CONTACTS
SUBJECTS
Oncologist Meeting 020321 1430 Meeting with Surgeon Bumped to after M
Oncologist Schedule Meeting for Continuing Treatment
0504 -
0504 - ..
0505 - Summary/Objective
0506 -
050601 - Follow up ref SDS 7 0001, ref SDS 5 Q78M.
050602 -
050603 - The oncologist is now Millie's primary care physician going forward.
050604 - ref SDS 0 MA3F A list of community support groups can be contacted
050605 - for arranging participation at convenient times and location.
050606 - ref SDS 0 LU6O Two pathology reports were submitted and reviewed
050607 - during the meeting, ref SDS 0 MA5K, and show diagnosis of Stage IIA
050608 - cancer which has about a 90% chance of survival for five (5) years
050609 - without any treatment. ref SDS 0 6Q4U An important finding is
050610 - metastasis in three (3) lymph nodes and extension out of the capsule.
050611 - ref SDS 0 FS6F and ref SDS 0 OJ9F The doctor discussed three good and
050612 - three bad factors in the prognosis for recovery. ref SDS 0 R97G A
050613 - nine (9) month plan is proposed of chemo therapy and radiation, in
050614 - addition to reexcision surgery on 030227 to obtain clear margins on
050615 - the original tumor in the left breast. ref SDS 0 FX7F Testing using
050616 - CT scan and Bone scan technology, along with further blood tests were
050617 - scheduled on an "urgent" basis to diagnose distant metastasis from
050618 - spread of cancer. ref SDS 0 FX5H The doctor set a meeting for 020405
050619 - to review test results and schedule start of treatments. ref SDS 0
050620 - A63O A schedule conflict delayed the CT scan until 020408, which can
050621 - be addressed by the doctor if necessary.
050623 - ..
050624 - [On 020327 0539 reexcission surgery to remove remaining
050625 - cancer tissue in left breast, again reported successful,
050626 - ref SDS 11 8R39, and following up initial surgery on
050627 - 020312. ref SDS 5 Q78M
050629 - ..
050630 - [On 020402 reviewed record with Michelle to assist the doctor in
050631 - preparing for follow up meeting. ref SDS 13 LX6X
050632 -
051038 -
051039 -
051040 -
051041 -
051042 -
051043 -
051044 -
0511 -
SUBJECTS
Oncologist Primary Care Physician Meets Patient
Dietary Advice to Prepare and Tolerate Cancer Treatments with Chemoth
0704 -
0705 - 1455
070601 - ..
070602 - Oncology Doctor Single Point of Contact Case Management
070603 - Primary Care Physician Team Leader Assisgned to Oncology Doctor
070604 -
070605 - The doctore apologized for being 45 minutes late.
070607 - ..
070608 - The doctor noted that going forward he will be Millie's primary care
070609 - physician to diagnose, prescribe, and plan care for cancer, and to
070610 - advise and coordinate treatment for all medical issues, under Kaiser's
070611 - Team Care practice for integrated medical management, reported on
070612 - 990625. ref SDS 2 2784
070614 - ..
070615 - The doctor explained that so far there has not been enough time for
070616 - collaboration with the surgeon on Millie's case. The doctor asked
070617 - Millie for patient impressions from memory on remarks after the
070618 - operation on 020312. ref SDS 5 Q78M
070620 - ..
070621 - This aligns with objectives on 020318, ref SDS 7 Q56I, and telecon
070622 - with Diane, ref SDS 7 6Z7F, and noted as well by Sharee at that time
070623 - saying that Team Care requires support by the patient for
070624 - coordination. ref SDS 7 HL6M
070625 -
070626 - [On 020402 reviewed record with Michelle to assist the doctor in
070627 - preparing for follow up meeting. ref SDS 13 LX6X
070629 - ..
070630 - [On 050204 there was not enough time for collaboration between
070631 - Oncology and Surgery under the Team Care practice. ref SDS 30
070632 - RD3M
070634 - ..
070635 - [On 050311 the doctor has not seen the report from the surgeon,
070636 - ref SDS 31 UH3O; doctor calls surgeon asks for another
070637 - examination to report on performing surgery to remove pockets of
070638 - resistance to chemotherapy. ref SDS 31 XQ41
070640 - ..
070641 - The doctor advised that cancer presents very complex case management
070642 - scenarios that require collaboration through a strong doctor/patient
070643 - partnership. Case management coordinates multiple medical practices
070644 - to treat expanding range of health disorders caused by the underlying
070645 - cancer.
070646 -
070647 - [On 090121 Millie thanks Doctor Johnson and his assistant,
070648 - Arlette, for 7 years of excellent care. ref SDS 50 F23Y
070650 - ..
070651 - The doctor explained his job as Millie's Primary Care Physician (PCP)
070652 - at Kaiser provides a single point of contact coordinating patient
070653 - care, including diagnosis of primary and collateral medical problems,
070654 - prescribing treatment, referrals, monitoring progress, and case
070655 - management to comply with oncology standard of care, including getting
070656 - second opinions when needed to aid assessment by front-line
070657 - physicians, as called out in Kaiser's procedures reviewed on 990625.
070658 - ref SDS 2 455N
070660 - ..
070661 - [On 030606 the doctor disclosed that chemotherapy treatment for
070662 - cancer diminishes ability of bone marrow to replenish blood
070663 - counts, and this weakens the immune system, which enables
070664 - cancer, other disease, and infections to grow, which lead to
070665 - death; and so there is a difficult balance to strike between the
070666 - treatment and maintaining blood counts. ref SDS 26 JP7G
070668 - ..
070669 - "Single point of contact" simplifies case management with professional
070670 - expertise and experience, similar to project management directing the
070671 - work to meet objectives, requirements, and commitments, reviewed on
070672 - 950721. ref SDS 1 6N5J
070673 -
070674 - [On 060728 project management for medical oncology practice was
070675 - reviewed; Knowledge Management more apt model for medical
070676 - oncology practice. ref SDS 37 YV5R
070678 - ..
070679 - [On 070927 Kaiser's Senior Advantage EOC section 2 assigns
070680 - primary care physician responsibility to coordinate case
070681 - management. ref SDS 39 N26O
070683 - ..
070684 - Project management is commonly recognized for efficient coordination
070685 - of the work in health care. Research shows "single point of contact"
070686 - is common managing team work for health care. See...
070687 -
070688 - Healthcare
070689 - Project Management
070690 -
070691 - http://agfabeint01.net.agfa.com/bu/mi/Mednet/MedNet.nsf/AllDocs/E3A591FBF325896BC1256EBD0049EDB0/$FILE/GB-HEALTHCARE.project%20manag%204.0.pdf
070693 - ..
070694 - Single Point of Contact
070696 - ..
070697 - Healthcare projects are always complex and invariably involve a
070698 - large number of people working in a team. This can cause
070699 - confusion when an update on a project's status is required.
070701 - ..
070702 - That's why ... project managers not only coordinate every step
070703 - and activity... but also provide one single point of contact so
070704 - that you don't waste your precious time chasing the individual
070705 - responsible for each element of the project. In this way you
070706 - can spend your time handling the big issues secure in the
070707 - knowledge that we work with you to coordinate and manage your
070708 - internal and external resources.
070710 - ..
