Health Topics

Advantages of Seeking Specialized Care

Andrew Schorr:

Well, I want to thank you on behalf of a lot of people for what you do. Now, Dr. Raizer, let's talk about this specialization. It's not common but people are diagnosed with brain tumors all around the country, and they may be out in the suburbs or out in the country, but what is going on at an academic medical center like yours where you've brought a lot of resources together for a brain tumor institute that people should consider at least going to a place such as yours, at least for a consultation? What advantage could that give? How much of a difference could that make?

Dr. Raizer:

I think it provides a lot of advantages. I mean I'm obviously biased, but the when you have to get something treated you want to get treated by somebody who does a lot of them. So whereas in most of the community we have medical oncologists who primarily see all cancers, breast cancer, colon cancer, and then every once in a while a brain tumor will come through their door, I only see patients with various kinds of brain tumors, but brain tumors only. I do see some patients with systemic cancers like lung cancer or breast cancer that has spread to the brain, but that's sort of a minority of what I'm doing. So I'm really focused on one area. Because of that area I go to meetings that are focused on that area, and so you stay much more in the loop than going to, say, one of the big general oncology meetings where you're running to a lung lecture or a breast lecture, because those are the patients you're going to see day in and day out.

Now, the other flip side of that is most of us at academic centers, and part of the reason I came to develop things at Northwestern was, is we do a lot of clinical trials. We're trying to advance the field, and physicians in private practice or small hospitals occasionally can be part of a cooperative group and maybe have one clinical trial open for a brain tumor. They're not going to have that many because they're just not going to have that many patients to justify having a study open, whereas we may have three, five, six, eight studies open at the same time for various stages of patients' disease.

So I think you get the best of both worlds. You get people who specialize in one thing. We have more of a multidisciplinary program, again because the surgeons I work with, the radiation oncologists I work with, the nurses I work with, we're all focused on one area, whereas again in the community they're not likely going to have a brain tumor conference. So I think it always behooves people to seek an opinion or at least make a consultation with somebody.

And even if they want to get their care in the community because it's easier, they may want to touch base because I see a lot of people who get a treatment started and then come to see me for an opinion, and at that point I can't offer much beyond what they're already doing, whereas if I saw them early on I might have said, you know, you'd be good for this clinical trial. Or somebody will do a treatment with this modality and then they come see me, and I'm like, well, because you did that you're not eligible for any clinical trials until something changes. And it's not an intentional fault of the community physicians; they just offer what they can offer at where they practice.

And I offer what I can offer which is, as I always like, the analogy is, when you go to a restaurant you want to have more than one thing on the menu. So I don't want one clinical trial. I want multiple clinical trials for people when they're first diagnosed for people if their tumor comes back the first time or the second time or the third time, you know, clinical trials for various tumor types. And we're actually now starting to develop, myself and other places, clinical trials where we try to use therapies that target specific aspects of tumor biology that will hopefully then give us information that hopefully may allow us to select the appropriate therapy based on what the patient's genetic tumor profile is. And a lot of the studies we're now doing in that area, sort of incorporating those type of analysis into them.

Andrew Schorr:

Personalized medicine. Before we take another break I just want to make a couple of comments because I'm a leukemia survivor, happily, and I was in a clinical trial. And the treatment that I received years ago is what most people get now for my type of leukemia. So a couple of points for people that I want to underscore, and I'm sure Darren and Dr. Raizer would agree. And that is it's important when you're diagnosed with a life threatening condition that you get smart. And obviously you have to find providers that you trust. And in the case of brain cancer, where it's rare, truthfully and there's variations of it, and Dr. Raizer was just talking about personalizing it to your tumor type and your biology, your exact situation, then you really have to at least consult with people who do that and a whole team ideally.

And one other thing, Dr. Raizer, you're a medical oncologist, and I think people if they're diagnosed with cancer understand that and they understand the surgery, but I think it's important for people to understand that it starts with knowing what exactly you're dealing with, and there are sort of the unsung heroes in that area, and those are the pathologists. And so you have, would they be neuropathologists, Dr. Raizer, who help you know exactly what's going on with that tumor type, right? And you have that at Northwestern.

Dr. Raizer:

Correct. So again at a community hospital you probably have a general pathologists, and because they don't get a lot of brain tumors they end up sending it out for a second opinion, whereas 95 percent of the tumors I get I don't typically send out unless something maybe doesn't seem right and I just want to make sure because it influences treatment. And I'm actually a neuro oncologist, so I'm neurology trained as opposed to a medical oncologist, which adds another slant of why I think neuro oncologists are better at dealing with these patients because we're adept of the side effects of the steroids and the seizure medicines we have to use, whereas a lot of medical oncologists are not. They don't use them on a day to day basis.

Andrew Schorr:

You're learning all the time.

Dr. Raizer:

Right. So the neurologic aspects of things we're much more attuned to I. And all of us look at all of our own imaging as I know others in academic centers also do. We look at all our own imaging, and if it's questionable we talk about the neuroradiologists, who are also an integral part of our team in reading scans. And so it really requires I think a large effort to provide expertise and excellent care which at the end of the day is really to benefit the patients.

Andrew Schorr:

Right. And the reason I'm explaining this, whether you go to the brain tumor institute at Northwestern or you live far away, but you seek out a place like that, I urge you if you're diagnosed with a brain cancer that's the kind of team you need.

We're going to be back with much more. Now, you can ask a question of Dr. Raizer or Darren as well. We'll be right back with much or our discussion about brain tumors in our live webcast. You're listening to Patient Power.