Is chemo / radiation / hormon therapy a must?

Anonymous

Is chemo / radiation / hormon therapy a must?

icic14

My mom's 58.

Result says she has an invasive breast cancer in her right breast (ER+,PR+,HER2-). Around 1.55 to 2 centimeters. But her right breast is so much smaller than the other one, and there's redness (flaky) on her breast skin.

She was diagnosed with OCD & a lil bit of Schizophrenia around 7-8 years ago. And has gotten better around 3 years ago, but she still has anxiety. She has tremor on hands, can't really walk. Lately her legs are so weak that she keeps on falling, doesn't want to eat anything, refuse to take tamofen (or any other medicine & treatment).

Her onco said she need to shrink the cancer first to be able to do any surgery. Me & my father feel so helpless. We don't think she'll accept chemo and radiation procedure. Being able to do biopsy itself is a miracle. (Core needle biopsy).

After failing to feed her anything, we tried to feed her alternative medicine (herbs) that's said good for cancer. She took it for a few days (which needed so much persuasion and force), but these few days she didn't. We're tired of forcing her to eat medicine (she'll kick us, and she seems so tired, out of breathe after the process that it breaks our hearts).

We're thinking if it's better to find other surgeon who's willing to do surgery (without any other cancer treatment like chemo, radiation, or hormon therapy).

But we need more opinions before deciding on that :

1. Does every stage III cancer need chemo, or radiation, or hormon therapy?

2. Do you think it is better to just do the surgery (without being able to do any other cancer treatment)? Or is it better to leave the cancer alone (don't operate) and keep on trying to feed her alternative medicine?

We don't plan to feed her tamoxifen, I heard it'll have no effects if we cannot make sure she takes it every 24 hours. (Because most of the time she will refuse to)

Any opinion or ideas to help my Mom is very much appreciated.

Thank you so much.

Rah2464

Icic14 I am truly sorry to hear of your Mother's breast cancer diagnosis and the complications involved with her mental health challenges. What a very difficult situation for you all. Do you or your father have medical power of attorney so that you can discuss options with medical personnel? I hope that you can and do pursue getting another opinion given your Mother's anxiety around medications. Have you met with a breast surgeon at all?

Since the tumor is ER/PR + and HER2-, unless there is strong concern that they will not be able to obtain clear margins, wondering why they won't try the surgical route first. If you feel your mother could not tolerate radiation, would she be open to a mastectomy? I chose a mastectomy rather than lumpectomy + radiation, but I was able to achieve clear margins.

icic14

Rah2464 Yes we have the right to discuss it with medical personnel. But unfortunately, most of the one we talked to, won't give us any idea beside the conventional method : chemo -> surgery.

Sorry, but may I ask, if someone choose to have mastectomy, is hormonal therapy optional or a must?

Is it better to have mastectomy without hormonal therapy OR not to have mastectomy if the patient may not be able to proceed with hormonal therapy later on?

I understand that hormonal therapy lower the risk of recurrence and may shrink or kill the leftover cancer cells after surgery. But what's the risk if the patient cannot have it?

flashlight

Hi, I agree with Rah2464. If your Mom's pysch doctor can control her anxiety so that she could have surgery and then radiation it would give her a chance with or without Tamoxifen. Without surgery your Mom's cancer will grow. Best wishes.

jhl

Hello icic14,

There is so much to unpack with regard to your mom's health. As much as you may not want to, I agree with others that you & your Dad will need to get your mom's mental health in a better place. Is she seeing a psychiatrist regularly? Does he/she prescribe medication & is your mom compliant with her antipsychotics? When her oncologists speak about chemo prior to surgery, I don't believe he/she is referring to tamoxifen (which is only used in premenopausal women for the most part). He/she is referring to oral or IV medication which will require the ability to take it every day (for orals) & regular appointments for IV medication. These will also require frequent blood draws to monitor and sometimes fluid or electrolyte replacement. It is pretty standard for medication to be ordered for anxiety but not to the extent it seems your mom will need. It is not reasonable to expect nurses to deal with a combative & recalcitrant patient nor is it possible for her to be sedated to the extent she no longer has free will. Her behaviors as you describe them seem to be indicative that she does not want to participate in this treatment at all.