070711 - Single point of contact provides clear, consistent
070712 - communications...
070713 -
070714 - http://www.wireone.com/html/products/brochures/Project_Management.pdf
070716 - ..
070717 - Millie's doctor is well positioned to coordinate Kaiser Team Care case
070718 - management with knowledge of policies and procedures, understanding
070719 - organizational structure, and having adequate authority to direct the
070720 - work as chief of Hermatology/Ontology for the Diablo Service Area of
070721 - Kaiser Permanente Medical Group, as reported in the Spring 2002
070722 - edition of Member News, shown in an article on page 1 under the
070723 - title...
070725 - ..
070726 - New Walnut Creek Cancer Center
070727 -
070729 - ..
070730 - [On 020402 Michelle explained the doctor's desk is piled high with
070731 - important matters; there is not enough time to read patient
070732 - communications. ref SDS 13 KG4H
070734 - ..
070735 - The doctor is featured in the article explaining....
070736 -
070737 - We stress patient education, and provide social, mental health,
070738 - nutrition, pharmacy and physical therapy services.
070740 - ..
070741 - The article seems to confirm that the oncologist becomes the "main
070742 - physician" to lead a multi-disciplinary Kaiser medical team, that
070743 - includes...
070745 - ..
070746 - 1. Medical Social Worker available 4 days a week for emotional
070747 - support, prepare medical forms, find a community support
070748 - group...
070750 - ..
070751 - 2. Advise nurses can be called to resolve problems and obtain
070752 - information
070754 - ..
070755 - 3. Oncology pharmacists teach patients about medications.
070756 -
070757 - [...below, the doctor plans to schedule a meeting with the
070758 - pharmacist to explain medications and tolerance measures.
070759 - ref SDS 0 6T34
070761 - ..
070762 - 4. Breast care coordinators work with patients before surgery and
070763 - provide support during the course of care.
070765 - ..
070766 - This aligns with assistance by Viven and Diane earlier on
070767 - 020311. ref SDS 4 NL5N
070769 - ..
070770 - On 020318 Diane helped schedule a meeting with the doctor.
070771 - ref SDS 7 AZ82
070772 -
070773 -
070774 -
070775 -
070776 -
0708 -
SUBJECTS
Dietary Advice to Prepare and Tolerate Cancer Treatments with Chemoth
0803 -
080401 - ..
080402 - 5. Nutritionist is available every Monday to tailor a diet to
080403 - specific patient needs.
080404 -
080405 - Who contacts the patient and at what stage in the treatment
080406 - is the patient notified about dietary changes?
080407 -
080408 - [On 020326 Carol recommends asking about dietary advise
080409 - and support. ref SDS 10 GQ93
080411 - ..
080412 - [On 020405 phamphlets and other reading material was
080413 - submitted by the pharmacist on dietary issues.
080414 - ref SDS 16 GF6M
080415 -
080416 -
080417 -
0805 -
SUBJECTS
Clinical Trials for Experimental Treatments Available at Walnut Creek
0903 -
090401 - ..
090402 - Clinical Trial for Experimental Treatments
090403 -
090404 - The Walnut Creek Cancer Center has two clinical trial coordinators who
090405 - provide experimental or previously approved medications, based on
090406 - notice and approval by the patient.
090408 - ..
090409 - Do clinical trials present treatment opportunities in this case?
090411 - ..
090412 - During the meeting the doctor explained clincial trials are a routine
090413 - part of health care for cancer that aid the doctor in prescribing
090414 - treatments.
090416 - ..
090417 - [On 020405 doctor indicated changing treatment to Taxol instead
090418 - of Taxotere prescribed today for the 3rd phase of adjuvant
090419 - treatment, per below, ref SDS 0 51CX; upon notice, the doctor
090420 - changed back to chemotherapy with Taxotere and disclosed that
090421 - Taxotere is a new drug; there was no discussion of clinical
090422 - trial, per above, ref SDS 0 O49J, nor were results submitted of
090423 - clinical trials for Taxotere relative to using Taxol.
090424 - ref SDS 16 555X
090426 - ..
090427 - [On 040318 Kaiser proposes clinical trial referral to expand the
090428 - doctor's "tool kit" of drugs for treating Millie's relapse.
090429 - ref SDS 27 PU6M
090430 -
090431 -
090432 -
090433 -
090434 -
0905 -
SUBJECTS
Community Support Groups Recommended to Pool Experience and Advice fo
1003 -
100401 - ..
100402 - Community Support Groups
100403 -
100404 - During the meeting, the doctor submitted a list of 5 community support
100405 - groups where patients can meet to pool experience and compare notes on
100406 - advice for being an effective partner with the doctor in treatment and
100407 - recovery from cancer. ref OF 3 0001
100409 - ..
100410 - The doctor explained good experience with patients who participate in
100411 - cancer support groups.
100412 -
100413 - Need to develop contacts and investigate support opportunities.
100414 -
100415 -
100416 -
100417 -
100418 -
1005 -
SUBJECTS
Pathology Report and Testing Needed to Guide Treatment Options Radiat
Lymph Nodes 3 of 4 Positive Metastatic Cancer Disease Left Axillary
1704 -
170501 - ..
170502 - Pathology Report Review with Oncologist Primary Care Physician
170503 -
170504 - The doctor asked if the pathology report has been received and
170505 - reviewed?
170507 - ..
170508 - No reports have been received from Kaiser so far. The surgeon
170509 - discussed findings in a phone call on 030318, and advised that an
170510 - oncologist would provide reports and explain findings, and further
170511 - suggested calling oncology to arrange this meeting today. ref SDS 7
170512 - 0001
170514 - ..
170515 - The primary care physician explained findings from Millie's surgery on
170516 - 020312 when the surgeon described a left breast sentinel node
170517 - procedure along with a left axillary disection and left breast
170518 - lumpectomy. ref SDS 5 Q78M
170519 -
170520 - [On 020327 0539 reexcission surgery to remove remaining
170521 - cancer tissue in left breast, again reported successful,
170522 - ref SDS 11 8R39, and following up initial surgery on
170523 - 020312. ref SDS 5 Q78M
170525 - ..
170526 - The doctor provided copies of two pathology reports....
170527 -
170528 - 1. Left breast core biopsy dated 020304, 3 pages
170529 - ref OF 1 0001
170530 -
170531 - 2. Left breast sentinel node; lymph node from surgery on 020312
170532 - and dated 020312. ref OF 2 T06G
170534 - ..
170535 - The doctor highlighted and discussed the following points....
170536 -
170537 - 1. Report dated 020304 from biopsy taken on 020304 as a result of
170538 - discomfort under the left arm, as shown on 020306. ref SDS 3
170539 - 5K9F
170540 -
170541 - a. Specimen left breast core biopsy 1200, ref OF 1 6W7L
170543 - ..
170544 - b. Diagnosis infiltrating carcinoma. ref OF 1 PPTP
170545 -
170546 - The doctor said this is a professional expression finding
170547 - Millie has breast cancer.
170549 - ..
170550 - Triple Negative Status
170551 -
170552 -
170553 - c. Estrogen Receptor......... negative. ref OF 1 IS6K
170555 - ..
170556 - d. Progesterone Receptor..... negative. ref OF 1 IT3J
170558 - ..
