Can I stop check ups after 15 years? - 1272153

blaze100
Posts:18

Hi Dr. West, I was diagnosed with mucus BAC in 2000 at age 46. I had RUL and RML removed followed by concurrent chemo and radiation. I had 0.1mm margin in Hilar region. Nodes OK. No mets. Tumor was 12cmx6cmx5cm. That was 15 years ago.

Now husband and I have retired and moved full time to Oregon beach. I am in process of switching to new doctors. The closest oncology office is in Eugene. I am having trouble getting an appointment for yearly check up. They require a referral from my family doctor, and my new family doctor wouldn't refer me. I could keep going to my old oncology office in Medford, but it is 200 miles one way.

Are the doctors trying to tell me it is time to stop the check ups? I've been getting a yearly chest x-ray and a blood test at the Medford oncology office. I've asked you a few years ago, but is it time to stop my check ups with oncologist? Thanks. Barb

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Reply # - December 11, 2015, 04:49 AM

JimC
Posts: 2753

Hi Barb,

I don't think anything is different now than it was a couple of years ago when Dr. West responded to your post. Any former lung cancer patient is at greater than average risk for a new primary, making an annual screening x-ray a good idea.

Is your new family doctor willing to order the annual x-ray and blood test? If so, and there is a result that is suspicious, at that point you could make another request for a referral to the oncologist, or make the trip to Medford

Alternatively, is it possible to change your family doctor?

I hope you can find a way to work this issue out to your satisfaction.

JimC
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Reply # - December 11, 2015, 01:01 PM

catdander
Posts:

Hi Barb, I agree with Jim. An annual screening scan is recommended for people with a high risk of lung cancer including those who've had lung cancer. You primary doc can do it and insurance companies know the new standards and pay.

I hope all goes well and a BIG congrats on 15 years!
Janine

Reply # - December 11, 2015, 03:47 PM

blaze100
Posts: 18

Thank you Jim and Janine. I realized how silly my question was a few minutes after I posted.

My primary is probably not up to this. She is nice lady, but tired and getting ready to retire too. There is serious doctor shortage here.

I will ask my new OB/GYN to refer me to Eugene oncology. I go into meet my new cardiologist next month too. They are all part of the same health system as the oncology office, so I'm hoping they can get me in. I have good insurance coverage, so I'm not sure what the problem is getting a referral.....

Barb

Reply # - December 14, 2015, 05:27 PM

cards7up
Posts: 636

Why not have your previous oncologist talk with your primary and explain why they think this is necessary? Not sure why it would even be a problem if insurance is willing to pay for it.
Take care, Judy

Reply # - December 14, 2015, 07:21 PM

blaze100
Posts: 18

Yes, that will be my backup plan. My OB/GYN said she referred me to the oncologist office in Eugene this morning. They are supposed to call me.

I have very good insurance. I don't understand, except I think they are trying to tell me it is time to stop the check ups without actually saying it. Do you know anyone else with this problem? Do other people keep going to the oncologist office after 15 years out? Barb

Reply # - December 15, 2015, 10:49 AM

catdander
Posts:

Hi Barb,

I can't say what doctor is most often seen for those who have been clear for 15 years. I imagine it's a personal call on the part of the onc and patient. Since you've moved away from your original oncologist it would make sense to find a primary care doc who has similar values and let her/him do yearly scans. The important thing is to have the scans each year.

A bigger question than who orders the scans is what scan should be done for follow-up. Low dose
CT scan is the type of scan that has been studied and determined to be of benefit (and much more so than x ray) to those in the high risk category, in which you belong. A radiologist reads and reports on findings taking away much of the question of who orders it.

Another thought is since you're beginning a new relationship with a primary care physician you want to make sure she/he practices medicine in a way you trust. A doctor who wants to scan a person who has had lung cancer and is able to receive treatment if another cancer is found is a doctor you will be comfortable with.
You and your primary are a team, there is so so much new happening everyday in medicine it is absolutely impossible for one person to keep up with it all. Dr. West has said this about general medical oncologist so it would go for primary care docs a 1000x over. You may want to talk to your doc about what you know about follow-up scans, even take copies of reports from cdc and or aafp etc. If the doc isn't happy to see you're a team member in your health then you may want to think about finding a doc who is.

This recent thread addresses the question about scanning needs though not who orders them. http://cancergrace.org/topic/bac-follow-up-question-clarification

I sometimes have a problem with tmi :)
Janine

Reply # - January 14, 2016, 01:29 PM

blaze100
Posts: 18

Thank you everyone for the thoughtful replies. I was finally able to get a check up scheduled with the oncology office in Eugene. YAY! It took a few weeks due to the holidays, plus someone accidentally routed my referral to Urology instead of Oncology. :-)

Barb

Reply # - March 1, 2016, 02:18 PM

blaze100
Posts: 18

Well just to follow up. I went to see my new oncologist. He was happy to see me for yearly check-ups, however he said it was no longer necessary after 15 years. He's a younger doctor. He agreed to see me every year for follow ups if I wanted. (I wanted) So he ordered a chest x-ray and we'll see what it says.

I've re-read Dr. West's responses to my previous posts over the years regarding this. Even though a reoccurrence after this many years is unlikely, and most likely very slow growing, I still want to do yearly chest x-ray.

Barb

Reply # - March 2, 2016, 01:38 PM

catdander
Posts:

Hi Barb,

It's good to hear you've found someone. Just an FYI, the type of scan makes a difference, a low dose CT scan shows a far better picture of your lungs than an x ray. So as long as you are fit enough to have treatment in case something is found a CT is the standard of care. On the other hand if you wouldn't have treatment there's no need to look. Perhaps you'd like to have a conversation with your onc before scheduling an x ray.

I hope you're loving your new home!
Janine

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