The New Medical Oncologist and Moving Forward with Treatment
Yesterday, Patty and I met with Dr. Omene and her research fellow, Dr. Liu for a second opinion on my oncology treatment plan. It was quite a long wait to meet with them, but it was worth it. Much more on this to follow, but the takeaway is that Dr. Omene will be my new medical oncologist, and I'll be treated by her at the Stacy Goldstein Breast Cancer Center at the Rutgers Cancer Institute. The radiation treatment (as discussed previously) will occur under the care of Dr. Desai at Saint Peter's Radiation Oncology Center as originally planned. My surgeon will remain Dr. McManus.
Earlier yesterday morning, prior to the meeting with Dr. Omene and Dr. Liu, Mom had sent me a copy of the newly published RxPonder paper by Kalinsky et al (https://www.nejm.org/doi/full/10.1056/NEJMoa2108873). This is the clinical trial referenced in the Oncotype results and is pretty much the guidance for treating women with early-stage breast cancer who have similar prognostic elements as mine (hormone positive, HER2 negative, 1-3 lymph nodes positive, etc.).
Both Patty and I read it, and Mom walked me through it before Patty gave me her feedback. We all agreed that the most salient point for me was that it showed no chemo benefit for premenopausal women over 50. At the end of the paper, it also said that the benefits they did see were likely because of the ovarian suppression effect rather than the chemo itself. Having the paper in hand and understanding it was key to the discussion with the doctors. Big thanks to my scientist Mom for making that possible.
Back to the doctors. First, we met with Dr. Liu alone. She reviewed my records and asked me what I was thinking regarding the Oncotype test results and the treatment recommended by Dr. Fein. I pointed out the parts of the paper I thought were important and let her know that I was leaning away from chemo. After a long wait (at least 45 minutes), we saw Dr. Omene.
She gave us the history of how the research evolved over time, which was interesting, but I was impatient (and hungry because the appointment was at noon, and it was already after 1). However, the longer I listened, the more important the information became. She talked about the ovarian suppression piece of the puzzle and that she didn't think that I needed the chemo. Dr. Omene mentioned that she had brought my case to her director who said that she didn't think I needed it either. It was good to be affirmed. It also was helpful to hear her talk about ovarian suppression because that was not discussed by Dr. Fein at all.
I asked her what the treatment plan would be and she explained that I would receive a monthly shot of Zoladex (the ovarian suppression drug) and a daily dose of Tamoxifen (estrogen blocker) until post-menopausal. After menopause, she'll change the pill to an aromatase inhibitor, which will be more effective. I receive the shots for 2 years and the pills for 7. All that treatment begins after the radiation ends.
After the consultation, she gave me a thorough physical exam on my entire chest, not just the left side. I was pretty tender, so that wasn't pleasant. But it was useful for her to see the incisions and the healing, as well as the general state of things. Afterward, I told her I'd like to transfer to her as my medical oncologist and move forward with the treatment plan she described. On checking out, I made the next appointment for the end of January.
Patty and I did our post mortem on the short drive back to my place and over grilled mushroom, butternut squash, and refried beans tacos at the kitchen table. We agreed that it was very productive and that Dr. Omene was the right choice. Overall, I felt relieved to have come to a decision about the treatment plan and to be able to move forward in my breast cancer journey with confidence that this is the right way for me.
Next up, scheduling the radiation treatments and figuring out a work schedule/sick time to accomodate them. I'll continue working at home during radiation and likely a month afterward to deal with any cummulative effects (as mentioned in the previous Diaries entry). Fortunately, my Dean has been very supportive and flexible throughout this whole experience. Mind you, I'm not his first employee to experience cancer treatment, so no wheels had to be reinvented. Still, I'm very grateful for my situation and my cool boss.
Thanks, as ever, for everyone's support, kind words and thoughts, and prayers. I'm always glad to have your feedback, especially those who have been on their own journey with cancer.
Thanks especially to Patty Scott for showing up in a huge way (as usual).
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