quality of doctors or center

helenap

I am in a small town in iowa. i didnt like the way my family physican presented the news so off to Des Moines I went. I felt that with specialists at the breast center and with a specialized team of doctors that I was more comfortable with my decision. They even offered the mammosite option to me since I am 60 years old. For the first time since I moved here, the doctors sat down and spent an hour with me on each topic, surgery, oncology and radiation. I am suppose to meet with the specialilsts in lymphedma and still have the physical there as well.

Do you think having access to better treatment facilities improve one's chances of survival and reduces some risks>

i am thinking the hour trip has been so worthwhile. I am sorry i didnt do it sooner.

CrunchyPoodleMama

I absolutely think better doctors/facilities improve your recovery and reduce some risks, if for no other reason than when you feel comfortable with your quality of care, you feel more free to ask very important questions and feel more confidence in your course of treatment. A team of specialists is better prepared than a generalist to come up with a treatment plan customized to YOU... not just a standard plan they give to everyone with DCIS.

In the grand scheme of things, an hour's drive isn't that bad to get superior quality of care. I'd probably drive two hours if I had to, if it meant getting the best care possible!

dlb823

Helen, I started my tx with excellent local docs in a very upscale area with fine facilities.  However, when something about my pathology didn't seem right, I decided to take the advice of my sister, who has been in cancer reserach for 25+ years, and go to an NCI-designated facility.  Not only did they disagree with the odd pathology finding that would have sent me down an uneasy path, but they found a glaring omission in the tx I'd had to date that proved to be pivotal in my tx.  They also told me the chemo that had been recommended for me but that I thankfully hadn't started, was wrong for me.  Oh, and they offered a much more advanced type of reconstruction.

I know sometimes I must sound like I'm on a soapbox about second opinions and NCI-designated facilities, but my personal experience makes me agree completely with you -- that there is a difference.  This is not to say that many women don't get extraordinary care with local doctors, and there are some who feel lost or otherwise dislike a university hospital setting.  But when there's any red flag or reason to not be comfortable with what's happening, that's absolutely the time to look to the larger institutions that are on the front lines of research and offer the most cutting edge treatment, as well as having every specialist you need within the same facility, regularly conferring with each other as needed.     Deanna

3monstmama

I also think there is a difference and I think that second opinions are a very good thing.  You need to have confidence in your surgeon so that you will feel comfortable with what they will do to you.  I was treated at a breast center--the surgery was done by a surgeon who specializes in breast surgery and breast cancer, even the radiation treatment was set up by a radiation oncologist who specializes in radiating breasts.

I am about 2 weeks out from ending my radiation.  I can barely find my scar from my lumpectomy--its totally blended in with the outline of my nipple.  I did not have mega side effects from the radiation that I know some women experience and my zapped boobie is already almost the same color as the un-zapped one.  I was really scared about radiation but I was told by my doctors that because the center is involved in so many studies and grants about radiation and cancer, all the equipment is always in tip-top shape.

Driving an hour is a drag but dealing with unnecessary side effects is worse.  Do you know anyone in Des Moines that you could visit while you were getting treated?

helenap

if possible (wont know until surgery) they want me to do the mammosite and the rads are done twice a day for a week and then done. the oncologist will meet me during the same time to decide what hormone or drugs probably Tamoxfin.

i feel much better. but still not sleeping, eating etc. so not sure when that changes

helenap

if possible (wont know until surgery) they want me to do the mammosite and the rads are done twice a day for a week and then done. the oncologist will meet me during the same time to decide what hormone or drugs probably Tamoxfin.

i feel much better. but still not sleeping, eating etc. so not sure when that changes

iodine

I have done it both ways.  Major university ctr, for bs and ps---pathology wrong re: ER pos or neg.  PS was an ass and wouldn't ans. questions, also had a bad outcome, he said nothing could be done.

I have seen local onc/rad onc who will treat anyone who will sit down.  One is in prision for treating people who didn't have cancer, with half doses of chem and charging for full doses.  I have seen some local ones who were amazingly caring and patients and famillies love them. 

I went to the "big city" doc who invented a back procedure.  Man saw me once after surgery, wouldn't examine a complaint of pain which was dx'd when I returned home by my local small town ortho--instant relief with one cortisone shot.  "big city" wouldn't even examine my body re: complaint and increased pain meds and left me to ignorant interns and residents.

The worst doc in the specialty can have a good outcome and the best can have a bad outome.  Your trust and faith in your doc is a large part of treatment.  YOUR educating Yourself about your diagnosis is the best way to help determine if the guy is good.  If you don't like a doc, change docs.  A second opinion or third, is almost always helpful, either to confirm the first consult or offer a different perspective. 

