How to Navigate the Health System for Better Cancer Care & Outcomes
Featuring: Philip Leming, MD, Jillian Hunt, AOCNP
In short
Philip Leming, MD, and Jillian Hunt, AOCNP, of Cincinnati Cancer Advisors walk through the real dysfunctions in cancer care — fragmented communication, rushed appointments, doctors who never do a full exam — and explain what patients and caregivers can do about them. The focus is on moving from passive recipient to active participant: knowing who is in charge of your care, asking hard questions, and getting a second opinion when something feels off.
- •Identify one doctor who will serve as your 'quarterback' — the person responsible for coordinating all your specialists and making sure they are talking to each other, not just sending electronic requests.
- •Ask your doctor to explain the rationale behind every recommended treatment, not just the plan itself — and don't accept a vague answer; persistent questions are appropriate and expected.
- •Get a second opinion at key moments: at first diagnosis, before major surgery or aggressive chemotherapy, if treatment isn't working, or any time your concerns feel unaddressed.
- •If cost is a barrier, Cincinnati Cancer Advisors offers free second opinions for patients in eligible states, and Cancer Commons is a free online resource open to anyone.
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Brad Power July 2, 2025 “Patients are going to have better outcomes if they get engaged in their care, and they are not passive participants. They've got to challenge, they've got to ask questions, and we've got to figure out a way. All of those things are absolutely true. But the reality is the uneducated, motivated patient who doesn't know what questions to ask. Those aren't the patients that are seeking support.
Those aren't the patients that are engaging with additional services. Those are the patients that are being spoon-fed whatever answer the doc is giving them, and they're not questioning that at all. ” – Philip Leming, MD “If I can't do better than the guidelines, I need to not practice. I separate out oncologists into those oncologists that do nothing but quote guidelines, versus those that think beyond the guidelines.
Because anything that's on a guideline is automatically somewhat out-of-date. Yes, you want to be aware of guidelines, but if you're working at the level that you should, your level of thinking should be far beyond any guideline, knowing that whatever you think is standard of care, there are researchers and people that are five to ten years ahead of that.
Once you understand that, you're forever tortured because you can't just be happy with a patient getting something on the guideline. They're important, but they're what the consensus thinks. The guideline things aren't necessarily the best for that singular patient. If you work on the philosophy like we do, which is, if you can walk in the door, you're curable until proven otherwise in our eyes.
You don't want to be taken care of by a physician who doesn't have that mindset. Because anybody that thinks that they know everything, then they're wrong. The research world and that science level is far beyond what's accessible on a guideline or a day-to- day practice.
Meeting Summary
Navigating the dysfunction of our current healthcare system is challenging. " You need to grab one of your doctors and tell them to be in charge or find someone who will. It is disturbing how many patients have never been examined. , your psycho-social issues. Every treatment you get is like another illness. You may have an issue that is four times your cancer risk. The basics are not being done correctly.
Physicians are being asked to see too many patients with too little time, so they send patients to specialists. , leaving training sooner to start working. Philip Leming, MD, Medical Director, Cincinnati Cancer Advisors , and Jillian Hunt, AOCNP, are uniquely qualified to lead a conversation about healthcare system dysfunctions and the approaches that cancer patients and caregivers should take to address them. Dr.
Leming’s extensive educational credentials include receiving two Oswald undergraduate research awards at The University of Kentucky , Graduating from The University of Louisville Medical School with High Honors and a member of AOA honor society and Phi Kappa Phi medical fraternity. He completed an internal medicine residency at The University of Cincinnati and was selected as Chief Medical resident.
He also completed a fellowship in Hematology and Oncology at UC. He was then chosen to attend The National Cancer Institute, NIH which at the time was “the West Point of Oncology” where he spent two years in Cancer Research. He then returned to Cincinnati where he founded The Christ Hospital Cancer Research Department and remained the director until 2019.
In addition he was a member of an elite oncology group providing hematology/oncology care to patients in Greater Cincinnati. In 2019 he was offered an opportunity to establish an independent oncology second opinion program supported by The Cincinnati Cancer Foundation headed by Dr. Bill Barrett. The program has grown from Dr. Leming and Jillian Hunt CNP to 20 members and now a second branch in Naples, Florida. Dr.
