Update from Oncologist Visit Today

Hi Ladies,

I promised I would post after seeing my oncologist for my 6 month checkup.  Today was the day...had to drive through 8 inches of snow to get there but I made it!  My CXR results were fine.  I will get my annual CT scan in July.  Today we drew the usual labs, CBC, Chem Profile, Ca 27:29 tumor markers and a recheck of my Vit D level.  Here were our topics of discussion:

 ZOMETA:

I asked my oncologist about the Azure trial results as it relates to Zometa infusions.  She also was very disappointed in the results of that study but believes it is too soon to give up on Zometa benefiting other groups besides women who already have bone mets.  She said there is another clinical trial in progress which may shed more light on the specific subgroups that could benefit from prophylactic IV Zometa.  I believe this MAY be the trial she was referring to but don't know for sure.  At least this trial is still active and has plans to test over 5,000 Stage I, II or III women for benefit from the Bisphosphonates.

 http://www.clinicaltrials.gov/ct2/show/NCT00127205?term=Zometa+comparison+trial&rank=52

She is keeping me scheduled for my July Zometa infusion which will be my 11th dose over the last 5 years.  We will then take another look at the issue in 2012 to determine if I will continue on annual infusions or not.  She believes I do fit the current criteria for the subgroup in the Azure trial which did show benefit ie. post menopausal for more than 5 years before starting Zometa

 AROMASIN:

We then discussed the issue of my being on Aromasin a full 5 years this April.  She said there really is no study data for maintaining on the AI's longer than 6 years but we are both inclined to continue the Aromasin for this my 6th year.  Her plan is to stop my Aromasin later this year for 30 days and then draw Estradiol blood tests to determine how much estrogen my body is producing without the AI. If I am maintaining sufficiently low estrogen levels without the AI then we will trial staying off it,  I have adjusted to living with the joint inflammation and thinning hair side effects of the AI but my onc has concerns about the increased risk of cardiac issues particularly in patients who may already have an at risk cardiac profile. I do not have a hx of cardiac risk so it is not that great a concern for me, but if my body's natural production of estrogen stays sufficiently low enough without the drugs...then it make sense to limit other risks where I can.  I'm sure we will have more discussions on this issue throughout the year.

 VITAMIN

Pending my Vit D blood results from today I will stay on prescription Vit D until my levels reach at least 35.  My results last summer were 18.

 KRILL OIL:

My oncologist feels that fish oil should be a regular part of my diet particularly to benefit the cardiac system.  She said there is a new form of Fish Oil available now which is derived from "Krill" (think mini shrimp) which may provide more benefit than regular fish oils and allows for much smaller sized capsules in its formulation.  I have just double-checked online and see it is available at Walgreens and a variety of health food stores.  Will pick some up after our snow storm is over.

 ANTI-INFLAMMATION DIET:

I will have to do some research on this and find out what foods are considered "anti-inflammatory"  but my onc says that more studies are showing that systemic inflammation can play a role in cancer and numerous other health issues.  We know that inflammation can adversely affect lymphedema and my onc says our immune systems in general are made less effective by the presence of inflammation. 

 MAINTAINING A HEALTHY WEIGHT:

I successfully lost 40 lbs in 2010 and my onc is very happy with that for the benefit a nornal weight provides. I need to work this year on losing another 10 lbs but more importantly getting into an exercise routine which is going to strengthen my cardiovascular and tone up my musculoskeletal systems. She is concerned about my chronic fast resting heart rate which is most likely due to deconditioning and lack of regular exercise.  So I have my work cut out for me this year trying to get into an exercise routine.

STATISTICAL RISK OF RECURRENCE:

I did want to bring up the topic of my recurrence risk since I passed my 5 year mark last December but am aware that the risk never goes away completely. I am also aware that Invasive Lobular Cancer has an increased risk of later recurrence ie. between years 5-10 than for instance Invasive Ductal Cancer.  IDC statistically recurs sooner than ILC.  This is believed to be due to the different growth rates of the cancer types.

I am not the best with statistics but if I understand correctly what my onc told me, a 5 year NED survivor of ILC will have a 2% risk of recurrence for each year between 5-10 whereas a 5 year NED survivor of IDC will have a 1% risk of recurrence for each year between 5-10.  After 10 years NED the recurrence risk drops even further.....but never completely goes away.

So...that is the summary of my 15 min oncology visit.  I LOVE my onc and believe she is one of the brightest in the field.  Hopefully, this information will help others in similar discussions with their oncs for future treatment plans.