I’m in Canada and my oncologist told me that at my stage (2A) that the post surgery options are quite different.
Specifically that in the USA I would get adjuvant chemo, and in Europe, I would not.
Pyro70 wrote:I was in a similar situation. I was working in Indonesia when diagnosed. Obviously staying in Indo wasn’t an option so I came back to the US. At first I was worried about Insurance, but with the ACA it’s really not an issue if you can afford it. For about $12k/year you get access to the best oncology care in the world. If you move to the US now you’ll be eligible for special enrollment. Or you can wait until January - which would have some benefits. I also have German citizenship and I don’t care what people say about US healthcare, it’s better here for cancer treatment than anywhere else.
Rikimaroo wrote:This place from what I heard is one of the top institutions around the world and big on cancer treatment.
https://www.heidelberg-university-hospital.com/home/
[...]
Rikimaroo
CF_69 wrote:I’m in Canada and my oncologist told me that at my stage (2A) that the post surgery options are quite different.
Specifically that in the USA I would get adjuvant chemo, and in Europe, I would not.
Rock_Robster wrote:Sure jts, I’ll have a go. Just remember these are generalisations and may not apply to every country/hospital/doctor.
The protocols for stages I-III will be pretty similar. The main two differences are:
- Europe tends toward “short-course” radiation before surgery (ie higher daily dose over 5 days, then surgery soon after). The US favours long-course radiation (lower daily dose over 25 days, with surgery typically following 8 weeks later after the radiation has had full effect). There is evidence to suggest the two have very similar outcomes; obviously the EU approach is much faster, but patients do tend to report more side effects - some temporary, some permanent). I suspect (?) The EU approach would rule out the Watch & Wait protocol to potentially avoid surgery.
- I believe Europe favours FOLFIRI over FOLFOX for chemo. In the neoadjuvant setting they’ve been shown to be similar, but I believe FOLFOX has the edge in adjuvant (after surgery). FOLFOX has the downside of a greater risk of long-term side effects.
- Surgery-wise, I suspect the two are similar. Lapro or robotic are pretty common for RC now, and the choice of surgery (LAR, ULAR, APR, TaTME) would depend on the height, size and stage of your tumour.
I suspect the US is also a bit ahead on Total Neoadjuvant Therapy, if this is something of interest after research (or questions!).
If we’re talking stage IV then things change up a notch. But I’ll hold off on that here, and let’s hope we never need this conversation.
Best of luck,
Rob
DarknessEmbraced wrote:Welcome to the group and sorry for your diagnosis!*hugs* I don't know about cancer surgeons but I wanted to send you support and hugs! I hope it all works for you!*hugs*
jts wrote:Rock_Robster wrote:Sure jts, I’ll have a go. Just remember these are generalisations and may not apply to every country/hospital/doctor.
The protocols for stages I-III will be pretty similar. The main two differences are:
- Europe tends toward “short-course” radiation before surgery (ie higher daily dose over 5 days, then surgery soon after). The US favours long-course radiation (lower daily dose over 25 days, with surgery typically following 8 weeks later after the radiation has had full effect). There is evidence to suggest the two have very similar outcomes; obviously the EU approach is much faster, but patients do tend to report more side effects - some temporary, some permanent). I suspect (?) The EU approach would rule out the Watch & Wait protocol to potentially avoid surgery.
- I believe Europe favours FOLFIRI over FOLFOX for chemo. In the neoadjuvant setting they’ve been shown to be similar, but I believe FOLFOX has the edge in adjuvant (after surgery). FOLFOX has the downside of a greater risk of long-term side effects.
- Surgery-wise, I suspect the two are similar. Lapro or robotic are pretty common for RC now, and the choice of surgery (LAR, ULAR, APR, TaTME) would depend on the height, size and stage of your tumour.
I suspect the US is also a bit ahead on Total Neoadjuvant Therapy, if this is something of interest after research (or questions!).
If we’re talking stage IV then things change up a notch. But I’ll hold off on that here, and let’s hope we never need this conversation.
Best of luck,
Rob
Thank you. This is very helpful. I feel like I am shopping for a new car, but the "car" is me getting poisoned, blasted with radiation, and having my colon cut up. But looking at all the treatment and surgery options, and reading papers about their effectiveness feels a lot like shopping for a big thing. It is better than directly thinking about my own mortality.
One anecdote about German colon care. The first two times I was at the EDH doctor (one for the urgent visit, and then for the colonoscopy) both doctors kept talking about "the dignity of the tumor". This was before I realized how serious the situation was, so I was more concerned about the dignity of me. From context I guess they were mixing up the German "stellung" or "staging".
Thanks,
jts
jts wrote:Pyro70 wrote:I was in a similar situation. I was working in Indonesia when diagnosed. Obviously staying in Indo wasn’t an option so I came back to the US. At first I was worried about Insurance, but with the ACA it’s really not an issue if you can afford it. For about $12k/year you get access to the best oncology care in the world. If you move to the US now you’ll be eligible for special enrollment. Or you can wait until January - which would have some benefits. I also have German citizenship and I don’t care what people say about US healthcare, it’s better here for cancer treatment than anywhere else.
Thank you for pointing that out. I had the impression that the ACA kept getting chipped away at. It seemed risky, but now that I look, you're right. I could probably get a policy in my home state for approx $1k per month. Expensive, but possible.
The next two weeks will be important. I'm reluctant to do anything that will delay getting this underway, but now I know some important stuff to ask the doctors.
jts wrote:Pyro70 wrote:I was in a similar situation. I was working in Indonesia when diagnosed. Obviously staying in Indo wasn’t an option so I came back to the US. At first I was worried about Insurance, but with the ACA it’s really not an issue if you can afford it. For about $12k/year you get access to the best oncology care in the world. If you move to the US now you’ll be eligible for special enrollment. Or you can wait until January - which would have some benefits. I also have German citizenship and I don’t care what people say about US healthcare, it’s better here for cancer treatment than anywhere else.
Thank you for pointing that out. I had the impression that the ACA kept getting chipped away at. It seemed risky, but now that I look, you're right. I could probably get a policy in my home state for approx $1k per month. Expensive, but possible.
The next two weeks will be important. I'm reluctant to do anything that will delay getting this underway, but now I know some important stuff to ask the doctors.
jts wrote:
The oncologist had some foods to avoid. Grapefruit was one, and that seems like common advice, but he also said frozen pizza "and stuff like that". I'll certainly ask him again later, but any idea what "stuff like that" he was getting at? Anything with artificial preservatives? He didn't recommend any vitamins or supplements in preparation; just eat healthy.
jts
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