Follow-up appointments

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Jcolby
Jcolby Member Posts: 23

I'm curious what schedule others are on for follow up appointments after surgery and radiation. I finished radiation in December 2016. Last time I saw the oncologist was the week before last treatment, and I don't see him again, ever. I have seen a nurse, and will see her one more time in June to check on how I'm doing with meds. Then I won't see her again. She is the one I will call if I need a refill on my hormone therapy meds. I called the surgeon's office and they said if he wanted any follow up appointments he would let me know. Have heard nothing from him. Last time I saw the surgeon, was a week post surgery in October. I'm kind of feeling like they have washed their hands of me. They kept telling me my 2 cm tumor, grade 3, was very, very tiny, a minor inconvenience. My Oncotype dx score was 29, which they said is quite good. Oncologist said he fully expected me to have zero side effects, immediate nor long term. I do have side effects, but nothing life altering. Just the zingers and chest pain. Do I just do follow up with my primary care now?

Comments

  • Sjacobs146
    Sjacobs146 Member Posts: 770
    edited April 2017

    I have follow-up appointments every three months, alternating between doctors. I saw my RO in March, will see MO in June, BS in Sept. And MO again in December. I will continue like this until 5 year mark. Then I drop RO and BS, and just see MO twice a year. Once I hit 10 year mark, the MO will kick me out too.

  • Jcolby
    Jcolby Member Posts: 23
    edited April 2017

    Sjacobs:  that's kind of what I thought it would be, but after 5 months post-op, and no indication that they want to see me again, I was wondering.  Guess they feel my dx score was low enough they don't need to see me any more.  Even after I called and asked, I was told no more appointments.  Makes me feel a bit deserted.  Not even a follow up mammogram.  And this is Mayo.


  • ElaineTherese
    ElaineTherese Member Posts: 3,328
    edited April 2017

    Hmm, I had my last Herceptin in December 2015, and I still have follow-up appointments every three months. I also get mammograms every six months and have my second dexascan scheduled for June (I'm on an AI which can reduce bone density). But, every doctor is different!

  • KathyL624
    KathyL624 Member Posts: 217
    edited April 2017

    Was that 2 cm if DCIS? I assume so if they told you that oncotype is low. I had IDC, 8 mm and was seen every 3 months the first year now every 6 months

  • Beatmon
    Beatmon Member Posts: 1,562
    edited April 2017

    I'm surprised that they don't want to follow you at least every 6 months. You listed dcis and Idc. Mine saw me every 3 months for a year, then every 6 months for a year. Then unfortunately I had progression, so back in the 3 week loop

  • Leslie2016
    Leslie2016 Member Posts: 316
    edited April 2017

    I'm not quite done my treatment yet, but I'm at the same cancer center my mom was, and they still see her yearly 5 years out. I expect the same. I know I will have yearly mammo/MRI's; I think the BS is ordering them. I have herceptin through the end of this year, so I know I see my MO every 3 months until that's done, then I think every 6 months for the tamoxifen check ins. I believe some stuff is "downloaded" to my GP, but I don't expect to be out of the cancer center all together for years.

  • ChiSandy
    ChiSandy Member Posts: 12,133
    edited April 2017

    I had lumpectomy, radiation and am on my second of 5 yrs. of letrozole. Once my 16 radiation treatments were done, after seeing me weekly during the treatments my RO "set me free." I see my BS or her NP and get mammos every 6 months (alternating between just the R and bilateral—the bilateral is annual). I see my MO every 6 mos. too so she can check how well I’m handling the letrozole and to plan the next semiannual bone treatment (Zometa, which I tolerated poorly, the first time, Prolia the second—and probably for the third and fourth, after which I’m done). Medicare pays for bone density scans only biennially (one every 2 yrs) and I had my first in Nov. 2015, before starting rads or letro, diagnosing osteopenia, so I’m due for another one this Nov.—it will assess either how much the letro weakened my bones or how well the Zometa & Prolia protected them.

  • ual0307
    ual0307 Member Posts: 62
    edited April 2017

    I did one one month follow up with my RO. Hated him. Haven't seen him since.

    Have 2 MOs. One where I live, one in the states and see each once a year, six months apart.

    First year I did quarterly follow ups but then went right to the two visit per year.

    My MO and BS are both in the states so I see BS once a year too. Probably don't need to but I like her. I also see the vascular doc once per year ..since I'm in the neighborhood. Probably don't need to see her either but again I like her.

  • ksusan
    ksusan Member Posts: 4,505
    edited April 2017

    I saw the surgeon/his replacement until 2 years out from surgery. The RO has offered annual appointments, to be cancelled if I don't want them. The MO has seen me quarterly for 2 years since surgery, and now will see me every half-year for 3 years, then "annual for the rest of your life."

  • Jcolby
    Jcolby Member Posts: 23
    edited April 2017

    Thank you all so much for responding.  I feel that somehow I have fallen through the cracks.  Below items are directly from the surgical pathology report, to answer your questions.  I am also taking anastrozole.  Initially the MO said I would take it for 10 yrs, but it appears that will be cut short from what I read on my survivorship plan given to me by the nurse.  The nurse said I would no longer see the RO nor the MO in the future.  I asked her to call the BS office and see if she could find out anything.  Someone else from oncology (an appt clerk) called me back, and said the BS's office would contact me if he wanted to see me further.  That was 3 months ago, and no response.  Do you think my age (70) changes the usual protocol for post surgical visits/medications?  That's kind of my conclusion.  No other explanation.  Again, many thanks for your responses. 