170559 - e. Her2/neu.................. negative. ref OF 1 IT4L
170560 -
170561 - [On 040318 Millie's triple negative status limits drugs
170562 - for treatment; clinical trials expand drugs for treating
170563 - metastatic cancer. ref SDS 27 DG4J
170564 -
170565 - [On 041117 2nd opinion reports patient not candidate for
170566 - Herceptin because HER-2/neu negativity. ref SDS 29 YN4I
170568 - ..
170569 - [On 050907 doctor recommends retesting for status change
170570 - that could have a huge impact on treatment options.
170571 - ref SDS 33 AE6P
170573 - ..
170574 - [On 051121 primary care physician found an order to
170575 - retest the biopsy on 040419 for status change, but there
170576 - was no report, ref SDS 35 ZR6J; the doctor called the
170577 - pathology department and left another message asking to
170578 - expedite the order on retesting for status change.
170579 - ref SDS 35 PQ5L
170581 - ..
170582 - [On 060711 primary care physician found status change
170583 - report for the biopsy on 040419 was in Kaiser's computer
170584 - in a location that required training and experience to
170585 - access, and showed no change in status. ref SDS 36 SW7O
170587 - ..
170588 - [On 070105 Millie's triple negative status qualifies for
170589 - treatment on clincial study with cetuximab and
170590 - carboplatin. ref SDS 38 PK7L
170592 - ..
170593 - [On 071007 support group seminar indicates criteria for
170594 - HER2 negative may have dropped from 2 to 1.6; ask Doctor
170595 - Rugo at UCSF about propsects of expanding treatment to
170596 - use Herception available onlyt to HER2 positive patient
170597 - status. ref SDS 40 S68T
170599 - ..
170600 - [On 071009 Doctor Rugo advises that UCSF continue to rely
170601 - on HER2 negative standard at 2, i.e., there has been not
170602 - change in criteria. ref SDS 41 4Q4K
170604 - ..
170605 - [On 081016 Millie's IBC disease progresses; Doctor Rugo
170606 - proposes treatment with new sunitinib metronomic protocol
170607 - designed for multi-targeted treatment of cancer
170608 - receptors; order biopsy of left supraclavicular lump to
170609 - evaluate status change again. ref SDS 42 J36R
170611 - ..
170612 - [On 081107 biopsy performed at Kaiser Head and Neck
170613 - Department on 081107. ref SDS 43 7P5O
170615 - ..
170616 - [On 081119 Kaiser submitted a summary of final pathology
170617 - report, ref SDS 44 5O8G, for the biopsy on 081107,
170618 - ref SDS 43 496L, and it appears status is unchanged,
170619 - still triple negative. ref SDS 44 UQ5P
170621 - ..
170622 - [On 081119 Millie asks Kaiser for pathology report on
170623 - biopsy performed 081107 and finding triple negative
170624 - status unchanged; need to evaluate criteria in relation
170625 - to notice today that criteria for HER2neu has changed.
170626 - ref SDS 45 L34X
170628 - ..
170629 - [On 081120 Millie requested complete pathology reports
170630 - for the biopsy on 081022, and on 081107. ref SDS 46 VU9N
170632 - ..
170633 - [On 081120 Millie receives complete pathology report for
170634 - biopsy on 081107, ref SDS 47 1E6K; presents criteria for
170635 - determining status, ref SDS 47 LF9R, but does not present
170636 - findings that support a conclusion of triple negative.
170637 - ref SDS 47 QQ3K
170639 - ..
170640 - [On 081202 Millie's letter to Kaiser, ref SDS 48 UV5I,
170641 - asks Doctor Daamen for findings in pathology report for
170642 - biopsy on 081107 that support conclusion of triple
170643 - negative. ref SDS 48 GZ4P
170645 - ..
170646 - [On 081202 1456 Kaiser submitted results of pathology for
170647 - biopsy on 081107 showing HER2 neu FISH test = 1.1,
170648 - ref SDS 49 FG5G, well below criteria for positive 2.0,
170649 - and below change in criteria to 1.6 reported under
170650 - consideration on 071007. ref SDS 40 S68T
170652 - ..
170653 - f. DNA Index................. 1.6, ref OF 1 PSUW
170655 - ..
170656 - g. MIB1...................... 16% BORDERLINE,
170657 - ref OF 1 PSVT
170659 - ..
170660 - h. Borderline................ 15 - 31%, ref OF 1 T66L,
170661 -
170662 - High...................... 32 - 100%
170663 -
170665 - ..
170666 - 2. Pathology report dated 020312 from biopsy of tissue removed
170667 - during surgery on 020312....
170668 -
170669 - A. Metastatic carcinoma tumor infiltrating through the capsule
170670 - into the peri-nodal fatty tissue, left breast sentinel
170671 - lymph node. ref OF 2 PPTP
170672 -
170673 - [On 020603 PET scan found evidence of cancer in the arm
170674 - pit area where this capsule was removed; elevated CA
170675 - 15-3 cancer marker indicates some continuing metastasis,
170676 - but it appears to be localized. ref SDS 21 0001
170678 - ..
170679 - Three out of three lymph nodes positive for metastatic
170680 - disease, tumor involves the capsule, but does not extend
170681 - into the perinodal fatty tissue, left axillary tissue.
170682 - ref OF 2 00WP
170683 -
170684 - During the meeting today, the doctor hand wrote the
170685 - following in the right margin of this report dated
170686 - 020312....
170688 - ..
170689 - 4/4 LN +
170691 - ..
170692 - This reference is not clear in relation to the pathology
170693 - report that discusses 3 out of 3 lymph nodes?
170694 -
170695 - [On 020405 4/4 LN refers to 4 out of 4 lymph nodes
170696 - that includes both para A describing the sentinal
170697 - lymph node and para B that found 3 out of 3 lymph
170698 - nodes; adding 1 + 3 = 4 out of 4.
170700 - ..
170701 - Research on 020318 shows PET Scan tests are used to
170702 - check for distant metastasis when breast cancer occurs
170703 - because the most important factor determining long-term
170704 - prognosis is the involvement of the axillary lymph
170705 - nodes. Currently, dissection (ALND) is the technique of
170706 - choice for making this determination. However, it is an
170707 - invasive procedure requiring a hospital stay, and has
170708 - the potential for long-term complications. ref SDS 7
170709 - VN5F
170711 - ..
170712 - B. Infiltrating poorly differentiated ductal carcinoma (2 CM),
170713 - tumor present at the superior anterior margin,
170715 - ..
170716 - Ductal carcinoma in situ. ref OF 2 9N4J
170717 -
170718 - [On 051027 biopsy left breast surgery tissue finds
170719 - ductal carcinoma in situ. ref SDS 34 615K
170720 -
170721 -
170722 -
170723 -
1708 -
SUBJECTS
AJCC Cancer Staging Handbook Extract Pages 162 - 165 Used by Doctor J
Stage TIIA Cancer 5 Years Survival No Treatment
T1 Tumor Not More than 2 CM in Greatest Dimension
2005 -
200601 - ..
