Declining Chemotherapy
I am seriously considering declining chemotherapy, and having radiation only. Five years ago, I had a course of six chemo treatments for ovarian cancer . I cannot explain that experience, but the word horrific comes to mind. At that point in time I made a decision "never again". As an RN, I am not against medical treatment, and encourage people to pursue it if it is right for them.
MyTNBC tumor is 2.2x 1/7x2.2m, infiltrating ductal, Stg 2 ,no positive nodes and the margins clean. I am 62 y/o (not young) but in good health, work full time as an advanced practice RN and I do have plenty to live for. I have strong family and friend support, a great faith community, and have a strong personal faith. When I look at the research literature that's out there, there does not seem to be a big advantage as far as survival with chemotherapy. It appears it is not even yet known what the most effective drugs are for TNBC . Am I correct in drawing the conclusion that the 5 year survival rates for TNBC are iffy, even with chemo? I just want all the rest of the days of my life to be the best quality , even if they are short.
You all are the true experts. Perhaps I just need encouragement, affirmation, scolding???? Time is running out as i am to start chemo in 3 weeks.
Thanks for listening.
Comments
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Well, I'm not triple negative and I have no idea what type of chemo you had for your ovarian cancer, but I finished 4 tx of TC on March 2nd and while it wasn't a walk in the park, it was not terribly awful either. I had no nausea, but lots of fatigue and a "flu like" feeling for a few days after tx. The worst thing actually was the Neulasta shot the day after chemo. That caused horrible bone and muscle pain, but only for the first tx, as I saw a tip on here to take Claritin (it works).
I'm sure some triple negative girls with more info will come along shortly, but, honestly, I'd do it again in a heartbeat to improve my odds of beating this disease. -
i also had 6 rounds of tac one every 3 weeks and i will also say it was not that bad that i would not do it again. i might of had 1 or 2 bad rounds but i chalk that up to dehydration because i am not a good drinker even though i know i should. i agree about the shot also. my cancer markers went up this last visit and i had a pet and cat scan this past week and i have 4 questional spot on my body so i go for a biospy this week. i am scared to death, but there is nothing i would not do to try to be with my kids as long as possible. i am 58 years old 8 grandchildren and 2 on the way aug/and oct and i will fight til the end to be here for them. so hang in there if nothing else for your boys!!
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by the way i am triple negative
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Dear hartbeat,
I can totally relate to your thougts about completing Chemo. I was diagnosed in April 2008 with Triple Negative and had a Modified Radical Mastectomy in June 2008. My Surgeon advised me that Chemo and Radiation were my only options once Surgery was completed.
I was defiant that I didn't want it and would not do it. After meeting with the Oncologist and Radiologist, and from much urgency between the both of them, I had the Port put in my chest.
My treatment plan was to have 4 rounds of A/C then 12 rounds of Taxol. I completed the first two rounds of A/C and decided to have the Port removed, but did agree to the 33 rounds of Radiation which I did complete.
I lost the second Breast 2 1/2 years later, however, only four lymph nodes were removed as they came back clean. My recent PetScan came back negative....so far, so good.
Only you can truly decide what works best for you I guess is the message that I'm trying to convey. I felt that I wasn't being true to myself by having the Chemo, and therefore, didn't finish that part of my treatment.
This June 5th will be four years since my first surgery. I live every day to the fullest and waste no time in thinking about the past. I'm in total agreement with you about living your days in quality.
Those were my exact thoughts as this Journey was beginning for me. I've always said as I come across people who have disagreed with me not finishing my treatment that...."You don't have to like my decisions, I simply ask that you respect them".
No matter what decision you decide....I wish you the very best.
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My cancer was a bit too early for chemo, but I still got the full offer of slash, burn and poison. I eventually and reluctantly went along with it all. None of it was/has been as bad as I imagined.
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I am not Triple Negative, but Triple Positive. I started Chemo Dec 27, 2011 with 4 A/C. I just completed 9 of 12 Taxol. I am 56 years old. Although it has not been easy, it has not been nearly as bad as I had envisioned. Of course I am looking forward to it all ending, but the lessons I learned about life and love during Chemo honestly have been invaluable.
I didn't want Chemo, but knew I had to do it deep in my soul. All you can do is listen to that inner voice and do what is best for you.
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wow hart,,not sure what to say here..I can tell you what I KNOW to be true...reocurrence rates are very high for tn's within the first couple of years..after that it drops down to even less than our er pr positive sisters..have you talked to your onc about reocurrence rates?
