Topic: Free/universal healthcare (non Americans)

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Posted on: Feb 8, 2021 02:57PM

Posted on: Feb 8, 2021 02:57PM

illimae wrote:

This is not a political debate post but as the US considers future healthcare options, I have questions for those of you from countries that already provide it.

1. What country are you from?

2. Are you able to choose your doctor and hospital or are you assigned to one?

3. Are tests and results scheduled in a timely manner, like two weeks?

4. Do people generally agree that the higher income tax rates are a fair trade for the medical benefits? (I only ask this because I can’t see how it would be possible to provide it without raising taxes)

5. What’s the best/worst things about your healthcare system?

Thanks for sharing your experiences :)

Diagnosed at 41 Stage IV De Novo Dx 11/16/2016, IDC, Left, 5cm, Stage IV, metastasized to bone, Grade 3, 3/13 nodes, ER+/PR-, HER2+ Targeted Therapy 1/1/2017 Perjeta (pertuzumab) Chemotherapy 1/2/2017 Abraxane (albumin-bound or nab-paclitaxel) Targeted Therapy 1/2/2017 Herceptin (trastuzumab) Surgery 6/26/2017 Lumpectomy; Lumpectomy (Left); Lymph node removal Radiation Therapy 8/10/2017 Breast, Lymph nodes Dx 10/5/2017, IDC, Left, 5cm, Stage IV, metastasized to brain, Grade 3, 3/13 nodes, ER+, HER2- Radiation Therapy 10/19/2017 External Local Metastases 10/19/2017 Brain Radiation Therapy 4/18/2018 External Local Metastases 4/18/2018 Brain Radiation Therapy 5/23/2019 External Local Metastases 5/23/2019 Brain Surgery 1/22/2020 Radiation Therapy 2/16/2020 External Local Metastases 2/16/2020 Brain Radiation Therapy 7/20/2020 External Local Metastases 7/20/2020 Radiation therapy: Bone Radiation Therapy 12/4/2020 External Local Metastases 12/4/2020 Brain Targeted Therapy Tukysa (tucatinib) Chemotherapy Xeloda (capecitabine) Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Feb 8, 2021 04:01PM redcanoe wrote:

I am in Canada

I could request a new doctor but was very happy with the surgeon and the oncologist I was assigned to. My surgeon is a professor and expert on oncoplastic surgery and my oncologist is the head of clinical trials at a highly regarded teaching hospital.

I had some delays in diagnosis but that is largely due to the fact that I live in extreme rural/remote community and not due to UHC. Once I was transported to a major centre, my wait times for things like full body ct with contrast, breast mri and ultrasound guided biopsy have been anywhere from 1 to maybe 10 business days? Certainly less than 2 weeks.

I don't think our taxes are that much worse than American taxes plus insurance premiums plus co-pays. We get taxed more, yes but we don't have to pay for health insurance with our after tax income and there is no such thing as a co pay.

Honestly, since being diagnosed with cancer, I do see some disadvantages of our system. For starters, I think if I was being treated in the US, I'd probably be getting TCHP but I'm not getting perjata because it hasn't been proven to improve odds significantly enough to justify the side effects and expenses. But I'm only 34 so I want all the drugs. If I won the lottery tomorrow, I'd probably fly to MD Anderson and pay for everything I can get.

In conclusion, I'm overall pretty happy with our system. I havent paid a cent out of pocket for treatment or medication since being diagnosed with cancer. I have access to experts. The only disadvantage is that I can't pay to elect for more aggressive treatment.

Toni - age 34, mom to 4 kids ages 11, 8, 5 and 3 Dx 11/19/2020, DCIS/IDC, Right, 2cm, Stage IIB, Grade 3, 2/5 nodes, ER+/PR+, HER2- Surgery 12/14/2020 Lumpectomy; Lumpectomy (Right) Chemotherapy 1/11/2021 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 1/11/2021 Herceptin (trastuzumab) Radiation Therapy 6/9/2021 Whole breast: Breast, Lymph nodes Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Feb 8, 2021 04:13PM moth wrote:

1) Canada.

