How to make my doctor consider other options ?!

Hi. was diagnosed just recently.

Starting my Chemo treatment tomorrow. My physician wants me to take Taxol.

I have chatted with another doctor who said that Taxotere is also a common drug to be used. I went back to my doctor and she was very unhappy with the fact I talked to other doctors. But on the other hand - she told me that both drugs are fine and its a "trial and error" process where we need to find to which drug my tumors reacts better.

By the way - I didn't pay anything to the other doctor... I am on this app called BELONG for cancer patients. which is pretty cool.

Anyhow - I don't like the fact that its a "trial and error"... but seems like in many other cases its how things are. Starting with Chemo X... not responding ? OK. Lets go to Chemo Y... but time is the one resource I assume I don't have enough of...

How do you make a decision here ? How can I be sure my physician is doing the extra mile for me and not just following the protocol ?

Thank you all.

Emma

Thanks Sjacobs146

Yes. He did explain in details why would someone prefer one drug over the other. The kind of facts that I did not hear from my doctor. He talked about toxicity levels, about side effects etc...

My doctor (like many other out there) only knows how to follow protocols. she wont even listen to other ideas.

Frustrating...

I'm not at all surprised that your doctor won't change her treatment plan based on what another doctor told you, at no cost. In her eyes, that's about the same as "My sister's best friend's aunt is a doctor and she suggested doing "xyz" instead."

If you are truly concerned about your treatment plan, take all your records to another doctor and get a second opinion. (As in, going to another doctor's office, being examined by that doctor, and have that doctor go over your records.) Then, you can take that second opinion back to your doctor and discuss it. I'm certain that if you do it this way, your doctor will be more open and willing to listen to you.

My oncologist told me from Day One, that he has NO problems with me getting a second opinion at any time, but to stay off of Google and avoid the "I know someone who knows someone and they said" garbage. Info that I find in say "Dr. Susan Love's Breast Book" and bring to him, he listens to and we discuss if it's relevant to me and if so, will it work for me. He's been wonderful....BUT....that's because I followed his advice and don't bring him second opinions from God knows where or things that I learned on Google.

As mentioned, Taxotere and Taxol are similar, they come from the same class of drugs "taxanes". One difference is the side effects they cause. Everyone's body reacts differently to the drugs. Some tolerate Taxotere better, others Taxol. They may start you on one and change to the other based on your side effects. Some get Taxol in weekly doses to reduce the side effects. The drugs are made by different pharmaceutical companies.

Here are some links, copied from a past discussion on this topic.

http://www.phcog.org/Taxus/Taxus_Web.html

http://packageinserts.bms.com/pi/pi_taxol.pdf

http://www.taxotere.com/

http://www.chemocare.com/bio/taxotere.asp

http://www.chemocare.com/bio/taxol.asp

Hi Emma:

You didn't really provide much information about yourself, such as where you are located, your age, estiimated stage, histology (e.g., ductal), size of tumor, ER, PR, HER2 status, or clinical evidence of node involvement, other than being "recently" diagnosed.

When you refer to your "physician" do you mean your "Medical Oncologist"? Presumably, your physician is a medical oncologist by training, is licensed to practice medicine in your location, and is affiliated with a reputable medical institution, so their qualifications are clear.

Since you didn't mention surgery and referred to seeing how the "tumors react", are you talking about receiving neoadjuvant chemotherapy (i.e., chemotherapy before surgery)? If so, it may indeed be possible to check for tumor response to treatment and to make a change in regimen, if indicated. This possibility of checking for response, or what you refer to as "trial and error", is an advantage of neoadjuvant therapy in certain settings. This is not a defect in a proposed neoadjuvant treatment plan, but a potential advantage. Unfortunately, medical oncologists cannot predict with certainty whether or not a particular patient will have a complete pathological response (pCR), indicative that the tumor responds to the drug. That your oncologist admits that she cannot be certain which is the best treatment at the outset, and that there may be a change, strikes me as an honest and accurate response.