200602 - Stage IIA Cancer 78% Chance Survival 5 Years No Treatment
200603 -
200604 - The doctor explained Millie's condition of cancer tumor in the left
200605 - breast, with cancer out of capsule in lymph nodes on the left arm pit
200606 - (axillary), ref SDS 0 4U8X, most closely fits the profile for stage
200607 - IIA cancer. He submitted copies of pages 162 - 165 of the AJCC Cancer
200608 - Staging Handbook, ref OF 4 0001, and highlighted the following
200609 - portions....
200611 - ..
200612 - [On 020326 Carol suggests asking the doctor about survival
200613 - rates he has observed for the diagnosis in this case.
200614 - ref SDS 10 QY6J
200616 - ..
200617 - [On 040318 relapse diagnosed as secondary IBC. ref SDS 27
200618 - 8R6M
200620 - ..
200621 - [On 040614 IBC diagnosed changed stage IIA to stage IV
200622 - treatment protocol, survival prospects dim. ref SDS 28 QH8F
200624 - ..
200625 - a. Primary Tumor (T), ref OF 4 TL6M
200626 -
200627 - The doctor indicated that the pathology reports suggest a
200628 - classification as....
200630 - ..
200631 - T1..Tumor 2 cm or less in greatest dimension. ref OF 4 XQ8J
200633 - ..
200634 - This seems to align with the pathology report on 020312 in
200635 - section C of diagnosis, ref OF 2 9N4J, and in section C of
200636 - Gross Desc, which says in part "...firm, fairly well-
200637 - circumscribed tan tumor measuring at greatest dimension 2.0
200638 - x 2.0 x 2.0 cm." ref OF 2 N16H
200640 - ..
200641 - It appears that a 2 x 2 x 2 cm tumor may meet conditions
200642 - for a T1c classification. ref OF 4 0L9H The implications
200643 - of this correlation were not presented by the doctor; may
200644 - be reflected in the treatment plan.
200645 -
200646 -
200647 -
200648 -
200649 -
2007 -
SUBJECTS
Lymph Nodes N1 Metastasis to Movable Ipsilateral Axillary Lymph node(
Metastasis in 1 to 3 lymph nodes, any more than 0.2 cm and all less t
2204 -
220501 - ..
220502 - b. Regional Lymph Nodes (N), ref OF 4 PQPP
220503 -
220504 - The doctor indicated that the pathology reports suggest a
220505 - classification as....
220507 - ..
220508 - N1..Metastasis to movable ipsilateral axillary lymph node(s),
220509 - ref OF 4 PQPY
220510 -
220511 - The basis for this opinion is not clear in the pathology
220512 - reports.
220514 - ..
220515 - Research on 020318 shows the most important factor
220516 - determining long-term prognosis is the involvement of the
220517 - axillary lymph nodes. ref SDS 7 VN5F
220518 -
220519 - [On 050324 research indicates that metastatic cancer
220520 - diagnosed for IBC is not always inoperable when
220521 - regional lymph nodes are involved. ref SDS 32 O85N
220523 - ..
220524 - The doctor did not highlight anything in the section for
220525 - Pathologic Classification (pN) shown on page 163 of the
220526 - AJCC Cancer Staging Handbook. ref OF 4 0234
220528 - ..
220529 - There is a classification shown for pN1bi Metastasis in 1
220530 - to 3 lymph nodes, any more than 0.2 cm and all less than 2
220531 - cm in greatest dimension, ref OF 4 025A As well,
220532 - classificaton for pN1biii describes extension of tumor
220533 - beyond the capsule of a lymph node metatasis less than 2 cm
220534 - in greatest dimension. Both of these descriptions seem to
220535 - align with the pathology report dated 030212 that says in
220536 - section B of the Diagnosis section that "Three out of three
220537 - lymph nodes positive for metastatic disease, tumor involves
220538 - the capsule, but does not extend into the peri-nodal fatty
220539 - tissue, left axillary tissue." ref OF 2 00WP
220540 -
220541 - [On 020405 the doctor discussed this matter. ref SDS 16
220542 - DP6G
220544 - ..
220545 - [On 020603 PET scan found evidence of cancer in the arm
220546 - pit area where this capsule was removed; elevated CA
220547 - 15-3 cancer marker indicates some continuing metastasis,
220548 - but it appears to be localized. ref SDS 21 0001
220550 - ..
220551 - This may not have been highlighted, because there is no
220552 - apparent use of this factor in the Stage Grouping table,
220553 - also shown on page 163. ref OF 4 PRRS
220555 - ..
220556 - The doctor discussed extension outside the lymph node
220557 - capsule in explaining good and bad pathology factors that
220558 - relate to treatment and recovery. ref SDS 0 OJ9F
220559 -
220560 -
220561 -
220562 -
220563 -
2206 -
SUBJECTS
Distant Metastasis Spread of Cancer to Other Areas of the Body No Ass
2303 -
230401 - ..
230402 - c. Distant Metastasis (M), ref OF 4 0308
230403 -
230404 - The doctor indicated that the pathology reports suggest a
230405 - classification as....
230407 - ..
230408 - MX..Distant metastasis cannot be assessed
230409 -
230410 - This seems to relate to whether cancer has been transferred
230411 - elesewhere in the body.
230412 -
230413 - Testing ordered today will assess distant metastasis
230414 - showing whether cancer has spread. ref SDS 0 FX5H
230416 - ..
230417 - Research on 020318 shows PET Scan tests are used to check
230418 - for distant metastasis when breast cancer occurs because
230419 - the most important factor determining long-term prognosis
230420 - is the involvement of the axillary lymph nodes, which has
230421 - been diagnosed, per above. ref SDS 0 6Q6N
230423 - ..
230424 - Below, PET Scan test not ordered at this time.
230426 - ..
230427 - [On 020402 bone scan test performed. ref SDS 14 0001
230429 - ..
230430 - [On 020405 bone scan test indicate no evidence of cancer,
230431 - i.e., no distant metastasis. ref SDS 16 GJ5M
230433 - ..
230434 - [On 020603 PET scan found evidence of cancer in the arm pit
230435 - area where this capsule was removed; elevated CA 15-3 cancer
230436 - marker indicates some continuing metastasis, but it appears to
230437 - be localized. ref SDS 21 0001
230439 - ..
230440 - [On 030109 PET scan found early evidence of masses in left
230441 - upper chest, left axillary, and left supraclavicular regions
230442 - which a year later were identified
230443 - as symptoms of IBC.
230444 -
230445 -
230446 -
230447 -
230448 -
230449 -
2305 -
SUBJECTS
Stage Grouping of Cancer Pathology Factors for Prognosis of Survival
2403 -
240401 - ..
240402 - d. Stage Grouping
240403 -
240404 - Stage IIA....... T1........N1........M0, ref OF 4 PRRS
240406 - ..
240407 - e. Observed Survival Rate - 5 Years with No Treatment 78% Chance
240408 -
240409 - The doctor showed in the chart on page 164 that a Stage IIA
240410 - patient has an approximate 78% chance of survival for 5
240411 - years without any treatment, compared with 92% for people
240412 - with no signs of cancer. This seems to indicate that the
240413 - chances of living another 5 years with Stage IIA cancer are
240414 - about 10% less than if the patient had not contracted
240415 - cancer. ref OF 4 8H4H
240417 - ..
