• Medical Oncologist

    Asked by emmmi on Saturday, August 3, 2019

    Medical Oncologist

    I am a stage 1 breast cancer patient and in remission since October, 2018. Small tumor, lumpectomy, no node involvement and 3 weeks radiation. I have had 3 visits with a medical oncologist, who has never examined me, forgot to follow up on my oncotype test, when he said he would, did not know when I finished radiation, as his office tried to cancel an appointment because they thought I never started radiation and did not order a bone scan, when he said he would and I had to ask my primary care doctor to do so. When it was unclear whether I needed chemo, he said, “we would have the talk” when my oncotype score was available. Oncotype took 4 weeks and I called for the results. He has prescribed anastrzole. I am so afraid of a recurrence. I think I’m not sick enough for this guy to be interested and thinking I should look for another doctor. I am upset with this doctor and wondering about your experiences.

    20 Answers from the Community

    20 answers
    • Created07's Avatar
      Created07

      It's just my opinion, but I would find another dr. You need piece of mind. My breast cancer was confined to the ducts..lumpectomy...no lymph node involvement...6 weeks of radiation....checked every 4 months..then 6 months with a mammogram. I always see my oncologist and he always talks to me in depth. Just had a clear mammogram,, it's been every 6 months since 2014, They said I could go bsck to once s yesr, but oncologist said he wanted to see me every 6 months anyway. You need a doctor who cares, God bless

      5 months ago
    • Judytjab's Avatar
      Judytjab

      Emmmi, I would absolutely see another oncologist. I also had stage 1 breast cancer and my oncologist saw and examined me and also did lab every 4 months. When I hit the 4 year mark, I saw him every 6 months. You need that peace of mind and you will be glad you changed. I wish you peace and big ((hugs)). Let us know how you’re doing.

      5 months ago
    • ChildOfGod4570's Avatar
      ChildOfGod4570

      Yes, I would see another doctor; You should be checked out every time, for cancer is nothing to take lightly. Please find a doc that will listen to you and take you seriously. With all you are going through on a cancer journey, a doctor who cares and listens is not supposed to be a luxury but a necessity. HUGS and God bless.

      5 months ago
    • carm's Avatar
      carm

      @emmmi,
      Hello, I am an oncology nurse and although would question his bedside manner, anastrazole is the standard recommendation for a stage 1 with no lymph envolvement. If you are to switch doctors, I would for the lassiez faire attitude and approach but I doubt that you will find an oncologist that would recommend a treatment that would do more harm than good when the anastrazole is sufficient . Best of luck to you.

      5 months ago
    • Dltmoll's Avatar
      Dltmoll

      Yes, get another doctor. 10 months out is too soon to be written off as not needing to be seen, if only for your peace of mind. A schedule for follow-up mammograms and consultation about how you are doing on Anastrozole are important facets of your ongoing care. You need someone you can trust for this part of the journey.

      4 months ago
    • emmmi's Avatar
      emmmi

      Hi Carm, I’m not looking for another process, as I feel that I’m doing well with the anastrozole. I’m looking for more information as to what the 5 year process entails. How often for a bone scan? I’ll ask my primary care, how do I know anastrozole is working? Are there blood tests? Guess I’m answering my own questions ..... I need another med onc. He never went over lifestyle changes, ie, alcohol, exercise, nutrition. I think I’m too healthy to be of interest and I’m very thankful for that. I am terrified of a recurrence, but feel that is normal.

      4 months ago
    • emmmi's Avatar
      emmmi

      Hi Carm, I’m not looking for another process, as I feel that I’m doing well with the anastrozole. I’m looking for more information as to what the 5 year process entails. How often for a bone scan? I’ll ask my primary care, how do I know anastrozole is working? Are there blood tests? Guess I’m answering my own questions ..... I need another med onc. He never went over lifestyle changes, ie, alcohol, exercise, nutrition. I think I’m too healthy to be of interest and I’m very thankful for that. I am terrified of a recurrence, but feel that is normal.

      4 months ago
    • Amor's Avatar
      Amor

      Hi Emmmi ~ I too recommend replacing your current medical oncologist for one who you can TRUST and has more compassion. I can empathize with you, having felt dismissed by a certain doctor before who made me uncomfortable and anxious (before, during & even after our meetings), instead of PEACE of MIND! Anyway, I let him go and found a much, much more caring doctor who I trust to look after my well being.

      Don't be afraid to ask your doctor your questions about lifestyle changes yourself, especially since you are terrified of a recurrence. That is natural and should even be expected. So, please find another medical oncologist.

