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Chemo for a 75-year old?

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Magritte View Drop Down
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    Posted: Aug 24 2017 at 5:01pm
New member here and trying to get a bit more perspective as my wife and I help her 75-year-old sister get through her treatment. She had a mixed tumor--24 mm in size and split evenly between ductal and lobular). The lobular component was triple negative (ductal component was ER positive) so the oncologist is treating her as if she's triple negative. Negative margins and lymph nodes following her surgery. 

Not surprisingly, my sister wants to avoid chemotherapy. (And I mean, she really, really doesn't want to do it.) The oncologist is recommending a two-drug chemo regimen and we do realize that chemotherapy is the standard of care in her case. (She'll also have radiation and HT for the ductal component.) 

We, of course, want her to have the appropriate treatment. That said, we do share a concern about how much benefit the chemo will have versus her QOL at age 75. Although we attended the appt with the oncologist, we didn't leave with a good sense of that answer and we're trying to formulate some follow-up questions for the doctor. (Or perhaps even get a second opinion.)

I'd appreciate any insights this community might have as we move forward.
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123Donna View Drop Down
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Post Options Post Options   Thanks (1) Thanks(1)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Aug 24 2017 at 10:15pm
Magritte,

You are asking lots of good questions.  I can understand your wife's sister's reluctance to do chemo.  It's a hard decision.  A second opinion is always a good choice especially if you have questions.  Ask the oncologist the chance of recurrence with chemo and without chemo. 

The following links are from the NCCN Guidelines for breast cancer treatment (stage 1 and 2).  


Donna

DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Meadow View Drop Down
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Post Options Post Options   Thanks (1) Thanks(1)   Quote Meadow Quote  Post ReplyReply Direct Link To This Post Posted: Aug 25 2017 at 12:15am
I'd ask the oncologist what the odds of recurrence are with chemo and without chemo. Knowing what the difference is might help with making a decision.
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Magritte View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Magritte Quote  Post ReplyReply Direct Link To This Post Posted: Aug 25 2017 at 7:10pm
Thank you both for your replies. These are uncharted waters for us, so your comments are very helpful. We definitely need to dig a bit deeper before moving forward...
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Post Options Post Options   Thanks (1) Thanks(1)   Quote ChiefJack Quote  Post ReplyReply Direct Link To This Post Posted: Aug 25 2017 at 10:20pm
My wife is in the same boat and here is what we were told by our Medical Oncologist. She is triple negative, 73 years old, tumor size 13mm, clear margins, clear nodes after lumpectomy. The 5year and 10year survival stats were 75% and 57% without chemo but with radiation. The 5year and 10years stats with chemo were only 3% more. Of course every situation will be a bit different but this is sorta the average all things considered. She has MS also and due to the fatigue factor with MS and the added fatigue factor associated with chemo she opted for radiation only. "Off the record" the oncologist said that is probably a wise decision. As I am sure you realize each case is different and the mortality figures included persons that passed due to other conditions i.e. heart attack etc. so they are not quite as stark as they appear. We are new to this chapter in our journey and this site has provided much needed info and different perspectives.

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Magritte View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Magritte Quote  Post ReplyReply Direct Link To This Post Posted: Aug 26 2017 at 1:26am
Thanks ChiefJack...I appreciate the additional context, although as you say each case is different. Re your stats, which nomogram did you use? We're familiar with the predict site, but curious about your numbers. 

Of course, we don't want to get too caught up in stats...
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Post Options Post Options   Thanks (0) Thanks(0)   Quote ChiefJack Quote  Post ReplyReply Direct Link To This Post Posted: Aug 26 2017 at 2:41am
The stats did come from the Predict computations. We plugged in the relative data and those were the results. age 73, Screen-detected, 13mm size, grade 3, positive nodes 0, triple negative, K167 unknown, second chemo regimen.  Stats are certainly not absolute but all things considered, including the stats, the decision to skip chemo was the result. A 3-4% point spread, if that is even close to being accurate, vs chemo was her personal decision and there is really no way of telling if that was the correct course of action. Will be keeping a close eye on this site for any late breaking news on new treatments etc.
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Magritte View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Magritte Quote  Post ReplyReply Direct Link To This Post Posted: Aug 26 2017 at 9:45am
Thanks ChiefJack...I had earlier run the same numbers through that site and value of adding chemo for my SIL was 4% for 5 years and 5% for 10 years. 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote gordon15 Quote  Post ReplyReply Direct Link To This Post Posted: Aug 29 2017 at 6:11pm
I want to thank Chief for the posts, I think, from all my extensive reading, that chemo increases longterm survival  by about 3-5%, but obviously, there is probably an error rate of 3% per situation (?), but I also want to remind that TNBC patients are less likely to have a recurrence after 3 years, so not sure if this makes this post more complicated, but the slope of recurrence rates starts descending after 3 years, and after 5 yrs, maybe it goes down faster, not sure about that/
wife: IDC/Lobular Stage2B 2008 lumpectomy/TAC+rads
TNBC Stage 3A/w/metaplastic/squamous Nov2015 Carboplatin-Gemzar chemo/masectomy Taxolchemo+rads 4-16
PET scan stable 9-2016/ 1-2017
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123Donna View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Aug 29 2017 at 7:02pm
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (0) Thanks(0)   Quote ChiefJack Quote  Post ReplyReply Direct Link To This Post Posted: Aug 30 2017 at 12:14am
Gordon..being very new to the TNBC group I was wondering if there are any tests/procedures you are aware of that would give a recently diagnosed person a "leg up" on possible recurrence in the follow on years after surgery and radiation. I saw in you footnotes that PET scans were performed 2016 & 2017. Waiting for symptoms to present themselves seems not to be very proactive when it comes to "nipping in the bud" any future cancers. Are PET scans considered preventative measures/tests?  Recent visit to our Medical Oncologists resulted in  "schedule a followup visit in 3 months" with no mention of follow on testing other than report any "unusual" symptoms that may present themselves. Thanks - Jack
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Magritte View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Magritte Quote  Post ReplyReply Direct Link To This Post Posted: Aug 30 2017 at 11:55am
As the OP, I appreciate the additional information. Sure is a big drop off in recurrence after three years and quite a peak at one year. 

