To Chemo or Not to Chemo......For my Wife

BLMike, a very hard decision for sure. Your wife has an intermediate onco score. You may ask her MO to order a mamma-print test that will give her a high or low recurrence risk score, if she is still undecided. I had a 21 onco score, did TC and although it was no picnic, my SE's were minimal and it was manageable; not as bad as I had anticipated. You may also ask if there is a less aggressive chemo regimen that they could recommend, such as CMF. Another idea might be to get a second opinion. Other things to consider are: Does she have a family history or other health issues? BRCA gene? Best wishes to you both!

I know this is a very difficult decision that only you and your wife can make. Several red flags stand out to me, which you might give particular weight to:

This is your wife's 2nd cancer. (I'm surprised she wasn't on an aromatase inhibitor after treatment for DCIS.)

Her Oncotype is 27 - that's the high end of the intermediate range.

The probable benefit is 8% - that's pretty substantial; there's a big difference between a 10% chance of distant recurrence and 18% chance.

3 out of 3 MDs consulted have recommended chemo

She has family history. (There could be other genetic mutations other than BRCA 1/2 involved.)

I don't see her grade listed, which could influence her chances even more.

I really do understand your reluctance but if I had all those factors stacked against me, I would bite the bullet and do chemo. Distant recurrence is NOT recurrence in the same or contralateral breast; it is metastasis to other organs and is incurable, although treatable. It means that the remainder of one's life much more deeply involved in the world of treatment - and one's lifespan may well be shortened.

It sounds as though a long, no holds barred discussion with her oncologist would benefit both of you. I'd raise every single concern, ask about any/all alternatives, bring up all the fears and concerns and what ifs. This is a major decision you're facing and you need/deserve answers and information.

I'm sorry you're in this situation and wish you both well as you navigate through the quagmire.

You've gotten some good advice here. I would just add that chemo doesn't necessarily have to involve "pain and suffering." It's different for each patient. Chemo for me was doable, and I was able to work through it. Not every patient is as lucky, but many chemo side effects are familiar (but annoying) conditions. For example, Taxol gave me mild diarrhea, which I controlled with Imodium. Best wishes to you and your wife!

Chemo is not as bad as it is made out to be. If she has already had 2 occurrences, you must consider without treatment, she probably will have another and this time it could metastize to other organs. Maybe just have a bmx and be fine with it. Without nodes, she would not have to do chemo or radiation. Just hormone therapy, which I cannot imagine they did not put her on with first episode. Fear of chemo does strange things to peoplesjudgement. Consider it would go through and "catch" all kinds of pre- cancerous cells also.

Best wishes to your wife. I was much in the same boat: DCIS and IDC found at the same time, but no spread to lymph nodes or anything. I was devastated when I learned that my Oncotype score was leaning towards the "chemo" end of the scale. I was desperately hoping that I'd be able to skip it because the cancer hadn't spread. No luck - I had my oncologist follow up with a Mammaprint test, which came back "High Risk" and my fate was sealed. It was chemo for me! I spoke with my doc at length, chose the TC regimen (Taxotere/Cytoxan) based on my medical history, went home, and cried about it for a while. I didn't like the idea of feeling gross for weeks, and the possibility of severe side effects.

Well, I'm still going through the chemo. And there are times when I feel really, really gross. I don't like it, no. My hair's gone patchy, my taste buds are pretty well shot, I feel achey sometimes, my nose drips, and I'm always so tired! I sleep a lot. I have also lost a lot of weight which I can ill afford to lose because I was so skinny to start with and now I'm officially underweight, but my appetite's gone downhill as chemo progresses and food just doesn't have any appeal. I've been through a battery of anti-nausea drugs and we found some that "mostly" work, but it's not a perfect solution; I just got a prescription for a new kind to use next round, so we'll see how that one goes. I'll be glad when this is all over! Even with the chemo associated troubles, I can tell you, it's completely doable for most people. It's just a pain in the you-know-what and your wife may be uncomfortable for a while, but this too shall pass, as they say.

The reason we do chemo for these little early-stage cancers is because we don't want them sneaking back into our lives 5 or 10 years down the road, showing up in bone or liver or what-have-you. I desperately hope that I don't have to deal with cancer again. I'm sure your wife feels the same way. If the doctor is recommending chemo, discuss your concerns about it but ultimately I would follow doc's recommendations and lean towards the aggressive side of treatment. Here's to many cancer-free years to come.

Oh, and my number one chemo tip: Hydrate the crap out of yourself. Drink water until you can't stand it and then drink some more. It will help flush the chemo toxins out of your system and trust me you feel LOADS better after chemo if you stay extremely hydrated before, during, and after infusion.

Jiffrig - a bmx accompanied by negative nodes does not automatically get one a pass on either radiation or chemo, and particularly for a second occurrence, as is the case with the OP's wife. It would be nice to think that it was that straightforward. As is generally the case with breast cancer, it's a lot more nuanced.

I only bring this up because too many women are under the mistaken impression that they are safe from recurrence if they have a bmx and, sadly, this is not the case. I think we all need to counter this misapprehension when it arises.

I hope you're doing well with your treatment and recovery.