Hey Doc, If You Were in My Shoes …

Most Cancer Doctors Recommend Same Treatment They Would Seek for Themselves

From the WebMD Archives

Jan. 28, 2008 (Orlando) -- If you're faced with a diagnosis of cancer, it may be worthwhile to ask your cancer doctor what he would do if he were in your shoes.

A survey of 150 oncologists that treat colon cancer shows that nearly three-fourths would recommend the same course of therapy to their patients that they would choose for themselves.

"Asked by a patient, 'What would you do, doctor?' Seventy percent of oncologists will flat out answer the question. And another 20% will answer if pressed," says researcher Neil Love, MD, president of the Miami-based medical education company Research To Practice.

"In 73% of cases, their recommendations were identical to what their personal treatment choices would be if they were in the same situation," he tells WebMD.

There were some exceptions, with the doctors favoring a more aggressive treatment course for themselves than for their patients.

Only about 30% of the oncologists surveyed said they would recommend a course of chemotherapy drugs to a patient who had undergone surgery for early-stage colon cancer and was considered to be at very low risk of relapse. But 47% would take the drugs if they were that patient.

Doctors Shy Away From 'Off-Label' Drug Use

The other discrepancy was about Avastin, a targeted cancer therapy that starves tumors of their blood supply, curbing tumor growth. It's approved to treat colon cancer that has metastasized (spread) to other organs, including the liver or lungs.

The survey showed that 24% of oncologists would take Avastin for colon cancer that had spread to many lymph nodes, but had not metastasized to other organs. That's called "off-label" use of a drug. Only 10% of the doctors would recommend Avastin to a patient in the same situation, a significant difference.

Love says the disparity is relatively inconsequential. "Yes, slightly more physicians opted for Avastin [in this scenario], but still, 74% didn't want it," he says.

Also, many doctors recommend that patients with a similar diagnosis take Avastin as part of a clinical trial, he adds.

The findings were reported at the annual Gastrointestinal Cancers Symposium.


Minority of Patients Ask

The doctors surveyed estimated that fewer than half, 41%, of their patients ask them how they would want to be treated.

Jordan Berlin, MD, chairman of the committee that chose which studies to highlight at the meeting and clinical director of GI oncology at the Vanderbilt-Ingram Cancer Center in Nashville, says only about 10% of his patients ask him what he would do if he were in their shoes.

"Far more, about 50%, ask about a mother, father, or other relative," he says.

Berlin tells WebMD that "the recommendation I give them is what I would do for myself or my family.

"You become incredibly honest working in this job, treating people facing the scariest disease on earth. I can't even tell my wife if her dress looks bad. I certainly can't be less than truthful with my patients," he says.

Love now plans to interview people with early-stage colon cancer to see if their responses concur with those of the oncologists.

The survey was funded by Sanofi-Aventis, which makes cancer drugs.

WebMD Health News Reviewed by Louise Chang, MD on January 28, 2008


Fifth Annual Gastrointestinal Cancers Symposium, Orlando, Jan. 25-27, 2008.
Neil Love, MD, president, Research To Practice, Miami.
Jordan Berlin, MD, GCS program chair; clinical director, GI oncology, Vanderbilt-Ingram Cancer Center, Nashville.

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