Can I delay the start of chemo for 1 month?

Expat2uruguay

Hello everyone. This is my introductory post. I'm recently moved to South America and in addition to breast cancer, I'm also struggling with language difficulties. I am having trouble getting specific information from my doctors, since they don't speak very good English and I don't speak very good Spanish. Uruguay has an advanced Healthcare System and my healthcare organization is very knowledgeable about breast cancer. But I am not, so I don't know the terminology or what questions to ask. So I think this is one way that this group can be helpful for me, so that I can ask intelligent questions of my caregivers. I will be accompanied by a bilingual friend to assist in the conversation with the oncologist.

I had a lumpectomy on my right breast on June 5th, removing a malignant tumor of just under two centimeters. My lymph nodes were tested during surgery and two levels were removed. I don't yet have results from analysis of those tissues. Yesterday was my first appointment with the oncologist and they want to start 8 sessions of chemo on 21 day schedule, followed by six to eight weeks of targeted radiation treatments. Ugh.

I would like to visit my family in the US before starting treatment. I already have a plane ticket that I purchased before diagnosis for August 1st. I next see the onocologist on the July 24 and I plan to discuss with him then the idea of a four-to-six week delay before starting my chemo treatments. Tomorrow they are testing my blood for creatinine and a complete blood count.

So my questions today really center around the things to consider when contemplating a delay of the start of treatment, and how to ask intelligent questions from my doctor. Tests so far have shown that there's no more cancer in my body right now, but he does want to do more tests.

Thank you in advance to those who respond with advice. It is really scary to face this alone in a foreign land, but I am unwilling to return to the US for treatment so I'm looking to make the best of the situation.

mustlovepoodles

All you can do is ask, I guess. I had my lumpectomy Aug 19, then re-excision to get clean margins. Due to an infection I had to delay chemo for 2 month, until Oct 19. My MO wasn't thrilled with that, but chemo couoldn't start until the infection was completely cleared up.

moth

"Overall, the authors found no evidence of adverse effects when patients started chemotherapy between 31-60 or 61-90 days after their surgery as compared to patients who started their chemotherapy in 30 days. However, for patients who started their chemotherapy 91+ days after their surgery the results weren't so good. These patients experienced worse overall survival (hazard ratio [HR], 1.34; 95% CI, 1.15-1.57) and worse breast cancer–specific survival (HR, 1.27; 95% CI, 1.05-1.53). "

(this is from a breast surgeon's blogpost reporting on studies about the effects of delaying surgery and chemo)

https://respectfulinsolence.com/2016/01/12/breast-...

this is the actual study https://www.ncbi.nlm.nih.gov/pubmed/26659132

the study also noted that triple neg cancers especially had poorer outcomes if there was a delay in the chemo so you should probably take that into consideration. Do you know your tumor's hormone receptor status?

Moderators

Hi Expat and welcome to Breastcancer.org!

We're so sorry to hear of your diagnosis and that you're facing such challenges while navigating your treatment. We hope you find great answers, advice, and support here!

We wanted to point you in the direction of the same studies moth references above. For an easy-to-understand version of what the studies mean for you, check out the main Breastcancer.org site's Research News Article Timely Breast Cancer Treatment Improves Survival.

We hope this helps and we look forward to hearing more from you soon!

--The Mods

Shellsatthebeach

Looks like moth already asked you about what kind of tumor you had. Some are more aggressive than others. I believe the two types you wouldn't want to delay is triple negative and/or if you have IBC. It sounds like you don't have triple positive since you would have had to start chemo treatments before surgery along with a special kind of therapy.

Expat2uruguay

Actually, there's no results yet from the tissues they took duringmy surgery 6 weeks ago. Should I be concerned that it is taking so long to get the results? Did they lose it!!!?

Meow13

My oncologist told me no. He said if I delayed more than one week it would not be offered to me again. I passed on it.

mustlovepoodles

Expat, you've been waiting for results 6 WEEKS?! Where did they send it, Antarctica?

molliefish

I delayed chemo for 3 weeks based on the project I was working on and that my surgeon took 4 weeks from the surgery to the day I got my results I figured if they weren't in a rush I wasn't In a rush. Your decision should be based on your diagnosis and your gut instinct. No one can predict what the impact of a slight delay will be. Go with what your heart tells you.

Expat2uruguay

Original poster here. So, I was able to delay the start of treatment for 3 weeks and started today. I filled out more information on the statistics regarding my diagnosis and treatments so that information is available to those who ask or are interested. Thank you to all who responded.

wanderweg

meow - your oncologist said you would not have the option of chemo if you delayed by a WEEK? That’s one of the craziest things I’ve heard. I would understand him pushing you to move quickly but that’s just a dick move to threaten you like that.

Meow13

He wanted me to start December 21st and I asked if it could wait till after the holidays he said no. I had mx on November 5th one month after diagnosis.

So it was pushing 3 months Jan 5th. It just rubbed me the wrong way almost like a used car salesman. The info from oncodx was pushing for the chemo at 34. But my pathology showed grade 1 and just barely grade 2 on the other. Both tumors 1cm each multicentric not multifocal. I looked over the ststistics presented by oncodx and said no chemo much to my mo's dismay.

I think I made the right choice especially to take anastrozole not tamoxifen. I found later that it was the pr- which drove the oncodx score to 34.