... Thanks for responding and if anyone can think of anything else we need to research or look at please let me know...
1. Research the precise details of the Opdivo+Yervoy mCRC protocol that DH is on. The details will change starting on the 5th infusion, and DH needs to know in advance what his dosing choices will be starting from that point onward -- assuming that he will be allowed to continue with immunotherapy. You can get the information on the dosing schedule options on page 18 if this document: https://www.opdivo.com/assets/commercial/us/opdivodtc/en/pdf/crc/CRC%20Digital%20Brochure.pdf
2. Research the precise surgery type that the CRC surgeon is planning to do for the 2 primary tumors (e.g., simple colectomy? left hemi-colectomy? with simultaneous re-join (anastomosis), or with delayed re-join (anastomosis) requiring another surgery some weeks later; with or without a temporary ileostomy
(right-side of abdomen)? with or without a temporary colostomy
(Hartmann's procedure with a temporary colostomy placed on the left-side of abdomen)? an open surgery vs. laparascopic surgery vs. robotic surgery vs. hybrid surgery? All of these things need to be discussed beforehand rather than just leaving it up to the surgeon to decide. This is because the surgeon might just decide to do the type of surgery that is easiest or most profitable to do rather than the type that is most beneficial for the patient over the long term. (There are several threads on this forum discussing this type of dilemma.)
3. Research the precise location of the lower of the two primary tumors. If the lower tumor is too close to the recto-sigmoid hairpin-curve junction, then the recto-sigmoid junction itself might need to be removed, too, which would convert the surgery into more like an upper rectal surgery -- which would complicate things even further.
4. Research the fall-back options to consider if/when the Opdivo+Yervoy regimen stops responding.
5. Find out why DH doesn't yet have results for the simple KRAS/NRAS/BRAF mutation test
. This test is needed in order to determine which regimens are available as second-line treatment options whenever DH's first-line Opdivo+Yervoy regimen fails.
6. Research the qualifications of the doctors on DH's team. Research the ratings of the hospital(s) where DH is being treated now, and where he will be having his surgeries done.
7. Do some research on the "Medically Underserved Areas" in the region.
shows the extent of Medically Underserved Areas in the region. The areas that are colored "pink" are considered medically underserved areas. In contrast, areas that are all "white" are thought to have adequate medical services.
What this all means is that if your hospitals and doctors are in the pink counties then there are likely to be some shortages of highly experienced medical staff and shortages of new, state-of-the art equipment and facilities important for comprehensive cancer care. In that case, better medical care for serious illnesses like cancer could more likely be found in the white areas -- in other words, in one or more of the big metropolitan areas in the region.