Improving Patient Quality Of Life
For patients who can avoid chemotherapy, the impact on their quality of life is tremendous.
This year, more than 270,000 women in the United States will be diagnosed with breast cancer, and approximately two-thirds of them have this HR-positive, HER2-negative subtype,” Shak says. “This is the most common and most treatable, but weve got to treat it right.”
The RxPONDER trial shows the benefits of tailoring breast cancer treatment to each individual. “It identified that more than 75% of women received chemo for node-positive breast cancer because it appeared there might be a benefit for everyone,” Shak says. “The results now show that the majority of women with one to three positive lymph nodes can be safely spared chemo without compromising their outcomes.”
Having more detailed information on a patients cancer type also guides patients and providers in making more patient-specific treatment plans.
Almost every breast cancer is different at the gene level, so there is no one-size-fits-all approach, , clinical director of breast medical oncology at Seattle Cancer Care Alliance and incoming chief medical officer for the American Society of Clinical Oncology , tells Verywell.
When Gralow is making a recommendation for treatment, she looks in-depth at the patient and factors in:
- The type of cancer they have
- Any comorbidities they may have
- Where the patient is in life
Breast Cancer Surgery And Prostheses
If you need breast cancer surgery such as a mastectomy or lumpectomy, Medicare Part A covers services you receive if youre admitted to a hospital, and Medicare Part B covers outpatient services.
For outpatient procedures such as some lumpectomies, youll owe 20% of the Medicare-approved charge after you pay the Part B deductible. For in-patient surgeries like mastectomy, youll pay the Part A deductible, $1,484 in 2021 there is no coinsurance payment for your first 60 days in the hospital. A typical hospital stay for mastectomy is three days or less.
Reconstructive breast surgery is covered by Original Medicare. If, after mastectomy, you receive one or two surgically implanted breast prostheses in the hospital, Medicare Part A will provide coverage. If you receive an implant as an outpatient, Part B applies. Part B also covers some external breast prostheses, including a post-surgical bra.
Vitamins To Avoid During Radiation Therapy
Your radiation oncologist may tell you to avoid taking certain antioxidant vitamin supplements, such as vitamins C, A, D, and E, while you’re having radiation therapy. These vitamins might interfere with radiation’s ability to destroy cancer cells.This is because radiation works in part by creating free radicals highly energized molecules that damage cancer cells. Free radicals in the environment can damage all cells, but in the case of radiation treatment they are focused on the cancer cells. Antioxidants help keep free radicals from forming or neutralize them if they do form.
Because of the potential conflict between the goal of radiation therapy and the goal of antioxidants , it makes sense to stop taking any antioxidant supplements during radiation therapy. When radiation is finished, you can resume taking your supplements.
Throughout your treatment, do your best to eat a well-balanced diet that contains all of the vitamins you need. Vitamins that come naturally from food are unlikely to interfere with treatment.
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What Diagnosis Requires Chemotherapy
When considering the right treatment for you, Dr. Gorman will take into account the stage and characteristics of the diagnosis.
Chemotherapy generally begins after surgery to rid the body of any cancerous cells. However, if the tumor is at an advanced stage, Chemo may be used to reduce the size before removing it.
Below is a list of the various stages of breast cancer and what might be expected:
Early Stage Breast Cancer
In early stages, chemo is necessary if:
- Cancer has spread to the lymph nodes.
- Test results are hormone-receptor-negative and HER2 positive.
Advanced Stage Breast Cancer
Advanced stages are treated with chemo to destroy cancerous cells. Chemo medicines run throughout the entire body and are beneficial in killing cells that have spread to other areas, known as Metastatic cancer.
Many Chemotherapy medicines are available, and Dr. Gorman and your medical oncologist will determine the right medication for you based on your specific needs.
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Where You Have Chemotherapy
You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so its a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.
You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.
For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.
Clare Disney : Hello, my name is Clare and this is a cancer day unit.
So when you arrive and youve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. Were going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
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When Is Chemotherapy Given For Breast Cancer
Chemotherapy is sometimes given before surgery in order to shrink the tumor so it can be removed more easily or so that a lumpectomy can be performed instead of a mastectomy. When breast cancer is localized only to the breast or lymph nodes, chemotherapy may be given after a lumpectomy or mastectomy. This is known as adjuvant treatment and may help reduce the chance of breast cancer recurrence.
Chemotherapy may also be given as the main treatment for women whose cancer has spread to other parts of the body outside of the breast and lymph nodes. This spread is known as metastatic breast cancer and occurs in a small number of women at the time of diagnosis or when the cancer recurs some time after initial treatment for localized breast cancer.
