Hypertension (high blood pressure)
• Diabetes
• Heart disease
• Kidney or liver disorders
• Autoimmune disorders

“‘Controlled’ does not mean ‘gone,’” notes Hassan. “And chronic health conditions can influence your risk of complications from certain cancer treatments, or even determine whether or not they’re appropriate for you.”

Certain chemotherapy drugs might not be recommended, for instance, if you have an underlying heart condition. And a history of gestational diabetes could be relevant, even if you are not currently pregnant.

“The administration of steroids, which are used often during cancer treatment, can push someone who is already predisposed to developing diabetes over the edge into active disease, or exacerbate a case that was previously under control,” explains Hassan.

Autoimmune disorders such as lupus and rheumatoid arthritis can also flare up intermittently, even if they are not currently active.

2. Medications and nutritional supplements

When you share a list of current medications with your doctor, don’t limit yourself to the drugs you’ve been prescribed.

Anything you ingest – including vitamins, minerals, herbs and other dietary supplements – can affect your entire body once they enter your blood stream. Even substances that are absorbed through the skin, such as CBD oil or medicated creams or lotions, may interact with cancer drugs or other therapies, potentially rendering them less effective, ineffective or even harmful.

“A lot of times, people don’t think of non-prescription supplements as being relevant,” says Hassan. “They’re thought of as a safer alternative to more conventional treatments for pain, anxiety and other issues. But it’s important to remember that all of these supplements do have side effects. And, they could potentially interact with other medications and impact your cancer treatment.”

3. Childhood illnesses

It won’t be necessary to rattle off every time you developed strep throat. But if you ever had something out of the ordinary as a child – particularly a significant infection such as pneumonia or tuberculosis – it’s important to mention it.

“Even if it’s no longer active now, it could still be potentially relevant,” notes Hassan. “Having a history of serious infections as a child could be a sign of an impaired immune system. In addition, some infections, such as the human papillomavirus, also known as HPV, have been linked to different types of cancer.”

It’s also important to let medical providers know if you didn’t receive the standard, recommended schedule of childhood vaccinations for any reason.

“Cancer treatments can increase the risk of infection in general,” notes Hassan. “But if your immune system is compromised, you may be more susceptible to those diseases, even as an adult.”

4. Current infections

Hepatitis B and hepatitis C are chronic liver infections that can remain dormant in the body until “reactivated” by cancer treatment.

“Be sure to mention these or any other chronic infections you might have, such as AIDS or HIV, to your care team, as they could cause complications during your cancer treatment,” says Hassan.

5. Surgical procedures

Also tell your doctor about any major surgical procedures you’ve had, especially if you experienced serious complications, such as a reaction to anesthesia or excessive bleeding. 

Even if you’ve never had surgery, be sure to report any other unusual bleeding you may have experienced. 

“A history of heavy menstrual bleeding – or even prolonged bleeding after a dental procedure or giving birth – could be a sign of a bleeding disorder,” notes Hassan. “It’s important to let your care team know about these, so they can make appropriate preparations for any necessary procedures.”

6. Family illnesses

Some diseases run in families. So, if more than one direct ancestor has a particular condition, be sure to share that with your care team.

“Often, someone with colorectal cancer will mention relatives who’ve had that same type of cancer, but not close family members who’ve had other types of cancer,” says Hassan. “Certain hereditary cancer syndromes can increase the risk of multiple types of cancers, so it is important to report any cancers in your family.”

Addiction has also been known to run in families, so if anyone in yours struggles with substance abuse, be sure to mention that, too. Special precautions can be taken by your care team when prescribing painkillers, and alternatives can be suggested to prevent opioid addiction.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

While many people may not know her name, those who have received or provided care at MD Anderson in recent years are likely familiar with Jacqueline Mason’s work. 

In her 12 years at MD Anderson, the program director in Internal Communications has been the heart and soul behind communication campaigns to inform and engage employees about internal safety initiatives and regulatory safety inspections.

Mason directs communications related to our Core Value of Safety, including High-Reliability Organizing, Excellence in Safety Awards and safety protocols adopted during the COVID-19 pandemic. 

She uses storytelling to celebrate the creative ways teams come together to improve lives and champion patient safety, quality and performance improvement.

“I studied to be a professional communicator,” Mason explains. “But I did not realize until I joined MD Anderson that I could apply my chosen profession to a cause that I am so passionate about personally.”

Family experience inspires interest in health care safety

Mason ascribes her interest in health care safety to her experience following her maternal grandmother’s stroke.

“It was hard for my family to see our matriarch move between hospitals and long-term care facilities for two years,” she explains. “Through that experience, I recognized that there is a team – an entire system – behind the person who is face-to-face with a patient and their loved ones.”

A passion for MD Anderson

Mason says she is honored to contribute as part of MD Anderson’s team, pointing to its progressive safety culture and strong leadership commitment to safe, innovative cancer care. 

“I am motivated to do my best every day to spotlight our safe practices and our safety heroes so they are comfortable engaging our patients and their loved ones in their own safe care.” 
 
Learn about careers at MD Anderson.

As a patient access representative for Lymphoma, Graciela “Grace” Chavez is the first point of contact for many new MD Anderson patients. She handles intake and helps them prepare for their first visit, including completing registration, obtaining medical records, and scheduling their first appointment.

“Patients are often scared before their first appointment,” says Jennifer Canales-Olmos, supervisor of patient access operations. “But Grace is always calm, kind and professional. She takes time to explain things to patients and talk them through any nervousness. It’s a special skill set.”

Prioritizing patients’ needs

Assisting patients took on a new level of importance when Hurricane Beryl made landfall in Texas early on July 8. Like millions of people across Houston, many MD Anderson employees lost power, internet connectivity and reliable phone service. While most of her colleagues were without power, Chavez wasted no time springing into action.

“I still had power and an internet connection at home, so I immediately asked Jennifer what she needed me to do,” she recalls.

For hours, Chavez contacted patients who had appointments scheduled for that day. She walked them through the process of rescheduling and reached out to other MD Anderson teams to help reschedule imaging and labs.  

“I knew their anxiety was sky-high, so I did my best to comfort them,” she says. “The patients were very understanding and grateful I could get them new appointments. They said just hearing somebody’s voice from MD Anderson relieved their stress.”

A reliable teammate

Canales-Olmos calls Chavez a “Hurricane Hero” for how she stepped up to help patients and her teammates. Up until she lost power, Chavez checked in on her coworkers to see if they were doing OK, reached out to their patients and communicated messages from Canales-Olmos.    

“Grace was the last person standing,” Canales-Olmos says. “She kept me updated with everyone’s status when messages to and from my team weren’t going through. She was an amazing partner to me and the rest of the Access Leadership team.”

Chavez says she couldn’t ask for a better team.

“We all help each other out,” she says. “It’s not an option. If my team needs me, I’m there.”

Request an appointment at MD Anderson online or call 1-877-632-6789.