240418 - [On 020326 Carol suggests asking the doctor about survival rates
240419 - he has observed for the diagnosis in this case. ref SDS 10 QY6J
240420 -
240421 -
240422 -
240423 -
240424 -
240425 -
240426 -
240427 -
2405 -
SUBJECTS
Prognosis Good and Bad Factors for Treatment and Recovery Extending L
T1 Stage IIA Tumor is a Good Factor
Her 2 / neu * - Negative a Good Factor
MIB1 16% - Bad Factor
Angiolymphatic No Evidence -- Good/Bad????
N1 - out of capsule - Bad Factor
ER/PRO - Negative - Bad Factor
DNA 1.6 - Bad Factor
3210 -
321101 - ..
321102 - Prognosis - Good and Bad Factors Affecting Survival and Treatment
321103 -
321104 - The doctor wrote out by hand on the back of the copy for page 162 and
321105 - 163 from AJCC Cancer Staging Handbook, the following matrix showing
321106 - three (3) good factors and three (3) bad factors....
321107 -
321108 - [On 020326 Carol suggests asking the doctor about survival rates
321109 - he has observed for the diagnosis in this case. ref SDS 10 QY6J
321111 - ..
321112 - This explanation was presented with professional sensitivity, care and
321113 - detail that enabled understanding and imparted assurance of effective
321114 - analysis.
321116 - ..
321117 - Good........................................ Bad
321118 - --------
321119 -
321120 - T1 - Good
321121 -
321122 - T1 is generally "good" compared with
321123 - T2, T3 and T4 classifications shown
321124 - in the AJCC Cancer Staging Handbook
321125 - on page 162, ref OF 4 XQ8J, as the
321126 - doctor discussed above. ref SDS 0 6Q4U
321127 -
321128 -
321130 - ..
321131 - N1 - out of capsule - Bad
321132 -
321133 - It is not clear why N1 would be a
321134 - bad factor, as discussed by the
321135 - doctor, above, ref SDS 0 6Q6N,
321136 - since there are two classifications,
321137 - N2 and N3 that are worse than N1. If
321138 - N1 is "bad" why isn't T1 bad, as
321139 - well?
321141 - ..
321142 - [On 020603 PET scan found evidence of cancer in the arm pit
321143 - area where this capsule was removed; elevated CA 15-3 cancer
321144 - marker indicates some continuing metastasis, but it appears to
321145 - be localized. ref SDS 21 0001
321146 -
321147 - The reference may be to extension of
321148 - the tumor outside the capsule as
321149 - reported on 020312, ref OF 2 PPTP,
321150 - and ref OF 2 00WP, however, that
321151 - condition is not shown as a factor
321152 - in the AJCC Cancer Staging Handbook
321153 - under Regional Lynph Nodes section.
321154 - The condition is described under
321155 - Pathologic Classification (pN) for
321156 - pN1biii, ref OF 4 01WT, as noted
321157 - further above. ref SDS 0 634E
321159 - ..
321160 - Below, no discussion of no evidence
321161 - of angiolymphatic involvement with
321162 - tumor in the breast specimen
321163 - (specimen c). The criteria for
321164 - extensive ductal carsinoma in situ
321165 - are not fulfilled. ref SDS 0 6U4O
321166 -
321168 - ..
321169 - ER/PRO - Negative - Bad
321170 -
321171 - This seems to refer to the pathology
321172 - report on the biopsy taken on 020304
321173 - that says estrogen receptor and
321174 - progesterone receptor are both
321175 - negative, ref OF 1 0245, which was
321176 - received on 020306. ref SDS 3 0245
321177 - The reason a "negative" diagnosis is
321178 - bad was not explained in relation to
321179 - a negative diagnosis for Her2/neu
321180 - also being negative, shown next in
321181 - the matrix.
321182 -
321183 -
321185 - ..
321186 - Her2/neu * - Negative - Good
321188 - ..
321189 - Seems to refer to the pathology
321190 - report on 020304, ref OF 1 IT4L,
321191 - and received on 020306. ref SDS 3 S67O
321193 - ..
321194 - Why is Her2/new - negative "good"
321195 - while estrogen and progesterone
321196 - also negative are "bad."
321197 - ref SDS 0 OJ5G
321198 -
321199 - [On 041117 2nd opinion reports patient not candidate for
321200 - Herceptin because HER-2/neu negativity. ref SDS 29 YN4I
321202 - ..
321203 - [On 050907 doctor recommends retesting for status change that
321204 - could have a huge impact on treatment options. ref SDS 33 TX6J
321205 -
321207 - ..
321208 - DNA 1.6 - Bad
321209 -
321210 - This seems to refer to the pathology
321211 - report on 020304. ref OF 1 PSUW
321212 -
321213 - Robert explained that this indicates
321214 - the tumor is expanding at the rate
321215 - of 1.6 times, however the period of
321216 - growth was not clear. Is this over
321217 - a day, week, month, year???
321219 - ..
321220 - The doctor seemed to indicate that a
321221 - DNA factor of 1.1 or 1.2 would be
321222 - good, where 1.0 means no growth and
321223 - 2.0 means doubling.
321224 -
321226 - ..
321227 -
321228 - MIB1.... 16% - Borderline
321229 -
321230 - Seems to refer to the pathology
321231 - report on 020304. ref OF 1 PSVT
321232 -
321233 - Not clear why MIB1 is a positive,
321234 - compared to what?
321236 - ..
321237 - May relate to figures on page 3 of
321238 - the report on 020304 that says
321239 - 15-31% is borderline, while 32-100%
321240 - is "high." However, the meaning of
321241 - this factor was not clear during the
321242 - meeting today.
321244 - ..
321245 -
321246 - No evidence of angiolymphatic -- Good/Bad????
321247 -
321248 - The doctor did not discuss finding
321249 - no evidence of angiolymphatic involvement
321250 - with tumor in the breast specimen
321251 - (specimen c). The criteria for extensive
321252 - ductal carsinoma in situ are not fulfilled.
321253 - ref OF 2 PPYQ
321254 -
321255 - [On 020405 no questions were asked no further explanation of
321256 - these matters were discussed. ref SDS 16 R97G
321257 -
321258 -
321259 -
321260 -
321261 -
3213 -
SUBJECTS
Cancer Tests and Research
Testing for Distant Metastasis Spread of Cancer
Testing Cat Scan CT Abdomen for Distant Metastasis Spread of Cancer
3505 -
350601 - ..
350602 - Testing for Distant Metastasis - Spreading of Cancer
350603 - Distant Metastasis - Spreading of Cancer Requires Vigorous Testing
350604 -
350605 - Follow up ref SDS 7 QS5H.
350606 -
350607 - The doctor highlighted the section in the AJCC Cancer Staging Handbook
350608 - on page 163, and advised that that there is not enough information at
350609 - this time to assess whether there is distant metastasis, as defined in
350610 - the AJCC Cancer Stagig Handbook. ref OF 4 0308
350612 - ..
350613 - The doctor feels that diagnosis showing a tumor, ref SDS 0 3C6L, and
350614 - extension of the tumor outside the capsule, noted above, ref SDS 0
350615 - JE8H, shows vigorous testing for further cancer along with immediate
350616 - treatment are required.
350617 -
350618 - [On 040318 following a year of treatment shows distant metastisis
350619 - identified based on biopsy of lumps in the neck that found cancer
350620 - in lymph nodes. ref SDS 27 WA9L
350622 - ..
