Coordination between docs at different centers?

I am staying local for my treatment. My cancer center also has the "multi-specialty team" thing. So earlier this month my surgeon was supposed to present my case at their monthly conference so that the other doctors not directly involved could give their feedback.

The only thing I am planning on going to the big city for is the reconstruction. My surgeon is actually the one recommending going out of town for it.

ok, you have a really small, low-grade tumor. I also had a grade 1 tumor-- LOVE the word indolent!

The fear is, you are young, and have many years ahead of you. But, most studies have found that your chances of never being bugged by this type of cancer again are the same as they are for us older women --over 90% of us are fine, forever.

You can go for a big, fancy schmuck treatment center, but your recommendations are most likely to be exactly the same. This is a very standardized treatment. I would look for a doc who makes you feel safe, and taken care of -- you will be sEwing them for 5 years, so liking them helps. I went local, and honestly they see and successfully treat enough women with this diagnosis that they will take good care of you

Hugs, hate that you have to do thid, but remember, if you must have IDC, this is the kind to have

for me, I went out of state for recon because there was very little local experience for DIEP. I really didn't talk to my local surgeon about it, I just went! But my MO and RO coordinated just fine. They didn't need to 'compete' about my care.

It was when I got IBC that I needed to get to the experts for direction of my care. Once you get to rare and complex, a second opinion with experts, I think, is necessary. My local surgeon, and tumor board, was afraid about what to do. My MO wanted me to get expert opinions and she coordinated my care so I could get chemo at home. Due to my complex case I chose to have both surgery and radiation out of state.

You can always get a second opinion to verify the local treatment plan. Your case does not appear complex. It's quite stressful traveling for care but you must trust your team. If you do not trust your local team then branch out. I have known other ladies whose docs refused to coordinate care. Also, my PCP has nothing to do with my cancer care---it's out of her range of expertise. My insurance doesn't require Dr referrals; I can self refer

I have IBC, which cider8 correctly pointed out, is rare and complex. But, even with rare and complex I have a team of doctors at a major cancer center who are more than happy to coordinate with a more local radiation oncologist so that when I have to go every single day for that treatment it won't be so bad. I do travel to another state for my weekly care right now though. So, given that you are facing a much more straightforward set of problems, I would think that you should definitely be able to coordinate care more locally, at a minimum the RO part of it that would require daily visits.

Mine originally was thought to be 7mm on ultrasound & core-needle biopsy, but after lumpectomy turned out to be 1.3cm. Still considered “small,” though until the surgery they were calling it “tiny.” Mine was grade 2 (moderately differentiated), but the mitotic score was 1, or slow-growing. Low oncotype score, ER+/PR+/HER2- profile, and my age (almost 65) made chemo inadvisable, and because of the location of the tumor I am even a candidate for partial-breast radiation (3 wks rather than 6).

I went to a major university-hospital breast cancer center (North Shore Evanston Hospital Center for Breast Health and Kellogg Cancer Center) from the get-go, because it’s only 20 min. away and I’d been getting my screening mammos there for years. Nobody had to (or tried to) sell me on their team, but they are all wonderful and I am glad to be eligible for several trials and to reap the benefits of others that had taken place there. If I were you, I would go for the best in-network breast surgeon you could find--bearing in mind you will have to return for followup appointments; and a lumpectomy (the most likely scenario in your case) would be same-day surgery, with no hospital stay. So you might, if going to a distant hospital, arrange for a hotel room close by to stay overnight in order to give your family or friends who drove you a chance to rest. (You won’t be able to fly for a month afterward, so the hospital should be within driving distance). You can do radiation locally as long as your local hospital has the necessary equipment for the therapy deemed most appropriate for your cancer. In fact, you should do your radiation at a facility that wouldn’t require a long commute, as you’ll be going every day M-F for at least 3 if not 6 or 7 weeks. I lucked out because Evanston/Kellogg is close by and one-stop shopping. The only one of my doctors not part of North Shore Health is my FP/PCP--and North Shore sends him all my reports. In fact, they let him do my pre-op EKG and bloodwork. Chemo, if you need it (that’ll depend on your tumor’s cytology, node involvement and margins--and perhaps your youth), is usually every 3 wks or so, but your local hospital may be able to administer it after consulting with your med. onc.

Marijen, my tumor was in the 10 o'clock position (lateral, upper). The reason I'm a candidate for partial RT is because I'm only at stage IA (clean margins, neg. nodes), the tumor was 1.3cm, grade 2 (but mitotic score 1, or slow-growing). low oncotype score (16); and besides being the same hormonal profile as yours, I’m nearly 65. At stage III, grade 3, you may have a more aggressive tumor and with lymph nodes involved, probably a suspicion of micromets in your breast beyond the tumor cavity. Did you get Femara yet? (If you did, neoadjuvantly since your lumpectomy’s not till next week and the tumor shrank, maybe the Femara took care of any micromets). But in your case whole-breast might give you a better, albeit temporarily uncomfortable, overall outcome.

Radiation does leave you very fatigued, SOS. I was very lucky in that my son and his family live 20 minutes from the two-hours-away NAICC facility where I had my surgery, and where my onc and a couple of other docs are located. I stayed with the kids and went home weekends and once or twice during the week. This worked out fine.

My suggestion would be to meet with an RO or two closer to home, then, if you decide the faraway hospital is where you want to go, do so, but be prepared to stay in the area one or two nights/week (more if it snows!). Also remember that where you start is where you'll finish. There is so much preparation, and mathmatics, and physics, and interdepartmental meetings and so forth in setting up a radiation therapy plan that switching facilities midstream is almost never done. Also a big no-no is stopping in the middle of treatment as that leaves any errant cells untreated and precludes you from having rads to that area in the future. Pretty much all your other treatments and providers and facilities are flip-floppable, but rads is really a commitment.

sos, I haven’t started my treatment yet--having my simulation session this afternoon. But the accelerated partial-breast protocol, despite delivering higher doses than the 33-session, does cause less fatigue because of the fewer number of sessions--and fatigue usually sets in at about the 3-or-4-wk mark. The difference is that with the shorter protocol, you’ll be done by the time fatigue (if any) hits, and by then you’ll already be on the mend; with the longer protocol you have fatigue through the last 2 to 3 weeks of treatment.

If your treatment can be done closer to home acc. to the protocols set by the RO at U. Mich, and with the same kind of equipment by equally-skilled techs, no reason for you to have to drive all the way to Ann Arbor & back every day for3- 6 weeks.