Mom had her follow-up CT scan on Weds and got the results on Friday.  The adrenal tumor has shrunk, which is probably why she hasn’t been in much pain.  Unfortunately, the liver tumors have grown.  The doctor informed her that they could do surgery to remove the tumors from the liver and hope that the liver would regenerate, but given the fact that so much of the liver is diseased, that was not highly probable.  In fact, the chances of surviving the surgery are not great.   Mom has opted not to have surgery.  Hospice has been contacted and Mom will begin working with them on Monday.   Everything I’ve heard about hospice is that it is good to get them involved as early as possible so that they can develop the relationship with the patient and the family.  We are all glad that there will be somebody to work with us to make sure Mom is able to stay at home and get the treatment she needs to be comfortable.

A couple of weeks ago I had the opportunity to listen to a presentation about Oncology and standards of care.  It was very interesting and highly informative, especially now that I am immersed in the system.  The biggest slap on the head I got from it was that the Oncologists make about half of their salaries from selling medications (chemotherapy).  I didn’t get how that worked until I asked — Since most chemo is delivered in the doctor’s offices, they buy the chemotherapy drugs wholesale and then charge full rates when they bill for it.  The bottom line is that the physicians are incented to prescribe meds and treat to the full extent possible versus really taking into consideration what is truly in the patient’s best interest.  I know that I have a “quality of life” focus on the issue so I’m sure there are good arguments to the contrary. 

I also learned that there are many doctors who prescribe treatments that don’t make sense, and don’t follow “best practices” as defined by their peers (i.e. the American Academy of xxologists).  As a health care consumer, I wonder if there’s a way of finding out which doctors are the best in their profession.  Admittedly, I prefer using doctors who have a good bedside manner and a nice personality (looking fiiine in scrubs is an added bonus).  Unfortunately, none of my criteria leads me down the path to ensure I am getting appropriate care. 

 Anyhow, I think Mom landed with a great physician who is compassionate beyond belief, offers up every opportunity to fight the cancer battle, and is supportive of Mom’s decisions about care.   It will be interesting to see how the whole hospice piece plays out.  I’m guessing it will be very positive.

Next week begins the next phase of this journey.