350623 - Research on 020318 shows PET Scan tests are used to check for distant
350624 - metastasis when breast cancer occurs because the most important factor
350625 - determining long-term prognosis is the involvement of the axillary
350626 - lymph nodes. ref SDS 7 VN5F
350628 - ..
350629 - The doctor did not order PET Scan tests, per below. ref SDS 0 QA5G
350630 -
350631 - [On 020430 doctor ordered PET Scan test because CT Cat Scan
350632 - test shows 1 cm cyst on liver and blood test shows CA 15-3 is
350633 - 81 and not falling as fast as expected following surgery on
350634 - 020327. ref SDS 19 7N5H
350636 - ..
350637 - [On 020603 PET scan found evidence of cancer in the arm pit
350638 - area where this capsule was removed; elevated CA 15-3 cancer
350639 - marker indicates some continuing metastasis, but it appears to
350640 - be localized, rather than "distant" or systemic. ref SDS 21
350641 - 0001
350643 - ..
350644 - The doctor ordered two tests with urgent status, requiring performance
350645 - by Kaiser within two weeks....
350647 - ..
350648 - 1. Cat Scan (CT) Test Schedule for Next 2 Weeks Urgent
350649 -
350650 - The doctor seemed to indicate this would cover the abdomen
350651 - region, but not the head.
350652 -
350653 - Reveiw on 020318 showed Cat Scan testing is performed on the
350654 - brain, chest and abdomen. ref SDS 7 VM5N
350656 - ..
350657 - Not clear why the brain and chest are not being tested for
350658 - cancer at this time using the Cat Scan method? The chest xray
350659 - on 020311, ref SDS 4 PY61, evidently did not show any danger
350660 - of cancer, based on Doctor Riley-Paull's comments following
350661 - the surgery on 020312. ref SDS 5 YA4F
350663 - ..
350664 - After meeting with the doctor, went to the Radiology Imaging
350665 - Department.
350667 - ..
350668 - Christine advised that the Radiology Imaging Department does
350669 - not have an opening that fits the doctor's request for an
350670 - "Urgent" CT test within the next 2 weeks. She said the
350671 - earliest Kaiser can perform this work is on 020408.
350673 - ..
350674 - Christine noted 020408 is 3 days after meeting the doctor
350675 - scheduled on 020405 for reviewing results of tests and
350676 - scheduling treatment. She said the doctor can call the
350677 - Radiology Imaging Department to move the date of the test
350678 - ahead, if necessary.
350679 -
350680 - [On 020329 Arlette advised that the computer at Kaiser
350681 - shows the cat scan test is actually scheduled for 020409
350682 - 0930. ref SDS 12 QJ7G
350684 - ..
350685 - [On 020329 the doctor called and said the test on 020409 is
350686 - adequate and will not cause delay of the meeting on 020405.
350687 - ref SDS 12 504H
350689 - ..
350690 - [On 020430 the doctor ordered PET Scan test because CT Cat
350691 - Scan test shows 1 cm cyst on liver and blood test shows CA
350692 - 15-3 is 81 and not falling as fast as expected following
350693 - surgery on 020327. ref SDS 19 M94O
350695 - ..
350696 - [On 020501 the doctor approved delay in PET Scan test to
350697 - 020529 about 2 weeks after urgent meeting scheduleed for
350698 - 020513 to review results of testing. ref SDS 20 0001
350700 - ..
350701 - [On 020603 PET scan found evidence of cancer in the arm pit
350702 - area where this capsule was removed; elevated CA 15-3
350703 - cancer marker indicates some continuing metastasis, but it
350704 - appears to be localized, rather than "distant" or systemic,
350705 - ref SDS 21 0001, as described above. ref SDS 0 FX5H
350706 -
350707 -
350708 -
350709 -
350710 -
350711 -
3508 -
SUBJECTS
Testing Bone Scan for Distant Metastasis Spread of Cancer
3603 -
360401 - ..
360402 - 2. Bone Scan Test Scheduled for Next 2 Weeks Urgent
360403 -
360404 - Background and procedures for bone scan testing is reviewed in
360405 - the record on 020318. ref SDS 7 A327
360406 -
360407 - This test will be performed by Nuclear Medicine.
360409 - ..
360410 - After meeting with the doctor, went to Nuclear Medicine. The
360411 - Department was closed, so the test request prepared by the
360412 - doctor was placed in the box next to the door.
360413 -
360414 - [On 020322 received test schedule from Kaiser. ref SDS 9
360415 - M46M
360417 - ..
360418 - [On 020628 bone scan shows no evidence of distant
360419 - metastasis. ref SDS 22 QA6L
360420 -
360421 -
360422 -
360423 -
360424 -
360425 -
3605 -
SUBJECTS
Testing Blood for Distant Metastasis Spread of Cancer
3703 -
370401 - ..
370402 - 3. Blood Laboratory Tests Scheduled for Today
370403 -
370404 - The doctor prepared a form requesting further blood tests,
370405 - that can be performed today at the Laboratory after this
370406 - meeting. On 020311 blood tests are identified as effective
370407 - procedures for identifying spread of cancer. ref SDS 7 A406
370409 - ..
370410 - This supplements blood tests taken on 020311 for the surgery
370411 - performed on 020312. ref SDS 4 A65H
370412 -
370413 - [On 020405 blood tests are favorable, except the results
370414 - showing CA 15-3 H 85 U/ML was expected to be lower; so
370415 - further test was scheduled prior to chemo therapy scheduled
370416 - for 020423. ref SDS 16 6T8K
370418 - ..
370419 - [On 020430 the doctor orders PET Scan test because CT Cat
370420 - Scan test shows 1 cm cyst on liver and blood test shows CA
370421 - 15-3 is 81 and not falling as fast as expected following
370422 - surgery on 020327. ref SDS 19 M94O
370424 - ..
370425 - After meeting with the doctor, and after visiting with the
370426 - Medical Imaging Department, and dropping off the request for a
370427 - test schedule at Nuclear Medicine, went to the Laboratory.
370428 - There were quite a few people waiting for tests.
370430 - ..
370431 - Steve had the presence of mind to have taken a number on the
370432 - way to the Medical Imaging (Radiology) Department. When we
370433 - returned from scheduling the CT and Bone scan tests, the
370434 - numbers had progressed quite a bit, so we only had about a 20
370435 - minute wait, rather than a 40 minute wait.
370436 -
370437 -
370438 -
370439 -
370440 -
3705 -
SUBJECTS
PET Scan for Distant Metastasis Spread of Cancer Not Recommended by D
3803 -
380401 - ..
380402 - 4. PET Scan Test Not Scheduled, May be Used in Future
380403 -
380404 - There was discussion of a PET scan, based on input from Pam.
380405 - ref SDS 8 0G6M
380406 -
380407 - On 020318 research on PET scan tests indicate this procedure
380408 - monitors response to treatment and provides early feedback on
380409 - its efficacy. ref SDS 7 KO5O
380411 - ..
380412 - Brain cancer is detected by PET Scan tests. ref SDS 7 MG7G
380414 - ..
