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WOMEN IN
MEDICINE

large tumor burden and her young age,
the decision for use of cytotoxic therapy
was given. She underwent an initial treat-
ment plan with dose dense chemotherapy
(instead of a q 3-week schedule of ther-
apy, data now support treatment given
more frequently and in shorter intervals
including every two weeks and weekly
schedules of therapy).
This patient’s tumor initially did not
appear to be responsive and so unlike
some current approaches with use of an
alternate regimen, she was taken to sur-
gery and due to the BRCA mutation
presence, she underwent bilateral mastectomy. Since post mastec- gist. She had researched her selection of her oncologist as she was
tomy irradiation to the right breast and axilla was to be performed given many names based upon their online reviews, posted infor-
postoperatively, she was deemed a candidate for use of tissue ex- mation about training and experience and location from her home.
panders for a delayed reconstruction after all of her chemotherapy Interestingly, though there were oncologists closer to home which
is done. She was not deemed a candidate for autologous reconstruc- was critical for her home-schooling efforts and provision of child-
tion. Failure of achieving a pathologic complete response (PCR) is care, she selected someone whose office was farther away based
a poor prognostic factor (unfortunately, she has many) but is not upon the online reviews and word-of-mouth reputation regarding
uncommon to see in patients with Hormone receptor (HR)-positive delivery of care.
breast cancer. Most recent estimates suggest HR +Breast cancer pa- Use of social media and online sources is a common way for
tients receiving NAC achieve a PCR in the range of 20 to 40 percent quick access to information today and though I have not seen this
depending upon the associated HER 2 Neu status of the tumor in influence a patient’s treatment plan completely, many patients are
comparison to HR negative breast tumors where PCR may be as influenced by what is deemed acceptable. I have patients who had
high as 60 to 80 percent. stayed with one provider just simply due to a perceived sense of a
The challenges of providing such care are beyond the scope of more or less aggressive approach as dictated by friends or family. I
this writing because of the complexity of the disease and her poor have many people tell me on their first visit that they knew about
prognosis and the complexity of treatment. She will now complete me and had looked me up online to be sure that I was the right fit
a full year of HER 2 targeted therapy in addition to consideration for them.
of what is the best strategy for estrogen blockade though a future Along with all the complexities of treating a challenging disease
complete hysterectomy that will likely render her post-menopausal and supporting a patient is the influence of right and wrong ap-
which then provides an option for use of an Aromatase Inhibitor. proaches and “established” approaches that influence patients’ care
As she began her journey, the best sources of information were and acceptance of care based upon social media.
other survivors, but she also checked websites that provided infor-
mation and she talked to me and other health care professionals. As Sharon T. Wilks, M.D., FACP is an oncologist working
a result, which is common today, she had a sense of treatment op- for Texas Oncology. She specializes in hemotology and
tions that should be offered prior to her first visit with her oncolo- medical oncology.

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