Finding Cancer Care

An oncologist is a doctor who has special training in diagnosing and treating cancer. When choosing a doctor for your cancer care, it may be helpful to know some of the other terms used to describe a doctor’s training and credentials. Most physicians who treat people with cancer are medical doctors (they have an M.D. degree) or osteopathic doctors (they have a D.O. degree). Standard training includes

• 4 years of study at a college or university
• 4 years of medical school
• 3 to 7 years of postgraduate medical education through internships and residencies

Doctors must pass an exam to become licensed to practice medicine in their state.

Specialists are doctors who have done their residency training in a specific field such as internal medicine. Independent specialty boards certify physicians after they have met needed requirements, such as meeting certain education and training standards, being licensed to practice medicine, and passing an exam given by their specialty board. Once they have met these requirements, physicians are said to be “board certified.”

Besides oncologists, other specialists who treat cancer include:

• hematologists: focus on diseases of the blood and related tissues, including the bone marrow, spleen, and lymph nodes
• radiation oncologists: use x-rays and other forms of radiation to diagnose and treat disease
• surgeons: perform operations on almost any area of the body and may specialize in a certain type of surgery

Finding a Cancer Doctor

To find an oncologist, ask your primary care doctor to suggest someone. Or you may know of a specialist through the experience of a friend of family member. Also, your local hospital should be able to provide you with a list of oncologists who practice there.

Another option for finding a doctor is your nearest NCI-designated cancer center. The Find a Cancer Center page provides contact information to help health care providers and cancer patients with referrals to all NCI-designated cancer centers in the United States.

Some organizations have online directories that may also help you find a cancer doctor. Some examples are below.

• The American Board of Medical Specialties (ABMS) creates and implements the standards for certifying and evaluating doctors. It has a list of doctors that have met certain requirements and passed specialty exams, called Is My Doctor Board Certified?
• The American College of Surgeons (ACS) lists member hospitals and surgeons by region and specialty in their online database for patients. 
• The American Medical Association (AMA) provides information on licensed doctors in the United States in their Find a Doctor database.
• The American Osteopathic Association (AOA) has a searchable database, Find a D.O., of member osteopathic physicians.
• The American Society of Clinical Oncology (ASCO)  provides Find an Oncologist which lists names of member physicians and health professionals worldwide who have agreed to be included.

Local medical societies may also keep lists of doctors in each specialty for you to check. Public and medical libraries may have printed directories of doctors’ names listed geographically by specialty.

If you have health insurance, your choice may be limited to doctors who take part in your plan. Your insurance company can give you a list of doctors to choose from. It’s important to contact the office of the doctor you’re thinking about, in order to check that they're accepting new patients through your plan. It’s also important to do this if you’re using a federal or state health insurance program such as Medicare or Medicaid.

If you can change health insurance plans, you may want to decide which doctor you would like to use first and then choose the plan that includes your chosen physician. You also have the option of seeing a doctor outside your plan and paying more of the costs yourself.

To help make your decision when you’re considering what doctor to choose, think about whether the doctor

• has the education and training needed to meet your needs
• has someone who covers for them if they are unavailable and who would have access to your medical records
• has a helpful support staff
• explains things clearly, listens to you, and treats you with respect
• encourages you to ask questions
• has office hours that meet your needs
• is easy to get an appointment with
• uses telemedicine when visits don't need to be in person

If you're choosing a surgeon, you will want to ask questions such as these listed below.

• Are they board certified?
• How often do they perform the type of surgery you need?
• How many of these procedures have they performed?
• At what hospital(s) do they practice?

It’s important for you to feel good about the cancer doctor you choose. You will be working with this person closely as you make decisions about your cancer treatment.

Getting a Second Opinion After a Cancer Diagnosis

After you talk to a doctor about the diagnosis and treatment plan for your cancer, you may want to get another doctor’s opinion before you begin treatment. This is known as getting a second opinion. You can do this by asking another specialist to review all the materials related to your case. The doctor who gives the second opinion may agree with the treatment plan proposed by your first doctor, or they may suggest changes or another approach. Either way, getting a second opinion may

• give you more information
• answer any questions you may have
• give you a greater sense of control
• help you feel more confident, knowing you have explored all your options

Getting a second opinion is very common. Yet some patients worry that their doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies pay for a second opinion or even require them, particularly if a doctor recommends surgery.

