Why Medical Oncologists seem to differ in treatment approaches?

As my MO explained it, their job is part science, part art. In some cases, there are reasons for choosing one over another. In other cases, it may come down to what the MO is familiar with, what they prefer, random other justifications in their minds. Patient age, health, medical and life goals, work status and daily life requirements also factor in. My MO is thoughtful that I work and will typically recommend a chemo course that is a higher dose but more time in between so there is less disruption at work. Because I am relatively young and healthy, I can handle the higher doses. There is no fixed recipe for mets, fortunately and unfortunately.

I have been at MD Anderson since 11/15, and I know that on a couple of occasions, my MO has presented my case to a group (a tumor board?) for input and fresh perspective when the path forward wasn't straightforward. From the beginning, he let me know that there were options and discussed the pros and cons with me. But, I've now run out of standard protocols and am being vetted for a couple of clinical trials and that is an even twistier path!

You raise an interesting point and one I've puzzled on too. As a concrete for-instance, over on the Xeloda thread, people start at all kinds of different doses. You'd think there would be a standard dose, but the truth is the "FDA-approved' dose is too high. MOs know this but philosophically vary on what starting dose to use.

I agree with all the points above and would add that some MOs 'keep up' better than others.

There actually are recommendations from the NCCN on which treatments to use for different kinds of MBC. I don't think they specify what order to use them in and I'm too lazy to look it up. So that could be part of it. Sometimes the hospital has a protocol for treatments (mine does for Xeloda dose).

There's also the point that if you are looking at people's profiles, they may have started treatment before Ibrance came on the market! (That's me) Or they had taken Femara before diagnosis so they have to start with something else.

Sometimes the patient gets to decide which treatment next. It depends on your relationship with your MO. Regardless everyone should always ask their MO for their rationale behind what treatment they are recommending. (edited to add "oops that reads as preachy. I didn't mean it that way")

Hi Everyone,

This may not relate directly to this thread, but it is a question that has been nagging me for a while. I was dx de novo Stage IV in February 2016. I had mets to liver, spine, ribs, femur and skull. I had radiation immediately and then six months of Taxol along with Herceptin and Perjeta. I currently receive infusions of Herpeta/Perjeta every three weeks and have been on Femara for about two years.So far, so good as I have been stable since September of 2016. 

My question is this, how often do your oncs run the CA-15-3 and the Carcinoembryonic antigen (CEA) tumor marker blood tests? I have not had them for one year now. I have scans every six months. I always wonder about the time in-between the scans and whether something should be done in the interim just to make sure everything is OK. 

If anyone could share their experience, I would appreciate it. I haven't asked my onc about this. It seems whenever we have a chance to talk I forgot to ask this. 

Thanks much,

Nancy

In addition to all of the above, I recently read an article that said single any /or childless people are treated less aggressively, apparently because they have less to live for! I had never thought about it that way and found it to be very alarming. 

Dorimak I was disturbed too when I read it. Someone shared it on fb. Of course they were being general/statistical, but apparently some look at it like you won't have the support needed to tolerate harsher treatment, might not have as much will to live, stuff like that. I am single and never had kids but to my parents I will always be a kid and they have a much harder time with me having this cancer than I do. 

Yeah, that kind of discrimination against single people and/or ones who do not have children is unethical. I would have to consider the source of the article and personally, I don’t believe it. As doctors are highly educated, they know that all people have vast amounts of worth beyond being a spouse or parent.

HLB, that is a disturbing article! It sounds like the author has some major issues but suspect (or hope!) that not all oncologists view the world like that. That type of bias does exist, sadly - and is a huge pet peeve of mine - but I would hope it is not across the board. I suspect the same people who do not view women as equal to men have biases about marriage and motherhood and would be willing to wager the author is not a woman. I am also curious whether the author devalues single, childless men in the same way or do those men have value in the author's mind in other ways - such as their success at work . . . . On a more positive note, one of my MO's favorite BC patients is single and childless. He has so much respect for her and treats her more like a colleague in some ways than a patient.

When I was younger, at a previous job, my boss would always make statements about how I could work late because I didn't have a family to go home to (unlike the rest of the department).Made me irate. Everyone deserves a life outside of work and everyone deserves a fighting chance (if they want one) with metastatic BC.