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SCLC patients, how aggresive is your medical team?


Golfman

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As we all are, I'm new to cancer treatment. But I'm older, so I've experienced tons of medical help throughout my life. Sports injuries, car accidents, dumb decisions, etc. I've done them all. And it seems that I've had Drs who are really excellent clinicians but poor communicators, poor clinicians, Drs who maybe just barely passed the state licensing board, and Drs on their way to Sainthood. This disease has enabled me to meet even more physicians and I began to think about my experiences. Of the 4 physician types I mentioned, I've met all of them during my brief treatment. Not every banker, lawyer, engineer, I meet is on their way to Sainthood, and so I guess I shouldn't expect my cancer physicians to be either. But I'm curious, are you satisfied with the quality and the aggressiveness of the physicians assigned to your case? 

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Golfman,

Indeed, you've posed an interesting question: satisfaction with the quality and aggressiveness of my treatment team physicians.  Personally, yes I am.  But the question caused some reflection to think about the 4 physicians most closely associated with my treatment.

You've chosen two difficult satisfaction criteria: quality and aggressiveness.  They are subjective criteria and likely vary from person to person, patient to patient. If quality is measured by how well they performed for me, then my four top the chart. Aggressiveness is much more difficult to characterize because in my case, my wife and my general practitioner pushed for aggressive treatment so I think that "push" is a big part of the equation.

The three specialists on my team (surgeon, oncologist and pulmonologist) were biased by a tenant of the Hippocratic Oath -- do no harm.  At each decision node in my treatment, my success odds were a long shot. My team needed to be poked and prodded to take on risk and my surgeon was the most risk averse of the group.  Interestingly, the reason for my surgeon's reluctance -- suture healing after conventional radiation -- actually occurred and turned a pneumonectomy into four follow-on surgical procedures, each a nightmare for both the surgeon and me.  But he went there, predominately because my general practitioner pushed.

My experience suggests patient (wife) advocacy is a necessary precondition to receiving aggressive treatment.  Without a strong signal from the patient, the Hippocratic Oath will likely dictate.

Stay the course.

Tom

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I am content with my cancer team.  My oncologist made it clear that if there was to be surgery, he would refer me to M D Anderson in Houston.  It took 3 months to get an appointment....part of the problem was a loss of records ....twice. It was my sister who pushed, connected me with a patient advocate at M D Anderson who got the appointment. The surgeon was amazing. I had top right lobe of lung removed with some lympth nodes cancerous. My oncologist scheduled chemo followed by radiation. I believe this is standard when lympth nodes are involved. I wouldn't call the treatment aggressive. Thanks to my sister...treatment got going.

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4 hours ago, Robert Macaulay said:

Can someone explain what  aggressive treatment entails for cancer treatment. Compared to what they are receiving now.?

With my family they thought after surgery I should have received more Chemo just to be sure nothing was left behind. They thought I should have fought harder to get it. 

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Robert,

These would be some examples of aggressive treatment that come to my mine:

  • Pneumonectomy or lobectomy when proximate lymph nodes are shown to have metastatic disease (surgery also removes nodes)
  • Treating primary and distant metastatic tumors (Stage IV disease) with curative precision radiation
  • Surgery after first line conventional radiation and chemotherapy
  • Surgery to address recurrence after first line conventional radiation and chemotherapy
  • Pneumonectomy when tumor is close to or intrudes into bronchus
  • Double lobectomy of a tumor in each lung (one lobe removed from each lung) [Stage IV disease]
  • Precision radiation for recurrence in or near the area covered by first line conventional radiation

Stay the course.