380415 - Research on 020318 shows PET Scan tests are used to check for
380416 - distant metastasis when breast cancer occurs because the most
380417 - important factor determining long-term prognosis is the
380418 - involvement of the axillary lymph nodes, which has been
380419 - diagnosed, per above. ref SDS 0 6Q6N
380421 - ..
380422 - The doctor seemed to indicate that a PET scan is not
380423 - recommended at this stage of treatment, but that this method
380424 - could be used at a later stage after results of the initial
380425 - testing have been evaluated.
380426 -
380427 - [On 020430 the doctor orders PET Scan test because CT Cat
380428 - Scan test shows 1 cm cyst on liver and blood test shows CA
380429 - 15-3 is 81 and not falling as fast as expected following
380430 - surgery on 020327. ref SDS 19 M94O
380432 - ..
380433 - [On 020603 PET scan found evidence of cancer in the arm pit
380434 - area where this capsule was removed; elevated CA 15-3
380435 - cancer marker indicates some continuing metastasis, but it
380436 - appears to be localized. ref SDS 21 0001
380437 -
380438 -
380439 -
380440 -
380441 -
3805 -
SUBJECTS
Treatment Recovry 9 Month Program Chemo Therapy and Radiation
Reexcision Surgery on 020327 to Obtain Clear Margins on Pathology of
4004 -
400501 - ..
400502 - Schedule Treatment Plan Recover from Breast Cancer
400503 - Treatment Requires Surgery, Chemo Therapy and Radiation for 9 Months
400504 -
400505 - The doctor wrote out in handwriting on the back of the copy provided
400506 - for page 162 and 163 of AJCC Cancer Staging Handbook, a preliminary 9
400507 - month treatment plan.
400509 - ..
400510 - Treatment will commence in approximately 3 weeks, and will be
400511 - scheduled during the next meeting with the doctor on 020405.
400512 -
400513 - [On 020405 dates for treatment scheduled. ref SDS 16 549R
400514 -
400515 - [On 020423 treatment begins with AC. ref SDS 17 0001
400517 - ..
400518 - [On 021204 treatment completed, ref SDS 24 MO7O, showing CA 15-3
400519 - high and rising. ref SDS 24 SP5G
400521 - ..
400522 - At this time the recommended treatment will be...
400524 - ..
400525 - 1. Reexcision on 020327
400526 -
400527 - This is the surgery scheduled by Doctor Riley-Paull to get
400528 - "clear margins" in a call on 020318, ref SDS 7 5V7I, and
400529 - further on 030219. ref SDS 8 5V7I
400531 - ..
400532 - The pathology report on 020312 received from the doctor
400533 - mentions "margin" several times in para C of the Diagnosis
400534 - section, ref OF 2 9N4J, and also in para C of the section for
400535 - Gross Desc. ref OF 2 N16H
400537 - ..
400538 - There was no discussion today about findings on 020312 that
400539 - guide treatment toward reexcission surgery.
400540 -
400541 - [On 020405 this issue was not reviewed. ref SDS 16 FX7F
400543 - ..
400544 - Possibly the report on 020312 para C under Diagnosis that says
400545 - in part... DUCTAL CARCINOMA IN SITU APPROXIMATELY 4 MM FROM
400546 - THE MEDIAL MARGIN, ref OF 2 9N4J, shows that "clear margins"
400547 - were not achieved in the first surgery.
400548 -
400549 - [On 020327 reexcision surgery was performed. ref SDS 11
400550 - 0001
400552 - ..
400553 - [On 020405 results of reexcision surgery show clear
400554 - margins were achieved. ref SDS 16 HY5F
400555 -
400556 -
400557 -
400558 -
4006 -
SUBJECTS
Chemo Therapy 4 Cycles Adriamycin (AC) and Cytoxan 1 Treatment a Mont
4103 -
410401 - ..
410402 - 2. Chemotherapy Treats Distant Metastasis; Radiation Treats Tumor
410403 -
410404 -
410405 - 4 cycles of Adriamycin and Cytoxan (AC) over 4 months.
410407 - ..
410408 - The doctor propsoed chemotherapy teatments once every 3 weeks
410409 - over an approximate 4 month period.
410410 -
410411 - [On 020326 Carol suggests asking the doctor about
410412 - alternatives in the event these drugs are less effective
410413 - than expected or needed. ref SDS 10 IK7N
410415 - ..
410416 - [On 020603 PET scan found evidence of cancer in the arm pit
410417 - area where this capsule was removed; elevated CA 15-3 cancer
410418 - marker indicates some continuing metastasis, but it appears
410419 - to be localized; the doctor changes chemotherapy treatment
410420 - to Taxotere. ref SDS 21 0001
410421 -
410422 -
410423 -
4105 -
SUBJECTS
Radiation Treatment for 4 Weeks 4 Days Per Week
4203 -
420401 - ..
420402 - Radiation over 1 month Treats Areas Where Cancer Detected
420403 -
420404 - There was discussion this treatment would occur over a period
420405 - of 4 weeks following the first 4 months of chemotherapy.
420406 -
420407 - Treatment will be five days a week for four weeks.
420408 -
420409 - [On 020405 raditation will be directed at the area where
420410 - the tumor occurred and under the arm where infected lymph
420411 - nodes were removed. ref SDS 16 6SWY
420413 - ..
420414 - [On 020603 PET scan found evidence of cancer in the arm
420415 - pit area where this capsule was removed; elevated CA 15-3
420416 - cancer marker indicates some continuing metastasis, but it
420417 - appears to be localized; the doctor changes chemotherapy
420418 - treatment to taxotere, and expects this treatment together
420419 - with radiation to follow, will destroy this new cancer.
420420 - ref SDS 21 0001
420422 - ..
420423 - [On 020628 radiation treatment scheduled to begin on
420424 - 020708. ref SDS 22 QB5Q
420426 - ..
420427 - [On 020708 Doctor Moini plans six (6) weeks of radiation
420428 - treatment.
420429 -
420430 -
420431 -
420432 -
420433 -
420434 -
420435 -
420436 -
4205 -
SUBJECTS
Taxotere Chemo Therapy 1 Treatment Per Month Over 4 Months
4303 -
430401 - ..
430402 - Doctor's handwritten notes on the back of page 162 and 163 of AJCC
430403 - Cancer Staging Handbook further lists...
430404 -
430405 -
430406 - 4 cycles of Taxotere over 4 months
430407 -
430408 - The doctor advised the schedule for this treatment will be
430409 - similar to the first 4 cycles of AC, per item 2 above.
430410 - ref SDS 0 6SWS
430412 - ..
430413 - [On 020405 doctor indicated change to Taxol instead of Taxotere
430414 - prescribed today for the 3rd phase of adjuvant treatment, per
430415 - below, ref SDS 0 51CX; upon notice, the doctor changed back to
430416 - chemotherapy with Taxotere and disclosed that Taxotere is a new
430417 - drug; there was no discussion of clinical trial, per above,
430418 - ref SDS 0 O49J, nor were results submitted of clinical trials
430419 - for Taxotere relative to standard protocol using Taxol.
430420 - ref SDS 16 555X
430422 - ..
