Chemotherapy

Lets break it down. Side Effects

-Hair, your going to loose it. it will grow back

-your gonna feel tired. The first time I got AC I felt really wired but also like I had this lead blanket on me. Yeah sure its scarey, I didn't really have nausea so bad. I took my nausea pills a lot. I lost my appetite. I couldnt poop. not pooping is the worst.

if I can do it. you can too. being stage 4 now, I have had yrs of chemo. It doesnt scare me. Bring it on!

Get your fighting gear on and kill some cancer cells!

The problem is you will never really know if chemo wasreally necessary or not unless you don't have chemo and then go on to have a recurrence or metastasis. Perhaps you could seek a second opinion from another oncologist. Typically your age and any pre-existing health conditions as well as the things you have mentioned need to be considered.

Hi mom8016:

You mentioned, "He said that without chemo recurrence is about 34%. with chemo it is about 24%."

Do you know (a) what type of recurrence risk estimates those are (e.g., average 5-yr risk of distant (metastatic) recurrence or something else?); and (b) how they were determined? Please ask your medical oncologist ("MO") to explain it again, if you are not sure of the type or how they were determined.

Please also ask what specific clinical and pathologic factors indicate to your MO that the tumor is "very aggressive", and weigh in favor of his recommendation for chemotherapy, to ensure you understand the basis for the recommendation.

In general, the number that medical oncologist's typically focus on when weighing risk / benefit in treatment recommendations is the size of the "risk reduction benefit" (e.g., ~10% or the difference between recurrence risk with a specific treatment (e.g., 34%) and residual recurrence risk without that specific treatment (e.g., 24%) (34% - 24% = 10 %).

This is a personal decision made after weighing medical advice and information about potential benefit and potential risk, in light of your personal risk tolerance. Although this is from an older book, this explanation still holds today:

"Thus, the higher your risk, the greater the need for treatment and the bigger the benefit you can reap from the treatment. At the same time, when making treatment decisions, potential side effects should be part of this equation. The possibility of experiencing side effects remains the same no matter what your risk is from the cancer. The higher the risk of your disease, the more likely the potential side effects will seem worth that risk in order to gain the benefits from the treatment. "

Excerpt From: Carolyn M. Kaelin & Francesca Coltrera. "Living Through Breast Cancer." (2005)

One recent 2016 ASCO guideline states (without citation):

"Several studies have suggested that the odds of fatal, life-threatening, or permanent life-changing toxicities [associated with chemotherapy] are at least 2% to 3% in healthy women who participate in prospective trials."

Advanced age and/or certain co-morbidities may place some patients at greater risk of severe side effects.

Please confirm this estimated risk of severe adverse events with your Medical Oncologist to ensure accuracy, currency, and applicability to your situation and recommended chemotherapy regimen, in light of your presentation and any co-morbidities (which may alter personal risk profile relative to an average observed in healthy women).

In general, note that a ~10% risk reduction benefit numerically outweighs a potential risk of severe adverse events of ~3% risk by 3-fold. As you can see, the estimated size of the risk reduction benefit (estimated ~10%) is quite important, which is why it is useful to understand how your MO arrived at the 34% and 24% numbers.

If you wish, and if you have time (ask your MO), you may find a second opinion to be helpful for obtaining additional discussion and expert professional input regarding your risk / benefit profile, and an independent recommendation.

Best,

BarredOwl

{ Edited quote to indicate [associated with chemotherapy]

Usually, the focus of benefit of chemotherapy is on reducing distant recurrence risk. Please seek confirmation of your understanding of the estimates provided. Does adding endocrine therapy reduce risk further? }

Thank you, mom8016, for starting this thread. I am struggling with this question as well--is chemo worth it? The risk of side effects may be low, but one has only to read some of the other discussions on this site to see how awful they can be if they do occur.

In my case, my MO is also pushing chemo (and other stuff) strongly. So strongly, that I don't really trust her. She poo-poo's my concerns about side effects (very condescending).

I think your concern is valid.