Which doctor will manage your regular check up/ monitoring after your breast surgery
Hello. I was just diagnosed with IDC. I’m still confused about the roles of different doctors. I know the surgeon does the surgery. The medical oncologist deals with meds (tamoxifen, etc). The radiology oncologist does radiation therapy. However, I’m not sure what doctor is devising the treatment plan (do I need chemo, do I need radiation), doing the coordination and provide you with a monitoring plan after the lumpectomy/mastectomy is done (what type of tests are needed and how often). Could someone shed some light?
Also, I guess it is beneficial to use all these doctors from the same cancer center. Is this assumption correct?
Thank you.
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sunflower777
From my experience, the breast surgeon contacted the medical oncologist. The Medical oncologist made an appointment with the Radiation department. The medical oncology department gave me my treatment plan. They scheduled the MRI's, CT Scan, Bone scan, Ultrasound and other tests i had. The Nurse Practitioners coordinated all of it. My MO though, with the team of DRS in the Oncology unit weekly meet to cover patients with unique circumstances to alter a plan if need be. I had some results that required a change of plan. I also had the plastic surgery department which my Medical Oncology department set up.
For follow-up, after my surgery was done, I was to see the breast surgeon at least for 3 years, every 6 months. My breast surgeon moved to another hospital, so I see her there, but i missed a year so August is my 1st.My medical oncologist moved to the same hospital as my breast surgeon, so I plan to go there for her. I have a new MO, but I want to keep the one who created my plan.
We advocate for ourselves. I hope you are at a good hospital that is known for treating cancers. I am sure others will pot after me, but I am at a hospital in California that does a good job.
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My medical oncologist developed the treatment plan which included everything from meds to rads. Your surgeon, both general and plastic if recon is involved, will care for you during the post surgical period. Of course the RO planned the exact course of rads as that’s his field, but my mo directed the overall course of tx. All ongoing treatment and monitoring is done by my mo. I belong to an all inclusive medical/ hospital system, so all my providers are already coordinated in every way. There is a lot to learn about breast cancer , it’s not as simple as the pink ribbons portray it, but try to digest it in small bites. All the best to you.
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Exactly which doctor does what varies somewhat depending on the institution. When they are all in the same location they tend to work as a team. For example, my surgeon ordered my oncoyped dx since it required a pathology sample but I discussed the results with my MO. While there are many different types of bc there are standards of care for each type. For example, if the tumor is ER+ and HER2- whether or not you need chemo depends on your oncotype score and your age. If you are HER2+ or triple negative you will have chemo. If you have a lumpectomy radiation will be on the table. With a mastectomy radiation is only recommended if there are positive nodes. Anyone who is ER+ will have HT recommended. There are many other scenarios depending on your particular diagnosis.
For follow-up things are different depending on your institution so it’s best to ask when surgery/chemo/rads are done. Many times you will see an NP or PA instead of the doctor. Other times you will be referred to your PCP. For example, my MO deals with anemia during chemo but later it’s the PCP’s remit. If you have reconstruction you will see your plastic surgeon. Many people don’t see their ROs after the three month post rads checkup but I had late term side effects so I still see mine. Those with more complicated cases have a different frequency of appointments.
It sounds more difficult than it actually is. If you have a problem call the office of whichever doctor you think would deal with it. If they know the responsibility is another doctor’s they will tell you who to call. This is the same if your doctors are in different locations.
It’s a steep learning curve at first but once you know what your treatment plan will be there are fewer variables. All the best!
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Excellent point, maggie! There is no single standard way that this is managed as each institution has their own protocols.
