The Breast Conference

Friday was a good day.

I had a very interesting glimpse into the healthcare system in Canada or at least British Columbia.   I have been receiving all of my treatments at the BC Cancer Agency.  Both my oncologist and radiologist are based out of there as well.
On Fridays, once or twice a month, maybe more frequently, the BCCA holds the Breast Conference.  It is a gathering of the oncologists and surgeons, sometimes radiologists from BCCA, and surgeons and docs from the Rapid Access Breast Clinic may also attend, to discuss specific cases and brainstorm.  My surgeon from the RABC thought that my case should be discussed and Friday was the day.

I went up to the BCCA and was put into one of the exam rooms.  After a couple of minutes the onc that chairs the meeting came in and introduced himself and told me that after my case was discussed some surgeons, maybe some oncs, some residents, and students will come in to examine me and ask me some questions.
I waited about another 15 minutes and three people, 2 surgeons and another woman, came in.  The 2 surgeons examined me and asked me some questions.  The basic crux of the discussion was that after having seen my file they felt that I was responding extremely well to treatment so it looked like there were a lot of possible options for the next step in my treatment.
One surgeon asked if I was doing 6 rounds of Taxol.  When I said no, only 4, and I had just had my 4th, he suggested that perhaps I should consider having 6.

For a bit of background on the idea of 6, I had actually thought about that about a week ago, cringed, and stuffed that thought in a box and buried it deep in the files of my brain.  I am so ready to be done with chemo.
With round 3 of Taxol I did not feel I had as much response as with the first 2 rounds.  This is similar to what happened with the first set of drugs.  Each round it felt as though the tumour response was decreasing.  When I had round 4 of Taxol, however, the response was almost immediate.  Within hours of receiving the drugs I could feel tumour response.  Maybe round 3 was a blip and I should have more Taxol.
Ugggh.  I don't want more chemo yet.  Into the box you go!

So, when the surgeon asked about 6 rounds I did say I had thought about it but I was not sure.  I was really ready to take a break and recover from chemo.  He said he could understand that feeling and again he and the other surgeon said that there were lots of options available.
The three people left and I waited some more.

After another half hour or so my surgeon from the RABC came in.  She had heard how much response I had had since she last saw me and wanted to examine me herself.  She was very impressed and we discussed a bit more about my options.  Because of the response I have had she feels we don't have to rush into any decision.  We will stick with our original plan of waiting to see what the scans show.  Also, it is possible to delay surgery for now and just have radiation.  Then, should there been any recurrence at the primary site we have the option of surgery later.
For now we will wait for the scans.

After another about 45 minutes my oncologist came in.  She apologized for the long wait and that my case had been put up first and it ended up taking up a large portion of the meeting time and they did have other cases they needed to cover so things ended up running long.  I don't mind waiting if all the local cancer brains are debating the best course of action for my care!
My onc had not seen my since before Christmas and I told her there had definitely been tumour response since then so then she examined me.  Just in case your keeping track that is 4 people groping me in an hour and a half - the joy of the cancer patient, you must have no shame;)

After the exam she said that during the meeting people had lots of ideas so she is now more confused than ever but she is definitely booking me for a PET scan.
At least something was decided!
By having all three of the bone/CT/PET scans done we can do a thorough comparison of the before and after and have a really complete picture of exactly what is currently going on.

Regarding surgery, the general consensus was that surgery would not prolong my life span so at this point in time it is not truly necessary.  Although one person did suggest that the planned radiation would be easier to do if I had surgery first.  So, the surgery decision will continue to be delayed until after the scans come back.
Regarding the 6 rounds of Taxol, my onc said that right from day one she had really intended my to only do a total of 8 rounds.  Her thinking is that by only doing 4 Taxol now we can save it for when the cancer starts getting active again.  We already know the tumour responds to it, and the side effects are not too horrendous so we can pull it back out in the future and do another 4 rounds with it before having to start moving onto a new drug.
If I had 6 rounds now that would remove Taxol from the arsenal and we would have to start with something totally different when the cancer starts activating. The reason for the usual limit of 6 is the high rate of nerve damage to the hands and feet.

My onc is hoping to push through the PET scan so we have the results before my next treatment to help us make a decision about whether more Taxol would be helpful.  If the mets to my bones and liver are mostly gone then more Taxol would really be overkill, I think, and we can move right on to the radiation and focus on the primary tumour.

So, yes, Friday was a great day.
The only decision made was that I will have a PET scan, but any time a cancer patient is told that they are responding so well to treatment that there are endless further treatment options and there is no need to make any snap decisions, that is utterly fantastic!!!

And a certainly feel like I am getting world class care.