When talking with your doctor about getting a second opinion, it may be helpful to express that you’re satisfied with your care but want to be certain you’re as informed as possible about your treatment options. It’s best to involve your doctor in the process of getting a second opinion, because they will need to make your medical records (such as your test results and x-rays) available to the doctor giving the second opinion. You may wish to bring a family member along for support when asking for a second opinion.

If your doctor can’t suggest another specialist for a second opinion, many of the resources listed above for finding a doctor can help you find a specialist for a second opinion. You can also call NCI’s Cancer Information Service at 1-800-4-CANCER (1-800-422-6237) for guidance.

Choosing a Cancer Center or Hospital

As with choosing a cancer doctor, your choice of cancer centers or hospitals may be limited to those that take part in your health insurance plan. If you have already found a doctor for your cancer treatment, you may need to choose a cancer center or hospital based on where your doctor practices. Or your doctor may be able to recommend a facility that provides quality care to meet your needs.

Some examples of questions to ask when deciding where to go for cancer care are below.

• Does it have experience and success in treating my condition?
• Has it been rated by state, consumer, or other groups for its quality of care?
• How does it check on and work to improve its quality of care?
• Has it been approved by a nationally recognized accrediting body, such as the ACoS Commission on Cancer and/or The Joint Commission?
• Does it explain patients’ rights and responsibilities? Are copies of this information available to patients?
• Does it offer support services, such as social workers and resources, to help me find financial assistance if I need it?
• Is it conveniently located?

If you belong to a health insurance plan, ask your insurance company if the facility you're choosing is approved by your plan. If you decide to pay for treatment yourself because you choose to go outside of your network or don’t have insurance, discuss the possible costs with your doctor beforehand. You will want to talk to the hospital billing department as well. Nurses and social workers may also be able to give you more information about coverage, eligibility, and insurance issues.

The resources below may help you find a hospital or cancer center for your care.

• NCI's Find a Cancer Center provides contact information for NCI-designated cancer centers located throughout the country.
• The American College of Surgeons (ACoS) Commission on Cancer (CoC). The ACoS website has a searchable database of cancer care programs they have accredited. 
• The Joint Commission evaluates and accredits health care organizations and programs in the United States. It also provides guidance about choosing a treatment facility, and offers an online Quality Check® service that patients can use to check whether a specific facility has been accredited by the Joint Commission and to view its performance reports. 

For more information or help with finding a cancer center, call NCI’s Cancer Information Service at 1-800-4-CANCER (1-800-422-6237) or visit cancer.gov.

Getting treatment in the United States if you're not a U.S. citizen

Some people who live outside the United States (U.S.) may wish to obtain a second opinion or have their cancer treatment in this country. Many facilities in the U.S offer these services to international cancer patients. They may also provide support services, such as language interpretation or help with travel and finding lodging near the treatment facility.

If you live outside the U.S. and would like to get cancer treatment in this country, you should contact cancer centers or hospitals directly to find out whether they have an international patient office. The NCI-Designated Cancer Centers Find a Cancer Center page offers contact information for NCI-designated cancer centers throughout the United States.

Citizens of other countries who are planning to travel to the U.S. for cancer treatment must first obtain a non-immigrant visa for medical treatment from the U.S. Embassy or Consulate in their home country. Visa applicants must show that they

• want to come to the U.S. for medical treatment
• plan to stay for a specific, limited period
• have funds to cover expenses in the U.S.
• have a residence and social and economic ties outside the U.S.
• intend to return to their home country

Contact the U.S. Embassy or Consulate in your home country to find out the fees and documents needed for the non-immigrant visa and to learn more about the application process. The U.S. Department of State provides a list of links to the websites of U.S. Embassies and Consulates worldwide.