I dunno...if you want me to be blunt I will be...62 years old is NOT old...do the freaking chemo...chemo can help...I know of some ladies on this thread that no..it didn't work..but there are alot of us that it has worked..
Even my onc says you just don't know if it will work or not...gah..if we only knew...you may be able to avoid it and be just fine...but you can't know that right now...
If you are in good health..you will be able to handle the chemo...maybe you can talk to your onc and get a "lighter" chemo.
I'm 3 years out from diagnosis..and I hope to hell the 5 year's out isn't as bleak as you say...my onc hasn't had me planning my funeral yet
and hart..we aren't experts on here...just trying to survive that's all..I wish I could tell you that by not doing chemo you will be just fine....or that doing chemo you will extend your life until you are 100..but no one knows dang it...
I dunno..chemo lasts about what 4 months out of your life...it may take a little while to "come back" from it..but you will....whoever told you horror stories about disabling se's is WRONG
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I'm not triple negative and did not need chemo due to a low Oncotype score, BUT, if it had been recommended I would have done it in a heartbeat. It's your life and your decision. (Triple negative is a very aggressive cancer.) I am 63 and want another 20+ years. I'll do what I can to achieve that goal.
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It's a decision you have to make, but typically with triple negatives, they want you to do chemo and rads. I've had bc twice. First time was DCIS. I had a bilateral mastectomy and reconstruction. 2nd time I had IDC & DCIS, triple negative. I did 4 rounds of dose dense A/C and 12 rounds of weekly Taxol. The A/C was not fun, but the Taxol was okay. There are a lot of chemos out there. Usually A/C T and TC are the most common for triple negative. 62 is not old.
Good luck and hugs!!!
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I know how you feel. I also was terribly ill during my treatment. I almost passed several times and had to cancel many vacations. I used to beg for my family just to let me die. I am glad that I did it and I am better. I have stage IV breast cancer and was only given a 30% chance to live and 90% chance to get it back within 3 years. I am also a registered nurse. I was only 40 when diagnosed and had a small child. I know it is hard, but it is worth it in the end. You can do it!!!!!
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Ask your doctor about the likely recurrence stats with or without chemo. There is a tool that doctors use to advise patients about this. It's called Adjuvent Online.
Or google cancermath for a tool that you can use yourself to find the likelihood of recurrence for your type and stage of bc. It can't tell you if you will have a recurrence, but it can tell you the odds.
As you had ovarian cancer, have you had genetic testing? This might also be a factor affecting your prognosis.
Discuss these issues with the oncologist and consider a second opinion also. -
hartbeat, I'm sorry you're facing these decisions. I'm not TN, but I have the strong opinion that not all medical teams are equally qualified to treat TNBC patients because some have rarely even seen a case of TNBC. If I was in your situation, I would seek out an onc who specializes in TNBC, because I think they're finding that all TNBC isn't always the same, and the more experienced onc and the most targeted tx you can get, the better.
I think this is true of all bc (that not all docs are equally qualified), but maybe even more so with TNBC, because of its rarity.
Good luck, and I'm glad you've found BCO! (((Hugs))) Deanna
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I don't know what chemo you had before, but my first chemo (TAC) was hard but I still managed to work except for about a week following each infusion. I respectfully disagree that the research doesn't support much advantage for treatment with chemo in regard to triple negative. If you look at the neoadjuvant studies, those who have a Pcr with chemo have a fantastic survival rate - those who have residual disease (like I did) have a higher risk for recurrence. So...if you are one of the ones for whom chemo really works, it helps tremendously - it is just that TNBC is so heterogenous and there is no way - yet - of classifying each of our cancers.You might be one of the great responders. I had TAC x 6 then surgery, then rads, then went to a clinical trial and had 6 more cycles of eribulin (Halaven) because I didn't have a complete response to the first chemo. (I have 5-10% ER receptors they found after surgery - actually my oncologist feels the first chemo made my cancer mutate into low ER positive.)
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Hello sister, the literature out there is sometimes just crazy. Your assumptions aren't correct and I very happy to tell you. In reality, the true expert oncologists on Triple Negatives will tell you that chemotherapy actually works BETTER on triple negs than on regular breast cancer. That is becuase chemo wipes out rapidly reproducing cells and triple negative BC tends to be rapidly reproducing. It is true that there isn't one single chemo that is our cure so for that reason, we tend to do the standard BC treatment (I may not be up to date but at Stanford 4 years ago I was given 4 dose dense A/C and then Taxol).