2) You choose your family doctor - but there's a shortage of family doctors and some people are struggling to find regular ongoing care & relying on drop in clinics. The cancer agency in Vancouver now has Nurse Practitioners to provide ongoing care for those who don't have a family GP. For an oncologist, you are kind of assigned but you can make requests and changes and get 2nd opinions. But the cancer care system in my province is highly integrated - all the cancer centers work together from the same guidelines and any cases that don't fit into neat categories are discussed at regular tumor board conferences so my sense is there is not much variation in treatments. I had a choice of surgeons and endocrinologists etc.

3) For me they have been. I'm in a large metropolitan area though. In some smaller towns there are delays and levels of service are not the same. Everything for me has been smooth and quick, even during covid.

4) in my group of friends & family, yes. There is also pretty broad support for expanding healthcare to include a pharmacare program (currently drugs are not covered unless you are on social assistance and even then, not always; or if you have private extended health insurance through an employer. Cancer therapy drugs are *mostly* covered but the drugs to deal with side effects are not.Also, new cancer drugs are often not covered.) and also some coverage for dentistry

5) best - we don't go bankrupt for medical care whereas I understand it's one of the leading causes of bankruptcy declarations in the US. Worst- things take a while to get approved (we're often a couple years behind the US for cancer drugs for ex) and some are approved but NOT covered by the gov't. Nationwide, decisions on whether a cancer drug will be recommended for financial coverage are based on recommendations that will benefit the most people. So a very expensive drug that only helps a few and only a bit, will likely not get approved because it's better to provide other, more effective therapies to more people. Needs of the many outweigh the needs of the few....
And again, on the worst side - wide disparities based on region. Remote areas of Canada have greater health challenges and poorer services.

I take weekends off

Initial dx at 50. Seriously?? “Sometimes the future changes quickly and completely and we’re left with only the choice of what to do next." blog: Never Tell Me the Odds

Dx 12/2017, IDC, Left, 1cm, Stage IA, Grade 3, 0/5 nodes, ER-/PR-, HER2- Surgery 12/12/2017 Lumpectomy; Lumpectomy (Left); Lymph node removal Chemotherapy 2/14/2018 AC + T (Taxol) Radiation Therapy 8/13/2018 Whole breast: Breast Dx 2/2020, IDC, Left, Stage IV, metastasized to liver/lungs, Grade 3, ER-/PR-, HER2- Chemotherapy 3/18/2020 Taxol (paclitaxel) Immunotherapy 3/18/2020 Tecentriq (atezolizumab) Chemotherapy 11/25/2020 Abraxane (albumin-bound or nab-paclitaxel) Radiation Therapy 12/9/2020 External Hormonal Therapy 12/15/2020 Femara (letrozole) Radiation Therapy 3/3/2021 External Local Metastases 3/3/2021 Radiation therapy: Bone Targeted Therapy 1/1/2022 Trodelvy (sacituzumab govitecan-hziy)
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Feb 8, 2021 04:16PM beesie.is.out-of-office wrote:

1. What country are you from? Canada. It's important to note that healthcare here is managed by the provinces, so there are differences from one province to another (similar to differences between the States in the U.S.). However there are 5 principles within the federal healthcare act that all provinces must deliver to: 1) universality; 2) portability; 3) accessibility; 4) comprehensiveness; 5) public administration.

2. Are you able to choose your doctor and hospital or are you assigned to one? Yes, I can choose, and I can opt for a second opinion. Second opinions can be more difficult in smaller locations where all doctors work for the same hospital or in some provinces where there is a provincial cancer authority that manages and coordinates all care.

3. Are tests and results scheduled in a timely manner, like two weeks? Depends on the situation and location. I'm in a large city so there are lots of hospitals and lab/screening facilities and I can usually get most tests done within 48 hours. Biopsies have generally been scheduled out a week. MRIs tend to be booked up so when I was getting annual screening MRIs, I'd be sure to call to book a couple of months in advance and as a result I'd always have my MRI right on schedule. When I needed an MRI prior to surgery, as I recall it was scheduled about 10 days out. Our system runs on priority of need, so urgent needs are always slotted in quickly while less urgent needs may have to wait. In small towns, where there may only be one testing facility, waits can be much longer, but I would expect this is true in U.S. small towns too.

