This page explains how to use databases and online resources, but not how
to access these resources. For that, see my pages on accessing medical databases, and online information sources. Another option is to
pay a medical search service to search
the databases for you. Rather than go through the details of the user
interface to these databases, I present a conceptual view of how to use
them that is independent of the particular database and user interface.
Before starting your search, you need to know some basic information
information on your cancer particularly its medical name and stage. For
more information on these subjects, see my page on getting basic information on your cancer.
You should also spend a little time to think about exactly what kind of
questions you want to answer. Perhaps you want to see if there are any new
treatment options that might increase your odds or perhaps you would like
to find experts in treating a rare cancer. Maybe you want to look into an
alternative therapy that you've heard about.
Your doctor will have the answer to many of your questions, and for lots
of things, it makes a lot more sense to ask your doctor than it does to
start searching the technical medical literature. If you have a question
about a specific symptom or side effect you are having, or about the
interpretation of test results, your doctor certainly should be your first
source of information. This is also true if you want to know the success
rate of a proposed treatment, or about the side effects, although in these
cases, it might be also reasonable to look into it yourself. Especially if
you aren't satisfied with the answers you're getting or just demand more
detail than your doctors have time to give you.
The Research Cycle
Researching the literature is not a single path that proceeds straight
from initial question to final answer. It is actually more like a cycle.
Initial questions lead to references to the medical literature, which lead
to papers, which lead to more references, and more questions, and so on.
Eventually, you will zero in on the information that is most valuable to
you. This process cannot usually be completely conducted on-line.
Following the research cycle will probably take you to medical databases,
doctors, and medical libraries.
Before continuing, you should understand the differences between
references, abstracts, and papers. References are just that, references to
published journal articles, and sometimes to books and conference
proceedings. A reference contains the title and author of the work as well
as the name of the journal, and the year, volume number, and page numbers
as appropriate. Given a reference, you can look-up the paper in the
medical library. An abstract is a short summary of a paper. An abstract is
usually enough to determine whether a paper is interesting enough to
actually be worth looking up at the medical library. Almost all papers
start with an abstract, and high quality medical databases such as MedLine
contain abstracts for many of the references, but I know of no database
that has the full text of articles. The paper is the actual report of the
work, and contains all of the details on the background, methods, results,
and conclusions. Every paper also contains a list of references at the
Where to Get References
There are many sources for references, including:
- Other papers
As I mentioned above, every paper in the medical literature has a list of
references at the end. Often this list is both lengthy and comprehensive.
- Your doctor
I have found many doctors quite willing to give me references and even
Xeroxes of papers supporting their positions on treatment questions. All I
had to do was ask!
Cancer.gov is the website of the US
National Cancer Institute. The PDQ Health Professional State of the Art
Treatment Statement for each type of cancer contains some references, and
Cancer.gov also has some pre-done, but non-specific database searches for most
kinds of cancer. See CancerGuide's Tour of Online
Resources for a more detailed guide to Cancer.gov.
- Protocol Documents
If you are considering a particular clinical trial and want to know more
about it, you should know that each clinical trial has a protocol document
that defines the complete plan for the trial and includes scholarly
discussion of the history and prior results of the treatments being tested
in the trial. This includes a list of references to relevant papers.
The doctors conducting the trial you are considering should be willing to
make you a copy, but sometimes they do refuse. With some drug company
sponsored trials, the protocol document is confidential, and the doctor is
"not allowed" to show it to you. I think this is an outrage. If I were in
this situation, I would contact the drug company, and demand to be given a
copy, while offering to sign a non-disclosure agreement.
- Medical Textbooks
Oncology texts such as Cancer Principles and Practices by DeVita,
Hellman, and Rosenberg have an extensive list of references at the
end of each chapter. This probably won't include references to the most
esoteric experimental approaches, and cannot include references to
discoveries made since the last edition of the book was published.
- Medical Databases
Databases such as MedLine are by far the most powerful way to find
references, although some effort is required to learn how to use these
resources effectively. The huge size of these databases with millions of
references, and abstracts from thousands of journals means that if the
information you seek has been published, the references are there. The
ability to focus your search on words or (better) concepts that interest
you allows you to extract just the references that pertain to these words
and concepts. The biggest problem with these databases tends to be getting
too much information, not too little.
For detailed information on accessing and using Medline, see my article on
MedLine Access along with the associated how-to
Types of Papers in the Medical Literature
Typically a list of references, such as that generated by a database
search, has references to many papers, but most of them will be
irrelevant. You want to develop the ability to scan the list of references
and quickly pick out the relevant ones. Usually you can tell whether a
reference might be interesting just by the title. It helps to have some
knowledge of what kinds of papers are out there.