I left the tumor in while I did hte chemo to be able to tell it's effectiveness. The A/C took my very palpable tumor and made it disappear. The taxol cleaned up the rest. Upon sergury there was no more cancer in my breast at all and it had been quite extensive. BUT....when they took out all of my lymph nodes they found cancer in a NON SENTINAL NODE. That means taht if they had only sampled a few sentinal nodes they might have labeled me "no node envolvment" at that time but that was not true.
The thing is that if the cancer has slipped past some nodes and into your body (or even though vascular entry) then there can be cancer in your body and radiation won't help a bit with that. Chemo is just so effective...it greatly increases survival in triple negatives. Also, after the 5 year point if there is no recurrance...we are generally thought of as cured...still have to be cautious for a few more years but triple negatives tend to recur in the first 1 to 3 years. It's a quick disease but by no means unbeatable. We won't all be cured by chemo. I wish that was the case but many, many, many of us are. I pray I am one of them.
Before chemo, I had mulitple involved nodes. Clearly the cancer had left my breast and entered my body...also it was high grade (3)...rapidly reproducing. I did chemo. If I had not, without a doubt, I'd have metastatic cancer by now...probably for a long time now. Because of chemo, there is a good chance I am cured. I am now at 4 years and 3 months since I began treatment. I had tons of cancer in the breast and nodes and no doubt body but thank God for chemo.
I wonder if when you did chemo before if they did not give you proper anti-nausea drugs. Get the max allowable. It is so doable. Do it for you life sister. You will greatly increase your chances of a long happy life.
Meg
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I don't know if this will help but I too am recently dx with TNBC. I entered a clinical trial at Dana Farber in Boston which was studying a new drug Evimerilus sp? in combo with Taxol and Cisplatin on TN before surgery. I had read a study that an Onc Dr Garber had studied Cisplatin on TN and got promising results. It's an old chemo drug but not used for BC. My research also showed that TN responds to chemo and since there are no target txs like Tamoxifen or Herceptin, as of now chemo is our best option. I had 12 wks of the trial (just finished #10) and the tumor can not be felt. Like many, my gut reaction when diagnosed was to cut it out right away and I was leary of letting the cancer be in me any longer. But when you're monitored during the chemo, response can be measured rather that trusting the fact that this poison is doing what it's supposed to do. I guess I like concrete results and don't trust easily. I'm hoping that any stray cells are responding the same. Ultra sound May18. Still deciding on what surgery and since lymph nodes haven't been biopsied there's still some unknowns. I'm supposed to have the AC after surgery and can't say I'm looking forward to it. Like Meg said load up on the anti side effect meds.My theory is that it's aggressive so, so will I. I hope you're at peace with whatever you choose. Nance
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Hartbeat, you have some good questions for your Oncologist, and if you don't feel you can ask your Oncologist, then get a different Oncologist. Yes, there are statistical tables that will show your statistical chances with and without chemo. Of course, that doesn't tell the whole story because individuals vary, but its good to have that information when you are making a potentially critical decision.
Have you had genetic testing? With a history of ovarian cancer, I think you may want that information also.
There are good drugs to help with the SE's of chemo. I hated going through it, but continued to have a life during that time. I went out to dinner and exercised, and made it through. I think Accupuncture and exercise help with SE's.
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Thanks to everyone for your caring and supportive responses. I will be taking the summer off for my course of chemotherapy. My onc is modifying the treatment drugs and schedule to hopefully address the problems I experienced before.
Not sayin' I'm embracing the idea...
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Hartbeat, if you haven't already been in contact with this group, they may be able to give you important information about 3NBC. http://www.tnbcfoundation.org/
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HARTBEAT,
I'm only 1 treatment into my chemo, but I can tell you that I fought chemo every step of the way. I have to admit that it wasn't the greatest experience of my life, BUT I DID SURVIVE IT! It wasn't near as bad as I thought it was going to be. I drank 4 16.9oz bottles of Dasani water during the treatment and I kept thinking positive thoughts while listening to my favorite songs on my MP3 player. I believe that keeping a positive attitude during this nightmare has made it so much easier for me. I lost the rest of what was left of my hair this morning. I had a good cry, put on my hat and came on in to work. 8 hours later, I am fine. I have worked almost everyday since the treatment, only missing a few days, so it can be done. I have pushed myself get on with my life and I have to say that trying to stay in my daily routine has helped me so much. I hope you make the right decision for YOU! Not fun, but not that horrible either. Drink lots of water, push yourself gently to keep going, pamper yourself & let others do it too! Keep a positive attitude even if your have to fake it...it works! We are all in this with you!
