@happydappy , One of the biggest frustrations in addressing my dad's cancer and my own is the "serial" nature in which they schedule appointments. One thing has to happen before another, and then they think about it, and then schedule your next, and you repeat the waiting cycle...

There might come a time when you want to get a second (and possibly third) opinion about your case. If you opt for those, they will also start you with the whole new-patient delay thing, and it may be too late (or too far into your first treatment) to get useful information from another institution.

I would recommend trying to make things happen in parallel while you wait:

1) Ask your insurer if they offer any sort of a "Virtual Second Opinion" program from a center of excellence. They can be very efficient about collecting and reviewing records.

2) Consider the other centers of excellence you might like an opinion from. If your primary center is Duke, you might not be too far from Vanderbilt or Emory. They might even be able to see you more quickly than Duke, depending on the backlog.

The only conflict I've experienced with the above was getting pathology slides from one center to the next in a timely manner. If anyone is sending your slides around, make sure you know where they are and what the chain of custody is.

Another advantage to having multiple institutions on board is if you need to get into a clinical trial. I have found that most big institutions don't refer patients to any trials outside their own. There might be a better option for you at another center, and if you're already an established patient there (even from just one consultation), it will eliminate the new-patient paperwork and speed up your access to a follow-on visit.