Does everybody go to big cancer centers?

[Hapa]

My dh is going to oncologists that has a private practice. His treatment is folfox. We met with radiologist yesterday who has a private practice but is attached to local small hospital. In reading post it seems like many people are going to large facilities.

I am wondering if you started with large facility? We didn't get a 2nd opinion. We chose the oncologist that our surgeon recommended & chose the radiologist based on a referral from a friend of the oncologist that lives in our area.

Almost sounds like the "stand alone imaging center " question.

Thanks


Dh stage 3 rc

[TomUSMC]

I've been going to MD Anderson and have been very happy with their care. Once I start my chemo I'll probably head back to Maryland and have the treatment done at Hopkins.

[weisssoccermom]

No, not everyone does. After being on this board for 5+ years, it is pretty apparent that chemo is chemo and that almost exclusively, oncs follow the 'standard of care'. Even those like Gaelen, who went to Sloan, ended up getting their chemo from a local onc. Their local doc may work with the docs at the larger center, but I feel confident in saying that most of us on the board would tell you to initially go where the patient feels comfortable. IF you like your onc, if you trust him/her and if you have a good relationship with him/her then there probably is no need to go elsewhere. I had my radiation and chemo all locally and had my surgery up in Seattle. There really was no reason to go to Fred Hutch (big cancer center in Seattle - rated #5/#6 in the nation) for my treatments. It would only have been more of a hassle to drive, park, etc. From my perspective, unless you have something out of the ordinary, unless you have tried the 'standard of care' treatments and they have failed, I'm not really sure why it is necessary to have your treatments at a big cancer center. I think you'll find that many patients on this forum go to private practice oncs or oncs/radiation onc affiliated with local hospitals and not necessarily the 'big cancer centers'.

You have to make the decision about what feels right for YOUR situation and your situation alone. It's not a 'one size fits all' type of a decision.
Jaynee

[KarMel]

After I was first diagnosed, my local oncologist strongly encouraged to go to a Big University Medical Center for a second opinion. It was , I think, mainly for me to be reassured that my local onc was doing everything that the "big boys" do. I live in a town of 12,000. I really do feel that I have gotten as good of care as I would have at a large center.

The only think I feel that he is not on top of is some of the newer drugs and treatment. I asked to go on regorafenib and Zaltrap. I was first of his patients to try either. I told him about the immunotherapy trial at the NIH. He has been willing to help me in any way, though. And agreeable to support my choices and requests.

[justin case]

I live in Houston, and have a MDA facility 6 miles away. My GP was affilliated with another hospital, so I was reffered there. I had good treatment, but changed facilities, as I was not happy with their billing practices. I believe with all the advances in cancer care, and the standards of protocol, baseline treatment is universal. However, if I should develop mestasis, I would opt for MD Anderson, for the more complicated protocols, and it is in my neighborhood.
Regards,
Michael

[Felicia]

I think if you are just doing chemo -- the protocol is the same. My husband has stage 4 and there is no way our surgeons in Austin would have been as good at his liver resection as the doctors at MD Anderson. I say that because we have general surgeons vs surgeons who are specialists in liver resection and do them everyday.

I think if it's not too far to travel to at least get a second opinion and get a file going in their "system" I would visit a big hospital. That way if something does come up and you need them -- you are already in their system and can get an appointment easier.

We do all of his chemo locally though.
HTH,
Felicia

[SkiFletch]

Chemo is the same at the big cancer center or at your local oncologist. The individual attention you get may differ with either one being a "better fit" for the patient. Many things go into the decision of who and where to get treatment from. I chose convenience and attention as my primary factors in originally making the decision. Went with my mothers' private oncologist because he's close to my house, he's intelligent, gives me the attention I require it when I do (along with all the other nurses and staff), is willing to admit when he doesn't know everything (and thus calls others), and I dig his personality. The chemo nurses there are wonderful. I could have been treated at Roswell Park (the country's original cancer hospital) and gotten all that big-center stuff. However the onc I met there was curt, manipulative, her way or the highway and not warm at all. The chemo center was a cattle-call with patients barely getting attention and I feared they wouldn't listen to anything about side effects, etc. When both oncologists said the same chemo treatment (folfox), I went running to my current onc. That said, when it came time for HIPEC, Roswell had a phenomenal surgeon able to perform the complicated procedure. He is wonderful and the surgery and research teams there are truly top-notch.

