We have talked to
Assoc. Prof. Priv.-Doz. Dr. Rupert Bartsch
Specialist in haematology and oncology
Vienna General Hospital, University Clinic for Internal Medicine
Clinical Department of Oncology, Breast Outpatient Clinic
Prof. Bartsch, when during breat cancer treatment do patients see an oncologist?
We usually see only patients with early 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 we also care for patients with anti-hormonal treatment which in our centre can also take place at the Clinic for Surgery.
In the case of metastasised breast cancer – i.e. if there are metastases in other organs – treatment is primarily carried out at our department.
Thus, the diagnosis has usually already been confirmed in patients who come to our department for their first consultation.
However, second opinions are also offered, which often go beyond the scope mentioned above. A primary referral to oncology or a primary clarification via our department, on the other hand, is rare.
In the initial consultation with their patients, oncologists suggest 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 give a recommendation.
But of course we do not leave patients who are not trained and do not have the 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 options. This is always conveyed, consciously or subconsciously, to the patients through body language and in the way it is communicated.
The women concerned have the authority to make decisions, especially in the case of hormone receptor-positive tumours. In individual cases, it can be discussed which women would benefit from additional chemotherapy. 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 have to be involved, they have to decide actively in favour of chemotherapy. Some women don’t want chemotherapy, at least not if it only reduces the risk of recurrence 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 make a decision?
We usually have time. Usually patients see their oncologist about two weeks after surgery. If we start therapy within 6 weeks after an operation, I am satisfied.
Medically, we usually have no pressure with breast cancer, not even with metastatic breast cancer. The only exception is visceral crisis, i.e. when the tumour disease triggers severe organ dysfunction. However, this is extremely rare and is the only exception to the rule.