More information about non-immigrant visa services is available on the U.S. Department of State Visitor Visa page. If you are planning to travel to the U.S., make sure to check the page for any possible updates or changes.

Finding a cancer center or hospital outside the United States

Cancer information services are available in many countries to provide information and answer questions about cancer. They may also be able to help you find a cancer treatment center close to where you live.

The International Cancer Information Service Group (ICISG), a worldwide network of more than 70 organizations that deliver cancer information, has a list of member organizations on their website. They also have the list, Cancer Information in Other Languages. For questions or comments, email ICISG.

The Union for International Cancer Control (UICC) is another resource for people living outside the United States who want to find a cancer treatment facility. The UICC consists of international cancer-related organizations devoted to the worldwide fight against cancer. These organizations serve as resources for the public and may have helpful information about cancer and treatment centers. To find a resource in or near your country, you may send the UICC an email or contact them at:

Union for International Cancer Control (UICC)
62 route de Frontenex
1207 Geneva
Switzerland
+ 41 22 809 1811

Finding Health Insurance

The Affordable Care Act (ACA) allows for many Americans to have affordable health insurance. Through the ACA, people have rights and protections that make health coverage more fair and easy to understand. The law also expands the Medicaid program to cover more people with low incomes.

If you do not have health insurance or want to look at new options, the online Health Insurance Marketplace lets you compare plans in your state based on price, benefits, quality, and other needs you may have. To learn about the Health Insurance Marketplace and your new coverage options, please go to Healthcare.gov or CuidadoDeSalud.gov or call toll-free at 1-800-318-2596 (TTY: 1-855-889-4325).

If you can’t afford insurance and are ineligible for Medicaid or Medicare, ask about charity care and sliding-scale programs at hospitals and clinics. These are programs in which fees are based on your income. Some hospitals are required to see patients who are uninsured. Contact your local department of health or social services, or the business office of the hospital you choose for more information.

Home Care Services

Sometimes patients want to be cared for at home so they can be in familiar surroundings with family and friends. Home care services can help patients stay at home by using a team approach with doctors, nurses, social workers, physical therapists, and others.

If the patient qualifies for home care services, such services may include

• managing symptoms and monitoring care
• delivery of medications
• physical therapy
• emotional and spiritual care
• help with preparing meals and personal hygiene
• providing medical equipment

For many patients and families, home care can be both rewarding and demanding. It can change relationships and require families to cope with all aspects of patient care. New issues may also arise that families need to address such as the logistics of having home care providers coming into the home at regular intervals.

To prepare for these changes, patients and caregivers should ask questions and get as much information as possible from the home care team or organization. A doctor, nurse, or social worker can provide information about a patient’s specific needs, the availability of services, and the local home care agencies.

Getting financial assistance for home care

Help with paying for home care services may be available from public or private sources. Private health insurance may cover some home care services, but benefits vary from plan to plan.

Some public resources to help pay for home care are:

• Centers for Medicare & Medicaid Services (CMS): A government agency responsible for the administration of several key federal health care programs. Two of these are
  • Medicare: A government health insurance program for the elderly or disabled. For information, visit their website or call 1-800-MEDICARE (1-800-633-4227).
  • Medicaid: A joint federal and state health insurance program for those who need help with medical expenses. Coverage varies by state.

Both Medicare and Medicaid may cover home care services for patients who qualify, but some rules apply. Talk to a social worker and other members of the health care team to find out more about home care providers and agencies. For more information contact the CMS online or call 1-877-267-2323.

• Eldercare Locator: Run by the U.S. Administration on Aging, it provides information about local Area Agencies on Aging and other assistance for older people. These agencies may provide funds for home care. Eldercare Locator can be reached at 1-800-677-1116 for more information.
• Department of Veterans Affairs (VA): Veterans who are disabled as a result of military service can receive home care services from the U.S. Department of Veterans Affairs. However, only home care services provided by VA hospitals may be used. More information about these benefits can be found on their website or by calling 1-877-222-8387 (1-877-222-VETS).

For other resources for home care, call NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237) or visit cancer.gov.