[chrisy]

Hi Pink,
Great question, as usual!

Speaking as someone who's first real interaction with medical oncologists came after a stage IV diagnosis, I'll share my thoughts.

I agree, everyone will probably get the same "standard of care" regardless of who they see. My case was a bit complicated, and I was lucky to have my REALLY GREAT local oncologist refer me to my other REALLY GREAT (and big name) oncologist.

Initially, the value for me was twofold: I got to have a pair of great doctors confirm that, at that time, the best treatment was TCH. This was the proven approach and the standard of care in my situation. So I felt very confident in that "choice". I named the 2 doctors "Dr. cautiously optimistic" and "Dr. hope" because although both doctors recommended the same treatment, Dr. Hope was the first one who actually made me feel hopeful - coming from more of a research perspective - that I might have a lot more time than the statistics would suggest. In fact, my local oncologist(s) rely on this other doctor to do the same - keep them apprised of the early info from the research side.

So, I got a very effective treatment that put me in remission and kept me there for 2 1/2 years. I loved my local oncologist, and still do.

WHEN the cancer recurred, the advantage to me of having a relationship with the "big name" doctor was that I had immediate access (and actually already had an appointment) to some promising clinical trials - first a pairing of Avastin/Tykerb which kept me stable for 8 months, then the DM1 trial. I believe having the 2 oncologists allowed me to be in the "right place at the right time" when I needed it.

I do occasionally "name drop", not to offend or impress anyone, but because I believe that the big name doctors bring a different perspective as they tend to be those who are on the cutting edge of research. They're not necessarly better doctors, their orientation is just different - they are researchers first and clinicians second.

But as for the question "we all get the same standard of care treatment", most of the time that's true. As Joan and Jean have said, it is more critical with advanced stage or more complex situations.