Is the person or the place more important when it comes to oncology?

Is it the person who treats you or where you get treated that makes a difference? This is a question I have after seeing different opinions in other discussions. When I started on here some told me I should go to this cancer center or that cancer center or that I should see this doctor or that doctor.

Also on some discussions people state that they wish they could go to a cancer center but can not afford it or their insurance is the type that will not allow it.

In may particular case I have chosen to stay with my original oncologist that was refered by my doctor in my insurance system. I asked my oncologist if I should be going to a cancer center. He told me he would authorize a second opinion any where I wanted to go. I did consult with a comprehensive cancer center and guess what, the second opinion was the same treatment I am getting for first line anyway.

After discussing this further with my oncologist he said that these cancer centers and Universities do not hide anything. They do not have any secrets or hold anything back to try and compete with the rest of the medical community. All the research they do and discoveries they make are shared public info. If your doctors stays up to date with the latest they will know everything the cancer centers know.

So that brings me back to the original question. Is it where you go or who you see that matters? Also please feel free to correct anything above I am wrong on.

By sheilake
Posted June 27, 2009 at 10:12 pm
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Here's just one opinion. Both are important. Having an oncologist who is well informed, who cares, who has a hopeful sense of urgency, and is responsive is critical. Equally as important is having a hospital you trust. Life-threatening mistakes as well as MRSA happen at the staff level (no pun intended). Cleanliness, staff/patient ratios, and competence can save/take your life when the oncologist is no where to be found.

When I shopped, I chose the hospital first. Then I found good doctors who were tied to that hospital. I figured that if I were in a hospital, there was something critical going on and I wanted to trust the people around me. Having a team of doctors who talk to each other is also valuable and rare.

For what it's worth...
Sheila

By stage4survivor
Posted June 27, 2009 at 10:33 pm
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SP,
Good question.
1) If it feels right, go with it
2) Many, many docs DON'T keep up with the latest
3) There can still be a "lag time" with innovative treatments
4) Second, third, etc opinions can be reassuring
5) Go with experience
When I first met Dr. Roman Perez-Soler he was super positive and very human, I'm sitting there thinking, do I want to schlep 20 miles into Manhattan for chemo when I could easily get it in my neighborhood? Keep in mind, I only got 3 doses. Fortunately, I stuck with him.
When he left NYU to go to Einstein in the Bronx, even further a drive, I followed him.
In November it will be my 10 yr anniversary!
Yathink I made a good choice?

G

By stage4survivor
Posted June 27, 2009 at 10:53 pm
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Sheila brings up good points, except the staph levels! MRSA=Methacillin-resistant staph aureus(get it? staff levels!)
An infection that can be VERY difficult to treat due to antibiotic resistance.

By brooklynda
Posted June 27, 2009 at 11:43 pm
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Salty: I can't say definitely what is right and what is wrong for anyone, but I do say that I go with what ultimately feels right for me - of course with some checking too. I have to have confidence in the person who is treating me (cancer or anything else for that matter) and also is following up that what they are recommending is being implemented by their team or medical staff. Can that be guaranteed? Probably not, but I have noticed in hospitals that some doctors are taken more seriously than others. Wishing you all the best! Blessings! Brooklynda

By Granny888
Posted June 28, 2009 at 10:13 am
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I think it boils down to what matters to you. To me it matters how I am treated. To me it also matters that I am treated. I don't always agree with my doctor, but I always get some type of satisfaction -- he listens to me and we consult with one of the 'big guys' (at his insistance) on a fairly regular (or when it seems necessary) basis. So he knows he is not THE expert, he knows where to go, and he tries to keep up with the 'latest' I don't always agree with his interpretation of the latest.

What's important is
1) You being your own advocate. It is unfortunate, when we are sick, to have to do that but either we or someone close to us has to be able to look at and gather information and make some sense out of it, ask the right questions. Expect to disagree. Don't ever expect "less than" for your experience. I'm the boss of me :)

2) You being treated like a human being. Numbers don't recover as well from cancer. Staff is more important than just about anything, and WILL go to bat for you. Make sure you have a staff that talks with their doctor.

3) Always have that second opinion consult, even if your intent is to see them once, get an opinion, and have them on your side. It really does help. Second opinion doesn't have to mean 'change.' It doesn't have to mean "either or". It is a second opinion. The best scenario I think is when #1 speaks to #2 and they come up together with what is best for YOU. These are professionals.

Good luck.

By Granny888
Posted June 28, 2009 at 10:20 am
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Yea, they say some ungodly percentage of us health care workers carry MRSA on our phones. It's one of those things that we always have that doesn't usually get out of control (staph). Meth resistant is just one kind and has to be even harder with us immune-compromised people. What is really tough is having MRSA and VRSA -- I think in the hospital you are pretty much isolated for life. It doesn't go away til you are cleared, getting cleared while having cancer (gulp!) doesn't much happen.

