Calling Your Doctor with a Cancer Worry

During my group this morning, we talked a lot about when to call your doctor with a concern and which doctor should you call with a particular problem. Obviously, unless you have been asked to do so, no one needs hourly or daily updates from you. They do, however, need to know if there is a problem, especially if you are in the middle of active cancer treatment.

If you are soon to begin or are receiving chemotherapy, the reminder is this: Don’t suffer in silence. Call if you are worried about something. Especially when someone begins a chemotherapy protocol, all that can be offered is our best guess about which medications will help most with any side effects. Remembering that everyone is different, it is possible that some other combination will work better for you. Some people don't call because they assume that feeling terrible is standard during chemo.This is a mistake.There have been great advances in drugs that help with chemo-induced nausea or other GI problems, and there are always other things to try if you are not doing well.

At BIDMC and all other cancer treatment places, there is someone available 24/7. If you are miserable at 2 AM, call. Taking your call is someone’s job, and that conversation may help you feel better by 3 AM. This also comes up later in treatment if you have a new side effect. Or if you have a side effect that seems worse than earlier cycles. Again, call.

Another variation of this, which is equally relevant for someone who is no longer on active treatment, is the Two Week Rule. Especially, but not only, during the first moths after completing cancer treatment, every single ache or pain or cough brings on panic. We immediately assume that the cancer must be back, and that this particular symptom is announcing the recurrence. If our back hurts, we jump to this terrible conclusion rather than remember that we spent yesterday cleaning out the attic.Obviously the Two Week Rule does not apply to something that could be a medical emergency. If you think you might be experiencing a heart attack or a stroke, call 911 immediately.Most things, however, go away on their own and don’t last for two weeks. It can help to make a note on the calendar of the day you first noted your right shoulder pain. If, two weeks later, it is still there, it is time to report it.Chances are good it will be gone by then.

If the shoulder pain, or whatever else is worrying you, is still there after two weeks have passed, the next question becomes who to call.Some people prefer to start with a call to their PCP who seems less scary.Others prefer to go directly to the oncologist and acknowledge their fear. My suggestion would be to call the doctor with whom you feel the most comfortable and who is likely to call back quickly.During the months of active treatment, many oncologists function as your PCP. During this period, that should be your first call. In either case, you may receive immediate-on-the-phone reassurance or you may be asked to come in. If an appointment is offered, don’t panic. This does not mean that they concur that the cancer may be back. It means that they are taking you and your health seriously and want to be responsive to your needs. What happens next depends on the specific symptom, but,most of the time, the end result will be reassuring.Most things are not cancer.

Almost all of us go through something like this at least once.It can be a reassuring memory the next time an ache appears.We can then remind ourselves of the backache that passed or the cough that was just a lingering cold.