In answer to some of your specific questions, no, alternative medication has not been shown to alter the course of breast cancer. Hormonal therapy is not a must. There are several women on this site who have chosen not to pursue this type of treatment. Surgeons and medical oncologists will want to follow the current accepted guidelines to give your mom the best possible outcome and in her case, it appears chemotherapy is required before any surgery can commence. Chemotherapy is not a walk in the park for anyone.

Finally, there are questions that are really hard to think about. Treatment is not easy even for those of us in a good mental space. Is your mom lucid enough to understand what she is facing? The side effects of any treatment will be experienced by your mom alone - not you, not your Dad. Will she be able to understand that pain, nausea, vomiting, exhaustion, limitations of movement, fatigue are all in an attempt to prolong her life? I sympathize with your situation. I wish all of you the best going forward.

Jane

Beesie

icic14, you've posted this in the Stage III forum and you've said that your mother is Stage III.

Has the oncologist told you this? What's the basis for this? Based on the tumor size, your mother could be Stage I. Has it been confirmed via biopsy that she has extensive nodal involvement? Or because of the redness, is it believed that she might have IBC, inflammatory breast cancer? These are both very important factors when discussing treatment options and the risks associated with passing on having recommended treatments.

To your question about hormone therapy, the risk in not having hormone therapy depends on the diagnosis and the patient's risk of metastasis. Hormone therapy can reduce the size of a tumor and does reduce the risk of a localized (in the breast area) recurrence, but it's most significant benefit for those with invasive cancer is that it reduces the risk of a metastatic recurrence (i.e. a distant recurrence somewhere in the body, such as the bones or liver) by about 1/3rd. So with a low risk of mets, the risk of skipping hormone therapy is lower. But if your mother is Stage III and has a higher risk of mets, without chemo and hormone therapy she will be doing nothing to lower this risk. Surgery, whether a lumpectomy or mastectomy, is a localized treatment for the cancer in the breast and does not reduce the risk of mets. And mets is how breast cancer becomes deadly.

exbrnxgrl

I'mfollowing up on beesie's post . If your mother has stage III this puts her in a different position than earlier stages so comparing her situation to what those at stageI or II is not of much value. With respect to surgery, it used be be common to have surgery and then whatever treatments were recommended. In recent years it has become more common to do chemo first, to shrink the tumor, then surgery. Both approaches are still used and I imagine that each case is evaluated by an oncologist to determine which would benefit the patient most. Chemo can be IV or, in some cases, oral. Hormonal treatments, Tamoxifen (usually used in premenopausal women) and all three aromatase inhibitors (Arimidex, Aromasin, Femara) are mainly used by post menopausal women. None of these drugs are considered chemo.

As others have said, natural or alternative treatments are out there and you will find plenty of websites and online groups supporting them. However, little science based evidence exists to support their efficacy. You will find lots of anecdotes and testimonials but that does not equal evidence. I am not saying that these alternatives are useless but rather that there is a lack of evidence to show they are useful.

I have no great advice for you and your family but working with psychiatric support may help. There are even psychiatrists who specialize in working with cancer patients. Stage III is serious and needs treatment. Surgery alone is generally not the recommended path at this stage, but it seems as if her anxieties and psychiatric issues need to be addressed first if you hope to have her be a willing participant in treatment. As beesie noted, it's not cancer confined to the breast that will kill you but rather metastasis to other parts of the body and that is what systemic treatments are trying to control. I wish you all the best.

** I want to add that nothing is a “must". Doctors make treatment recommendations based on what they think will benefit the patient most, but patients are always the ultimate decision maker.

flashlight

icic14, It doesn't sound like your Mom would be compliant with treatment. You don't want her to suffer the consequence of not having the cancer removed. Necrotic tissue, deep wounds, odor, and drainage. Localized treatment would be the kindest treatment, for comfort care, if she doesn't or can't pursue the best treatment to benefit her like chemo or hormonal therapy.

Cowgirl13

icic14, regarding your mom's OCD, is she on medication for that? Also, is she on medication for her slight schizophrenia. If she is for one or both, do Not give her any herbal/alternative medications as they can interact very badly with the OCD and schizophrenia meds. Is a psychiatrist prescribing meds?