Surgery in Boston or NH?

ScarletO · December 2017

Hello all - newly diagnosed at Elliot Breast Health Center in NH with IDC, hormone positive, HER2 negative. Have gotten second opinion in Boston at Dana Farber. DF seems like the obvious choice for surgery and treatment due to reputation, but I am struggling with this decision. Really liked the team at Elliot, but just not sure liking them is enough to overcome DF’s excellent reputation. Both gave essentially same diagnosis and recommendations for surgery (lumpectomy and lymph node dissection). Boston is not terribly inconvenient but but not as convenient as Manchester. I know it’s its largely a personal decision but I’m having a difficult time deciding where to proceed. I have MRIs scheduled at both hospitals next week, so I need to figure this out. I welcome any insight

Cpeachymom · December 2017

Hi ScarletO, I also got my second opinion at DF, but easily decided it was not worth the trips to Boston for treatment when there was a brand new cancer center near me. This may be especially true if you need radiation because that is every day for weeks. If you are comfortable with your team, that is important. Now if you had some rare cancer or complication, That would be something to consider, and you could always go back to DF if something like that came up. It’s a good sign that they both suggested the same treatment. Mine were not, so I went with DF recommendation and my team was willing to defer to them.

I hope this helps, best of luck to you!!

dtad · December 2017

ScarletO...so sorry you have a difficult decision to make. IMO where you get treated is a huge piece of this journey. I would go to Dana Farber without hesitation. You have to keep in mind the best docs and state of the art equipment are there. The smaller facilities just cannot compete with that. You are lucky to be close to such a great facility, and I think you should take advantage of it. Good luck and keep us posted

Georgia1 · December 2017

Good morning Scarlet. I would take this one step at a time and schedule surgery with the most experienced surgeon. Then you can get opinions from both on radiation (which I'm just guessing is your next step) and do radiation at the facility closest to you for the sake of convenience.

I was blessed to have two great hospitals nearby; did second opinion on everything; and ended up with surgery at one place and radiation at another.

ReginaZ · December 2017

Hi Scarlet,

I went to my local surgeon at a run of the mill local hospital and I couldn't be happier with the result. He was highly recommended by the nurse navigator where I was initially diagnosed. There are excellent surgeons and doctors in every community. And basically, everyone is following the same guidelines. If you are comfortable with your local team and you get a recommendation you trust for a great surgeon, I would recommend going with that.

Good luck with whatever you decide,

Regina

grrifff · December 2017

I'm in Central NH and had the same surgeon who did my gallbladder surgery do my lumpectomy and axillary node dissection. I like him very much, he also did my biopsy. My first oncologist was DF affiliated but I didn't like her or her treatment plan. Unfortunately I'm Stage IV. She knew I had a few suspicious spots on the CT scan but still had me set up for my port to be placed. DF tumor board said hold on, this needs to be biopsied. Unfortunately breast cancer cells on my L1. Now I see an awesome oncologist at DHMC in Lebanon. Worth the drive once a month. I went with my gut.

JoniB · December 2017

My friend with colon cancer had to decide between MSK in NY or Overlook in NJ. She chose Overlook for convenience thinking the doctor trained at MSK. When she was diagnosed with stage IV she went to MSK but it was too late. Maybe she would have passed away anyway but maybe not.

dtad · January 2018

Hi everyone....I cannot stress enough how crucial it is to be seen at a major university teaching hospital. I'm in the medical profession and I can honestly tell you that small community hospitals are just not well equipped to treat serious illness. Of course that does not mean that everyone being treated at a community hospital will do poorly. However there is a reason why the top docs in the country are found at university based facilities. IMO at the very least get a second opinion at one. I also do not agree that every facility have the same protocols. Also unfortunately just liking your doc is not enough. Do your research. Find out where they went to school and did their training. Good luck to all navigating this complicated disease. Happy New Year

ReginaZ · January 2018

I don't think you'll find any evidence that early breast cancer patients treated at major university settings have better outcomes than those of us treated at community hospitals. Maybe for complicated, advanced cases of cancer...Unfortunately, breast cancer is now so common the treatment is standard and routine and there are many providers who are able to provide excellent care.

momand2kids · January 2018

I had my surgery at MGH and treatment at Dana... I think if you have access to two of the top 5 NCI hospitals, why wouldn't you? Skill is what matters for the surgery--- the longer term relationship is with the MO if you need one... I think that is the person you need to connect with and like.... surgeons need to be very skilled and do the surgery every day.... generally you won't be followed by the surgeon- and while I actually loved my surgeon, I only saw her once or twice after the surgery--but I have seen my onc, her asst, staff, etc. once or twice a year for the past 9 years-- and they are the people to whom I pose questions, ask for research, etc. I love them..... and they are all at Dana Farber.

