Is six percentage points worth chemo?
Chemo and radiation reduces my chance of my early stage TN breast cancer from coming back in other parts of my body from 90 percent to 84 percent. Just six points. He is leaving it up to me to decide. Only thing he is insisting on is radiation, of course. I just don't know if know if six percentage points is worth it. Anybody ever been in a similiar situation?
Comments
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Not triple negative, but with slow-growing IDC, chemo gave me only a few percent. I took it because I had lymphatic involvement, so although it was slow, it was steady, and I will do pretty much anything I can that shows evidence of decreasing my risk. With TN you have fewer options, so it may be worth working the ones you do have. Remember that the percentage is an average--you could get much more or less benefit than that average.
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This is your chance to prevent metastasis. Once it spreads, you will be on treatment forever, and with triple negative, that will mean one sort of chemo or immunotherapy forever. That is just something to consider. Triple negative is aggressive. That being said, it depends on your age, your health status, and any underlying conditions that chemo could worsen. You could get a second or third opinion to help you decide.
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I didn't have TNBC. I had IDC. My percentage points were kind of like yours, didn't seem like much of a difference, but I wanted to throw everything I could at in "just in case". IDC is more slow growing, so chemo was my best bet to help ensure that it doesn't come back. While there are no guarantees, I wanted to try everything I could.
Maybe you should get another opinion from a different MO and see what he/she says.
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I think another important factor is if you have kids. There was one poster on this site who had a recurrence after 2 years. I'll never forget her posts about hoping to live to see her kids graduate, the thought of never seeing her grandchildren. She has been has been living with Stage IV for 8 years. Thankfully she has seen her children graduate. A few points could matter tremendously, although there is not a guarantee. For myself, being triple positive meant that I had to have chemo (standard protocol for triple positive). I thought about skipping chemo but I knew if I had a recurrence I would have constant regret that I did not have chemo. Just wanted to add some thoughts. Of course, your decision is up to you and you have to do whats right for you,
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What kind of chemo are they recommending? Is it the kind that comes with a risk of irreversible heart failure? What will your risk of developing leukemia be from the chemo course that's being recommended? I would totally do chemo for a six percent reduction in cancer recurrence, but not if that six percent reduction in recurrence comes along with a five percent risk of heart failure and a one percent risk of leukemia. That's a wash in my opinion. Some chemotherapies confer these risks and others don't, so ask your MO.
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hapa's analysis is good. I read on another threat in TN that you have neuropathy issues already. That might be a major reason for not doing chemo, if (for example) you had a 20% chance of worse neuropathy...
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I third hapa’s recommendations. I would also take the 6 percentage points. Chemo can be fairly awful but you will get through it and many people have minimal SE’s these days. There are lots of meds to help. It’s not like in the movies. That said, you do have to weigh against permanent risks. I had to stop Taxol early due to peripheral neuropathy which can become a permanent loss of function in your hands and feet. But I also have antihormonals to go onto because I’m ER/PR+. None of it is easy, just make sure you have all the information you need and that your decision is one you can live with no matter what happens. Best of luck.
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I couldn't work through radiation, but there is another teacher at my school who worked through chemo! So I felt like a bit of a wimp. But this is to say, at least for some women, it is possible to work a demanding and relatively physically active job through chemo.
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6 percentage points is a giant leap in oncology, and there are currently no other ways to target triple negative breast cancer systemically as there are for hormone receptor or HER2 positive breast cancer.
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Salamandra:
My great aunt worked through chemotherapy, but she had a desk job.
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Hapa I agree with your post but today I’m struggling with SE from 6 rounds of TCHP. This last one being the worst with vomiting and diarrhea. How was your experience
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I worked through 6 rounds of TCHP. I had very few major problems but tons of little ones. I had neuropathy which left my hands and feet numb after one of my rounds, I had to leave work that day because I was too clumsy to walk and couldn't type worth crap. I had one day of bad vomiting, besides that I was okay, I just needed to stay on top of the nausea; I think once you start vomiting you're kind of screwed, so I would take the anti-emetics for a few days once the steroids wore off. I started getting swollen after the last two rounds which was the worst side effect, I think. I work in a factory and after 8+ hours on my feet my legs would be really swollen and uncomfortable. I was also anemic and tired, but not so bad that I needed a transfusion (I never would have consented to a transfusion anyway; I'm convinced it's all hobo blood). I worked out 5x/week until the bitter end, even if it was only 20-30 minutes on the elliptical at the lowest resistance, because it made me feel better. The swelling started to go away a few weeks after I finished chemo and I was able to start back on regular workouts about 5 weeks PFC (but had to stop again for my mastectomy). I had my last TCHP on July 11 and the last bit of neuropathy seems to have cleared up recently. It had been very mild all throughout chemo but got a lot worse after my mastectomy, and I wonder if that's because I had quit working out. I did four rounds of accupuncture with electrical stimulation for the neuropathy, but I'm not sure it helped.
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I did chemo and just cold capped and chilled my hands and feet. You get good pain medication and the steroids help push you through. I was only 43 or 44 with my recurrence my doctor was so so if chemo would help prevent it from coming back a 3rd time or spreading but I wanted to throw the kitchen sink at it. I work through chemo and through radiation I'm a nervous Nelly though. I don't regret doing it damm glad I did. 3 yrs NED.
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One hundred people are in a room that nobody wants to be in. Eighty-six get to leave, and fourteen are left in there. Yikes. But wait — six more will now be allowed to leave. Is six percentage points worth chemo? It is if you are one of those six people.
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ShetlandPony, that's a great way to look at it.
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