How long should a cancer diagnosis take?

Patients are frequently frustrated by the length of time it can take to get a clear cancer diagnosis. They are left in limbo and fear since they know something is wrong, but not exactly what and therefore can have no plan of action.

Often the first signs of an abnormality are non-specific and difficult to pin down or identify:

• Cancer may present with fatigue or weakness only, which everyone experiences at one time or another.
• There may be non localized pains, a nagging cough, a small lump or other signs and symptoms that aren't pursued initially or take some time to find. It is not uncommon for weeks to elapse from initial symptoms to the start of the diagnostic work up.
• Some cancers, for example early colon cancer, can have no symptoms at all, and only be discovered incidentally or by screening (colonoscopy).

Once an abnormality is found, further laboratory tests or diagnostic imaging are usually used to further evaluate it:

• These tests often take a day or two to run (clinical lab tests), or several days to schedule and perform.
• Then a biopsy (in the case of a solid tumor) or blood sample (in the case of leukemia or lymphoma) is usually taken. A biopsy of a solid tumor such as a breast biopsy is usually performed by a radiologist or surgeon and this can take days or weeks to schedule.
• Once the biopsy is performed it goes to the Pathology laboratory for analysis to determine if it is cancer, what type exactly and what prognostic features it has. This usually takes 1-3 days of work and may entail sending the biopsy specimen to other specialized labs to detect specific features that may determine which kinds of treatment are appropriate and this could take additional days or even weeks. Every tumor in every patient is unique and some are very difficult to diagnose based on current medical science and could require the review by a pathology specialist who studies only one kind of tumor. There may only be a few of these specialists in the country and this kind of review could take additional days or weeks. For more information visit, The Pathologist's role in cancer diagnosis and care >>
• Once the diagnosis is made, evaluation by oncologists is necessary to determine the exact type of treatment necessary. These appointments can take days to schedule and more than one opinion is often necessary to get the plan solidified. Sometimes a particular treatment (eg. neutron beam radiotherapy) is only available in a few places in the country and getting into these treatment facilities can take days or weeks. For more information visit, Cancer: What's in a diagnosis?

Thus it takes quite a while to get a diagnosis and get started with the best treatment. Fortunately most cancers are quite slow growing and have often been present in the patient for years prior to diagnosis and so a few weeks delay usually has no outcome consequence, but delays are clearly associated with emotional stress and turmoil.

Although it may not feel like it, your team is working very hard to get a timely and accurate diagnosis for you. However, as with all your health care decisions, if you ever feel as though you are falling through the cracks, speak up.

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How to make the most out of every patient visit

Editors Note: We met with Susan Covey and Pam Clay, Certified Medical Assistants who serve as Clinical Staff at the Providence Regional Cancer System Clinic in Lacey, WA to ask them, “How can patients make the most out of their visit?” Here are their top 6 …

1. Bring a list of your medications. See “I take one blue pill and three pink pills twice a day.”
2. Write your questions down. We find that it’s helpful for our patients and their support partners to keep a journal beginning the day they leave their last visit to the day of your next one.
3. Bring a support partner. It’s not only helpful to have a second set of ears listening to your care team’s instructions; it’s also beneficial to have a second person’s questions while the doctor is present.
4. Let us know if you’ve been to another doctor, or had tests done somewhere else. This information helps us to ensure the treatment plan we are creating for you is the most appropriate and complete.
5. Be a good patient. This means, don’t be afraid to give us the full picture.
   - Tell your doctor everything you tell your nurse. Often patients will share openly with their care team up until the point they see their doctor. Not wanting to look like they are “complaining to their doctor” they stop sharing and simply answer the doctor’s questions, painting an incomplete picture of their treatment.
   - Don’t ignore your side-effects! Every day we make more progress managing the side-effects that cancer treatment often brings … but we can’t address them if you don’t tell us about them. See “Cancer and pain: It’s okay to ask for help.”
6. Be yourself. We think our patients and those who support them are some of the bravest people we know … but we also know that you are feeling scared, confused, frustrated … the list goes on. When you come to see us don’t be afraid to tell us how you really feel. We’re here to help.

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"I take one blue pill and three pink pills twice a day."

You would be surprised to learn just how often our clincial staff hear those same exact words. Or maybe, "I take 10 mg every day for my blood pressure." Our next question is almost always, "10mg of what?"

It may not seem like a big deal but the importance of knowing the medications you are on can never be stressed enough. With thousands of drugs being prescribed every day, not to mention the availability of natural remedies you can understand how confusing it may be for us to narrow down your drug just by color or mg. So why do we care? Medication reconciliation helps us to optimize the drug therapy you are on while also reducing the adverse side effects that can occur when two drugs are mixed (ie: taking St. John's Wort during chemotherapy reduces the effectiveness of the chemotherapy).

 What falls under the category of things we want to know about?

• Prescription medications (including any sample medications you have been given)
• Vitamins
• Over-the-counter drugs
• Vaccines
• Diagnostics and contrast agents
• Radioactive materials
• Respiratory therapy-related medications
• Blood derivatives
• Intravenous solutions
• Any other produt the FDA has designated as a drug

In all honesty, if you're putting it in your body we want to know about it. Need a place to put it all? You can pick up a personal pocket medication card in any of our clinics or you can request we mail you one by sending us your address.

The inside of the "Personal Pocket Medication Card" provides space for you to write all the information your care team needs.

How do I refill a prescription?

All medication refills/request require 2 business days notice but it's always a good idea to allow more time for processing on holidays and weekends.

The medication request lines:

• Aberdeen: 360.533.6909 ext. 1708
• Centralia: 360.330.8939 option #2
• Lacey: 360.754.3934, ext. 2520

For any prescription that requires a physical/hard copy (narcotics) call your clinic's medication request line and leave a message with the following:

• Spelling of your first and last names
• Medication name, dose, directions and quantity
• When you will be able to pick up the written prescription. NOTE: You will be notified when the prescription ready to be picked up.

For all other medication refills please call your pharmacy and ask them to fax a refill request to your physician. This is for any refill request, including if your medication bottle states "No Refills".

Any requests received after 4 p.m. may not be processed until the next business day.

How do I contact my nurse from home?

One of the most common questions we get from our patients is, how do I contact my nurse from home. About 6 months ago we created the Providence Regional Cancer System Nurse Line. To contact us simply call your main clinic number and asked to transferred to the nurse line. At this point you will be asked to leave a message. We ask that you provide the following information:

• First, and most important, leave a message! Many times people call and hang up (instead of leaving a message). We cannot know that you called us unless you leave us a message.
• Provide your name, first and last. Please speak slowly and clearly and spell your name for us. This will help us to quickly find your records and locate your nurse.
• Leave a phone number where we can reach you. If you don't leave a phone number we will use whatever number is listed in your medical records. However, often times this is your home number and you're not at home. If you leave us the number that you know you will be at we can get back to you that much faster.
• Tell us as much information as you think we need. The nurse line receives 150-250 phone calls a day. We triage these calls and call back our patients accordingly.

If you have a suggestion for how we can make our nurse line better please e-mail us. As a new system we know that there are kinks we need to work our and we would love your feedback as to how we can better serve you.

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