Facing a cancer diagnosis can be overwhelming. Yet, understanding what to expect when visiting your medical oncologist for the first time can help make this challenging journey more manageable. Your first visit to a medical oncologist marks the beginning of your personalized cancer treatment journey. It is my hope this article will provide some guidance regarding what to expect with your visit, what you need to prepare, and ensure a smooth and effective first appointment.
Understanding the Role of a Medical Oncologist
A medical oncologist is a specialist in diagnosing and treating cancer using chemotherapy, targeted therapy, immunotherapy, and other systemic treatments. They serve as the main health care provider for someone diagnosed with cancer and coordinate treatment provided by other specialists such as surgical oncology and radiation oncology. I like to think of myself as the captain of the ship or the quarterback of the team. Every patient and tumor type are different, each presenting with their own unique circumstances and challenges. It is imperative the medical oncologist properly understand the diagnosis and stage which often involves a discussion with the pathologist and radiologist before discussing all the potential treatment options that are available to the patient. If more than one option is available, then it is incumbent on the oncologist to understand from the patient and family their wishes to how aggressive or conservative they want to be in the treatment depending on the treatment intention. Or perhaps present your case to a multidisciplinary tumor board for a consensus opinion. The treatment intention is always one of two possibilities: curative or palliative?
What to Bring to Your First Appointment
1. Medical Records and Reports
It’s vital to have all your medical information at hand or at least know where they can be found. This includes recent medical records, lab reports, pathology reports, and any diagnostic imaging (like CT or MRIs). Having this comprehensive set of information allows the oncologist to fully understand your health background. Most often, if all the tests, procedures, imaging, pathology were done at the same institution, then these items are typically available at their fingertips to the medical oncologist. If the patient is coming from a different institution where all the records are available, then the new patient appointment scheduler of the new institution will ask you where those records are and specifically request those records be faxed over with their permission.
2. List of Current Medications
Bring a detailed list of any medications you’re currently taking, including prescriptions, over-the-counter drugs, vitamins, and dietary supplements. Make sure to note the dosage as well. This list will help the oncologist understand potential interactions with cancer treatments. For instance, it will be imperative for an oncologist to know if the patient has an ongoing infection requiring antibiotics which may caution the oncologist about the use of chemotherapy. Or if the patient has a history of autoimmune disorders requiring immunosuppressive treatment which are relative contraindications for immunotherapy. Drugs that are given to the patient are either cleared by the kidney or liver and so drug-drug interactions are vital to know in order to minimize adverse effects while optimizing efficacy.
3. Written Questions and Concerns
It’s easy to forget your questions during the actual appointment. Prior to your visit, write down any concerns or questions you have about your diagnosis, treatment, or anything else. Hopefully, by the end of the visit, most of your questions will be answered. If not, I always ask, “do you have further thoughts or questions” before I leave the room. If you forget to ask the medical oncologist after they left the room, don’t fret, usually you will have the nurse, pharmacist or navigator available soon after who may also be able to answer questions as well or get back with you after directing those questions to your treating oncologist.
What to Expect During Your Visit
4. A Detailed Medical History Interview
The oncologist will conduct a comprehensive review of your medical history. Be prepared to discuss past and present health conditions, lifestyle habits, and family history of disease. Some patients will have a straightforward story while others have complicated complex oncologic histories. Again, do not fret. Your medical oncologist will know what information is pertinent to your case or know where to find the information from your prior institution. Occasionally, it is easier for any oncologist to just pick up the phone and call anyone that may help fill in the gaps! You should feel free to add any further information that may impact your care such family history, social situation, work schedules, preferences and yes even vacation plans.
5. A Physical Examination
A thorough physical exam will be conducted to assess your general health status and to identify any signs or symptoms of cancer. Usually, this is more focused for medical oncologists depending on your tumor type and detailed if there’s consideration for clinical trial enrollment.
6. Discussion of Potential Diagnostic Tests
Based on your medical history and physical examination, the oncologist may recommend further diagnostic tests. These could range from additional blood tests to scans or biopsies to molecular analysis. The results of these tests help in staging the cancer and forming a treatment plan. With permission, I will usually show the CT, PET or MRI scan pictures openly to the patient. It is not difficult to view your pictures. These are direct “kodak” pictures of your visceral organs and a picture can be a thousand words. Often, seeing your own pictures puts the patient and families at ease as they see directly without any ambiguity or confusion what exactly is going on inside their bodies at baseline or through their journey with repeat imaging.
Understanding Your Diagnosis and Treatment Plan
7. Understanding Your Diagnosis
Your oncologist will explain your type and stage of cancer, what this means for your health, and your prognosis. Don’t hesitate to ask for clarification if you don’t understand something. How much do you want to know? I always say that if you ask direct questions, then you deserve direct answers. Let’s not fudge it or dance around the diagnosis, prognosis, or whether the treatment intentions are truly curative for the long term, or are we simply doing our best to control the disease and improve quality of life for the patient?
8. Learning About Your Treatment Options
You will discuss potential treatment options, which may include surgery, chemotherapy, radiation, targeted therapies or the combination of all the above. The oncologist will explain the goal of each option, its effectiveness, potential side effects, sequence of treatment, and the impact on your quality of life. There is no such thing as a “dumb question”. Ask away but please do so with respect to the time allotted. If all questions can’t be answered during the initial visit, then no worries, you will have other providers to see you or perhaps keep a running list of questions for your next visit or another provider you may see as part of your care team. I like to think that when you see me or my radiation oncology or surgical oncology colleagues, that most often we all know each other extremely well enough to help answer “big picture” questions about any aspect of the treatment plan.
9. The Role of Clinical Trials
Clinical trials are research studies that test new treatments. You might be eligible to participate in one. Your oncologist can explain the potential benefits and risks. Know your standard of care options then consider additional investigational options via clinical trials if available at the cancer center. Every cancer center may have their own unique portfolio of trials that may not be available at other institutions. Don’t be afraid to ask or decline if offered!
After the Appointment
10. Next Steps and Follow-up Appointments
Before you leave, ensure you understand the next steps in your care. This might involve scheduling future appointments, organizing additional tests, or arranging referrals to other specialists. Make sure to take home all relevant documentation, summaries, and instructions. I always worry about information overload with the first visit and if you feel this is becoming an issue with your first visit, then let your oncologist know. Some folks need more time to understand their diagnosis and treatment before moving forward with treatment. I think it is always helpful to bring in family members or friends to the visit to help you understand the totality of the conversation. That way, you can continue the conversation and iron out the wrinkles beyond the visit or perhaps develop a new list of questions for the next visit.
The first visit to a medical oncologist is a critical step in your cancer journey. Arriving prepared will enable you to make the most of the visit and provide a solid foundation for the decisions ahead. Always remember that every question is worth asking, and every concern is worth addressing. You’re an integral part of your healthcare team, and your input significantly impacts the decision-making process with your care team.
About the author
Dr. Sajeve Thomas is a distinguished medical professional and a compassionate guide in the field of oncology. With over a decade of dedicated experience as a board-certified medical oncologist/internal medicine specialist, Dr. Thomas has become a trusted expert in the treatment of melanoma, sarcoma, and gastrointestinal conditions. Currently practicing at the renowned Orlando Health Cancer Institute, he brings a wealth of expertise to the complex and challenging world of oncology.