Questions About Hospitals-Vermont

Positive_Mental_Attitude

Hi All,

I am a kidney cancer survivor, and I understand the general language and treatment of cancer.  I was fortunate to be treated in NYC at Memorial Sloan Kettering with fabulous results.

My 42 year old brother who lives in Rutland, BT was just diagnosed with supraglottic mass.  He had his CT scan, and they did a biopsy yesterday.  He will get more info next Friday.

I have been telling him that he needs to go to the best hospital for cancer, and not just go the local route.  If I did that with my kidney cancer, the local doctor would have removed my entire kidney, whereas at MSKCCC, they took only 5% of my kidney.

He has Vermont medicaid for insurance.

He wants to have the surgery done by a local doctor in Rutland at Rutland Regional Medical Center. They have no specialty in ENT or Cancer.

http://health.usnews.com/best-hospitals/area/vt/rutland-regional-medical-center-6130210

 

Next closest hospital is Dartmouth-Hitchcock Medical Center

They have specialities in ENT and Cancer.  It is a National Cancer Institute "comprehensive" or "clinical" cancer center.  Seems to be the best choice, but my brother said that they are not kind to the patients on Vermont Medicaid.  I see that Dartmouth-Hitchcock sued Vermont Medicaid over reimbursement rates.  Of the ENT doctors affiliated, none of them list Vermont Medicaid as an option.

Next choice is University of Vermont Medical Center

The ENT doctor he has seen there was named to U.S. News and World Report’s Top Doctors list for 2012-2013. Dr. Brundage placed in the top 10% for excellence in Otolaryngology with special expertise in Head & Neck Surgery and Thyroid Cancer.  While their cancer speciality does not appear to be as strong as Dartmouth-Hitchcock, it seems from the research I have done, this may be the best place for my brother.

 

Thoughts?

Thank you.

 

Barbaraek

You will get a variety of answers to this question

Some will adamantly insist that you must go to a "big" cancer center, others will say that local is fine. So you must take everything with a grain of salt and make the choice that best fits your circumstances. I am speaking from the perspective of a wife whose husband trained at Memorial Sloan Kettering and who has worked for the past 12 years at a Comprehensive Cancer Center. Some years he has made the "best doctors" list and other years he hasn't. For what it's worth...

1. Comprehensive Cancer centers have a tumor board where the case is dicussed and a consensus is reached about the best course of treatment. In this case, many heads are better than one. Comprehensive Cancer centers and University based programs also have more options for clinical trials when standard treatment doesn't do the trick. They may also have more up-to-date equipment for different therapies.

2. Having to travel long distances or live away from home adds an extra burden to treatment...for some it is definitely worth it, for others (especially being away from family/friend support) it can be very onerous. Also...if you have a complication in between treatment days/times, where will you go for an emergency? These are things to think about.

3. Take the "Best Doctors/Best Hospitals" list with a grain of salt. Yes, they note leaders in the field...but knowing how the lists are constructed from an insider's point of view....they are not the last word on who is good and who is not. There are a multitude of competent, caring physicians in the USA who are NOT on the list. And due to the way they are reported/tabulated they are at least a year or two behind what is current. Here is an actual example - Dr. X, working at the hospital where my husband is a cancer surgeon, is listed as a "best doctor" in his specialty mostly because of the research he does, and the national positions he's held...BUT the number of surgical cases he does is limited and compared to other surgeons his technique is average. Also "best doctors" go by a very limited rating system - they won't indicate if they have a good bedside manner, how compassionate they are etc. "Best hospital" ratings have similar faults - they are a snapshot of how many cases are done, infection rates, research etc. they give you a picture but not the whole story.

4. Pathology is important - If you're not comfortable with local, you can still ask for a CCC or University based program to help with the workup and development of a treatment plan that is then implemented locally. Knowing the exact pathology is key in deciding the best treatment. Also it may lead you down the path of personalized medicine with gene sequencing and immunotherapy...these are usually to be found in the larger centers.

5. Wherever you choose - find out how familiar that hospital and doctor are with the disease and treatment. How many cases per year do they see? How many years experience do they have etc.

Good luck with everything!

Barbara

donfoo

welcome

Glad to see you get onboard so early in the process for your brother. CCC are generally known for solid, state of the art cancer diagnosis and treatment. They are closest and best qualified to handle rare conditions as these facilities are where such cases are often treated. 