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@sunflower777 I have had that question for a while so thanks for asking! When I was diagnosed in May, I had to find a breast surgeon and it was a daunting task, despite the fact that I live in a major metro area with excellent providers and hospitals. It was only after I was in the hospital system (having finally found someone) that the care became more seamless, but that doesn't eliminate the challenges or questions. Sometimes, the oncologist/RO/plastic surgeon is not available or taking new patients or maybe you want to see someone else. For me, I saw a breast surgeon who referred me to a plastic surgeon, and then to a RO. Finally, there was a referral to an oncologist. So it does seem to be somewhat out of order, but maybe not if radiation is always in the cards. I find myself just getting on and off the train when they tell me to. Somehow it seems easier! I will say, staying within a hospital setting is easier because of the portals they use, but I am also trying to research other options to find the best one for me.
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I went to a cancer center hospital. My insurance recommended a breast surgeon, after checking her out, i went ahead with an appointment. I was new to the area so my biopsy was done elsewhere or they would have had recommendations. My Surgeon met me first and sent me to meet and greet a medical oncologist, radiation oncologist, nutrition counseling, ALSO she ordered MRI, Mammo on the right breast since the records showed all the attention on left and neglected right, Social psychologist worker referral, and financial counseling. May have been another but I cant think of who besides the Nurse Navigator.
Meet and greet was a waste of time and specialist copay before the pathology from surgery. I was motivated to get the tumor out ASAP since previous doctors and mammo pathologist had waited so long between thinking it may be scared tissue or malignancy (1 year wait). So no chemo before surgery. Previous doctors closed offices a few months later, deservedly so.
After surgery, I was referred to PT for lyphodema exercises.(the best) I am in a PPO not an HMO. Also got a referral to genetic counseling and test is still forthcoming.
Turned out i did not like the MO who told me treatment was mandatory chemo because of TN (i'm 68) but it would give me 30 years cancer free (her words check the lit). also since my TN had not metastasized to nodes i was not qualified for immunotherapy. (her words check the recent lit) Seriously 30 years that's older than my mom who passed at 93. I refused her treatment plan. I still plan on seeing the surgeon followup in October/Nov and will ask about mastectomy on the right for preventative.
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My primary recommended a surgery group and I took the first available surgeon. His Mom was being treated for BC and he recommended her oncologist. Oncologist ran the show, but cc'ed surgeon and primary. It worked out beautifully….and, fast!
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When I was diagnosed, I first saw a surgeon who got me into a medical oncologist that same week. I also interviewed a second surgeon who I ended up using. The BS gave me names of PS who she worked with. The MO referred me to RO.
My MO has followed me all through treatment and ever since. After radiation, the RO discharged me and said my MO would follow me and send notes to her. I stopped seing my BS and PS after 3.5 years as I was tired of seeing so many doctors. My MO was still seeing me every 3 months. At 5 years, my MO moved to every 6 months. I'm 18 years since finishing chemo and radiation and my MO still follows me every 6 months. His speciality is breast cancer and for any other issues, he either refers me back to my PCP or another specialist. Now I also have Nephrologist, Hematologist, Endocrinologist following me.
There seems to be no standard of practice in how long you are followed my MO. We need to quarterback our health team.
All the best to everyone.
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Thank you all for sharing your experiences. It really helps.
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I only had surgery and no meds or rads. But my MO still is like my primary dr. Refers for my scans. Post BC 7 yrs.
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I walked through BC with a wonderful team of doctors. My breast surgeon says she will follow me for life as i have Brca2. I like to think if new treatments to keep my cancer from resurfacing come up, I will get a call or i will call if i read about them!!
Then my blood was found to have not recovered from that treatment and i was diagnosed with MDS. I had a bone marrow transplant in April of this year. My hematology doctor I saw just Friday told me that him, his team and me are married for life. I was in a research study and so fa,r it has worked. I love being part of the 3rd phase where they know it works but now, they find out more details with different people with different blood cancers. It was a pill i took day 5-day to day 100 to prevent GVHD- Graft vs Host Disease. 5.5 months after transplant, none. The scientist Doctors want cures. We never have to be in a research study, but for mine, it felt right to say yes. Above all else, tell you DR or NP on any pain or numbness. if they do not know they cannot help.
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