    C) Breast, left, wire localized excisional biopsy:  INVASIVE DUCTAL CARCINOMA. ....Histologic type: Invasive ductal carcinoma.  Tumor size: 20 mm in greatest dimension.  Histologic grade: Grade 3 (Nottingham score 8 of 9; tubules: 3, nuclei: 3,  mitoses: 2)

    D) Breast, left medial margin, reexcision:  DUCTAL CARCINOMA IN SITU, HIGH NUCLEAR GRADE, WITH FOCAL MICROINVASION  IS IDENTIFIED AND EXTENDS TO WITHIN 0.5 MM OF THE NEW SURGICAL MARGIN.


  • farmerlucy
    farmerlucy Member Posts: 3,985
    edited April 2017

    That is a puzzle to me too. The oncotype of 29 must be on the IDC, which is in the intermediate area. I saw my onc every three, then every six months to five years. Now I'll see her annually. Do you have the option of changing oncologists?

  • Jcolby
    Jcolby Member Posts: 23
    edited April 2017

    Lucy:  the oncotype DX was on the main tumor (IDC).  He said the decision for further treatment (chemo, radiation, meds) was totally up to me.  I almost said I would do nothing, but that didn't make any sense at all.  So I opted for the minimum radiation.  I felt I was an annoyance to him with my trivial diagnosis.  Oh, dear, now I'm whining. 

    Thanks again.

  • VelvetPoppy
    VelvetPoppy Member Posts: 649
    edited April 2017

    Follow-up appointments:

    BS saw me 10 days after surgery, then 3 weeks post-rads; now every six months for 5 years; then , she says, annually after that (until I die or she retires?).

    RO saw me 3 weeks post-rads, then 3 months later & 4 months after that; now every 6 months for the next year, then annually for total of 5 years.

    MO has seen me every 3 months since February 2016. He has not told me if it will stay that way. I only know I will be with him for 5 years.

  • LisaAlissa
    LisaAlissa Member Posts: 1,092
    edited April 2017

    "Initially the MO said I would take it for 10 yrs, but it appears that will be cut short from what I read on my survivorship plan given to me by the nurse."

    Hi Jcolby!

    Did the nurse just give it to you? Was it personalized, or just a printed form they gave you? Or did you get to discuss it with either the nurse or the medical oncologist the nurse works for?

    It used to be that they just stopped seeing you, and you didn't have any idea who was supposed to follow you (if at all) or what sorts of tests should be done. The idea of a "Survivorship Plan" was supposed to answer all of those questions for you and your primary care doc.

    Here is a link to a discussion of Survivorship Plans from BCO (which says those who get the least follow-up are actually younger women).

    A link to ASCO's page on Follow-up Care for Breast Cancer (which includes a link to their Survivorship Plan forms).

    and one from th e Am. Cancer Soc's page on Survivorship Plans

    You might recognize the form your MO is using from one of these. At any rate if you don't know who is following you and how, I'd say your Survivorship Plan hasn't accomplished its goals. For example, you say your are taking anastrozole...is that being prescribed by the MO? (If so, I'm surprised that the MO would want to be responsible for writing those prescriptions if they aren't following your care...or is your PCP collaborating with the MO for those follow-ups?) Or do you have another doc who is taking on that portion of your care?

    A Survivorship plan is supposed to be a personalized document that will answer your questions about what care you need now that you're out of the "active treatment" phase, and who will order/review any scans that are recommended, who will monitor your health and what they should looks for. If your MO won't make an appointment to discuss these things with you, find out if your PCP got a copy of the Survivorship Plan, and make an appointment to discuss with them. You need someone to assume your on-going care, and you need to know what that care should be, and who you should talk to if you have a concerning symptom.

    Best wishes!

    LisaAlissa

  • Emily2008
    Emily2008 Member Posts: 605
    edited April 2017

    Jcolby, you're not being managed well. If I were you I would absolutely find a new MO to manage me. Your dx is not "trivial" nor does it matter what age you are. If you think you should have another 20+ years of healthy living (as we all hope), then you need adequate follow up. At *minimum* you should be seen every 6 months for a couple of years. Perhaps at Mayo you're not as much of a concern, but I would think at a private MO practice you would have eyes on you.

  • Jcolby
    Jcolby Member Posts: 23
    edited April 2017

    LisaAlissa:  My survivorship plan was prepared by a social worker and the nurse gave it to me.  Most of it is pre-printed with my personal info entered into the appropriate place.  Such as name, address, diagnosis, treatments, side-effects, etc.  There is one area of "Surveillance"  which states exams should be performed 3-6 months the first 3 years, 6-12 months 4-5 years.  And states follow-up care with my primary care physician. 

    This discussion has me firmly believing I need to be my own advocate.  I still might hit a brick wall, but at least I will have tried.  Thank you all for taking the time to tell me your stories and follow-up schedules.

  • etnasgrl
    etnasgrl Member Posts: 650
    edited April 2017

    For my follow up care, I see my medical oncologist every 6 months and my surgical oncologist once a year.
    My surgical oncologist will order my yearly mammograms from now on, instead of my primary care physician. At the six month check ups with my medical oncologist, he performs a clinical breast exam, refills my Tamoxifen for the next 6 months and go over any issues/concerns that I may have.
    I don't see my radiation oncologist anymore. Once I was finished with radiation, I stopped seeing her and won't see her again. My follow up care is in the hands of my medical and surgical oncologist.

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