Chemo location

MD Anderson is fantastic; no regrets about referring you there, as long as frequent travel between Houston and the Dallas area is feasible. Should be lots of flights, but I don't know about price or hassles getting through airports, especially if you're fatigued after chemo. If you're getting Folfirinox, you'll have a pump you take home for two days. Easier to return to the center and have them disconnect it if you're nearby, but if it's one of the new disposable, elastomeric pumps, maybe not so bad. Either way, they can show you how to disconnect and flush the port yourself, and maybe return a traditional pump on your next trip 2-3 weeks later.

There are 3 NPF Pancreatic Cancer centers of excellence near you listed here:
https://pancreasfoundation.org/patient-resources/npf-centers-of-excellence/
(Dallas, Ft. Worth, Plano)

If you don't have any personal objections or horror stories, those might be tolerable, but I'm quite impressed by how many clinical trials they have going at MDA. It's nice to be in their system so you can reconnect in a hurry if necessary.

FWIW, MDA is not listed on that page as a Center of Excellence. I called NPF and asked why; they said they would look into it and return my call, but never did.

I drive 2.5 hours each way for chemo. With blood work, Dr/PA/RN consult and then 3+ hours of pre-meds and actual chemo, it makes for a very long day and a rough drive home. Houston < --> Dallas looks like an even longer drive that I wouldn't wish on anyone, unless you either have hotel points to spare or want to start racking them up.

Local might also be easier (as long as they're really good centers) when you count the possible extra trips for imaging and bloodwork (CA19-9, Signatera, etc) which you should always have done at the same lab for consistency.

Good luck either way!

Edit/update: Were the 2 lymph nodes identified positive during surgery after removal, or did they detect 2 lymph nodes (on imaging?) after the surgery? Just trying to make sure I understand whether you were Stage-3 at surgery but clean now and just getting adjuvant/maintenance therapy, or are Stage-3 now and getting treated for currently infected lymph nodes? Reason for asking is because of whether you might get radiation treatment later as well. I know MDA has a Proton Beam machine, which might be preferable if the centers closer to you do not.

I found out about lymph nodes after surgery. Two of 32 pancreatic lymph nodes positive for metastatic carcinoma. It was ampullary adenocarcinoma. Margins were clear. I am pT3b and pN1 . Can’t even remember what that means . Seeing local oncologist on Aug 24 . MD Anderson Aug 29 . My daughter lives about an hour away .

Strongly recommend replicating to Anderson for treatment.

You might also be interested in this related discussion:
- Question on Chemo: How often? At Mayo or locally administered?
https://connect.mayoclinic.org/discussion/question-on-cemo/