I did my chemo and radiation at Farber, even thought I probably could have done it at a local hospital (I am only 20 minutes away)... but I just felt really cared for and I felt the incredible competence of everyone at the Farber..... At a time I was at a high level of anxiety, it was one thing that reassured me.....

good luck with your decision.

Snickersmom · January 2018

I am in Florida and although I am treated at university of Florida/Orlando Health Cancer Center, I am fortunate enough to have one of the top oncologists at DF as my consultant/second opinion. (He is my best friend's son.) I could have gone to DF but stayed here because DF/friend's son and colleagues highly recommended my surgeon here and said he is one of the best. That being said, I wouldn't hesitate to go to DF if I ever need further treatment, as we are from CT and our daughters live near Boston.

My friend's son has always told us to go to a teaching university hospital and I'm so glad I did

dtad · January 2018

ReginaZ...I respectfully completely disagree! I'm certainly not saying that you cannot survive breast cancer, especially stage 1 if you are treated at a community hospital. What I am saying is that treatment protocols can definitely differ from one facility to another. Why wouldn't you want the best docs and the best state of the art equipment? I can give you many examples but let me give you mine. When I was first diagnosed my treatment plan was lumpectomy followed by intraoperative radiation. Intraoperative radiation is a one time dose of radiation given to the exact site of the breast cancer during surgery. My cousin was being treated at a community hospital with a very similar diagnosis at the same time I was being treated at a major NYC university hospital. My cousins doc had never heard of intraoperative radiation and it was certainly not available at the community hospital she was being treated at. This was several years ago and although it is more widespread there are still many hospitals that do not offer it. I also had direct to implant reconstruction. You would be hard pressed to find a PS who was experienced in this type of reconstruction at a community hospital. We all have to make our own informed decisions and this was mine. Good luck to all navigating this complicated disease.

Denise-G · January 2018

My mom, sister and I are all breast cancer survivors, diagnosed within 3 years. Our community hospital was convenient (1 mile away) BUT had we stayed at our community hospital, ALL 3 OF US were told we needed different treatments than we received at the NCI Designated University Teaching Hospital (University of Michigan for us) which was 120 miles round trip.

Several times the treatments we received at Univ of Michigan were not even heard of at our community hospital. AND my sister and I both have the Chek 2 1100 delc mutation. Our community hospital never heard of it. Our mom was 80 at diagnosis and told she would need chemo and radiation for her Stage 1 BC. At U of M, they recommended lumpectomy only. She is now 4 years out.

My sister was able to receive Breath Hold Radiation to help keep radiation from the heart. They never heard of it at our community hospital.

I know MANY people who get great treatments at their community hospital and live long lives. But for us, we are so grateful we had treatment where we did.

Sending my best wishes to you.

ReginaZ · January 2018

I'm not saying that every community has an excellent surgeon or state of the art equipment, but many do. It is definitely a personal decision

dtad · January 2018

ReginaZ... it is definitely a personal decision. However being in the medical profession I would like to encourage people to at least get a second opinion at a major university teaching hospital. Good luck to all

WhitneyK · January 2018

I was also diagnosed at Elliot in NH 2 years ago and went for a second opinion at Winchester Hospital Breast Center. I decided to go with the surgeon at Winchester, based on her experience and background. I don't regret that decision and still continue to go to MA for my semi-annual mammograms. That said, I did meet with the radiation oncologists in MA and found that the same treatment was available to me in NH. 27 weeks of daily trips to MA for radiation treatments would have been nearly impossible for me. The radiation oncologists in MA were more than happy to refer me to an oncologist near me with the same credentials and experience so I felt totally comfortable. All I had to do was ask! As others have said, you must feel comfortable with whatever decision you make and not second guess that decision. I wish you the best of luck in whatever decision you make.

reflect · January 2018

Hi Scarlet, I got a 2nd opinion at DF after I was able to switch insurance plans to one that would cover it. I was already nearly finished with chemo when I went. The MO would not have offered AC->T but would have gone straight to AIs instead...I think this is not the usual treatment, in any case, too late for me. I had lots of residual disease post chemo. The surgeon offered a lumpectomy at DF whereas the regional hospital said Mx only. It was a fancy procedure due to multifocal disease and I am very pleased I didn't have to deal with a loss of my breast in addition to all the other crap. My care there was tops--best skills, equipment and amazing caring as well. I did chemo locally, and radiation at the regional hospital. I was not happy with that experience.

My community hospital failed to diagnose my breast cancer or to refer me to a larger breast center despite findings on mammos and many risk factors. I was dx at Stage III. I would not seek treatment there for anything other than ... maybe gall bladder surgery? appendix? That said maybe there are community hospitals with docs who are top notch OR who know their limits,. But mine did not.

I vote for DF for a second opinion at least.

ScarletO · January 2018

Thank you all for your thoughtful comments and insights. I decided to go with DF;I cannot imagine that this will be a decision I will later regret. Wishing you all a speedy and lasting recovery.

Surgery in Boston or NH?

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