Metastatic Breast Cancer: Stories of Trials, Perseverance, and Hope.
My doctor just told me that my cancer is in remission. Does that mean that I’m cured?
Remission is the word that oncologists use to describe how well the anti-cancer treatment is working. It is not the same as cure. Remissions are complete or partial. Complete remission means that there is no longer any sign of cancer on your examination, blood work, or scans. Partial remission means that there is less cancer in your body than there was before treatment, but that there is still some sign of cancer on your examination, blood work, or scans.
Sometimes partial remissions become complete remissions after you get more treatment. The more cancer the treatment kills the better, and complete remissions usually last longer than partial remissions. Unfortunately, when it comes to metastatic breast cancer, even complete remissions are not forever. Though not curable, metastatic breast cancer is usually quite responsive to initial therapy, and there is a good chance that you will enjoy a remission for some time before the cancer grows back.
What are my chances of remission, and how long will it last?
That is not an easy question to answer. Some women with metastatic breast cancer live with their disease in remission for years, while others never have a remission and die within months. The likelihood that your cancer will respond to treatment depends on many complex factors. Your overall health and well-being and the amount of metastatic disease are important, but the most important predictor is how well you respond to the first couple of cycles of therapy. Usually, the faster and more complete your initial response, the fuller and longer it will last. Every time your breast cancer comes back, the chance of it responding to a new treatment regimen decreases and the duration of the remission gets a bit shorter. With time, your breast cancer will no longer respond to treatment and the focus of your care will change to managing the symptoms, often with the help of palliative care or hospice nurses. Although the proper time for this transition is a very personal decision, most oncologists feel that the chances of responding to additional chemotherapy are virtually nonexistent if you have not responded to your last three chemotherapy regimens, or if you are spending most of your day in bed or a chair.
Breast cancer that has metastasized to the bone or soft tissues generally grows more slowly, and responds to treatment more completely and longer, than breast cancer that involves the liver, lung, or brain. Breast cancer that recurs after many years generally grows more slowly and responds to treatment better than breast cancer that recurs during, or shortly after, the initial diagnosis and treatment.
The likelihood that your cancer will respond to treatment depends on many complex factors.
I feel pretty good during my chemotherapy treatments, and I worry that the treatment isn’t strong enough. Is it more likely to work if I get more severe side effects?
This is a common myth. There is really no link between how well the chemotherapy works and the severity of the side effects. Different people tolerate chemotherapy in different ways, and some chemotherapy drugs cause more side effects than others do. If you are not having severe side effects from your treatment, relax and don’t worry. There are now excellent medicines that prevent many of the side effects of chemotherapy. You should take these as prescribed and without fear.
There is really no link between how well the chemotherapy works, and the severity of the side effects.
How often will I see my oncologist during my chemotherapy treatments?
You will see your oncologist regularly throughout your treatment. At these visits, your doctor will see how you are tolerating the treatment and if you are having side effects. He will order medication to relieve any side effects, and, if these are severe, he may adjust your treatment schedule or dose. Another reason for these visits is so that your oncologist can see if your cancer is responding to the treatment.
Your oncologist will probably want to see you at the beginning of each cycle of chemotherapy. Most oncologists try to do this the same day that you get the chemotherapy, but sometimes it is more convenient to do this a day or two before. If you have any problems in the middle of your chemotherapy cycle, you should call your doctor to see if she wants to see you sooner. If your oncologist works with a nurse practitioner or physician’s assistant, she may see you at some of these visits. The primary reason for these scheduled visits is to be certain that it is safe to begin the next cycle of chemotherapy.
You will have blood drawn to be sure that your blood counts have returned to normal. Your doctor will examine you and ask questions about any side effects of chemotherapy that you had during the last cycle of chemotherapy. You can help your doctor by keeping a diary of any problems, concerns, or questions that you had during the last cycle of chemotherapy. When it is time to see how well your cancer is responding to the chemotherapy, your oncologist will have you get the necessary scans and blood work a few days before your visit. He will review these with you at your visit and discuss future chemotherapy plans with you.
Since the chemotherapy affects my immune system, is it still okay for me to work while taking it? Are there any precautions I should use in the work place or in other social settings?
The purpose of chemotherapy is to allow you to live your life in as normal a manner as possible, for as long as possible. The chemotherapy will certainly affect you, but you should strive to go about your regular business as much as you can. Though the chemotherapy will affect your immune system, this is really only a problem when your white blood cell count is low.
White blood cells (WBC), more specifically, the group of white blood cells called neutrophils fight infection, and, when they are low, you are at increased risk for infection. Your white blood cells drop to their lowest point (nadir) in the middle of your cycle of chemotherapy, stay there for a few days, and then gradually increase back to normal. Your greatest risk of infection is, therefore, in the middle of your chemotherapy cycle.
It is prudent to minimize your exposure to sources of infections during the entire time that you are on chemotherapy, but this is most important during the nadir period. You do not need to be a hermit during this period, but you should not go out of your way to be around people with colds and fevers. This is easy to do in your own home where you can ask visitors to stay away if they are sick.
This is harder to do at work or in large social settings, especially if you do not want to share your diagnosis with co-workers and friends. You need to be in control of your environment, especially when your WBC count is low. If this is not possible, it is best to avoid these situations all together or, if you must, limit the time of your exposure and wear a mask. It should go without saying that you should not share things like towels or drinking glasses, and always use common sense hygiene measures.
Actually, most infections that people get during chemotherapy come from the germs that normally inhabit your intestinal tract or skin. Your immune system usually keeps these germs in their own place, but when your WBC count is low, they can sneak through these natural defenses and cause an infection. Over the years, studies have shown that antibiotics, nutritional supplements, or a change in your diet will not prevent this from happening. Fortunately, the majority of patients who get chemotherapy do not get infected, and those that do usually respond to antibiotics quite nicely. However, immediate treatment is critical, and it is very important for you to call your doctor right away if you have a fever or any signs or symptoms of infection-even if these occur at 2:00 in the morning!
The purpose of chemotherapy is to allow you to live your life in as normal a manner as possible, for as long as possible.
Actually, most infections that people get during chemotherapy come from the germs that normally inhabit your intestinal tract or skin
Term:
Nadir – The low point of blood counts that occurs as a result of chemotherapy.