Leming remains as the Medical Director. Jillian Hunt, AOCNP, is an oncology nurse practitioner who has worked with Dr. Leming for the past 21 years. Jillian completed her undergraduate studies at the University of Cincinnati where she obtained her degree as a registered nurse. Her early career began at Cincinnati Children's Hospital in pediatric hematology/oncology/bone marrow transplant.
In 2004 Jillian shifted her career to the adult setting working as an infusion nurse with Dr. Leming in private practice. As her passion for oncology grew she continued her education at Indiana Wesleyan University and obtained her Master of Science in Nursing and began her career as a Nurse Practitioner in 2011 continuing to work alongside Dr. Leming. In 2019 Jillian and Dr. Leming started the Cincinnati Cancer Advisors.
This program aimed to “fill in the gaps” of cancer care, started initially as an independent second opinion program and has grown into a multi level approach to cancer care in both the Cincinnati and now Naples, Florida areas. Jillian serves as the Executive Director of Clinical Operations at both locations and continues to see patients with Dr. Leming. What are the potential downsides of being a passive recipient of treatment?
•Incomplete understanding of your diagnosis and treatment options
•Potential missed opportunities for better care or alternative treatments
•Risk of receiving fragmented care without proper communication between specialists
•Possible medication errors or inappropriate treatments
•Higher likelihood of experiencing unnecessary procedures or tests
•Increased anxiety from not fully comprehending your medical situation What are the potential upsides of being an active participant in your cancer care?
•Better outcomes
•Longer survival rates
•More personalized care that considers your whole health, not just the cancer
•Better understanding of your diagnosis and treatment options; empowerment to make informed decisions about your treatment; ability to ask critical questions and challenge medical recommendations
•Reduced fear and anxiety through comprehensive education
•Ensuring proper communication between different healthcare providers What are common dysfunctions you may see in your cancer care journey?
•Fragmented communication : your multiple doctors (oncologists, primary care, other specialists) not communicating with each other about your treatment, unsure who is "quarterbacking" your overall care
•Inadequate examinations : Doctors often document exams without actually performing thorough physical examinations, and rely more on technology and scans instead of basic medical practices.
•Time constraints: Your doctor has limited time with you due to system pressures and is forced to focus on documentation for billing rather than your comprehensive care, leaving them unable to provide detailed explanations about your diagnosis and treatment.
•Referral problems : You are shuttled between multiple specialists working in "tunnel vision" without understanding your complete situation.
•Treatment decision challenges : Potential conflicts of interest, such as academic centers recommending specific clinical trials that serve their institutional interests, while you have limited understanding of your treatment options. How can you effectively advocate for yourself and ensure you receive the best possible care and outcomes within the fragmented healthcare system?
•Ask questions: Be proactive and don't hesitate to ask detailed questions about your diagnosis, treatment, and potential side effects; ask about the rationale behind treatments, potential outcomes, and how different aspects of your care interconnect; do not accept surface-level explanations; challenge your doctors when something doesn't seem right; do not be afraid to "be a pain" by persistently asking questions and seeking clarity.
•Get second opinions : Consider consulting independent experts who can provide comprehensive explanations and help you understand your specific situation.
•Bring family members to appointments : Having support can help you process information and remember details.
•Educate yourself: Try to learn as much about your diagnosis and testing and treatment plan as possible, so you can be an informed and active participant in your care.
•Get a good doctor to take charge : Find a “quarterback”; seek doctors who take time to explain things in common sense terms and help reduce your fear and anxiety.
•Ensure all your doctors are communicating with each other : ask your doctor to call the referring physician, not just make an electronic request
•Verify basic medical practices are being followed : like accurate weight measurements When should you get a second opinion?
•When first diagnosed with cancer, especially with a rare or complex type
•If you're unsure about your treatment plan or have doubts about the recommended approach
•When facing advanced or metastatic cancer
•If you're not responding to current treatment
•Before starting a major treatment like surgery or aggressive chemotherapy
•When considering clinical trials or experimental treatments
•If you feel your current doctor isn't addressing all your concerns or providing comprehensive care How can you find and access a second opinion?
