Starting Chemo late

AMANN · June 2008

has any started chemo right at the 3 month mark after surgery... I am worried that I have waited too long. I waited for a second opinion and it's taking too long. I think I better just get on with doing the chemo. I am 43 y.o. with stage2A, lumpectomy, no limp nodes,and ER/PR+ HER-.

AMANN · June 2008

Has anyone started chemo right at the 3 month mark after surgery? ... I am worried that I have waited too long to get started. I was waiting for a second opinion but it is taking too long. I think I better jus get on with the treatment. I am 43 y.o with stage2A, lump, 0 nodes, ER/PR+HER-. Please someone comment.

Thanks.

otter · June 2008

Amann, you really need to ask your oncologist this question. I don't think anyone here is qualified to tell you whether you have "waited too long." All we can tell you is what we were told by our own doctors, and the things we've heard vary a lot.

I am sorry you are worried about this. Please ask your oncologist and see what he/she says. Perhaps more to the point: why has it taken 3 months to get a 2nd opinion? I take it you still don't have that 2nd opinion yet.

otter

AMANN · July 2008

I've been trying to get a hold of him since friday. He is suppose to be in tommorrow. I will not get a second opinion now it's not worth the wait. I didn't know it would take this long... first of all I waited Three weeks for my Onco score.

Thank you

Nico1012 · July 2008

Ok, here is my dumb question of the day. WHY would it be too late to start chemo?

One must assume that the cancer was there for quite some time prior to dx so what if the biopsy had been done a month or two sooner or later. It would change the dx date but not the fact that the cancer had been there all along. What am I missing here?

Nico

Nico1012 · July 2008

BUMP

Harley44 · July 2008

Hi... I started chemo on Aug. 7th, and I had my bi-lateral mast. on May 2nd, so I was just at the end of the three month period. I also had a delay, because I got a second opinion, and my second opinion onc helped me to get funding for the Oncotype test. The company paid for the test. Then, I was RIGHT IN THE MIDDLE, on the test results. My score was a whopping 28! Which I thought was WAY TOO HIGH! So I left my oncs office, having made the decision to NOT do chemo, but I didn't feel ok with it. So a couple of days later, I called my onc, and they waited til Aug 2nd or 3rd to get back to me, it was about 2 weeks! I was so mad that he took so long to get back to me, and this delayed my treatment even further.

Nico, I have read that chemo is more effective, if you start within THREE months of your surgery. My biopsy got ALL the bc, and it was in March, but my bi-lateral mast was not til May 2nd.

My surgeon told me that he 'just wanted me to do chemo', and he didn't care if I waited longer. I would call your onc, and perhaps he can explain why it took so long. I'm so sorry that it took you so long to get your Oncotype results and that you got started so late, but don't worry too much. I know, that is easy for me to say. I also felt like I was on the edge, waiting so long, but it couldn't be helped. My first onc was no help whatsoever, and the second opinion onc wasn't too much better, but at least he helped me to get the test, even if it WAS no help.

Good Luck! Let us know what your dr. says!! I'll be thinking of you, and praying that all goes well with your tx!!

Hugs,

Harley

otter · July 2008

Nico, the "12 week rule" might be based on a report that was published in the Journal of Clinical Oncology in 2006:

Lohrisch C et al. Impact on survival of time from definitive surgery to initiation of adjuvant chemotherapy for early-stage breast cancer. J Clin Oncol 2006 Oct 20; 24:4888-94.

Here's the abstract of the article: http://jco.ascopubs.org/cgi/content/abstract/JCO.2005.01.6089v1

I'm copying and paraphrasing the following summary of the article from a "journal watch" website:

"For women with early-stage breast cancer, the interval from surgery to the start of chemotherapy can be prolonged by a variety of factors. Although a few reports have suggested that delays as long as 12 weeks did not lead to worse outcomes, data have not been available on outcomes after delays of longer than 12 weeks.

"Researchers now report on a retrospective population-based study from the British Columbia Cancer Agency, in which survival was analyzed among 2594 patients with early-stage breast cancer, based on the length of time from definitive surgery to initiation of adjuvant chemotherapy (<=4 weeks, >4 to 8 weeks, >8 to 12 weeks, or >12 to 24 weeks). This study, conducted from 1989 through 1998, included patients who received adjuvant chemotherapy for stage I or II breast cancer; median follow-up was 6.2 years. Relapse-free survival and overall survival were similar for the 3 groups of women who started chemotherapy as long as 12 weeks after surgery. However, delays beyond 12 weeks resulted in shorter relapse-free survival and a significantly lower rate of overall survival.

"Although in this study the authors were not able to determine the factors that resulted in prolonged delays (>12 weeks) until the start of adjuvant chemotherapy, these data provide a strong argument for encouraging patients to proceed to chemotherapy within 12 weeks of primary breast surgery."

The article defines "definitive" surgery as the most recent surgery for the diagnosed breast cancer that was performed before the start of adjuvant chemo. In some cases, that surgery was a re-excision because of positive margins or was a full axillary dissection (ALND) when the primary tumor had been removed with an earlier surgery.

So, the bottom line is this: the length of time we wait between "definitive" surgery and the start of chemo matters, for whatever the reason. According to the study, waiting longer than 12 weeks resulted in a shorter time before tumor recurrence and an overall decreased survival. My own oncos used a more stringent rule--they insisted that I start chemo by 8 weeks after my mast/SNB.

otter

Nico1012 · July 2008

Otter,

You take my breath away. You know, don't you, that you can NEVER leave these boards.

They should put you on the payroll.

I think I'll start a new campaign.

OTTER FOR PRES OF BC.ORG!!!

Thank you, thank you for your post!

Nico

beergirl · July 2008

Otter for Pres! I like that and I totally agree!

otter · July 2008

Oh, NOOOOOOO!!!

I really appreciate the support, but, in the words of former U.S. President Lyndon Johnson, paraphrased: I will neither seek nor accept nomination for President of BC.org. I just retired last summer, and I'm enjoying it!

Even though I've finished chemo and moved on to an AI, I'm not going anywhere anytime soon. I like this place way too much to leave. Also, as my dh and I were driving home yesterday, we were listening to an "oldies" station on XM Radio, and guess what came on? Hotel California: "You can check out any time you like,
But you can never leave!"

otter

rock · July 2008

How about Otter for President of the United States, nay, the WORLD.

Seriously, Otter, I don't want you to feel like you must always be here for us forever or for us to keep you from moving on. Though I have gotten all teary just now, so grateful that I have had the good fortune to overlap chemo with you. When/if you move on to other things, I'll understand. (I'm sure everyone will.) You make a hard and confusing experience so much kinder, and less confusing. God knows how many women are better for you being here with us. I know you know this already. I just want to make sure it gets said.

(All this came out wrong. I'm trying to say: I don't want you to ever leave. But I don't want your sense of responsibility to hold you back or to weigh heavy on you, either.)

tuffgirl · September 2011

bump

Starting Chemo late

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