Family members wanted me to get my treatment at Memorial Sloan-Kettering or the University of Pennsylvania, the most prestigious cancer centers within reach. Meanwhile, I really liked Biren Saraiya, the smart and compassionate thoracic oncologist closest to home. I also didn’t like the idea of riding the train or driving an hour or two for chemotherapy infusions, tests, and appointments with the doctor (it was going to work out to at least one trip a week). With my coughing and fatigue, and the potential for nausea, I wanted to conserve whatever energy I had, and not use it all up on travel.
Dr. Saraiya is not just any community oncologist. He is affiliated with what was then The Cancer Institute of New Jersey (now Rutgers Cancer Institute of New Jersey), a National Cancer Institute–designated comprehensive cancer center. Still, TCINJ/RCINJ is not the same kind of household word in cancer treatment as Sloan-Kettering or Penn.
We came up with what I still consider a brilliant plan. Dr. Saraiya, who takes a collaborative approach I consider essential in thoracic oncology, encouraged me to go ahead and meet with the oncologists at Sloan-Kettering and Penn. If they could offer me something he couldn’t, like a spot in a promising clinical trial, he wanted me to take advantage of that. However, if they recommended treating me with drugs he also had at his disposal, he would treat me in New Jersey. Then, at any point along the way when we needed to contemplate a change in my treatment plan, I would consult with the big-city oncologists again.
I was worried that this was too complicated, but it turned out that Jamie Chaft, my oncologist at Sloan-Kettering, and Roger Cohen, my oncologist at Penn, liked the plan, too. There was no reason, they said, for me to endure extra travel for infusions with the exact same drugs I could get fifteen minutes from home. They would be happy to see me again at the next turning point in my treatment.
Dr. Saraiya explained that my being a patient at multiple centers improved his access to the latest information and clinical trial updates as well. He could always call oncologists at other centers for information, but returning his call might not always be their top priority. If they shared a patient, though, they could share information much more rapidly.
At the time, I was just pleased to be able to drive down the road for chemo, and not to have to go to New York or Philadelphia. Now, I’m actually stunned by the brilliance of my oncologists’ collaboration: because I am an active patient at three different centers, I have access to more clinical trials. (You can’t just sign up to take any experimental treatment; you have to be under the care of doctors who are involved in the trial.) Dr. Saraiya treated me from January to August of 2013; in August, when I joined the clinical trial for crizotinib at Sloan-Kettering, Dr. Chaft became my lead oncologist. If I ever need to go to the emergency room, though, I can still go right up the road, where Dr. Saraiya is right next door and has remained up-to-date on my illness and treatment.
The only thing is that I can’t assume they each know everything the others know. At every appointment, if I’ve seen one of the other oncologists, I try to repeat everything they said in my own words, to supplement the e-mails they’ve exchanged. I also keep a running list of questions for each doctor, and if they say they’ve asked or told each other something, I follow up.