4. Do people generally agree that the higher income tax rates are a fair trade for the medical benefits? (I only ask this because I can't see how it would be possible to provide it without raising taxes) Yes, absolutely. And keep in mind that we don't have huge insurance costs. That said, our system doesn't cover all costs, and what is covered differs by province. Here in Ontario, for example, drugs (and not all but most) are covered for children, for those over 65, and when administered in hospital (i.e. chemo). The rest of us have to pay for our drugs. Dental and vision care coverage depends again on age and the procedure. For example, being under 65, my eye exams aren't covered but my glaucoma tests are (glaucoma being a disease and I have a family history); when I hit 65 this year my eye exams will be covered. Many people get supplemental insurance coverage from their employer to fill in the gaps, or policies can be purchased, but they are cheap compared to U.S. insurance policies. I have lived without supplemental coverage and my costs, covering meds, dental and vision, have generally been just a few hundred dollars a year.

5. What's the best/worst things about your healthcare system? Best - not having to worry about cost. Worst - in Ontario, and I think all provinces, while doctors have full authority to decide what tests and procedures they want a patient to have, they do have to work within treatment guidelines. In some situations, they can veer off the guidelines easily, but in other situations (ordering PET scans, for example), there is a formalized approval process that they have to go through. Some docs are willing to go to bat for their patient but others aren't. Probably not that different than getting insurance approvals in the States but here it's only necessary in unusual situations and it's the doctor deciding yes or no to the extra procedure, not some backroom insurance clerk. Annoying - the PCP is the gatekeeper so everything is supposed to go through the PCP. If you want to see any specialist, the PCP needs to send in a referral, although once you are a patient of a specialist, you can continue to see them without the PCP's involvement. My current and previous (now retired) PCPs have always given me specialist referrals when I've wanted them (and sometimes when I wasn't sure it was necessary) but some PCPs prefer to handle things themselves and are stingy with referrals. So from this sense, the quality of care is very dependent on the quality of the PCP - but I suspect that's true to some degree everywhere.


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Feb 9, 2021 02:15PM sondraf wrote:

1. What country are you from?

Currently in the UK; have used both NHS (public, universal care provider) and private services

2. Are you able to choose your doctor and hospital or are you assigned to one?

Under NHS - I was assigned to a hospital for my initial dx, and would have had surgery there had that been the proper route. I was not happy with the surgeon OR the hospital, which was miles from my house, and I felt it was of questionable cleanliness. I was then reassigned to a different hospital for oncology, and reassigned to a new oncologist who I only saw once, instead mostly seeing junior oncologists/researchers/registrars. Appointment times were down into the 8 to 5 minute range and every new oncologist meant they had no idea who I was or my concerns. It drove me nuts so I switched to private care, where I was able to choose my oncologist and hospital and I see JUST HER every month, so she know me as a person and I feel much more at ease opening up to her.

3. Are tests and results scheduled in a timely manner, like two weeks?

Depends - my scans were moved from 3 to 4 months right away, mostly due to Covid pressures. Results were hit or miss, I once waited almost a month for the outcome of some scans. At diagnostics it took two weeks to find out I had cancer (for sure), then another two weeks to find out it was terminal, and then another 8 weeks before I started treatment. Under private treatment I use the same facilities but am "bumped to the head of the line" - my scans are now scheduled when they are convenient for my schedule (end of day), I can make changes, and my results are done within 24 hours. The same doctors work in the NHS and private systems as I don't think they can have hospital privileges without agreeing to see a certain percentage of NHS patients.

4. Do people generally agree that the higher income tax rates are a fair trade for the medical benefits? (I only ask this because I can't see how it would be possible to provide it without raising taxes)

The NHS is essentially a state religion in the UK and the link between tax payments and affording the health service has been broken. There is very much a sense of entitlement to "our NHS" - you get a lot of stories of timewasters who are drunks in the ER at 3 am every Saturday, or people going to the GP because their toe hurt, that sort of thing. Similarly you get people who "don't want to waste the NHS time, its just a little thing" when it actually is something that SHOULD be checked out, but there is this perception that the all-holy NHS can't cope year after year after year so we must all support it by... not using it?!