By Marg
Posted June 28, 2009 at 10:50 am
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Great discussion point!

When Mike was first diagnosed we had a wonderful grandfatherly oncologyst, the only onc in our town, but we trusted him completely, and like our local hospital and the staff in the cancer center was wonderful. But that onc retired and his replacement was a piece of work! His favorite sentence seemed to be, "I don't know that there is anything else to try, there is no cure for this."

So we found another cancer center in a town 20 miles away (not a big deal), we aren't as happy with the hospital or the staff, but when I asked this doc how long he would fight for Mike, he said, "As long as you want me to." That's what I needed to hear. Also, there are about a dozen oncs in this practice, so we have many docs working for us.

We are in a rural area and Mike won't travel far for treatment (He is a stubborn german) so our choices are limited. I'm not has happy with the hospital or staff, but I need to have a doc who is willing to go the distance.

By drawing3d
Posted June 28, 2009 at 11:47 am
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At MD Anderson, (the #1 rated hospital for cancer), my thoracic oncologist, Dr, "Pappa", (V. Pappadimitrakopoulou) treated me coldly, with distaste, mocked me when I became upset (a Stage IV diagnosis does that on occasion, ya know?), was lazy in returning phone calls (oops, I mean her PA was lazy...she never ever returned one of them), couldn't be found when the laboratory had questions about my chemo dosages and lack of creatine orders from her office, never ordered my EGFR test as she promised twice, failed to comment (actually avoided me) when my WBC count plummeted...and on and on... Long story short, treated me less humanely than she probably treats her lab rats, BUT it was the #1 Hospital for cancer as rated by US News.
On the opposite side of the spectrum, the Proton Center where I got my radiation, they were the absolute kindest, most respectful, attentive, encouraging, professional people in any institution I have ever been in. Dr. James Cox is "fatherly" and compassionate, and saved my life!
Botom line: I do think it is important to go to a CCC but when it comes down to it, your care will always only be as good as the dcotor behind you.
My advice is to turn it over to God and ask for his guidance.
God bless,
Ellen

By lovlyles
Posted June 28, 2009 at 1:14 pm
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I regret when I was first diagnosed in 2005 that I didn't immediately go to a CCC. I was somewhat satisfied with my ONC, but not completely. Whenever I would have to have tests it seems like it would always be a different place. It got to the point that I couldn't remember where I had what and I was running all over the place. I am now at Mayo in AZ and am so much happier. My ONC has set everything up and everything I need is right there and on their computers. That has taken a lot of stress away. I'm just sorry I wasn't there in the beginning.

Leslie

By henrymax
Posted June 28, 2009 at 2:34 pm
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The reason to go to one of the well known cancer hospitals is that they have seen more and dealt with more, so hopefully they have a better idea on how to treat what you present. the more they have seen the more they have treated gives them a better idea regrading what will work. Also, they have many more people with whom to consult with. And since that is all they do hopefully they do it well.

By linbur
Posted June 28, 2009 at 5:32 pm
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In my opinion your oncologist is the important person because they prescribe the course of treatment you recieve and also take care of any side effects you might have. You should find one that YOU feel comfortable with and it doesn't matter if they are a loner or affiliated with a cancer center.

By prathergirl
Posted June 28, 2009 at 7:05 pm
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I'm so glad you posted this discussion !. I believe also that it is the Onc who leads the treatment who needs to know the best treatment nomatter where he is. I've heard many success stories from people who received their treatment from " small town USA " at a regular place and successes from the major Cancer Centers. Unfortunately , I have also heard horror stories from both types of places. Our best bet is to choose who we are most comfortable with by their expertise. When I found my husband couldn't be treated at a Major Center 40 miles closer to our home because of his insurance , the person I consulted with did ask all of his medical information and he said they most likely wouldn't be doing anything more or different than he is getting already. Thanks for posting this discussion, Salty !
Carla

By kq182
Posted June 28, 2009 at 8:37 pm
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Hi, the most important thing I feel is that you have to find an onc you like, and his/her staff. My husband is being treated locally by a very nice, knowledgeable, caring onc and staff. We feel lucky that he is here, and feel very thankful for all the treatments, and care he has and is being given. I really do not feel by not going to a large Cancer Center that he would be treated any different. We are happy to be staying local, and very pleased with our onc. Karen

