Chemo being delayed because oncologist on vacation. Advice?
This is regarding my mom's Stage IIB TNBC, diagnosed late last year. This spring we had 2 rounds of AC with a 2 week break in between for mouth sores. Then oncologist advised nab-Paclitaxel with Atezolizumab immunotherapy. After 1 round of immunotherapy she kept developing a high fever so we stopped Atezolizumab and continued with just nab-Paclitaxel. After 4 rounds of weekly nab-Paclitaxel, imaging is showing no response.
The problem is when we followed up after imaging last week, we saw the nurse because the doctor is out of town. The nurse said everything is stable and to proceed with starting another 3 dose cycle of weekly nab-Paclitaxel. Then she handed us a copy of the results and left. That's when I actually saw what “stable" meant. It meant no additional reduction after the last 4 doses.
We hesitated to get another dose that day but went ahead. The next day I emailed the team expressing our concern and questioning whether we should actually add carboplatin. They forwarded this to the oncologist who replied and said we'll add carboplatin (which is once every 3 weeks) at the start of the next cycle of nab-Paclitaxel (which is weekly) on 8/27. Well that means we'll only get 1 dose of carboplatin because we'd only have 1 cycle remaining. I questioned this and asked why we can't add it now and they haven't responded yet.
The next dose of nab-Paclitaxel is tomorrow. Idk whether we should hold until the oncologist gets back and we see her on the 27th or proceed with the 2 additional doses of nab-Paclitaxel we know will essentially be wasted. If we wait, we can potentially get 2 mid-cycles doses of carboplatin (which is once every 3 weeks I believe). I just don't understand why the doctor won't authorize it now or why the nurse didn't consult the doctor before giving the go ahead. The doctor could have easily authorized the nurse to add carboplatin at the start of the current cycle last week
Any advice appreciated.
Comments
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Oh, dear, you're BOTH going through chemo at the same time? That must be so stressful!
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Don’t oncologists have someone cover for them when on vacation? I would ask his office. Sorry it has been a struggle.
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This is my exact frustration. I don’t mind that she’s out of town but there should be a protocol in place for another oncologist to sub in until she returns. She’s okay with adding carboplatin so why do we need to wait another 3 weeks before it’s added...
I asked and the nurse said the primary oncologist needs to authorize treatment change. However when we first started treatment, another oncologist there did authorize treatment because our primary was out the day of the first chemo.
I’m being told by family that I’m being unreasonable and I shouldn’t bother her while she’s on vacation...
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I don't think you are being unreasonable. Anyone going on vacation should have someone to back them up, and if not, it is their responsibility to deal with issues that arise. This is a critical issue and should not have to wait IMO.
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you are not being unreasonable and I have had to learn to advocate for myself. Ask to be transferred to another oncologist and make a fit until you are interfacing with someone who can manage this with experience not a nurse.
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What is your mother's input on all this? Are you her permanent caretaker, or is she used to making her own decisions?
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She is okay either way. I generally do all the research and then discuss with her to see what she’s comfortable with. If I feel strongly about one option over another, I will present the information and try to convince her.
The oncologist recommended the immunotherapy. I also felt strongly about the immunotherapy. My mom wanted to just do the regular treatment, but she reluctantly agreed. It didn’t work out so I’ve kinda been feeling maybe in hindsight the regular taxol + carboplatin path was the better option.
To everyone else who replied, thanks! Sorry idk how to individually acknowledge comments on here. To update, I did speak with patient advocacy and they were able to get us an appointment this week. Thank you
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