It is free at point of access so people push that to the limit. I am in a high tax bracket and pay over 40% of my salary on taxes, a lot of which goes to supporting the NHS. That is before you account for the local services monthly tax and the 20% VAT tax on everything else. My workplace 100% funds my medical insurance and I have no other deductibles and maybe a small copay (I had to pay the difference for my genetic testing - a whole £14). As a cancer patient, any medicine prescribed for me is free - so my letrozole or amoxicillan or whatever the GP may prescribe is always free, as are my Ibrance and other drugs. You can access other drugs in the private system as there are certain equations used to determine if a drug is useful to offer to the wider population.

Is it a fair trade? I think a small form of personal contribution to access services (say £10 for a GP visit, or £100 if you are using the ER as a drunk tank on the weekend) would help encourage people to take care of themselves better, fund improved services and access, and get people to realize that health care isn't free and no, the NHS can't just always patch you up and off you go. Many people in this country don't pay any form of income/contributory tax, so if you are stuck in the higher tax bracket, but below the super rich, you are paying a lot of money in contributions to the health system for others who won't take care of themselves (not everyone is like this, but you see the disincentive).

A small fee could also help fund better preventative care - mammograms dont start here until 50 (even then is every 2 years), its every 3 years for a PAP (which doesn't include breast/pelvic exam). The GP system acts as a gatekeeper into the NHS services so if you are "too young" for cancer they are more likely to put you off rather than refer to get something checked out. It took me almost four weeks to get my initial appointment to be seen for my breast lump. GP offices are not great - usually somewhat shabby with older equipment and I have never EVER had a single GP actually touch me. I had one diagnose my back problem from sitting behind a desk.

5. What's the best/worst things about your healthcare system?

Best - it is good to know it is there in case of job loss or whatever. They are really good at acute care, but that is because that means someone else is getting shoved off or things have been allowed to deteriorate so far that a simple issue BECOMES acute care.

Worst - it is just as political as the US system, and above challenge. It is essentially run at this point on the goodwill of nurses and doctors to push themselves to the limit of their time and energy and conscience, without proper compensation. To me, that is unacceptable and hides the true cost of healthcare delivery. Ten years of under investment, many layers of bureaucracy, etc and there are tens of thousands of nursing roles open that you better believe won't be filled now. I make 4x what a junior doctor makes, and frankly I wouldn't be surprised if a lot of doctors and nurses leave the NHS and emigrate to Australia or NZ after this is all over. Why would you put up with this bs if you could leave, move to a country with sun and beaches, make enough for proper housing and a good life, and work in updated surroundings?

To sum - I think everyone should have access to a base standard of healthcare, and not be subject to bureaucratic accountancy whims (that is true for a state system or an insurance system), with some sort of small contribution at access and for there to be insurance that serves as a top up on the state system (I believe Germany has this system) in case of larger issues. Unfortunately to bridge the gap would require a significant increase in wages and living standards that I just don't think is possible.

"The closer we come to the negative, to death, the more we blossom" - Montgomery Clift Dx 9/27/2019, IDC, Right, 5cm, Stage IV, metastasized to bone, Grade 3, ER+/PR+, HER2- Hormonal Therapy 11/28/2019 Femara (letrozole) Targeted Therapy 11/28/2019 Ibrance (palbociclib) Surgery 11/28/2021 Lymph node removal (Right): Underarm/Axillary; Mastectomy (Right) Targeted Therapy 3/1/2022 translation missing: en.treatments.targeted_therapy.targeted_therapy_medicine.short_options.lynparza
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Feb 10, 2021 09:00AM illimae wrote:

Thank you for the comments, I really appreciate your first hand experience.

Sondra, NHS does not sound like perfect model that some would like us to believe it is. I understand nothing is perfect but as a source of pride, almost no one mentions the flaws. And waiting a month for results stunned me, even if it’s uncommon, it is certainly shocking.

