June 2nd, 2008
06:51 PM ET

Deciding on a treatment plan

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

We now know Sen. Ted Kennedy flew down to Durham, North Carolina, over the weekend, and underwent awake brain surgery at 9 Monday morning at Duke. The operation was "successful," according to his surgeons, and a significant amount of his malignant glioma was removed. The whole thing was a bit of a surprise given that his doctors at Massachusetts General Hospital hadn't publicly raised the possibility of an operation. They mentioned only chemotherapy and radiation as his options. Clearly, over the last couple of weeks, the senator and his family decided they wanted more. They wanted to fight this tumor, and they talked to experts all over the country and finally decided on Dr. Allan Friedman at the Preston Robert Tisch Brain Tumor Center at Duke to help them in his battle.

So, what sort of things go into that decision making process?

Well, for starters, Duke is a highly regarded brain tumor hospital. The chief of neurosurgery has been at Duke for over three decades and removes around 90 percent of the brain tumors at that hospital. Its staff members,  along with those of several other hospitals, are regarded as experts in what is known as brain "mapping." Even as a neurosurgeon,  I find mapping to be a truly wondrous advancement.  As the patient, in this case the senator, lies awake on the table with his head immobilized, the doctors probe various areas of the brain with a device that looks like a small fork. Carefully, they "map" out the areas of his brain responsible for things like speech. While they are probing with a slight electrical current, if the patient suddenly has trouble raising his hand or identifying an object, the doctors know to stay away from that area – even if tumor is present. The risks would outweigh the rewards. First do no harm.

Kennedy may have ended up at Duke simply because he really liked the doctors and felt comfortable in their hands – attitude, such an important thing for a patient. He may have gone to Duke because he thought they were the "best." Finally, it could also be because of a vaccine clinical trial that is going on there. Just today, researchers at Duke reported on a small study that found that a cancer vaccine could double the survival time of people with one of the deadliest brain tumors, from around 14 1/2 months to 33 months.
The surgery Kennedy had today will most likely be covered by his health plan because removing the tumor is an approved treatment, even though he left his network of doctors in Boston to travel to Durham.  According to the NIH, health insurance and managed care providers often do not cover the patient care costs associated with clinical trials, if that is the route he decides to go.

All of this got me to thinking: how does the average person make these decisions? How do they decide where they are going to get treated and is it even possible for most to find the "best" in the country? I'm eager to hear your experiences and any tips you might have for fellow bloggers and patients.

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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.