It's Time to Take Ownership over Our Care

Back in the day, when it was suspected that we had cancer, we were sent for a biopsy. The cells were studied to determine if we had cancer and what kind of cancer we were facing. And, we never had another biopsy.

Rethinking how we approach treatment

But, we need to rethink that in today's world. Dr. Fred Ashbury, Adjunct Professor at Dalla Lana School of Public Health, University of Toronto (along with many other credentials), explained in a recent webcast why we should always insist on new biopsies when our tumors begin to grow or spread.¹

Our initial tumor that is biopsied can be thought of as the parent tumor. Doctors will generally treat the parent tumor with chemotherapy, immunotherapy, targeted therapy, and/or radiation therapy and, usually, it will respond for a period of time. Unfortunately, at some point, the tumors often develop a resistance to the treatment and begin to grow and spread.

Different therapies for different tumors

The new tumors, the children, will not be the same exact composition as the parent tumor. Like human children, they will bear resemblance to the parent, but they will not be identical. This means that different therapies may work better against the children than what was used against the parent.

This cycle continues. If the children tumors develop a resistance to their treatment, the grandchildren tumors will, again, resemble their parents and grandparents, but will not be exactly the same.

Biopsies provide valuable information

In most cases, a biopsy is a relatively simple way for oncologists to learn what the chemical makeup is of the new tumors they are treating. Resequencing the biopsy tissue will allow physicians to see what the genomic drivers are of the mutated cancer cells. They can then make informed decisions on what treatment plan is likely to be the most effective against your specific cancer.

Unfortunately, many community cancer centers will not routinely order new biopsies when tumors outsmart their treatments and begin to grow. However, Dr. Ashbury strongly encourages patients to insist on one, along with full panel genomic testing. Without the new testing, he says, doctors could be missing a real opportunity to accurately treat a person's cancer. And that could mean the difference between life and death.

Seeking second opinions

Also important are second opinions. Dr. Ashbury says that it is usually patients, not doctors, who fear second opinions. I know this personally. I am afraid to offend my oncologist, who I like and trust a great deal. But, according to Dr. Ashbury, oncologists, especially those in small or rural areas who do not have the benefit of working in large university centers where research and cutting-edge treatments are more commonplace, are often quite pleased to have an expert in the field give their opinion on the best course of treatment for their patient.

Think of second opinions in this way. How much effort do you expend before you buy a new television, car, or house? Most of us study consumer guides, read reviews, and ask experts while we are deciding what product to purchase. And yet, many of us turn our lives over to our oncologists and never question any decision they make.

Leading our care in the right direction

According to Dr. Ashbury, we patients need to take ownership of our health. As much as our medical team cares about us, in the end, no one cares as much as we do about our own outcomes.

Note to readers: On 4/5/2018, I listened to a webcast by Matt Ellefson, CEO of SURVIVEiT & Dr. Fred Ashbury that was recorded on March 23, 2018. That Webcast forms the basis for a lot of the information included here. The webcast can be found via Facebook by clicking here.