5 Questions To Ask Your Doctor

1) What is the exact benefit you’re expecting from this treatment? What is the specific measurement they’re going by? Is it months of life without disease? Is it years of life with disease? Is it shrinkage of a tumor? Is it a certain blood marker?

2) What is the relative benefit of what you’re recommending? (The percentage of people who benefit from the treatment more than not having the treatment.)

For example, let’s say your doctor wants you to increase the amount of green tea you drink from 0 cups per day to 6 cups per day to help with managing your breast cancer. You would ask, 1) “What is the exact benefit you’re expecting from me going from 0 to 6 servings per day of green tea? And 2) What is the relative benefit of doing this?

Your doctor would hopefully then quote something like this study, Green tea intake is associated with urinary estrogen profiles in Japanese-American women​, in which intake of 1-6 servings of green tea per week in the Japanese-American women resulted in a 41.1% decrease in urinary estrone compared to intakes of less than one serving of green tea per week, and that increasing urinary estrone has been associated with increased breast cancer risk in postmenopausal women (quoting this study, Endogenous sex hormones and breast cancer in postmenopausal women: reanalysis of nine prospective studies).

Your doctor may say that he/she hopes that you will have a similar result in your body, about a significant reduction in urinary estrone, considering differences in your nationality and genetics, and that that will help your body fight off the breast cancer.

3) What are the most common side effects of this treatment?

4) What are the least likely and/or most serious potential side effects of this treatment, and how often do they occur?

For example, your doctor may be recommending a Tamoxifen oral tablet to reduce your risk for breast cancer, and you ask what the most and least common side effects are for this treatment. Then, your doctor may list:
very common side effects (occurring more than 10% of the time) of Tamoxifen include edema, skin rash and fatigue; common side effects (occurring 1-10% of the time) include an irregular period, uterine fibroids, anemia, cataracts, pulmonary embolism, depression, thromboembolic events (including deep vein thrombosis and microvascular thrombosis), which are increased when used in combination with cytotoxic agents, bone pain and muscle cramps; uncommon side effects (occurring 0.1%-1% of the time) include endometrial cancer, hypercalcemia (increased calcium in the blood), thrombocytopenia, leukopenia, visual disturbances, interstitial pneumonitis (inflammation of the lungs) and pancreatitis; rare (occurring less than 0.1% of the time) side effects include angioedema (sudden swelling in the skin), optic neuropathy, neutropenia (low neutrophils), hepatitis, liver failure, endometriosis, uterine sarcoma; and very rare side effects (occurring less than 0.01% of the time) include cutaneous lupus erythematosus.

5) What studies or references do you have to back up what you're recommending/telling me?

Hopefully your doctor will have studies to back up his/her recommendations, such as the study above on green tea and urinary estrogen profiles in #2. I once went to an oncology appointment with a friend to help him ask helpful questions, and when I asked this question when the oncologist suggested a combination of three different chemotherapies, he came back with three studies, none of which applied directly to my friend’s situation; at least one was about the results of one or more of the treatments in a different type of cancer, and none of them addressed this specific combination of treatment in my friend’s type of cancer.