Here is a list of some of the kinds of articles you will find in the
medical literature, arranged roughly from most to least useful.
- Review Articles
Review articles are a virtual gold mine of information, and are one of the
very best places to begin your detailed search. Review articles are a
summary of all of the current work in some area of science or medicine.
Review articles are primarily intended to keep professionals up on the
latest research. If they can do that for professionals, they can do it for
you! Naturally review articles contain a very extensive list of useful
Reviews can actually be of two types, reviews of a particular disease or
condition, or reviews of a particular type of treatment or technology.
Depending on the situation you may want to look for one or the other.
It is extremely important to get recent review articles. Reviews
more than a year or two old are reviewing old data, and may not include
important recent developments. Even the most recent review has to be
somewhat behind the most recent papers since reviews summarize what's
published at the time the review is written, and there are significant
publication delays. Still, most important developments go through many
years of research before becoming "standard treatment," so the chances are
good that a recent review will contain some information on most promising
- Clinical Studies
These are reports of clinical trials of new treatments on patients. For
most people, decisions on what treatment is best depends primarily on the
prior evidence in humans. That evidence will be found in this key class of
papers. The word "trial" or the phrase, "clinical trial" appears in the
title of many of these papers.
- Case Reports
These are reports of an individual case or a limited number of cases of a
particular cancer or situation. Often these are about a cancer that shows
up in an unusual way, an unusual side effect, or an unexpected recovery.
Because these are reports of exceptions they are not applicable
or useful to you unless you happen to be a rare exception as well. If you
have a very rare cancer, you may have to
rely on case reports to some degree, but for most patients, these
references will not be useful. The phrase, "a case of," or "case report"
appears in the title of many of these studies.
- Animal Studies
Animal studies may be the only source of prior results for some very new
treatments, but it is difficult to generalize from animal models of cancer
to spontaneous cancers in humans. It is far better to rely on the results
of human studies than on animal studies. Note that titles with the word
"murine" refer to studies with mice which are, by far, the most common
- Reports on Diagnostic Techniques
These reports concern new diagnostic techniques, such as new blood tests,
or imaging techniques, or may probe the effectiveness of current
diagnostic techniques. Once in a while these reports can be useful to a
patient. In two cases where a patient was suspected to have hidden
metastases that could not be located, I found new imaging techniques that
could help find them so they could be removed surgically.
- Reports on Prognostic Factors
These reports attempt to determine which factors about a patient portend a
better or worse prognosis. Sometimes consideration of these factors can be
useful in determining whether a patient could benefit from additional
treatment, but anyone reading these reports will certainly be face to face
with some blunt statistics about their prognosis.
- Epidemiology Reports
These are reports of the association between various factors and
the incidence of various cancers and diseases. These reports do not
directly prove that factors that are associated with a disease are
actually the cause of the disease, but more to the point, knowing
possible causes for your cancer is of little help in deciding what
treatment will work best.
- Cell Culture Studies
These studies test the reaction of cancer cells grown in a test tube to
potential new chemotherapy drugs. These tests are usually done even before
animal studies, and it is unwise to place much faith in such results in
deciding about treatment. The phrase "in vitro," which literally
means "in glass," often appears in the title of these papers.
- Basic Science
This is a vast catch-all for research into the basic mechanisms and
biochemistry underlying the disease or its treatment. While this kind of
research is extremely important for those trying to devise new treatments,
it is of little help to a patient trying to find the best current
treatment. These papers are often the most technical and difficult to
read, and very often can be identified by the extreme (even worse than
usual) amount of technicalese in the title.
Next Stop, The Medical Library
After I scan a list of references from a database, or any of the other
sources I mentioned, the next stop is the best medical library around.
There I make copies of the most interesting complete papers to read at
home. While I'm there, I often skim some of the papers and look for other
interesting references in them. If I find any, I can get the papers right
away. Careful reading of these papers at home may lead questions that
prompt another database search, or another visit to the library.
[How to Find and Use a Medical Library]
Most people who are searching for a treatment do not have the luxury of
spending an indefinite amount of time on this kind of search. If you are
in this situation, you should not delay sharing the information you find
with your doctor, and talking to doctors who are doing research or giving
innovative new treatments.
You may come up with so many options that it becomes very difficult to
make a decision. It is quite common for many of the options to be about
equally promising. If you find this, then just pick any one of them.
Although it is difficult to make a decision, it is absolutely critical
that you actually do make a timely decision. If you don't make a decision,
you may end up getting no treatment, rather than the best treatment. No
decision is always the worst decision. I have actually seen this happen to
patients; don't let it happen to you!
This CancerGuide Page By
Steve Dunn. © Steve Dunn
Page Created: 2002,
Last Updated: August 9, 2004