430423 - [On 020603 PET scan found evidence of cancer in the arm pit area
430424 - where this capsule was removed; elevated CA 15-3 cancer marker
430425 - indicates some continuing metastasis, but it appears to be
430426 - localized; the doctor changes chemotherapy treatment to
430427 - Taxotere, and expects this treatment together with radiation to
430428 - follow, will destroy this new cancer. ref SDS 21 0001
430429 -
430430 -
430431 -
430432 -
430433 -
4305 -
SUBJECTS
Evaluation and Questions on Treatment Planning
4503 -
450401 - ..
450402 - Treatment Evaluation - Questions
450403 -
450404 -
450405 - [On 020327 irregular heart beat reported during surgery for
450406 - reexcision. ref SDS 11 HX7H
450407 -
450408 - [On 020405 the doctor ordered tests to evaluate this
450409 - condition. ref SDS 16 RP6H
450411 - ..
450412 - Additional Questions from Carol....
450414 - ..
450415 - [On 020326 Carol suggests asking the doctor about alternatives in
450416 - the event these drugs are less effective than expected or needed.
450417 - ref SDS 10 IK7N
450419 - ..
450420 - [On 020326 Carol suggests asking the doctor how long will it take
450421 - before he knows if the treatment has been successful? In other
450422 - words...is it 6 months post chemo? or when? ref SDS 10 GQ7H
450423 -
450424 - On 020318 PET scan tests are explained as monitoring response
450425 - to a given regimen and providing early feedback on its
450426 - efficacy. ref SDS 7 KO5O
450428 - ..
450429 - [On 020326 what tests will be performed during the nine (9) month
450430 - treatment regimine to assess benefits and progress being achieved
450431 - and whether to adjust course prior to completion of planned
450432 - treatments? ref SDS 10 6J7K
450433 -
450434 - [On 020405 CA 15-3 is a cancer marker. ref SDS 16 6T8K
450436 - ..
450437 - [On 020603 PET scan found evidence of cancer in the arm pit
450438 - area where this capsule was removed; elevated CA 15-3 cancer
450439 - marker indicates some continuing metastasis, but it appears
450440 - to be localized; the doctor changes chemotherapy treatment to
450441 - taxotere, and expects this treatment together with radiation
450442 - to follow, will destroy this new cancer. ref SDS 21 0001
450444 - ..
450445 - [On 020708 radiation treatment adjusted from 4 to 6 weeks.
450446 - ref SDS 23 TV4I
450447 -
450448 -
450449 -
450450 -
450451 -
450452 -
450453 -
450454 -
450455 -
450456 -
450457 -
450458 -
4505 -
SUBJECTS
Chemo Therapy Side Effects of Treatment and Discuss Tolerance Medicat
Exercise Okay During Chemotherapy
4704 -
470501 - ..
470502 - Side Effects of Chemo Therapy, Tolerance Measures and Medication
470503 -
470504 - The doctor will arrange a meeting with a pharmacist to explain
470505 - treatment medications and anticipated side effects, along with
470506 - medications to help tolerate some side effects.
470507 -
470508 - This aligns with the article in the Kaiser Member News, reported
470509 - above. ref SDS 0 547N
470510 -
470511 - [On 020326 Carol suggests asking Doctor how these drugs work
470512 - in tandem with radiation. ref SDS 10 5Y7H
470514 - ..
470515 - Treatment under para 2 and 4 is described as chemo therapy, and can
470516 - cause loss of hair. The doctor explained a variety of coping
470517 - strategies that women use in working through this experience,
470518 - including getting their hair cut short early, to get used to a new
470519 - look, and experimenting with jewlery and wigs to suit personal fashion
470520 - preferences.
470521 -
470522 - [On 020405 Pharmachist introduced, ref SDS 16 A63O, and
470523 - explains effects of treatment, prescribes medications for
470524 - tolerating treatement, and for handling anxiety. ref SDS 16
470525 - ZY4J
470527 - ..
470528 - The doctor advised that patients react differently to treatment.
470529 - Therefore, actual impact and degree cannot be assessed in advance of
470530 - treatment. He feels that since Millie has regimine of regular
470531 - exercise, she can try to maintain this. Exercise does not impede the
470532 - usefulness of chemotherapy. Many patients find that physical effort
470533 - is less attractive as treatments progress, but some are less effected
470534 - due to slight differences in biology. He encouraged activity to
470535 - maintain general health, strength, stamina and outlook.
470536 -
470537 - [On 020425 Millie exercising following first treatment.
470538 - ref SDS 18 ZP7L
470539 -
470540 -
470541 -
470542 -
470543 -
470544 -
4706 -
SUBJECTS
Treatment Preparations
4803 -
480401 - ..
480402 - Preparing for Treatment and Tolerating Drugs and Radiation
480403 -
480405 - ..
480406 - [On 020326 Carol suggests asking the doctor what kind of
480407 - preventative measures will be prescribed to help tolerate the
480408 - chemo drugs? (anti-emetics,pain meds, etc.). ref SDS 10 RZ8O
480410 - ..
480411 - [On 020326 can the patient do anything now to become better
480412 - prepared for tolerating chemotherapy? ref SDS 10 SY9I
480413 -
480414 - [On 020405 the pharmacist addressed some of these issues.
480415 - ref SDS 16 JP7I
480417 - ..
480418 - [On 020326 dietary issues to prepare for and tolerate treatment.
480419 - ref SDS 10 GQ93 The doctor relates in the current issue of Member
480420 - News that dietary advice is part of the Walnut Creek oncology
480421 - support, per above. ref SDS 0 FQ9G
480422 -
480423 - [On 020405 phamphlets and other reading material was
480424 - submitted by the pharmacist on dietary issues. ref SDS 16
480425 - GF6M
480426 -
480427 -
480428 -
480429 -
480430 -
4805 -
SUBJECTS
Working During Treatment
SDI Coordinate Submission Obtain Information from Office Nixon Peabod
5004 -
500501 - ..
500502 - Working During Treatment, Commuting on BART for an Hour Each Way
500503 -
500504 -
500505 - [On 020326 ask the Doctor about continuing to work during chemo
500506 - therapy and/or radiation treatment. Some chemo drugs bring your
500507 - immune system down somewhat making you susceptable to getting ill
500508 - especially around lots of people. ref SDS 10 EU5F
500509 -
500510 - Commuting on BART from Concord to San Francisco for about an
500511 - hour twice a day presents exposure to "crowded" conditions.
500513 - ..
500514 - [On 020405 the doctor reviewed this matter.
500515 -
500516 -
500517 -
500518 -
500519 -
5006 -
SUBJECTS
Meeting on 020405 to Review Results of Testing Schedul
5103 -
510401 - ..
510402 - Meeting Set for 020405 to Schedule Treatment Dates
510403 -
510404 - The doctor scheduled a follow up meeting on 020405 at 1430.
510405 -
510406 - At that time, he will have results of the CT scan, Bone scan, and
510407 - blood tests, and so can confirm the course of treatment.
510409 - ..
510410 - At this time a written analysis and schedule of treatments can be
510411 - submitted by the doctor.
510412 -
510413 - [On 020405 written analysis of Millie's condition, treatment plan
510414 - and schedule was not submitted. ref SDS 16 MA3F
510415 -
510416 -
510417 -
510418 -
510419 -
510420 -
510421 -
510422 -
510423 -
510424 -
510425 -
510426 -
5105 -