Week 9 – To Surgery or Not to Surgery?
This week, we had numerous patients scheduled, so I saw more patients than usual. While looking at back my notes made during shadowing, I noticed a common trend during this particular week which I’ll explain below.
Surgery in general is a relatively risky procedure, and thus, it is only typically done within oncology if medically necessary. The decision behind surgery is to usually remove the mass, which is most commonly pre-cancerous or cancerous. From what I’ve seen so far, most patients are anxious and typically want their surgery done as soon as possible to eliminate the potential cancer.
However, this week, many of the patients I saw wanted the surgery to alleviate certain symptoms or out of convenience in the long term. For example, one patient in particular had a benign mass, but one symptom in association with the mass was nipple discharge. The mass had a 20% chance of being precancerous but was still something that could be monitored every 6 months via mammograms. Thus, it was the patient’s choice to decide if they would like to proceed with surgery. The patient’s primary concern was their nipple discharge, and once Dr. Jatopi explained that there was a high chance the nipple discharge would be gone after the surgery, the patient decided to go with surgery. This patient is also pre-diabetic which puts them at almost quadrupled the regular risk of infection post-surgery. Despite Dr. Jatoi thoroughly explaining this risk, the patient still opted for surgery because of how much their nipple discharge was costing their quality of life.
Another patient had a genetic condition where their lifetime risk of breast cancer equated to about 30% which is more than double the average lifetime risk of 12.5%. Fortunately through endocrine therapy, requiring the patient to take a pill daily for 5 years, her lifetime risk would reduce to 15% which is why this option is usually the most recommended by the physicians. However, this patient wanted a preventative total mastectomy (essentially removal of both breasts) as she explained she did not want to have to take a pill daily nor come into the doctor’s office every few months for the required follow-ups. This patient planned on having no further children and was confirmed to have a plastic surgery reconstruction consultation which is added reason as to why she wanted a preventative total mastectomy.
There were about 4 more patients with similar reasoning to the previous two examples. Some of these patients also had added risks as mentioned in the first example either with diabetes, poor liver function, additional cysts, age, etc., but they still opted in for surgery because of how their quality of life would be impacted by the alternative options. Overall, this was a new perspective that I became more aware of after seeing the frequency of these specific patients this week. Before shadowing, I held a general belief that the alternatives to surgery were better options, but after shadowing for a few weeks now and truly listening to these patients’ reasonings and diminished quality of life, I completely understand their views behind why surgery was a better option for them.