Diagnosed at 41 Stage IV De Novo Dx 11/16/2016, IDC, Left, 5cm, Stage IV, metastasized to bone, Grade 3, 3/13 nodes, ER+/PR-, HER2+ Targeted Therapy 1/1/2017 Perjeta (pertuzumab) Chemotherapy 1/2/2017 Abraxane (albumin-bound or nab-paclitaxel) Targeted Therapy 1/2/2017 Herceptin (trastuzumab) Surgery 6/26/2017 Lumpectomy; Lumpectomy (Left); Lymph node removal Radiation Therapy 8/10/2017 Breast, Lymph nodes Dx 10/5/2017, IDC, Left, 5cm, Stage IV, metastasized to brain, Grade 3, 3/13 nodes, ER+, HER2- Radiation Therapy 10/19/2017 External Local Metastases 10/19/2017 Brain Radiation Therapy 4/18/2018 External Local Metastases 4/18/2018 Brain Radiation Therapy 5/23/2019 External Local Metastases 5/23/2019 Brain Surgery 1/22/2020 Radiation Therapy 2/16/2020 External Local Metastases 2/16/2020 Brain Radiation Therapy 7/20/2020 External Local Metastases 7/20/2020 Radiation therapy: Bone Radiation Therapy 12/4/2020 External Local Metastases 12/4/2020 Brain Targeted Therapy Tukysa (tucatinib) Chemotherapy Xeloda (capecitabine) Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Feb 10, 2021 01:41PM - edited Feb 10, 2021 01:42PM by exbrnxgrl

I am American and wanted to share my perspective. Countries that have national healthcare systems are usually happy but most I know freely acknowledge that it is not perfect. In the US, we have a tangled patchwork of ways to get medical coverage. Wait times for appointments, tests and results are all over the place and the reality is that if you have a very good insurance plan, you are often served more quickly and given more options. If you don't have insurance or have a plan that doesn't cover much, you're in for many more delays and fewer, if any, choices. Bottom line? If you have the money you can get great care, if not your care choices become limited. I have been fortunate to have very good insurance but would gladly “give up" some of the conveniences I've enjoyed sothat everyone can get decent medical care. So many other nations have figured this out. Why can't we?

Dx IDC, Left, 4cm, Stage IV, Grade 1, 1/15 nodes, ER+/PR+, HER2-
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Feb 10, 2021 02:38PM olma61 wrote:

this is great information from everyone and I thank illimae for starting the thread and the other ladies who took time to contribute in so much detail!

I do think that we in the USA are still pretty far away from a national system like Canada and the UK have

What I see in the immediate future with the new administration and Congress is that they will be shoring up the ACA, expanding subsidies and trying to get coverage for low income folks in states where Medicaid was not expanded.

And *maybe* lowering the age to qualify for Medicare by a couple of years.

If or when major change happens, we will probably have something closer to Germany, Switzerland or the Netherlands, which still has “choice” with heavy regulation of insurance providers.

Just my two cents and hope it is not a thread hijack

10/30/2017 Xgeva for bone mets 5/31/2018 Taxol finished! "If one just keeps on walking, everything will be all right” - Kierkegaard Dx 8/3/2017, IDC, Right, 2cm, Stage IV, metastasized to bone, Grade 2, ER+/PR+, HER2+, IHC Targeted Therapy 10/28/2017 Perjeta (pertuzumab) Targeted Therapy 10/28/2017 Herceptin (trastuzumab) Chemotherapy 10/29/2017 Taxol (paclitaxel) Hormonal Therapy 5/14/2018 Arimidex (anastrozole) Radiation Therapy 5/29/2019 External Local Metastases 5/29/2019 Radiation therapy: Bone
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Feb 10, 2021 02:47PM illimae wrote:

exbrnxgrl and olma, I agree and I’m not excluding the American perspective but want to encourage real, first hand experience by those who have national healthcare. There’s lots of talk about us doing what other countries do but I, like most people, don’t actually know the details of how other systems work, not enough to have an honest opinion of it anyway.

