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A 70 years old female Ms.H, was treated for endometrial cancer in a private hospital. She underwent laparoscopic surgery by a cancer surgeon and based on the post-operative pathology report, she was asked to undergo radiotherapy and she was referred to a radiation cancer specialist in the same hospital. The radiation specialist prepared the patient for radiotherapy and asked for an opinion from the medical oncologist (chemotherapy specialist) as he felt that adding chemotherapy along with radiotherapy would benefit the patient. The medical oncologist who was also in the same hospital, saw the patient and in his opinion, felt that radiotherapy is not required for this patient and he advised them to undergo only chemotherapy. Confused, the patient went back to the radiation oncologist to report this. Unfortunately, repeated attempts to get an appointment failed and due to obvious reasons, the patient defaulted further treatment. She neither received chemotherapy nor radiotherapy.
After 1 year she now comes with the cancer appearing again at the operated site. This time the disease has spread to the entire abdomen with cancer cells forming a lump at the laparoscope scar site also. Her entire abdomen is swollen with fluid due to cancer and now she cannot be cured!
If only the patient had received the chemotherapy and radiotherapy as advised by the surgeon, this patient might have got cured. The patient’s relatives say that lack of proper guidance from the doctors and the difference of opinion among the doctors led to this confusion and the unfortunate recurrence of the disease.
Retrospectively analyzing this from a doctor’s point of view, the doctors are also responsible when a patient is not able to understand the entire treatment process. It is our duty to ensure that the patient does not abandon the treatment without completion as planned.
Luckily, we at Harshamitra cancer centre have a Tumour Board that decides the treatment policy and then only the treatment starts. In the tumour board, all the three cancer specialists, the cancer surgeon, the radiation specialist and the chemotherapy specialist, all sit together and discuss about the various issues related to the patient and finally take a treatment policy. The patient’s relatives are also taken into the decision making process where not only the medical issues, even the socioeconomic issues are taken into consideration before deciding the treatment. The patient and the relatives are then made to understand the disease and the treatment proposed, the cost involved, the total time duration, the sequencing of the different treatments and the outcome. Thus, the patient’s relatives are made fully aware and we find that the treatment is completed as planned.
When all the three specialists sit together, the differences in opinion can be discussed and final consensus can be arrived based on the international recommendations. No chance is given for individual bias. The patient gets the best treatment possible. If this had happened to Ms. H, when she was first diagnosed with cancer, she would have been aware of the importance of radiotherapy and chemotherapy before the surgery itself and she would have completed the treatment and the recurrence could have been avoided.
All cancer patients should be treated only after a multidisciplinary team discussion. Wherever this facility is not available, patients must be referred for one such team discussion in a nearby institute or atleast an online discussion should be made and the treatment should be initiated. Such online discussion facility is available at Harshamitra. Doctors practicing in places where such tumour board facility is not available, can avil this facility. Our tumour board meets on the 2nd and 4th Saturday of every month. Your case details can be mailed to us at harshamitracancer@gmail.com or you can send it by whats app to 9444014312. The case history will be discussed in our tumour board and the treatment policy will be conveyed to you. This service is available free of cost.

CategoryOncologist Diary
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