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THE BENEFITS OF A SECOND OPINION

Doctors speak about the team approach to fighting breast cancer

People diagnosed with cancer can feel overwhelmed, both by uncertainty and by the dizzying number of doctors involved. They typically see a series of specialists, each giving them a separate piece of their treatment plan, it can feel like putting together a puzzle without ever seeing the picture on the box. A tumor board review offers patients and doctors that big-picture view. In these multidisciplinary second opinion meetings, radiologists, oncologists, surgeons and nurse navigators sit down together to discuss a patient's treatment plan. The result can be improved communication, individualized care, and a streamlined approach. Because medical imaging is central to the diagnostic process and can be crucial in forming treatment plans, radiologists play a key role these reviews. SMIL radiologists participate in several different local tumor boards. No two tumor boards are exactly alike. Some are free to the patient, some offer patients the opportunity to join the meeting and ask questions, but all offer coordinated care.

Doctors speak about the team approach to fighting breast cancer

Gerry Kato, MD
Medical Oncologist

When you get diagnosed with breast cancer, you have a breast surgeon, an oncologist, a radiation oncologist, a plastic surgeon, a radiologist. Its complicated. So, when you have a room discussing your case, and you have all the specialties, and you have all the specialties involved you can get a better plan. We discuss what's best for each patient and the type of cancer they have, and then the patient comes in. Patients love it because they can get a second opinion and ask questions of all the different specialties. They can get the overview of the treatment with everybody in the room, as opposed to seeing somebody today and seeing somebody else in a couple of weeks."

Linda Liu, MD
Breast Surgeon

One of the most distressing aspects of a new cancer diagnosis is fear of the unknown. The tumor board attempts to empower the patient and her family with information about her cancer. I think it is vert reassuring and valuable to provide a patient with a goal and timeline oh how we will get there. Inviting the patient to the meeting allows her to hear a full, integrative plan from all the specialties. She can not only understand better the over all treatment plan but participate in the decision-making. Instead of being a passive backseat passenger, she is brought to the front seat, so she can hat direction we are going in, actively help us navigate through the process and most importantly see that these in a finish line.

Vershalee Shukla, MD
Radiation Oncologist

One time (at a tumor board) there was a 32-year-old women with very advanced breast cancer. We decided to give her chemotherapy up front to shrink the tumor down, then do a mastectomy, radiation and reconstruction. Usually in young patients, I don't recommend immediate reconstruction because you don't want to delay radiation. But because we ere all there together, I could the imaging and her anatomy, and I could tell the plastic surgeon that if he placed the implant this wat and took certain measures, she could have her immediate reconstruction. We spared her another surgery and six months of the trauma of having to deal with no breast."

Patricia Clark, MD
Breast Surgeon

In a hospital-based tumor board, you have specialists from multiple different medical groups, so they bring multiple perspectives. You'll have doctors from a cancer and research center, medical oncologists and radiation oncologists from various groups, private practitioners, nurse navigators, social workers, and someone who monitors clinical trial. Where its really valuable is that some of the patients don't fit neatly within our national guidelines. So, you want to individualize the treatment to that patient, and its very helpful to have other experts in the field to weigh in. This also keeps the providers very current on the literature and the conferences because they have to defend their position to their peers and advise their peers.

Caroline Kilian, MD
SMIL Radiologist

The breast radiologist's contribution to the tumor board is integral to the discussion with the doctors, nurses, and support staff, not to mention the ultimate conversation with the patient. Many times, breast cancer is first diagnosed by imaging as well as image-guided biopsy, then further evaluated with more extensive imaging. The breast radiologist not only can describe to the doctors and nurses the tumor and the extent of the disease, but visually demonstrate it to the patient… the tumor board team is knowledgeable, caring and empathetic. Patients leave having received answers to their questions, which assist them in selecting the best option for their health success and having received at least some assurance during this difficult time."

Cheri Ong, MD
Plastic Surgeon

I can discuss options for breast reconstruction, taking into account the patients cancer treatment care plan. We can perform the reconstruction around their chemotherapy or radiation treatments so the optimal outcomes for the patient can be obtained. I can advise the breast surgeon about the different incisions and help design the surgical plan, so the aesthetic outcome of the patient can be maximized. There have been tough cases where all members of the tumor board were able to give their input and pull ideas together. I don't think the plan could've been made without the collaborative efforts of all members involved."

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