Treatment Plan

Stem cell transplants can be performed as part of the initial therapy, at the time of first relapse and later in the course of the disease. Following initial induction therapy, autologous transplants are being used in first remission for patients with mantle cell lymphoma and T cell lymphomas; although there is not uniform agreement on this practice. Patients with diffuse large cell lymphoma are generally offered autologous transplant when relapse occurs following a first remission. Patients with follicular lymphoma are not offered transplant until the have relapsed 2 or more times or when their disease has transformed to a more aggressive subtype. Stem cell transplants can be performed as part of the initial therapy, at the time of first relapse and later in the course of the disease. Following initial induction therapy, autologous transplants are being used in first remission for patients with mantle cell lymphoma and T cell lymphomas; although there is not uniform agreement on this practice. Patients with diffuse large cell lymphoma are generally offered autologous transplant when relapse occurs following a first remission. Patients with follicular lymphoma are not offered transplant until the have relapsed 2 or more times or when their disease has transformed to a more aggressive subtype.

Patients with newly diagnosed non-Hodgkins lymphoma can have an excellent prognosis, but it depends on a number of factors. The most important piece of information is to obtain an adequate biopsy so that a correct diagnosis can be made. Small needle or fine needle aspiration biopsies are inadequate and it is strongly recommended than a excisional biopsy be obtained. Second, is to complete staging to determine the extent of disease. This includes CT scan of the chest, abdomen and pelvis and more frequently, a PET scan. Bone marrow aspiration, blood and urine tests are require to judge the extent of disease. Once these tests are obtained, it will be possible to develop a treatment plan based on lymphoma type, staging of disease, prognosis and the patients symptoms. The treatment could range from watchful waiting without immediate treatment to aggressive chemotherapy followed by autologous stem cell transplant. Patients with newly diagnosed non-Hodgkins lymphoma can have an excellent prognosis, but it depends on a number of factors. The most important piece of information is to obtain an adequate biopsy so that a correct diagnosis can be made. Small needle or fine needle aspiration biopsies are inadequate and it is strongly recommended than a excisional biopsy be obtained. Second, is to complete staging to determine the extent of disease. This includes CT scan of the chest, abdomen and pelvis and more frequently, a PET scan. Bone marrow aspiration, blood and urine tests are require to judge the extent of disease. Once these tests are obtained, it will be possible to develop a treatment plan based on lymphoma type, staging of disease, prognosis and the patients symptoms. The treatment could range from watchful waiting without immediate treatment to aggressive chemotherapy followed by autologous stem cell transplant.

I require a very complete set of medical records for my new patients. I review these carefully. If I am unfamiliar with any aspect of their cancer or treatment, I research by reading my oncology text books, reading published studies and consulting with my naturopathic and oncologist colleagues. My first visits with new patients are typically 90 minutes so that I can learn as much as I can about each person as an individual (after all they are people with cancer, not just cancer diagnoses). I then several more hours developing my recommendations, which stem from my experience and additional research. I then provide my consultation note and my recommendations to the patient and to their other healthcare providers. I typically follow-up with patients in accordance with their treatment and disease experience on a repeated basis. I require a very complete set of medical records for my new patients. I review these carefully. If I am unfamiliar with any aspect of their cancer or treatment, I research by reading my oncology text books, reading published studies and consulting with my naturopathic and oncologist colleagues. My first visits with new patients are typically 90 minutes so that I can learn as much as I can about each person as an individual (after all they are people with cancer, not just cancer diagnoses). I then several more hours developing my recommendations, which stem from my experience and additional research. I then provide my consultation note and my recommendations to the patient and to their other healthcare providers. I typically follow-up with patients in accordance with their treatment and disease experience on a repeated basis.

It's fantastic that you ask! I think the best way is to have a multidisciplinary approach to treatment planning with input from all levels of the treatment team especially psych/counseling staff. Each patient is unique and will therefore have different bio-psycho-social needs and strengths. While the regimen for treating two different patients with the same diagnosis may seem to be the same, each will likely react differently to the treatment and may need alterations based on variables of personality, economics, primary support, etc.

The most important action to consider is that the physician LISTEN and PAY ATTENTION, not just to signs, symptoms, breath sounds and the like, but to the patient him/herself. Especially in Oncology, the spiritual connection between treatment team and patient must be cultivated and nurtured for the best outcomes to occur. It's fantastic that you ask! I think the best way is to have a multidisciplinary approach to treatment planning with input from all levels of the treatment team especially psych/counseling staff. Each patient is unique and will therefore have different bio-psycho-social needs and strengths. While the regimen for treating two different patients with the same diagnosis may seem to be the same, each will likely react differently to the treatment and may need alterations based on variables of personality, economics, primary support, etc.

The most important action to consider is that the physician LISTEN and PAY ATTENTION, not just to signs, symptoms, breath sounds and the like, but to the patient him/herself. Especially in Oncology, the spiritual connection between treatment team and patient must be cultivated and nurtured for the best outcomes to occur.

First it is important to understand the diagnosis. Some of the important factors to understand are:
- is the cancer invasive or non-invasive
- your mammogram
- your pathology report
- your margins of resection
- your medical history
- details of similar cases

After analyzing these factors, your medical team will determine the stage of the disease and treatment options. In many cases, surgery might be necessary to determine the stage of the cancer. In these cases the patient will have to make a decision for short-term treatment, as well as another treatment decision after the surgery.

An example of a common set of treatment options are the following:
- hormonal therapy
- breast conservation surgery - lumpectomy plus radiation
- mastectomy
- mastectomy plus radiation
- chemotherapy followed by surgery First it is important to understand the diagnosis. Some of the important factors to understand are:
- is the cancer invasive or non-invasive
- your mammogram
- your pathology report
- your margins of resection
- your medical history
- details of similar cases

After analyzing these factors, your medical team will determine the stage of the disease and treatment options. In many cases, surgery might be necessary to determine the stage of the cancer. In these cases the patient will have to make a decision for short-term treatment, as well as another treatment decision after the surgery.

An example of a common set of treatment options are the following:
- hormonal therapy
- breast conservation surgery - lumpectomy plus radiation
- mastectomy
- mastectomy plus radiation
- chemotherapy followed by surgery