Other folks have had different experiences as there are so many centers/oncs/options. My general thoughts when deciding on care is to first determine if both choices CAN provide the care required. Next would probably be your comfort with the teams there. Not all personalities mesh, plain and simple, and if the Dr rubs you the wrong way, why bother dealing with it? There's probably someone else that can do the job. Location has something to be said for it too. Do you want to drive an hour each way twice every other week when you're worn down from chemo? Or would you rather go to the place 10-15 mins away?

Finally you should decide how much you want to take part in your care. Some folks really want to get their hands dirty with learning things, making decisions, etc. Others just want to smile and nod and do exactly what the Dr says. And of course every variation between the two extremes. As a general rule of thumb, you can go ahead and get treated at facilities of your choice in the local area if you're willing to keep good records for yourself. Even though it's 2013 and we can video chat with someone on the other side of the planet whenever we want, medical records sharing and transferring is in the STONE AGE because of our society's pervasive fear for individual security of medical records. They're still MAILING things . That's a whole nother discussion but suffice it to say if you're willing to demand copies of EVERYTHING (reports, blood work, scans, notes, etc) when it's generated to keep your own medical history you can save yourself a lot of hassle when seeking treatment at multiple centers. If you're treated at a one-stop-shop major center, they're great at sharing records between the various departments and things work smoothly and the patient doesn't have to worry about that. I keep track of EVERYTHING done to me and have a whole medical file for that stuff which allows me to quickly jump from Dr to Dr across dispirate facilities and medical groups. That's just me, you may not want to do that.

[weisssoccermom]

Actually after reading Fletch's post, I'd like to add a few more of my own observations. I've heard from docs both at/not at the big centers and there seems to be a consensus on a few things. First of all, big centers seem to be more or less 'bound' to the standard of care unless there is a trial, etc. For example, I was flat out told that surgeons will NOT deviate from the standard at the big centers, particularly if they are a teaching hospital/medical center because one of their main jobs is to teach. A surgeon in private practice has more leeway to do what he/she feels is best and to 'tweak' things for the patient. Depending on the type of patient you are...that alone can be a huge factor.

Secondly, big centers tend to feel that their docs are the best, their facilities are the best, etc. When I had the 'second opinion' at Fred Hutch, the attitude was simple (and from what I've seen on the board, it's pretty universal). OUR facilities are better, our docs are better, our treatments are better. Ok, chemo is chemo....I don't care where you get it. For me, not driving 1 - 1.5 hours just to get to the 'big center', then finding a place to park, waiting and waiting and feeling like I was just a number was a big deal. Why should I do that when I can get the same treatment much closer to home in a smaller office where I got to know the staff, etc.? If you find comfort in the big centers, then by all means go there.

Recently my friend was diagnosed with breast cancer. She chose to go to Seattle for her treatment which was fine but it got real old fast. When the onc wanted to do radiation, he wanted her to have it in Seattle. Seems rather silly when there were just fine facilities much closer to her (about 10 minutes away). IMO, the docs affiliated with the 'big centers' want you to stay within their network - pretty much at all costs unless the driving is prohibitive.