Please note that following a "protocol" can be part of sound medical practice. Oncology is evidence-based medicine. Consensus treatment guidelines exist, such as those promulgated by the National Comprehensive Cancer Network (NCCN) in the US. These guidelines are routinely used by medical oncologists, because it is important to know what treatments are within the standard of care. Oncologists who keep up with current research may also incorporate more recent information, because the standard of care evolves with time and new reliable clinical information. In certain cases, there may be sound medical reasons to depart from the guidelines. But in many cases, it may indeed be appropriate for a medical oncologist to follow such guidelines or standard of care. It is possible that more than one drug regimen may be within the standard of care. Guidelines may indicate that one or some regimens are considered as preferred in the usual case, or if none is preferred and/or there is more than one reasonable option, then the sound medical judgment of the oncologist applied to the specific case and patient preference may come into play, in a discussion of risk/benefit.

As noted above, your oncologist has seen you in person, has access to all your records, is familiar with your personal and family medical history, including age, co-morbidities, other drugs you are taking (possible drug-drug interactions), and overall presentation. You can certainly ask your oncologist to please clarify the reasons why she feels Taxol (or the Taxol-containing regimen she recommended) may be the best choice for you in the first instance, and why she recommends it over a Taxotere-containing regimen in your specific case. You may also wish to inquire whether the guidelines address the question.

You have edited your post since this morning, but I think you mentioned that you provided a pathology report to the BELONG-associated person, who spoke with you by telephone about the best chemotherapy regimen for you. As noted above, this is a non-standard, unproven method of providing reliable medical oncology advice, and is subject to many possible issues relating to the quality of the source of the information and the quality of care. Such issues raise a reasonable concerns that the information provided may be inherently unqualified and/or unreliable.

The BELONG-associated person can only speak to the basic information in the pathology report (size, ER, PR, HER2 status) and what you may have remembered to disclose in the call. They can say this other drug is also used in this setting, but even if true, that does not mean it is a better choice. They can discuss generalities about known side effects of various drugs set forth in the FDA approved labels (which by the way, are easily accessed on the internet by anyone regardless of relevant medical qualifications (if any)), but they cannot determine whether these side effect profiles militate in favor of one drug over another in your specific case, if they are not familiar with your complete personal medical history.

The specific area of expertise and training required for chemotherapy decisions is that of "Medical Oncologists". What are the credentials of the the BELONG-associated person, and how could you independently verify that the person you spoke to is the person you spoke to (not just someone posing as Dr. Joseph Smith), is truly a medical oncologist by training, and is licensed to practice medicine in the country you are located in? What consensus treatment guidelines are they familiar with? Please note that different countries use different guidelines, and what is common elsewhere, within differing healthcare systems, economic and regulatory constraints, may not be the most common treatment and/or best practice in the United States.

If you would like a second opinion from a qualified medical oncologist, please ask your current providers if you can safely take the additional time to do so, and then seek out expert advice in person at an independent institution. If you need information about the second opinion process, please let us know.

BarredOwl

I can't add much to the conversation except to say that therapy IS somewhat trial and error. That might be shocking to realize but it's pretty true.

Also, do get a "full" second opinion. I used a type of taxol (called Abraxane) which has been concocted to reduce common side effects. Maybe taxotere has even fewer side effects, I really don't know. They're both in the same class as others have said above. Like cousins. I don't know this for sure, but I would not be surprised that if one taxane works for you, they all would.

Thank you so much rainnyc

I have a medical insurance but my plan only covers doctors from an enclosed list within Israel. Neither Sloan Kettering Nor the European lab is on that list... the price for Sloan Kettering services is around 2000$ if I recall.

There are great doctors in Israel and I already have a few names of top-notch oncologists (it was time consuming task just to find those names). I will definatily go see one. no doubt about it. Just hope to get answers.

Good luck to you too in your journey.

Emma

SEs - Side Effects

It sounds like you are really trying to have the best information possible. Is your Tumor greater than 2cm or are you node positive? If so can you get Perjeta? In the USA there are a lot of women on

TCHP-Taxotere, Carboplatin, Perjeta, Herceptin regiments.

Thank you BarredOwl for all the resources.

I did hear a lot of good things about Dana Farber as well as Sloan. I also heard that Dana Farber cancer center is considered as a very patient-friendly facility.

Emma