      By the way, having had cancer twice, having "canceritis" (fear of getting cancer again) is also natural. However, you'll need to learn to keep it from taking over your peace of mind. Here's a link to an article on Cure Today. Hope it helps. https://www.curetoday.com/community/bonnie-annis/2016/08/canceritis-after-breast-cancer

      Take care & God bless always! ~ Amor

      4 months ago
    • gpgirl70's Avatar
      gpgirl70

      I would change doctors because you should not have to chase down test results and need an oncologist who explains your after treatment care. You should never be made to feel unworthy of exceptional care because you aren’t sick enough. How can a doctor not know when a patient finished radiation? Good grief that’s alarming!
      The fear of recurrence does fade. I had stage 3c breast cancer in 2015 and then had thyroid cancer in 2016. I was a mess and thought I would be in a perpetual state of fear. I now have days without thinking about cancer.

      4 months ago
    • ChicagoSandy's Avatar
      ChicagoSandy

      If by "bone scan" you mean DEXA (bone density) scan, the baseline for ER+ breast cancer patients is done before starting aromatase inhibitor therapy, and repeated every two years. If you mean a nuclear bone scan (to check for bone metastases), it's done only if there are symptoms suggesting the cancer may have spread to the bone. Same thing with PET scans and tumor marker levels--they are not done routinely. If you are asymptomatic or your MO doesn't otherwise suspect spread, you will not be tested (scan or blood) for them. The risk of radiation overexposure--as well as cost and the emotional toll of "scanxiety"--is too high to "go fishing" if nothing's wrong,

      Usually, for the first two or three years, MO & surgeon visits and "diagnostic" mammograms (of the operated breast or breast) are done every six months (with a routine "complete metabolic panel"--and sometimes complete blood count &/or lipid profile if you tend to be anemic &/or have a cholesterol problem). Screening mammograms of the non-cancer breast are done annually. By the third year, you will probably be seeing your surgeon annually and your mammograms will revert to annual bilateral screening mammos. I am in year 4, and my MO gave me the option of seeing her annually instead of every 6 mos.; but since I have one more Prolia shot to go (can't take oral bone drugs due to acid reflux), which are given twice a year along with blood work, I still see her on the same day. If all is well at Sept.'s visit & shot, I will see her annually from then on.

      I hesitate to say that this is the standard 5-yr plan, as every patient is different, different hospitals or cancer centers may have different protocols, and standards may differ between states and localities. But generally, with a low-grade Stage IA ER+ cancer, once you have finished radiation and have decided what endocrine therapy to take and for how long, when it comes to followup "less is more" so long as you have no other symptoms.

      4 months ago
    • ChicagoSandy's Avatar
      ChicagoSandy

      Also, blood tests for "stable levels" of an AI are not normally done. If any endocrine-therapy-related blood tests are done, it is for levels of estrogen to see how well the drug is working (even that is rare). And as to ROs, they are done with you after the followup after finishing radiation, unless you are having difficult side effects.

      It is up to you to decide whether to seek nutritional guidance--there is a lot of conflicting dietary advice going around these days, and doctors receive very little training in nutrition. Most nutritionists don't have expertise in a breast cancer patient's dietary needs (and many offer one-size-fits-all advice, even though different breast cancers behave differently). They tend to be way behind the curve and recommend low-fat diets (circa 1977) which may be too high in sugar & starch according to 21st century research.

      The things oncologists & nutritionists agree on for ER+ bc patients is to limit alcohol to no more than 3 drinks a week, to exercise regularly, and to either maintain a healthy weight or try to lose weight if obese or even significantly overweight (easier said than done on endocrine therapy). Other lifestyle changes are dictated by common sense. You will probably get more extensive information advice from a "cancer wellness center" in your community than from your MO or a general nutritionist/registered dietician.

      I concur that you need an MO who is more attentive to your needs--but it's up to you to ask the questions. If your hospital system has a patient portal, the messaging function is an excellent tool for communicating with your care team. If not, and the MO will not give you access to contact information, that's not the right doctor for you (or for anyone, for that matter).

      4 months ago
    • Carool's Avatar
      Carool

      Emmmi, find another oncologist, preferably one specializing in breast cancer. Wishing you all the best.

      4 months ago
    • Carool's Avatar
      Carool

      Carm, I had stage 1 (which of course means no lymph node involvement); however, because my breast cancer tumor was HER2-positive, I had to have, after my lumpectomy, four infusions of Adriamycin and Cytoxan, together (after that, radiation). So, from what I know, stage 1 doesn’t always mean no chemo.

