changing onc

kuchagirl

changing onc

kuchagirl

Sadly, I asked my onc to transfer me to another oncologist in the cancer center earlier this week. 

I knew when I signed up with my breast onc that she was in her 1st or 2nd year as an attending.  She openly admitted that she didn't have a lot of patients on Tamox, which is my only treatment right now.  I was OK with that, as long as she was accruing experience over time with many breast patients.  I was rather cocky in my attitude - I was sure that I would breeze through the 5 years without any difficulties, so it didn't matter whether my doc was fully seasoned.  Heck, I could teach her a few things, rather than the other way around.

However, at my first post-radiation meeting, at the end of our appointment she mentioned that she was changing specialties (from breast to, say, G-I cancer), and that I could stay with her or she could transfer me to another doc.  This was my first substantial meeting with her, the day I started Tamox.  And here she was letting me know that she wasn't focusing on breast cancer anymore for her career track.  She offered to transfer me to a male onc in the breast department.  I asked about a specific female onc, and she said "I don't think I can get you with her."  I didn't know what that meant, but it sounded like I didn't have very many options about alternative oncs.  At that time I was very pleased that my cancer team was all female doctors.  I was deflated by the idea that the breast onc, now essentially my main cancer doc, would be a man.  So I stayed with the my original onc.  That was about a year ago.

Since then, during my weak moments when I visualize what it would be like to have a second primary, I've really worried about the idea that my doc is spending her work week studying G-I cancer.  I know that breast cancer is not brain surgery, and that a good medical oncologist is a good medical oncologist, and she is very well regarded (I mean, really well regarded within my institution).  We're doing annual MRIs, so any cancer outbreak will be caught early and hopefully only need local treatment.

My cancer was totally surgically excised, and I've done radiation & now Tamox, so by any reasonable measure I should skate through until the 5-year mark.

But there's the idea of "hope for the best, but prepare for the worst," and I want to feel like I have a soft landing place if I have a recurrence or 2nd primary. For me, a soft landing place is having an onc who has chosen breast cancer as her career.

Over the past year, I've worried about whether I would become a back-seat driver at a new diagnosis.  I came to realize that I wanted a breast onc who had current knowledge of various treatments, so that I could tussle with her and bring printouts of research, and generally be a little bit of a pest but so that I was content with my treatment plan.  That was how I processed the first cancer with my surgeon & my rad onc, and I was satisfied with my treatment choices.

But my onc is a straight shooter (which I value highly), and she doesn't speculate about things that she is not well versed in.  And I just imagined that we couldn't be partners in a way that I would have liked.

I wonder whether I'm being superficial, or whether there is another agenda that I'm unconscious about.  I'm a little mad that she took me on as a new patient right before she switched specialties.  But I've changed jobs in my life, and sometimes it left somebody in a lurch, and I couldn't be responsible for that, because it was my career that was important. I'm happy for her, if she is more energized by studying G-I cancer. 

It's all so confusing.  I have discussed the issue with my rad onc, and also with various people in my life.  Some people look at me like it's totally obvious that I should change oncs right away.  One person says it might be advantageous that my onc is now a G-I onc, because she will think outside of the box if I have a recurrence/ 2nd primary.  Other people, who are affiliated with the cancer center, say that I have one of the best oncs in the whole center, and that I should hold onto her like there's no tomorrow.

But I'm tired of the tension that I'm retaining.  The last two times I've seen her, either my pulse or my bp is startlingly high, and I think it's because I have doubts about this whole relationship.  My bp is normal with other docs.

I finally brought it up directly to her.  She said, OK, if this is bothering you, then we don't want it bothering you, so let's make a change.  She also said that most of her breast patients are "graduating" over time (hit their 5-year mark), and that her breast patient load is diminishing, and that she'll be spending less time looking at breast cancer.  She also said that her G-I workload is ramping up, and that this may be a good time to make a change.  I teared up, as it became obvious that a separation was clearly happening, and she asked whether I had been concerned that I would hurt her feelings.  She didn't say this in a compassionate way, but rather in a surprised & testy way, like "wait a minute, is any of this about ME?, that I would be upset about this?"  I said No, that I knew she was a professional, and it was more about me, and that I just wanted to get rid of an unnecessary worry.

I did blurt out, "Can I come back?" and she said with animation "Yes."  That was one of my worries, that I was closing a door.  In fact, she and I have a good relationship, she keeps herself on time (very important to me), and I like that she is rather non-paternalistic & doesn't speculate about things outside of her expertise.  I may realize that I appreciate her more than I initially thought.  I may want to come back.

Usually when she ends the appointment, she says something rather perky & positive about the next appointment, but this time she held her tongue.  She did say, "it's not the end, I'll see you again."  (I should admit that I am employed within the larger medical institution.) 

I won't be meeting my new onc until December.  I'm on a clinical trial, so my rad onc will see me in September, and she does a thorough exam.  My new onc will be a female, and she does have a substantial practice.

I wish this whole thing hadn't happened.  It did give me an opportunity to initiate a difficult conversation, and that's good experience for me.  I do feel that by making this change, I'll be removing worry & enhancing my psychological recovery.  It's so unfortunate about the lethality of cancer, so that these types of decisions are necessary to make sometimes.  It ultimately does involve my life & my peace of mind. 

iodine

Your last sentence says it all, to me.

"It ultimately does involve my life and my peace of mind."

It IS all about you.  Period.

We have many difficult choices to make and you have made another one.  How many times have I read on the board to go to a breast center---thousands.  You want someone who's on the cutting edge of bc, which is very different from other cancers and Tamox is a drug that needs close attention to side effects and a full understanding of them.

I've remarked in the past when someone didn't like or trust their onc if they should change oncs.  My argument has always been: how would you feel if you had a recurrance?  Would you want this onc treating you?  Even more: do you TRUST this onc to FIND  a recurrance?

Seems to me, you have ans. those questions in a excellent and well thought out way.