My 75-year-old SIL has made the decision to go ahead with chemo after a meeting with the NP and a detailed look at possible SEs. (That said, based on our other reading on this forum, there's definitely a wide disparity in SEs.) While the Predict tool was saying there was about a 5% benefit with her stats to adding the chemo, the NP felt it was closer to 10%. (I also wouldn't be surprised if the NP was trying to put an optimistic spin on things...)

BTW, I share ChiefJack's question about what to monitor in terms of recurrence. I'm a prostate cancer survivor and a rising PSA is a pretty good indication of recurrence, but there doesn't seem to be the magic market in terms of breast cancer. 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote lizjayne Quote  Post ReplyReply Direct Link To This Post Posted: Aug 31 2017 at 9:27am
I am 77 years old and was diagnosed with Triple-negative, Stage One breast cancer in May of this year.  After careful consideration and much research, I decided to not accept chemotherapy as the risks far outweighed the benefits.  I began radiation treatments the end of June.  Following the 16th treatment, I developed severe pain, swelling and extreme discomfort in the treated breast.  My Radiologist (after many attempts) contacted my Surgeon, who excised approximately two ounces of blood using a needle of some sort.  She used novacaine; however the breast was definitely NOT numb!  I am now going into my third week (since the barbaric procedure) and the pain has diminished.  I finally read my emails and discovered that I'd been sent a report.  The FINDINGS state:  A seroma is seen in the right breast at 7:00;11cm from nipple...  The IMPRESSION state:  Findings most consistent with a seroma in the right breast.
I cannot seem to find a definitive definition of "seroma".  Can you help?
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Post Options Post Options   Thanks (1) Thanks(1)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Aug 31 2017 at 10:06am
lizjane,

Hope this helps -

A seroma is a build-up of clear bodily fluids in a place on your body where tissue has been removed by surgery.

Seromas can happen after the following surgeries to treat breast cancer:

  • lumpectomy
  • mastectomy
  • lymph node removal

Seromas can appear about 7 to 10 days after surgery, after the drainage tubes have been removed. The breast area involved in the surgery may have a spot that's swollen and feels like there is liquid under the skin.

Managing a seroma

Most seromas are reabsorbed back into your body in about a month, but in some cases it can take up to a year. If the area becomes painful or the seroma doesn't improve, your doctor can drain the seroma. In some cases, the seroma may have to be drained more than once.

Tell your doctor if:

DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (0) Thanks(0)   Quote lizjayne Quote  Post ReplyReply Direct Link To This Post Posted: Aug 31 2017 at 10:42am
My problem with the report is that:  My breast was hot, swollen and extreme painful.  My radiologist thought that there might possibly be an infection.  When I saw my surgeon, she showed me a blood-fill tray, expressed concern that it was not a clear or yellow-tinged liquid at the end of the procedure.  My concern now is, what caused the breast to fill up with blood?  Was the cause because of the radiation treatments?  The breast appears to be healing as there is less pain; however, I've not been back for any future radiation treatments.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote lizjayne Quote  Post ReplyReply Direct Link To This Post Posted: Sep 16 2017 at 12:25pm
Okay, so I've resumed radiation treatment-- September 11, 2017 to be exact--with no problems!  I visited my surgeon on the fifteenth.  One more week, with two-and-on-half more to go!  I'll continue as long as I don't have any other unexpected occurrences.  I'm feeling quite positive about my outcome and am looking forward to the future.
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