As has been mentioned, two key factors is tumor board and treating lots of cases. Between having the power of a dozen or more specialists reviewing your case and having done this a lot of times provides them with the best wisdom to make the right call. Facilities other than just CCC meet this criteria.  Good luck and check in here often. Don

wmc

Opinions do very.

I can only speak of what I have seen and also what I had done. I am no doctor, but almost everyone thet I know of that went to the "Local doctores and hospital did not come through this anywhere close to how I did. I search out National Ranked Hospitals, but I was not restricted by insurance. First let me say where I live we do have very good doctors and the best in state with heart. I would never let them touch me for cancer and definally not ENT cancer. I was sent to the best in town to check me due to my weight loss and other complations.n I was told that I do not have cancer. He was oh so wrong, I had surgery in nine months and have been told mine had to be a minimum of one year and most likely one and a Half. Which makes me think if he would have found it back then, I might still have vocal cords. Also I personaly know a friends sister had to be ari lifted to Stanford to save her because they burned her so bad with radiation she almost did not make it. I know of some that went to large places in Southern Cal and can't rase their arm over there sholders from neck dissections. I had both sices done and more removed, but I have no problems.

Go to the best your insurance will ok and call them and seek there help as well.  I went to #9 ENT and #10 in Cancer, and have never regreated it. I chose them and even the doctor that would do the surgery.

I know it can be a mess with insurance and do wish you both the best. Just my 2 cents

Bill

Positive_Mental_Attitude

wmc said:

Opinions do very.

I can only speak of what I have seen and also what I had done. I am no doctor, but almost everyone thet I know of that went to the "Local doctores and hospital did not come through this anywhere close to how I did. I search out National Ranked Hospitals, but I was not restricted by insurance. First let me say where I live we do have very good doctors and the best in state with heart. I would never let them touch me for cancer and definally not ENT cancer. I was sent to the best in town to check me due to my weight loss and other complations.n I was told that I do not have cancer. He was oh so wrong, I had surgery in nine months and have been told mine had to be a minimum of one year and most likely one and a Half. Which makes me think if he would have found it back then, I might still have vocal cords. Also I personaly know a friends sister had to be ari lifted to Stanford to save her because they burned her so bad with radiation she almost did not make it. I know of some that went to large places in Southern Cal and can't rase their arm over there sholders from neck dissections. I had both sices done and more removed, but I have no problems.

Go to the best your insurance will ok and call them and seek there help as well.  I went to #9 ENT and #10 in Cancer, and have never regreated it. I chose them and even the doctor that would do the surgery.

I know it can be a mess with insurance and do wish you both the best. Just my 2 cents

Bill

Thank you for all of the

Thank you for all of the responses. 

I will pass the info on to my brother.  He is more inclined to just get the tumor out ASAP.  He is not married and has no children.  He will need to arrange rides from friends if he is to go to a hospital far from home.  I want him to get the best care.  My other concern is it does not seem he is willing to make the lifestyle choices to make a difference.  He is a heavy smoker and drinker.

My inclination is to try to steer him to the University of Vermont hospital in Burlington.  Aside from the "best doctors" reviews, the doctor he saw years ago has excellent reviews from patients on vitals and other patient rating websites.

Barbaraek

Positive_Mental_Attitude said:

Thank you for all of the

Thank you for all of the responses. 

I will pass the info on to my brother.  He is more inclined to just get the tumor out ASAP.  He is not married and has no children.  He will need to arrange rides from friends if he is to go to a hospital far from home.  I want him to get the best care.  My other concern is it does not seem he is willing to make the lifestyle choices to make a difference.  He is a heavy smoker and drinker.

My inclination is to try to steer him to the University of Vermont hospital in Burlington.  Aside from the "best doctors" reviews, the doctor he saw years ago has excellent reviews from patients on vitals and other patient rating websites.

I understand the need

to DO something and the desire to get the cancer out right away. That said...it's important to take some time to fully assess the situation so you can get the most effective treatment. You know that intellectually, it's just hard to process emotionally. Best of luck to your brother in the path that he takes.

Barbara

ratface

another perspective

There is nothing preventing treatment at multiple hospitals. You can do chemo/ radition in one place and then shop for a world class surgeon somewhere else if needed.

donfoo

ratface said:

another perspective

There is nothing preventing treatment at multiple hospitals. You can do chemo/ radition in one place and then shop for a world class surgeon somewhere else if needed.

another twist 2

Some also get their full diagnosis and treatment plan set at a CCC then seen actual treatment locally