Oncologist—do they have to be local?

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Oncologist—do they have to be local?

Postby Punky44 » Wed Oct 31, 2018 10:49 am

Hi! Question—

So my mom started off with an Oncologist in Iowa City who is currently handling her treatment plan. We also were able to visit Mayo yesterday for a consultation with their oncology, radiation and colorectal surgery depts. my mom is a candidate for the short course radiation and thus we will likely have her radiation and surgery done at Mayo. Both oncologists thought it was a promising approach to try neoadjuvant chemo with her first. We also have chemo services locally which everyone agreed was a reasonable place to go for infusions vs driving anywhere (“chemo is chemo.”)

So..who really ends up being my mom’s onc? Iowa City? Mayo? Or local onc? Can we pick or is it decided based on the physical location where she receives chemo? What about in the long run for scans and follow up?
Caregiver to my amazing mom (68 at dx)
10/1/18 DX with rectal cancer; CEA 17
Total neoadjuvant therapy:
8 rounds Folfox 11/5/18 - 2/11/19
Short course radiation 3/14/19 - 3/20/19
Robotically assisted laparoscopic LAR 3/21/19
Pathology report says yT2N0M0 with 0/38 nodes
6/28/19 Reversal and port out
CEA 2.1; 1.9; 2.6; 2.8; 2.3; 2.4; 3.0; 3.4; 3.1
Latest update: 6/28/21: Clear CT with CEA 3.1 (attributed to emphysema)

Me: 34, first colonoscopy 11/16/18—normal! Come back in 5 years.

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Re: Oncologist—do they have to be local?

Postby hiker » Wed Oct 31, 2018 11:11 am

Once I had my team at MSK, I needed a local oncologist for 3 rounds of Folfox that my MSK oncologist wanted me to have prior to liver resection. When I met with the local oncologist, I made it clear to him who was running the show. He was only to do what MSK prescribed. He was a pompous jerk, but went along with it - after all, he's making how much for each treatment?

I believe my MSK oncologist spoke with him regarding my treatment. And anyone who knows Dr. Kemeny knows she's not putting up with a bunch of stuff from anyone. I love her.

Colonoscopy 2/17, 5cm tumor descending
Diagnosed stage iv, liver mets 3/17
Colon resection 3/17
Told surgery not an option, get my affairs in order
Meet w/MSK team 5/01/17
Folfox(3rds) 5/17-6/17
Liver resection/implant HAI pump 7/17
HAI pump chemo(5rds) 8/17-2/18
Folfiri+Vectibix(11rds) 8/17-2/18
Spot on chest CT 10/17
Lung biopsy (that was fun) 11/17
Nocardia bacterial infection w/spread to brain (this is serious) 11/17
IV antibiotics 12/17-2/18
Oral antibiotics 3/18-12/18
Clear of cancer since surgery

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Re: Oncologist—do they have to be local?

Postby Gravelyguy » Wed Oct 31, 2018 11:26 am

My local oncologist deferred to Mayo. No attitude at all. Of course at first he thought palliative care was all they could do for me, so I think he was interested to see what the latest care was for stage 4.

6/17 dx mRC t3n1m1 very low rectal tumor 2 liver Mets 1.3 cm and .9 cm

6/17 begin 4 rounds Folfox w/Vectibix
9/17 short course radiation
10/17 rectal and liver resection LAR with coloanal anastomosis (no rectum left)
11/17-3/18 8 rounds Folfox
6/18 still NED!! Takedown
8/28/18 still NED! CEA .8 new low for me
10/18/18 colonoscopy clear
12/12/18 CEA .9 still NED!
6/11/19 CEA 1.0
12/19/19 CEA 1.0 still NED!
6/17/20 CEA 1.1 still NED!
12/15/20 CEA 1.1still NED!

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Joined: Fri Jul 21, 2017 3:43 am

Re: Oncologist—do they have to be local?

Postby NHMike » Wed Oct 31, 2018 12:51 pm

I spoke to the local folks and got second opinions from Dana Farber in Boston. The Dana Farber doctors (oncologist and radiation) agreed with my treatment plan from the local doctors. I am starting surveillance with Dana Farber in two weeks. I think that local/remote is fine.
6/17: ER rectal bleeding; Colonoscopy
7/17: 3B rectal. T3N1bM0. 5.2 4.5 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda radiation
7/5: CEA 2.7; 8/16: 1.9; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8; 5/1 2.8; 5/29 3.2; 7/13 4.5; 8/9 2.8, 2/12 1.2
10/17: 2.7 2.2 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx (8) 12/17-6/18
7/18: Reversal, Port Removal
2/19: Clean CT

Deb m
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Re: Oncologist—do they have to be local?

Postby Deb m » Wed Oct 31, 2018 1:00 pm

We considered our "main"oncologist the Dr. at MDA. He screened my husband, set up the treatment plan, did all the surveillance scans etc., our local oncologist just followed the orders from them as far as treatment, chemo. We live in Kansas and our "main" oncologist was in Texas at MDA. I think many people have this kind of a set up if your not fortunate to live near a major top rated cancer center.

deb m

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Location: Colorado

Re: Oncologist—do they have to be local?

Postby mandosquiddy » Wed Oct 31, 2018 5:21 pm

My main doctor is in Denver but I have traveled to the Mayo Clinic for some treatment. I consider the local doc the one in charge of my treatment but as others have posted it could certainly be the other way around. The choice is up to you.
4/2017 DX: sigmoid colon cancer
stage II with one positive margin
5/2017 - 11/17 12 rounds of FOLFOX
11/17 - 12/17 Increase in back pain and testicular pain.
CEA increased, CT scan indicated mass on rectal portion of colon
1/18 - 2/18 25 rounds of radiation treatment
5/18 surgery, interoperative radiation, bladder/ureter modification
7/18 normal blood work and CT scan
9/18 increased CEA, mass on small intestine
10/18 Debulking surgery/illeostomy
1/19 Ostomy reversal
12/19 CEA 1.3!!!!

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Re: Oncologist—do they have to be local?

Postby Phuong » Thu Nov 01, 2018 12:08 am

Mayo (and the other big oncologists) has plenty of experience with being your primary onc, and working with your local onc to execute the plan. Personally I think you have bigger benefits with making Mayo primary because they have more experience, depth of bench (specialists), and resources. Using the local onc to execute the plan is great for cost savings in addition to Mayo for the experience. That's my opinion, YMMV.
dx'd Stage III Rectal (T3 N1 M0)
Now Stage IV mCRC

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Re: Oncologist—do they have to be local?

Postby cptmac » Wed Nov 07, 2018 10:29 pm

My oncologist was with the University of Minnesota. I would see a primary on occasion in my hometown, 8 hours away.
As long as you're alive, there is hope.
dx 7/04 stage IV
colon resection 8/04
liver resection 9/04 with HAI pump installed
Stage II trial w irinotecan as systemic and FUDR for direct chemo to liver via HAI pump
Cured since 9/04

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