Dealing with Cancer Again
Q. How do you help a woman through a recurrence? What are the things she should know?A. The first thing to understand is that you are probably feeling the way you felt the first time. With any breast cancer diagnosis you think, "I’m going to be dead next week." But even with a diagnosis of metastatic or recurrent breast cancer, that’s not the situation. Many women do well and live long, normal lives, even though they will be showing up at the doctor’s office or the hospital for treatment regularly.
The good news is that she probably is already well plugged in to physicians, nurses, her caregivers, so it’s not the search for "Who can I find, who can I trust to take care of me?"
Q. Should you stay with your original team?A. When you are diagnosed with metastatic or recurrent breast cancer, it’s a good time to think about your doctor. If you’re confident and content, that’s great. But if you’re not, a recurrence can be a good time to change. Even if you really like your doctor, this might be a good time to get a second opinion, because there are different strategies for treating metastatic or recurrent breast cancer. You could consider a clinical trial — which some women look into the minute they are diagnosed with recurrent breast cancer. If your cancer is hormone receptor positive, you might choose to start with hormone treatments, which are certainly much less invasive. Or you might, like some women, choose to start with chemotherapy, thinking "Let’s try to hammer this," and then pull back to hormonal treatment when things seem to be under control.
Q. If a patient diagnosed with a recurrence is in a panic and wants to get a second opinion fast, is the clock ticking?A. A recurrence is not usually a medical emergency, although obviously it causes a psychological one. You really do have some time to decide. You shouldn’t wait months, but it’s perfectly okay if it takes weeks to see somebody. And it’s not as hard to get appointments as you think. Call the office and explain that you want a second opinion; many physicians are able to squeeze in second opinions faster than they’re able to squeeze in a new patient, because it’s a one-time thing.
Q. Do support groups work for women with a recurrence?A. I run the psychosocial oncology program at the Beth Israel Deaconess Medical Center in Boston, so I’m a big fan of newly diagnosed women finding other women who’ve had breast cancer to talk to. And I’m a supporter of women who have a newly diagnosed recurrence talking to somebody else who’s living through recurrent breast cancer. The caveat is connecting with somebody who’s had a similar situation. If you’ve just been diagnosed with a single bone metastasis, say, you don’t want to talk to somebody who’s got breast cancer spread throughout her body and is terribly sick.
A Caregiver’s Struggle
Q. Can you talk about how you felt with your own recurrence?A. I went to that appointment the way I always go to my yearly mammograms, not being very worried about it. My first breast cancer showed up as a lump, but not on a mammogram — which is not unusual — so I didn’t have a historically based worry. And it had been 12 years of perfect exams, so it was not at the front of my mind.
At our hospital, a woman who has already had one breast cancer has her film read by the radiologist while she’s there. So I left my appointment knowing that I needed a biopsy. I had it a few days later. Then I had to wait for the pathology report to come back. That gave me three or four days to be worried. The day the report came out, the radiologist tried unsuccessfully to get me, so he called my husband, who is the chief of oncology at the medical center, generally not a good move, because information should first be given to the patient, but okay given this weird situation. Then my husband called me on my office phone. It was 2:50 in the afternoon, and he said, "The report came in, and it’s not what we wanted. The surgeon can see you at three."