•If you’re in the right state, you can contact Cincinnati Cancer Advisors , which offers free second opinions sponsored by philanthropy, or use online resources like Cancer Commons which is also free.
•Check with local cancer centers or academic medical centers that offer second opinion services
•Ask your current oncologist for a referral to another specialist
•Verify the credentials and expertise of the physician providing the second opinion
•Gather all your medical records, test results, and imaging studies to share with the second opinion doctor.
•Check your insurance coverage and potential out-of-pocket costs How can you learn more about navigating the health system to get good care?
•Go to the Cincinnati Cancer Advisors website for information about their services
•Contact Phil Leming at philip.leming@cincinnaticanceradvisors.org or Jill Hunt at jillian.hunt@cincinnaticanceradvisors.org
•See previous Cancer Patient Lab discussions on navigating cancer care:
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•The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Cancer Patient Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action. You should always consult a doctor about your specific situation before pursuing any health care program, treatment, product or other course of action that might affect your health. For the video recording of this conversation, please see here. Meeting Notes KEYWORDS Cancer Patient Lab, second opinions, Cincinnati Cancer Advisors, Naples Cancer Advisors, philanthropy, healthcare system, clinical research, malignant melanoma, patient education, comprehensive care, communication, medical oncology, patient engagement, clinical trials. SPEAKERS Phil Leming (51%), Jill Hunt (23%), Chris Apfel (8%), Brad Power (6%), Rick Davis (6%), Lori Mckitrick (3%), Helen (3%) CHAT CONTRIBUTORS Rick Davis, Chris Apfel, Russ Hollyer, Allen Morris, Helen, Lori Mckitrick, Alexander Lalov, Jill Hunt SUMMARY Cincinnati Cancer Advisors is a free second opinion service for cancer patients. Phil Leming, a medical oncologist, and Jill Hunt, with 22 years of collaboration, established the program five years ago to address healthcare system deficiencies. They emphasized the importance of comprehensive patient care, thorough examinations, and effective communication among doctors. The program, now with 20 team members, includes specialists like Dr. Abdul Jazieh and Robin Zon. They highlighted issues like fragmented care, inadequate patient examinations, and the need for patients to be proactive and informed. They also addressed the challenges of generic chemotherapy drugs and the importance of patient engagement in their treatment. OUTLINE Introduction and Background of Cincinnati Cancer Advisors
•Jill Hunt and Phil Leming are from Cincinnati Cancer Advisors and Naples Cancer Advisors.
•Their services are free, sponsored by philanthropy. They provide second opinions in person.
•Phil Leming shares is a medical oncologist, trained at the National Cancer Institute, and has experience in private practice and clinical research.
•Phil Leming and Jill Hunt decided to establish an independent non-denominational second opinion oncology program.
•The program was initiated by Dr. Bill Barrett and started with minimal resources, including no phones, computers, or electronic medical records.
•Their initial approach is spending two hours with each patient to answer all their questions and educate them on their diagnosis and treatment options.
•The program has evolved to fill gaps in cancer patient care, especially during the pandemic, allowing families to accompany patients to appointments. Growth and Team Expansion
•The program has expanded, now having about 20 people, including medical partners like Dr. Abdul Jazieh and Robin Zon.
•The team includes specialists in various cancer types, such as breast cancer and gynecologic tumors, and has a comprehensive approach to patient care.
•They emphasize understanding the patient as a whole person before addressing their cancer, which is the philosophy behind their comprehensive internal medicine assessments.
•The program has become a training ground for patients and families to learn how to navigate the healthcare system effectively. Challenges in the Healthcare System
•The healthcare system is fragmented, with patients seeing multiple doctors without comprehensive care.
•Communication among doctors is important to avoid negative consequences for patients, such as drug interactions and inappropriate treatments.
•There are examples of patients receiving inadequate examinations and diagnoses, leading to unnecessary procedures and missed opportunities for early intervention.
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