I had my bc labs sent away to another lab---my gut told me to.  So glad I did. 

Listen to your gut.  I am not into mystical stuff, but you know that feeling when something isn't right.  Follow that feeling.  It is vital for us to take responsibility for our care, know when we feel it is not right and then DO something.  I learned the hard way.

roseg

I think your chances of survival are about the same in a local facility or a big cancer center!

If you don't mind the drive then go for it.

Kitchenwitch

DCIS has such a high rate of treatment success that I don't think survival is that big an issue.

However -- and maybe this a soft-science issue -- sometimes you just feel that people are taking better care of you, giving you information in a way that's more sensitive, and helping you along in a more caring way. All things being equal, I'd choose the practice I felt more comfortable with.

I live in NYC where it can be pretty hard-edged. However, I had some colon issues and my doctor and his practice could not have been more supportive. I think my breast surgeon did a fabulous job on me technically (sadly we're not done yet) but I cannot stand her support staff and, to some extent, her. I wish some things about her practice were different. I'd probably be having the same course of treatment - but I'd feel differently about it.

Some people can put that aside and just focus on the medical aspect. I have a harder time with that.

best wishes.

tovahsmom

Helen,

I too started out at my local hospital in Staten Island, NY. People told me I ought to take advantage of the cancer centers in Manhattan as I live so close but I wanted to stay local. Well, I ran into some sloppy medicine in Staten Island and I decided to switch my care to NYU. Its made a difference as NYU's examination of all my slides and films differed from Staten Island's and I decided to trust NYU.

My treatment is not over with yet, but so far I still have my breast. Staten Island recommended a mastectomy for multicentric DCIS which NYU said I didn't have. I also did my radiation at NYU. It was truly inconvenient to travel an hour each way on public transportation to get to my daily radiation treatments but it was worth it as NYU also has different equipment than Staten Island. 

speech529

I am getting treatment at a major medical clinic well known for its cancer treatment.  I have a friend who was treated by a local doctor who runs a breast treatment center.  My friend and I are equally happy with our treatment so far. 

However, for me, I appreciated a team approach at one facility.  My friend had to go to several different doctors and different centers. 

nolookingback

Always go with the best doctors you can get no matter what the diagnosis. When your treatment is over you will want to have regular mammograms or other diagnostic tests for years to come. Go with the people who will be alert to any changes. I love my local small town doctor for most of my medical care, but get me to a major medical center for cancer treatment. Others feel differently, but that's my take.

tweetybird

I'm from Long Island, and I could have went to Sloan Kettering or NYU in Manhattan, but I decided to stay local. I'm not much of a city person, and that would have just added to the stress of what I was going thru. I have and still getting the best care. I can be to my oncologist and hopsital that does my blood work in about 1/2 from work, and only 15 minutes from home. The hopsital that does my mamo/ultrasound/MRI is about 20 minutes from home, and about 20 minutes from work. This is also the same hospital that I had my lumectomy.

I just love the personal care that I get at both hospitals, and I often wonder if it would be the same at a large center/hopsital.

3monstmama

I'm at a large Seattle cancer center.  I felt I got VERY personal care--staff always greeted me by name and still remember me a month after my last Zap session.  I even ran into one Zap tech on the street--they recognized me and gave me a hug!  It was nice being someplace where I felt everyone was really up on the latest and greatest in cancer treatment.  I sailed through my zaps with barely any SEs and no long term issues.

I think the best advise is to find the best doctors around that make you feel comfortable.  You will have a relationship with these people for years so liking them, to me, is important.

FasttimesNY

yes I agree with you tweety...

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Claire_in_Seattle

Interesting question.  I was also treated where where I got coordinated care and a smooth hand-off.  This made a major difference in things like getting my port placed during surgery which is cheaper for them and easier on me.  (I was not treated at the same place as threemonstermama.)

I really appreciate the fact that my surgeon was concerned about the eventual cosmetic look, and she did a marvelous job that way.  She also made sure I had full range of motion.  To say nothing of nipple sensation.

Everyone supported my wanting to exercise throughout treatment, which was major important to me.

I learned that my bottom line with oncologist and radiation oncologist is that I want them to be up on the latest research and treatment options.  So what are the relative benefits of a particular course of action?  So no, the doesn't have to be a major gun, but they do need to be current in their field.  Deal breaker if they aren't.  (I did not have anything unusual going on.  If so, I would have wanted a second opinion with a major expert in the field.)

I appreciated being in a smaller place.  Very little additional wait time except for when I had surgery.  But I understand that one.

I am sure I will be running into some of my team at cycling events.  Just like I ran into bike shop owner and his wife at the Opera.

FasttimesNY

thanks for the info nolookingback

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