Tom

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I haven’t had to have cancer treatment beyond surgery.  Some may consider removing a third of your lung aggressive.  It could be considered aggresive that I went ahead with the surgery not knowing for sure if it was cancer.  My father was diagnosed with soft tissue sarcoma in his lower left leg when he was thirty, over 30 years ago.  His doctor recommended amputation below the knee.  He required no treatment after that.  His brother was diagnosed with the same cancer a few years later.  His doctors opted for treatment instead of amputation because his tumor was above the knee.  He went through that treatment for 10 years and it destroyed his kidneys and was a very difficult 10 years.  He is now on dialysis, though he has been cancer free for 7 years.  Arguments could be made for one or the other being too aggressive or not aggressive enough   

Sometime “aggressive” needs to be defined specific to the patient and the potential outcome.  I think I would pursue a cure as aggressively as I could, and I would expect my doctors to do the same.   If a cure wasn’t an option and the goal was prolonging life I would say the side affects of aggressive treatment versus how long my life would be prolonged would have to be considered.  My father confronted that with his lung cancer battle, 30 years after his soft tissue sarcoma amputation.  He was aggressive with treatment until the treatment was doing more harm then good.   

A big factor in the level of aggressiveness with cancer treatment comes down to the persons ability to withstand the treatment.  A person’s prognosis from treatment is dependent on that person’s ability to withstand the treatments and avoid associated complications.  Does your body five in to the treatment before the cancer does?  Many times people need to stop treatment because of adverse side affects.  Lance Armstrong wrote about this in his book.  He felt that he was cured because he was in a physical condition to withstand a very aggressive treatment approach that others wouldn’t have been able to tolerate.  

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41 minutes ago, Tom Galli said:

Robert,

These would be some examples of aggressive treatment that come to my mine:

  • Pneumonectomy or lobectomy when proximate lymph nodes are shown to have metastatic disease (surgery also removes nodes)
  • Treating primary and distant metastatic tumors (Stage IV disease) with curative precision radiation
  • Surgery after first line conventional radiation and chemotherapy
  • Surgery to address recurrence after first line conventional radiation and chemotherapy
  • Pneumonectomy when tumor is close to or intrudes into bronchus
  • Double lobectomy of a tumor in each lung (one lobe removed from each lung) [Stage IV disease]
  • Precision radiation for recurrence in or near the area covered by first line conventional radiation

Stay the course.

Tom

Tom

I agree and who is the best person to decide on above changes to a patient condition.

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17 minutes ago, Curt said:

I haven’t had to have cancer treatment beyond surgery.  Some may consider removing a third of your lung aggressive.  It could be considered aggresive that I went ahead with the surgery not knowing for sure if it was cancer.  My father was diagnosed with soft tissue sarcoma in his lower left leg when he was thirty, over 30 years ago.  His doctor recommended amputation below the knee.  He required no treatment after that.  His brother was diagnosed with the same cancer a few years later.  His doctors opted for treatment instead of amputation because his tumor was above the knee.  He went through that treatment for 10 years and it destroyed his kidneys and was a very difficult 10 years.  He is now on dialysis, though he has been cancer free for 7 years.  Arguments could be made for one or the other being too aggressive or not aggressive enough   

Sometime “aggressive” needs to be defined specific to the patient and the potential outcome.  I think I would pursue a cure as aggressively as I could, and I would expect my doctors to do the same.   If a cure wasn’t an option and the goal was prolonging life I would say the side affects of aggressive treatment versus how long my life would be prolonged would have to be considered.  My father confronted that with his lung cancer battle, 30 years after his soft tissue sarcoma amputation.  He was aggressive with treatment until the treatment was doing more harm then good.   

A big factor in the level of aggressiveness with cancer treatment comes down to the persons ability to withstand the treatment.  A person’s prognosis from treatment is dependent on that person’s ability to withstand the treatments and avoid associated complications.  Does your body five in to the treatment before the cancer does?  Many times people need to stop treatment because of adverse side affects.  Lance Armstrong wrote about this in his book.  He felt that he was cured because he was in a physical condition to withstand a very aggressive treatment approach that others wouldn’t have been able to tolerate.  

Curt

Think you summed it up with this statement

A big factor in the level of aggressiveness with cancer treatment comes down to the persons ability to withstand the treatment.  A person’s prognosis from treatment is dependent on that person’s ability to withstand the treatments and avoid associated complications

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