By Mar24
Posted June 28, 2009 at 8:39 pm
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I really think it has to be where you feel the most comfortable with, place and doctor. Plus I truly believe whoever you go to you really have to have a good line of communication and trust. Not all places are the same and not all teaching hospitals are the same. I went to my first oncologist for a year and truly trusted her in the beginning and truly was blessed with a great set of nurses who took great care of me. When I realized that my cancer was going out of the realm my doctor was familiar with that is when I switched doctors. I am glad everyday I made that decision because even though I trusted my first doctor and today I would recommend her to anyone. I am so thankful I made the switch because the doctor I have now has a vast knowledge of my specific cancer and all the ins and outs and doesn't keep anything from me. So I really think it is how you feel about the place/doctor and do you trust that person. Can you communicate with the doctor or be able to call or e-mail your doctor when you have a question. Trust your gut instinct, it nevers lets you down.
Good luck and keep fighting!
Maribeth

By D1
Posted June 28, 2009 at 9:20 pm
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I agree with all those who said "trust your gut feeling." My husband and I were both so impressed with the thoracic surgeon, Dr. Pass, at NYU (a CCCO, that we cx the second opinion we had scheduled because we just felt so positive about Dr. Pass. Similarly, if you are happy with an onc. who is not attached to a CCC, that would be an impt. factor to me. Still, there's one other big advantage to the CCCs. They tend to use a team approach; so, you end up getting "extra" opinions because the entire team reviews and discusses your case. You can't get that in a small ofc. Also, the CCCs have more money, so they can "buy" better equipment, better support staff, etc. But, my Mom (who just turned 91) had Stage 3 colon cancer at age 75, and she went with a sweet local onc. who CURED her; she hasn't been sick since. So, there are arguments in favor of each approach; so, back to the beginning: trust your gut feeling.

By kitkat4ever
Posted June 29, 2009 at 11:34 am
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I could go to UC Davis, Stanford, UCSF, UCLA, San Diego, BUT, I have a brilliant Oncologist right here in the small town of Woodland, CA. She is brilliant and researches constantly so I am sure she has all the info needed that the big teaching universities and cancer centers have. Also, she is available by phone and email, 24/7.

My brother is at UC Davis, he has CLL, and it takes forever to see his Oncologist, get tests done, and get the results.

So I went with my gut and I am winning big time now.
:-)

Kat

By saltypenguin
Posted June 29, 2009 at 3:49 pm
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Thank you for all the great advice. I do feel great about my oncologist and was very impressed when I emailed him on a Friday late afternoon and had a reply Saturday morning. My wife really wants to switch me to the UW Paul Carbone Comprehensive Cancer Center but I am not sure I want too. We have until October to decide though because she can not switch the insurance until then and it will not take affect until January so I have plenty of time to think about this.

By HighlandGuy
Posted June 29, 2009 at 4:43 pm
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I am shocked! One would believe that what was only important, is being treated "nice!" Bernie Madoff treated everyone nice!

What is important is how much experience does the doctor have in treating not cancers, but lung cancer! Does he or she level with you? Is her or she really knowledgeable of lung cancer or is he a phoney?

Lung cancer is an incredibly complex disease. If you doctor happens to hit on the right treatment like hitting a target with a dart, that's great! By the same right, the most brilliant doctor in the world may completely miss the target. That isn't the risk I want to take!

How can we improve the odds, is the name of the game.

The diagnosis and treatment of most lung cancers require the efforts of not one person, but a team of highly experiencesd, well trained physicians. Our lungs are shielded deep inside our bodies!

That means that the team is everybit as important as the lead doctor!

In a small community hospital, a doctor may see several dozen lung cancer patients a year. There is no way that a person treating so few patients with such a complex disease as lung cancer, can bcompetant to treat you!

In most large CCC, they have clinics where doctors meet weekly and collectively review, discuss and determine a cours of action. You get the collective opinion of a team of experienced experts.

In most general hospitals if an Oncologist is sharp, can you say the same for the Pathologist, the Radiation Oncologist that performs the FNA, the Radiation experts and specialized equipment for radiation, the Thoracic Surgeon competant in all the various applicable techniques use in treating lung cancers. Is his Anesthesist, and support personnel equally as qualified?

Most smaller community hospital oncologists treat all kinds of cancers. Let no one ignore the fact that treating lung cancer is utterly in another world!
Lung Cancer is like no other cancer, not to speak of being comparable to other medical conditions!

Certainly gut feelings are important, not because of the lack of bedside manner however, but in what kind of experience a doctor has, the knowledge he displays of lung cancer, the capability of the
team of different doctors displayed and demonstrate in caring for the most complex, most difficult to treat and most deadly of all cancers!

I am forever amazed at how little we value life when it comes to diagnosing and treating lung cancer.

As for me, I went to a cancer treatment center that sees and treatscertainly hundreds, perhaps thousands of lung cancer patients every year! I didn't go there because they treated me nice, not because it was onvenient (it wasn't), not because it was a well know hospital, but because I valued my life!

HighlandGuy

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