      4 months ago
    • carm's Avatar
      carm

      @emmma,
      Protocol varies from doctor to doctor and depends on the grade of the cancer. Normally the five year plan suggested is a CT scan every three to four months for the first 2 years, followed by CT scans every 6 months for 2 years and then annually after that. A bone scan is a nuclear med test so NCCN guidelines for these type of tests are usually no more than 2 in a calender year because with that type of test, they see injecting radiation into you. Blood work is dependent on the disease, grade, and other co-morbities. Generally blood work can be done anywhere between 1 month to every 3 months per year and then stretched further apart as time elapses. Some docs will just do annually unless there are indications to warrant it.
      @Carool,
      Your disease is Her2/ neu+. That type of cancer uses infusions of perjeta or herceptin for maintenance . Because it is a human epidermal growth factor 2 type and not a hormone driven cancer, the NCCN guidelines are different than for ER/PR+ cancers. Her2+ cancers are more aggressive and so the treatment is different. You can't use AI's or CDK4/CDK6 therapies like Ibrance, Kisquali, or Verzenio. Treatments vary depending on the type and grade but generally for a ER/PR+ stage I; chemo is not usually necessary. I hope this clarifies.

      4 months ago
    • Amor's Avatar
      Amor

      Hi emmmi ~ When you meet with your medical oncologist (MO) -- or any doctor or medical staff member -- jot down your questions on a piece of paper (or notebook), so you don't have to try and remember them. Not only will doing so get your questions answered, it will also demonstrate to the medical team that you are SERIOUS about your health condition and the treatment process moving forward. You may be nervous about doing so, especially if a doctor or any medical staff member doesn't seem to be receptive to your communication. Don't let it faze you; focus on what you need to know and the fact that their job is to support you. You have to be the best health advocate for your health; we all do. BTW: As we deserve to be communicated with respectfully by the medical staff, we should also be respectful in our communication with them. It is teamwork for your health on a two-way street. :-)

      4 months ago
    • Carool's Avatar
      Carool

      Carm, thank you. I mentioned what I did because you hadn’t specified that you were talking about non-HER2 tumors. Btw, my tumor WAS hormone-driven; it was ER+ and PR+, and once my other treatments were over, I started using Tamoxifen and, after that, Femara. And way back twenty years ago, when I was treated, Herceptin wasn’t being given at MSK, except to HER2+ metastatic b.c. patients, so I never got Herceptin.

      I also want to say, with reference to your mentioning frequent CT scans, that at my hospital (MSKCC) they never do routine CT scans once treatments for an early-stage breast cancer are done. As ChicagoSandy said here, CT scans aren’t done unless there are metastasis symptoms that need to be ruled out. CTs give off a lot of radiation, as you know, and are to be avoided unless really needed. Your hospital felt differently, I see. For my stage 1 triple-positive b.c., I wasn’t even given a CT scan or bone scan until my b.c. markers increased after my lumpectomy and chemo. Only then was I given a full-body CT (except for my head) and a bone scan (both negative). And MSK no longer does those blood tests for breast cancer markers, as those tests have proven unreliable.

      4 months ago
    • ChicagoSandy's Avatar
      ChicagoSandy

      CT scans every 3-4 months? Sounds like someone’s trying to recoup the costs of all that expensive equipment—at the risk to patients of excess radiation exposure that can lead to secondary cancers such as sarcomas and even potentially fatal myeloid & lymphatic diseases (MDS, leukemias, lymphomas and myeloma).

      4 months ago
    • carm's Avatar
      carm

      Actually my team approves scans for MSKCC and it depends on what type of breast cancer so I have approved scans for HER2+ and for Triple negative and triple positive stage 1 patients. But you are right... It does depend on the physician, the hospital and the disease of that particular patient. Often times docs will order scans of the abdomen and pelvis on stage 1 ER/PR positive patients. Every place is different

      4 months ago
    • ChicagoSandy's Avatar
      ChicagoSandy

      No need to order abdominal & pelvic scans in an ER/PR+/HER2- Stage IA (i.e., no lymph nodes involved) Grade 1 or 2 patient unless there are symptoms. "First, do no harm."

      4 months ago
    • Carool's Avatar
      Carool

      Carm, I’m surprised. Well, I certainly don’t know everything! And it’s been a long time for me.

      4 months ago

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