The main "special purpose" that I have in mind is to have a focused checklist that will help guarantee that all of the data elements, consultations and verifications necessary for developing a truly personalized Stage IV treatment plan are completed before any sort of treatment intervention is ever launched. This is to insure that the necessary thinking is done up front in order to make sure that the patient is not just routinely scheduled for a one-size-fits-all palliative standard-of-care (SOC) regimen that may turn out not to be the best possible regimen to guarantee a favorable treatment outcome in their case.
One of the big problems is metastatic staging itself. Damn near got my wife killed.
Simply, many nominal stage IIIs and even IIs get nailed by misunderstandings on metastases including what staging means/misses, incomplete information, miscommunications and errors, that are relevant to actual metastatic status from an omniscient clinical view,
or at least, the probability of being different stages in actuality. Probably the RCs stage situations get misunderstood most often because of neoadjuvant radiation downstaging, and the differences between clinical and pathological stage determinations.
To myself, I call this "all Mx'd up".
Note "Mx" itself was removed or deprecated in AJCC ca 2010 but the practical problem of "what am I really," persists for the patient. In my eyes the actual staging problem was actually aggravated by demanding an M0 or M1, rather than stating a probability or substantial uncertainty. The patient needs can be quite different than "today's" medical protocol needs or task, insurance, or drs "to do".
From the start, I realized that a lot of imperfections, problems and missed opportunities were occurring in real time on diagnostic information. I launched my inquiries into additional blood data with growing dissatisfaction as I asked more doctors with blank looks. Then I took two years to flesh the relevant panels with the medical literature that yield stage probabilities (for rough estimates) for a particular panel or combination in various conditions.
This staging concern came to a head with the
sudden and
tragic death of
Starbuck. I realized then that patients needed more independent, much better information than "std" because the drs not only couldn't see (or wouldn't tell us), much less stop the bullet in mid flight. In Starbuck30's case, they missed a rolling cannonball. (In the US Revolutionary War, some poor americans would "dance" at the edge of cannon fire to collect the slowing and rolling cannon balls' metal for ammo) I was traumatized by "Starbuck's surprise," being so badly blindsided. For months, I worried and searched the medical literature for panels to see such potential problems sooner and more completely.
My advice, people need to get the more comprehensive blood data first thing.
Ideally, at moment of diagnosis by the gastroenterologist before any treatment or even one more vitamin or OTC drug.