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I just saw your post, Hartbeat, and I'm glad to see that you have decided on chemo. I am also an RN, though have not worked for a very long time. Did work in the ICU way back, but stopped to raise my three kids.
As you probably know TNBC is agressive, and usually is diagnosed in younger women, that is premenopausal. My docs were surprised when they got my path back, as I too was not young at the time. Almost 61 when dx in Feb of' '06. Happy Valentine's Day to me! I did 6 months of chemo, starting in first week of March. No fun, but I wanted to be agressive with tx, so did four AC's followed by twelve weekly taxols. Followed that with seven weeks of rads, and six years later I am almost 67, and doing great! In '06 Mother's Day and my birthday [May 14th] fell on the same day, and I never had a worse b-day or Mother's Day, but since that b-day I have celebrated many more, and I've seen my oldest get married. Not to mention many more milestones in life.
As you probably know TNBC responds very well to chemo, and I'm so happy that you are giving yourself this extra boost to your tx. It's not easy, but is very doable, and you'll have lots of support here as you go.
Hugs to you!
Pat
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PS: Also, about TNBC, that the further out you get, the less likely you'll have a recurrence. At least that is what statistics tell us.
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I'm not triiple negative but am bored today and saw this pop up in the active topics and thought I could still help. I'm glad you have decided to do chemo because while I don't know much about triple negative, I do not believe that the five year survival rates are bad even with chemo, and a search on pubmed would no doubt come up with lots of hopeful abstracts.
The reason I'm responding is to tell you that your first experience with chemo may be an anomoly. What chemo did you do? I can tell you that I have done five so far (I'm Stage IV) and I do not consider any of them to be anything close to nightmarish. I started out Stage II and did carboplatin and taxotere. Half way through I started having a little neuropathy so I was switched to taxol. I did just fine. Then when cancer returned, I did Navelbine and with progression, I did Abraxane.
I won't tell you it's like doing nothing, but none of them created a nightmare scenario and in fact, I work every day. I think the side effects can be managed better than you described and so I would talk to your care team, share your previous experience, and see if they will do something to make sure you are more comfortable this time. And, you aren't likely to do the same combo you did last time and every chemo is different.
There is also a lot you can do to help yourself. As a nurse you probably know this but hydration really will help cut the side effects so tons of water is important, and eating the proper foods can help your colon stay balanced. Body aches can be managed with medicine.
Since you have decided to do the chemo I'll spare you my description of living with Stage IV cancer. Obviously, the consequences of not doing chemo can be severe. And, also obviously, there is no guarantee but I think most people feel better - even if cancer returns - knowing that they did what they could.
I hope that you are pleasantly surprised to find that your experience is different this time. I am not going to say it's a walk in the park and you'll be tired but horrific? It never has been for me and I hope it won't be for you.
I wish you nothing but the best.
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Not really a Nightmare scary in the beginning but in the end it worked out. I had the fastest reaction the nurses had every seen on Taxol, the nurse hooked me up, pushed the start button, then turned around to answer a question. Literally a drop hit my blood stream, got a knot in my stomach and I turned bright red in less than 15 seconds I grabed the Nurse who turned around had an OH Shit look on her face, and hit the emergency stop button, yelled something and some code was announced on the intercom. That was the beginning and end of Taxol had to wait around 6 hours as the doctor's figured out what they wanted to do and get the insuracne to pay for it, They where actually really exicted about it, I ended up on Abraxane, sailed through treatment no problems, no side effects and worked full-time. I had Chemo in the morning and was at work in the afternoon.
After two rounds of Abraxane, round of AC, radiation and BMX I have been NED since I think Oct. 2009, my brain is fuzzy on dates.
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Thanks for posting, hydeskate. I am so glad to hear that you've been NED since 2009... very encouraging about the effectiveness of treatment for TNs.
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I too am not going to do Chemo and will try an alternative method that my Mother used and it actually is documented that her tumor shrunk. I am going to give this 3 months because I feel that I don't really have much to lose at this point.
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