Inquired at

Assoc. Prof. Priv. – Doz.
Dr. Rubert Bartsch

Specialist in hematology and oncology, Vienna General Hospital, Department of Internal Medicine, Division of Oncology, Breast Outpatient Clinic

Prof. Bartsch, when in the course of breast cancer do patients come to see an oncologist?

We usually only see patients with early-stage breast cancer for whom systemic therapy is planned.
These are patients who are to receive pre- or post-operative chemotherapy with or without immunotherapy.
In addition, patients with anti-hormonal treatment are also treated, whereby this can also take place at our center at the Clinic for Surgery.

In the case of metastasized breast cancer – i.e. if there are metastases in other organs – treatment is primarily carried out in our department.

In the initial consultation with their patients, oncologists propose the treatment plan.
Is it right that patients have a say, if not the right to decide?

The final decision is made by the patient herself; we oncologists make a recommendation.

But of course we do not leave patients who are not appropriately trained and do not have the relevant background knowledge alone with such a decision.
Even if there are theoretically – which will almost never happen – two completely equivalent options, doctors will always prefer one of the two.
This is always conveyed, consciously or subconsciously, to patients through body language and the way they are communicated.

The women concerned have decision-making authority, especially in the case of hormone-receptor positive tumors.
It can be discussed on a case-by-case basis for which women additional chemotherapy makes sense.
In these cases, it is a matter of small advantages in the range of 5% – 10% absolute risk reduction for the risk of relapse.
Patients must be involved, they must ultimately make an active decision in favor of chemotherapy.
Some women do not want chemotherapy, at least not if it only reduces the risk of relapse by 5% in ten years.
Others do not want to take any risk at all.

This is what we mean when we say that the final decision lies with the patients themselves.

How quickly do patients have to decide?

We usually have time.
Patients usually see their oncologist about two weeks after the operation.
If we are within