Oncologist Nightmare
Hello again! I went to an oncologist today with more results from the second biopsy and sentinel node results. The initial pathology report showed a 5.2 cm mass, HER2+, estrogen negative, progesterone positive cancer; after the second biopsy, the margins were clear and the sentinel node and one other were clear (good news?). The oncologist staged the cancer at IIb, and proceeded to dictate that I have radiation followed by chemotheraphy using a cocktail of Herceptin, antihormone and chemo. I was shocked. He based his treatment recommendation on a 10-year-old clinical study done at UCLA for Stage IV metastisized breast cancer patients. Is there a less aggressive therapy that might be available to me? About 15 minutes into his scripted spiel, the oncologist began to refer to me in the third person while he addressed only my husband as though I was not in the room (this went on for about 10 minutes). The most horrible thing he said to me when I questioned him was, "If you want to voice your opinion and call the shots, this isn't going to work." I actually wrote that down. Fortunately, my husband has a calming effect on me. I definitely walked into a cookie-cutter approach to treating cancer with this particular individual, and I will be seeking another oncologist, but I was hoping you might be able to give me some insight as to options that might be available to me. Thanks!
Hi - You need secon opinion and a new oncologist. DO NOT put up with this guy. You're going to have a long-term relationship with whoever your oncologist is, so you want/need someone you can relate to, someone you trust, and osmeone who listens to you as well as he hands down edicts from on high.
As for his treatment plan - I'm confused. The Herceptin I understand; it's a long-term drug, one you'll be taking for years. The anti-hormone - ??? Is this to neutralize the progesterone? Your ER is negative, so it's not for that. And the chemo - not sure what drugs he calls for, so can't tell how aggressive that is.
Since your nodes were negative (HUGE plus there!), I'd ask if the Oncotype-DX test is appropriate for you. It's a test that helps you detemine whether chemo would be mor elikely or less likely to prevent a recurrence. But before you do that, I'd ask for a referral to another oncologist. Hopefully you're at a big enough facility that they have more than one. If you're considering another facility, take a look at this list of Comprehensive Cancer Centers, which are the top cancer facilities, as designated by the government.
At any rate, good luck. Hope things work out for you. And stay in touch here - we can help. PJH
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PJ Hamel
Thursday, July 02, 2009 at 01:53 PM
Thanks for the correction, Jan. I thought Herceptin was taken similarly to hormone therapy... I appreciate your setting the record straight here! PJH
Jan
Thursday, July 02, 2009 at 02:12 PM
You're very welcome! I know only because I took Herceptin and also worked for Genentech, the company that developed and sells the drug.
Cando
Thursday, July 02, 2009 at 08:27 PM
I saw my surgeon again this A.M. She fully agreed that I need another oncologist, and she supplied me with the names of several of her colleagues. I'll go through the list until I find the right person. I am also looking into the possibility of traveling to a top-rated cancer facility in my state. Based on what I am told by this next oncologist, I will decide whether or not this is necessary. I can't thank you enough for your support. 
No wonder you were upset! As if there isn't enough on your plate with a cancer diagnosis!
I think PJ is right, as are you. Change your oncologist. You will have a long relationship with your oncologist and it's important that you trust him/her. It's also important that he/she treat you with respect.
I think I would let this first oncologist know that you are changing doctors and why. However, I would do this as unemotionally as possible or you will reinforce in him the attitudes he currently holds towards women. He will dismiss you as a hysteric and not see that the fault lies with him. A well-reasoned letter would do the trick if you would find it difficult to speak to him unemotionally.
Good luck with your treatment. Sue
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Cando
Thursday, July 02, 2009 at 08:29 PM
Thank you for your encouragement, Sue. I, too, am a teacher (high school English), so writing a letter is right up my alley! 
Always go for a second opinion and try to locate a female oncologist. That is what I did to help me through my breast cancer options. Never trust just one doctors opinion especially since he treated you with disrespect.
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Cando
Thursday, July 02, 2009 at 08:23 PM
I thought he was not only disrespectful but that he was downright nasty. I'm afraid he is a technician without a hefty dose of human empathy. I'm hopeful that my next appointment with a different oncologist will go more smoothly.
When I was diagnosed with stage 3 invasive BC, I questioned my oncologist extensively about the recommended treatment. I found out @ Oregon Health Science University (OHSU - in the top 100 hospitals in the US) they have a "tumor board". Many clinics have tumor boards as well. This is where my oncologist presented my case before many other doctors . All of these doctors together (not just my one doctor) decided on what the best treatment was for me.
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carolyn97222
Thursday, July 02, 2009 at 04:58 PM
PLUS, always get a 2nd opinion on any important health issue. My original oncologist wanted to give me a chemo treatment that has a lot more side effects than the Taxotere.
Cando
Thursday, July 02, 2009 at 08:21 PM
Thank you! I will be seeing another oncologist next week. 
Actually, PJ, she would not be taking the Herceptin for years. Normally people take Herceptin for a year, and no longer. It is typically given with chemo, but may be given as soon as chemo is completed. Since Herceptin has cardiotoxic effects, researchers are looking into shorter treatment times.