Over treatment vs Under treatment in elderly

reachingforthestars

Hi all, thank you in advance for your replies. My mom was recently diagnoses with Stage 2a, possibly 2 b if they find more lymph nodes. Drs found a 2 cm mass in left breast and 2 enlarged lymph nodes via scan and tested positive for cancer via fine needle aspiration. She is ER positive 95% Pr positive 5% and her 2 Negative. Infiltrating duct carcinoma, grade 2. She is 81 years old with high blood pressure, high cholesterol, a bit overweight, and slight case of sciatica, general health is ok/decent.

Her Dr immediately states she need ACT, lymph node dissection, radiation of the axillary area, and aromatase inhibitor. He also denied her an oncotype dx test because he was sure that there would be more than 3 nodes when they open her up.

So, the classic question in the elderly is finding the balance of over treating and under treating, I understand that his orders are the gold standard of breast cancer treatment. However, it seems a bit drastic given her life expectancy as an 81 year old female. If she did not have cancer, it is postulated that she would on average live to 89. Lifemath predicts she would lose 1 year without ACT.

The only decision she has made is to have a lumpectomy. She is very scared of lymph node dissection. Have any of you declined lymph node dissection even though you had 2 or more positive nodes, and opted for radiation instead? Is radiation a good alternative to node dissection? She is on the fence about chemo, and whether it will have an impact on her overall survival. And if she opts out of the chemo will those remaining years just be full of pain?

She is most comfortable with the following treatment plan, Lumpectomy, radiation to axillary and breast area and aromatase inhibitor.

Does this sound reasonable? I know they say age doesn't matter, and overall health and physical strength are more helpful in guiding treatment options.

Would you say that this is an under treatment strategy? You fellow ladies are much smarter than the Dr's, they just go to school and memorize these regimens. You are actually going through it and know what it feels like, so sometimes it hard to trust a Dr that hasn't had to make that decision for himself. He just dishes it out as patients come and go, just numb to pt death or suffering.

Her oncologist was just so quick to the draw on his treatment plan, didn't really offer other plans, he said she will have side affects and didn't really seem to care if she got them or not, it was just a given. We are getting a second opinion, however at Kaiser Permanente everything is done by guidelines, the one treatment plan fits all program. So hopefully we can get a better answer from her new Dr.

Moderators

Dear reachingforthestars,

We are sorry to hear about your mom's diagnosis but glad that you reached out. Here is a reference to a study on Those over 80 on our main site for your interest. In that you are seeking a second opinion for your mom you may want to prepare a list of questions such that you have organized in your post to address at that appointment. There are programs around the country that address the specific needs of Older Adults and Cancer. You might inquire about such. The Mods

mustlovepoodles

Wow. I don't think I'd want to go through chemo at age 80. That's some wicked stuff. Can she get a second opinion?

Just for some perspective, my mom was diagnosed with end stage kidney failure last year at age 82. Her doctor told her the options were dialysis or--get this!--TRANSPLANT. What the heck?? She had dementia bad enough she didnt even know what dialysis was--and she was a nurse for 25 years! Dialysis is very hard on the body when you are young, but at 82? And transplanAnd transplant isnt even on the table when you're 82. Then they found stage 4 kidney cancer. I could not believe her bozo doctor suggested chemo! Thankfully, mom was lucid enough to understand THAT and decline it. She lived another 6 months on her own terms, no regrets.

Sometimes, I have to shake my head at these doctors...

letsgogolf

I would get another opinion. I would also want the Oncotype test. Without it, you would not even know if chemo would be of any benefit. Doctors need to look at the whole picture, including her age.

reachingforthestars

Thank you all for the input. Anything and all is helpful, in regards to that study, it included hormone negeative patients. Is it feasible to extrapolate that to hormone positive patients?

In your humble opinion, if she got a lumpectomy, radiation of lymph nodes and breasts and aromatase inhibitor under treatment? I’m not ask you what we should do or play Dr (aka God), just your opinion.

Thanks so much. I feel like I can ask questions freely here on this forum. When Speaking with friends and family they just say “it will all be ok” and “stay positive”, which is great don’t get me wrong. However they don’t understand the situation because they aren’t in it. I value everything thing and all the references you have. Thanks agai

ordinarybeauty

The oncotype dx test is for hormone positive folks. It will help determine if chemo would be of any benefit over and above hormone treatment and radiation. It showed me a probable reduction in recurrence of 25% in my case, given the specific genetics of my cancer tumor. I would insist upon the test before ruling out or in any specific treatment plan and then consider all the data when choosing a plan.

Hopeful82014

reaching for the stars - I sent you a private message.

lekker

Within Kaiser you can get a second opinion for free. I went to another Kaiser facility and met with the head of oncology for my second opinion. While they are strict on following the established guidelines (which can actually be a good thing), you can always decline all or part of a treatment plan. If you don’t feel comfortable with the first oncologist, ask to see another. All the best to you and your mother.

gemmafromlondon

I am very sorry to hear about your mother and the worry you are all having.

I think you need to have a serious talk with the medics about quality of life. It is not just a matter of survival. Axillary node surgery may well lead to disability. It is just not good enough to be informed that your mother will have side effects. These need to be quantified as far as is possible. You say she is reasonably well - if she is reduced to a totally dependant state she would probably be very unhappy and chemo might make her feel so ill that she might regret it. These decisions are very difficult as each one of us can be so different from the statistical averages docs quote in their "gold standard".but the quality of a patient's life is really much more important than just survival data. I have seen a number of friends spend their last year or so in a truly dreadful state when a good death a little earlier would have been much more humane. My very best wishes are with you.