There are a lot of factors that need to go into your decision as to where you want treatment. Remember, the onc is going to be the doc that you go to for a long time. For me, finding a set of doctors that were willing to work together, even though they weren't in the same place was very important. My surgeon is in Seattle, my GP is close by, my radiation oncologist was at the local office and my onc was in Tacoma. The onc & rad oncs had worked together before but none of the others had. My arrangement worked well for ME because I made it work. I made sure that blood work was sent to all the doctors (easier than trying to get all the office staff people on board) and I made sure that everywhere I was seen, my GP, onc and surgeon were all ccd on everything. Bottom line - even if you get some of your treatment at the 'big center' you don't have to get all of it there. Not knowing how far you are away from the 'big center' may be an important factor as well - especially as you begin radiation. Personally, there was NO way I was going to drive and hour+ for radiation treatments that last 10 - 15 minutes. That daily trek would have added more stress to me. Staying close to home for those treatments was the best decision I made because it helped me to feel more in control and overall - more 'normal'.

[justin case]

As was just said, I felt very comforted, when I went to my old oncs office, to pick up my records, and even the receptionist asked how I was doing. She showed actual happiness, when I told her I was currently without obvious signs of cancer. She showed her compassion even though I was going to a different onc. I don't think I would have gotten that personal attention, at a major cancer center, especially upon leaving, for care at another center.
Regards,
Michael

[PGLGreg]

No, I went to a 160 bed hospital, Castle Medical Center, outside Kailua, HI, which is a 10 minute drive from my house. My pcp in Kailua referred me for a colonoscopy to a gastroenterologist who does his procedures at Castle, and when he found cancer, my gastroenterologist referred me to a surgeon at Castle who specializes in transplant surgery, and he in turn referred me to a medical oncologist for chemo. Everybody knew everybody. I never have had any reason to question the expertise or professionalism of any of these doctors. I did have to drive to one of the larger hospitals in Honolulu for radiation treatments.

[lauragb]

Hi,
I don't have much to add but just wanted to say that I too go to a local oncologist but chose to go to a big center for my surgeries. I did see the oncologist at the big hospital for a second opinion at one time
and did not like him as much as my local onc. As others have said since I was having standard treatment, it seemed it would be more convenient to be closer to home.

So for oncology follow-up I'm still local and for surgical issues, it's up to the Clinic. I love the local nurses. I still have my port so when I go for a flush I just breeze in and breeze out.

Laura

[Lee]

I had my surgery, radiation and chemo done at local facilities and felt I got the best of care. I did have a 2nd opinion telephone conversation done with the Mayo Clinic and realized the protocal would be the same. Working with local Dr.(s), I felt I got personal one on one care. My Onc was able to get me on FOLFOX before the FDA had approved it for stage III folks. She fought the insurance company and got them to cover the cost. I was her first patient to get FOLFOX and today it is standard chemo. My surgeon went above and beyond for me. I truly feel these Dr.(s) are one of the reason I am NED today.

Lee

[elise]

Big cancer centre for me. I didn't do second opinions since my case was the talk of the dept for weeks. They all conferenced about it and I felt in good hands. If you feel in good hands, then you probably are.

Elise

[Joanne 814]

I live in CT. Small state. I went to local hospital, which had a beautiful radiation treatment facility attached to the hospital. I had chemo at Onc's office one street over from the hospital. Received the best care ever. My Onc is nationally known and been in the business for over 35 years. I love the "small town" feel. Glad to have the larger around (not too close to me), and certainly would travel to them if I am ever in need. But comforted to have the Cancer Center of Central Connecticut as my "home base".

ONWARD!!

Joanne

[cecioboe]

Jim went to the local hospitals. His surgeon is board certified in general AND gastro (who operates in Baylor Regional in Plano). He told us the names of the liver surgeon, the radiologist and the oncologist he works with. They are independents working out of the local cancer facility affiliated with the Methodist Hospital System. The cancer center itself is a small facility with state of the art radiation equipment, 1 radiologist and 2 oncologists. Jim's oncologist is a DO who treated all of Jim and not just his cancer. It is also wonderful to be recognized and greeted by name when we walk in to the facility. We were so comfortable with everyone we didn't even seek out a 2nd opinion once he found a gastro doc he liked. That took 3 tries.

Ceci