I appreciate all participation here, it’s very helpful.

Diagnosed at 41 Stage IV De Novo Dx 11/16/2016, IDC, Left, 5cm, Stage IV, metastasized to bone, Grade 3, 3/13 nodes, ER+/PR-, HER2+ Targeted Therapy 1/1/2017 Perjeta (pertuzumab) Chemotherapy 1/2/2017 Abraxane (albumin-bound or nab-paclitaxel) Targeted Therapy 1/2/2017 Herceptin (trastuzumab) Surgery 6/26/2017 Lumpectomy; Lumpectomy (Left); Lymph node removal Radiation Therapy 8/10/2017 Breast, Lymph nodes Dx 10/5/2017, IDC, Left, 5cm, Stage IV, metastasized to brain, Grade 3, 3/13 nodes, ER+, HER2- Radiation Therapy 10/19/2017 External Local Metastases 10/19/2017 Brain Radiation Therapy 4/18/2018 External Local Metastases 4/18/2018 Brain Radiation Therapy 5/23/2019 External Local Metastases 5/23/2019 Brain Surgery 1/22/2020 Radiation Therapy 2/16/2020 External Local Metastases 2/16/2020 Brain Radiation Therapy 7/20/2020 External Local Metastases 7/20/2020 Radiation therapy: Bone Radiation Therapy 12/4/2020 External Local Metastases 12/4/2020 Brain Targeted Therapy Tukysa (tucatinib) Chemotherapy Xeloda (capecitabine) Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Feb 11, 2021 08:03AM - edited Feb 11, 2021 08:04AM by flashlight

Hi illimae, This is an interesting topic. I retired from health care in 2018 and saw it evolve to more of a business in the US. Even saying that I wouldn't trade my health care for socialized medicine. I don't think that is the answer. Neither is having a $6000.00 deductible. I'm thankful for Medicare, but it isn't free. Medicare is only as good as the supplement (s) you buy in to. My husband has a less expensive supplemental plan and unfortunately this was his year to be ill. They denied his last hospital stay and all the tests. Nothing is ever easy.

Dx 11/15/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR-, HER2- Dx DCIS, Left, <1cm, Stage 0, Grade 1, 0/1 nodes Radiation Therapy Whole breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lumpectomy: Left
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Feb 11, 2021 10:14AM illimae wrote:

flashlight, I agree. I had a government job with great insurance and am now on Medicare with a Medicare advantage plan through my retirement plan. My costs are almost nothing, which I am extremely grateful for but being 45, it wouldn’t be available to me if I wasn’t stage IV. I see many young people struggle with the system we have now and I’m hoping there’s an affordable compromise somehow.

Diagnosed at 41 Stage IV De Novo Dx 11/16/2016, IDC, Left, 5cm, Stage IV, metastasized to bone, Grade 3, 3/13 nodes, ER+/PR-, HER2+ Targeted Therapy 1/1/2017 Perjeta (pertuzumab) Chemotherapy 1/2/2017 Abraxane (albumin-bound or nab-paclitaxel) Targeted Therapy 1/2/2017 Herceptin (trastuzumab) Surgery 6/26/2017 Lumpectomy; Lumpectomy (Left); Lymph node removal Radiation Therapy 8/10/2017 Breast, Lymph nodes Dx 10/5/2017, IDC, Left, 5cm, Stage IV, metastasized to brain, Grade 3, 3/13 nodes, ER+, HER2- Radiation Therapy 10/19/2017 External Local Metastases 10/19/2017 Brain Radiation Therapy 4/18/2018 External Local Metastases 4/18/2018 Brain Radiation Therapy 5/23/2019 External Local Metastases 5/23/2019 Brain Surgery 1/22/2020 Radiation Therapy 2/16/2020 External Local Metastases 2/16/2020 Brain Radiation Therapy 7/20/2020 External Local Metastases 7/20/2020 Radiation therapy: Bone Radiation Therapy 12/4/2020 External Local Metastases 12/4/2020 Brain Targeted Therapy Tukysa (tucatinib) Chemotherapy Xeloda (capecitabine) Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)

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