What Is An Anthracycline
An anthracycline is a type of chemotherapy that attacks enzymes inside of cancer cells DNA which helps them divide and grow. Anthracyclines used in breast cancer treatment include doxorubicin, liposomal doxorubicin, and epirubicin. These anthracyclines are bright red in color and may cause temporary discoloration of urine and bodily fluids.
A side effect of all anthracyclines is that they may cause a type of permanent heart damage, called cardiomyopathy. Because of this, there is a limit to how much anthracycline a person can receive in their lifetime. People receiving treatment with anthracyclines should have their heart function monitored with an echocardiogram or a MUGA scan, a special type of heart imaging technique.
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What If I Have Side Effects
You will see your doctor regularly while you are having treatment. Before each dose of chemotherapy you will have a blood test and a consultation with your medical oncologist to review your treatment. You will be able to discuss any side effects you have experienced and to ask questions. If necessary, the treatment can be adjusted for the next cycle.
What Matters Most To You
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have chemotherapy after surgery
Reasons not to have chemotherapy
I want to do everything possible to treat the breast cancer.
I would rather wait and see if the cancer comes back before I have more treatment.
I would have strong feelings of failure if the breast cancer returned.
I know there’s no way to know for sure whether chemo would keep the cancer from coming back.
I want to have the added treatment and be done with it.
I would be comfortable having frequent follow-ups, without the added treatment.
I feel ready to deal with the possible side effects of chemo.
I am very worried about the side effects.
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Chemotherapy ‘unnecessary’ For Thousands Of Women With Breast Cancer
Oncologists say the TAILORx trial is likely have an immediate impact on how the disease is treated in the UK.
Monday 4 June 2018 06:47, UK
Gruelling chemotherapy may no longer be required to treat breast cancer following a landmark study.
More than 10,000 women with the most common form of early breast cancer took part in a trial that found the treatment was not necessary for many after they had surgery.
A leading oncologist said the findings will lead to a “fundamental change” in how the disease is treated.
It is estimated that 3,000 to 5,000 women in the UK are likely to avoid chemotherapy every year following the trial.
Each year more than 20,000 women in the UK are diagnosed with hormone-receptor positive, HER2-negative, node-negative breast cancer.
Historically around half of these patients undergo chemotherapy after surgery to remove their tumour to stop the cancer returning
The TAILORx trial shows that only 30% of women with this particular form of early-stage breast cancer derive any benefit from the treatment.
Treatment Of Breast Cancer Stages I
The stage of your breast cancer is an important factor in making decisions about your treatment.
Most women with breast cancer in stages I, II, or III are treated with surgery, often followed by radiation therapy. Many women also get some kind of drug therapy. In general, the more the breast cancer has spread, the more treatment you will likely need. But your treatment options are affected by your personal preferences and other information about your breast cancer, such as:
- If the cancer cells contain hormone receptors. That is, if the cancer is estrogen receptor -positive or progesterone receptor -positive.
- If the cancer cells have large amounts of the HER2 protein
- How fast the cancer is growing
- Your overall health
- If you have gone through menopause or not
Talk with your doctor about how these factors can affect your treatment options.
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Radiation Therapy Side Effects
The side effects of radiation therapy depend on the type of radiation therapy youre having. In general, the side effects tend to develop as treatment goes on and may be more troubling toward the end of treatment. Overall, the most common side effects are redness, swelling, and skin peeling in the area being treated. Read more about radiation therapy side effects.
Study: More Breast Cancer Patients Can Safely Skip Chemotherapy
A federally funded study has found that many women with the most common type of early stage breast cancer likely do not need chemotherapy after surgery. The study was presented June 3, 2018 at the American Society of Clinical Oncology meeting in Chicago, and simultaneously published in the New England Journal of Medicine. It is likely to change the way many newly diagnosed breast cancer patients are treated.
“With results of this groundbreaking study, we now can safely avoid chemotherapy in about 70% of patients who are diagnosed with the most common form of breast cancer,” said Kathy Albain, MD, a co-author of the study. “For countless women and their doctors, the days of uncertainty are over.”
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What Are Some Common Chemotherapy Combinations Used In Breast Cancer
Chemotherapy regimens usually have acronyms to help simplify what theyre called. They can also include other medications like HER2 target therapy, discussed below. A few examples of some common breast cancer chemotherapy regimens are:
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AC T: Doxorubicin and cyclophosphamide followed by paclitaxel
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AC T: Doxorubicin and cyclophosphamide followed by docetaxel
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AC THP: Doxorubicin and cyclophosphamide followed by paclitaxel, trastuzumab, and pertuzumab
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TC: Docetaxel and cyclophosphamide
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TAC: Docetaxel, doxorubicin, and cyclophosphamide
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CMF: Cyclophosphamide, methotrexate, and fluorouracil
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TCHP: Docetaxel, carboplatin, trastuzumab, and pertuzumab
These acronyms consist of the first letter of each medications name in the regimen, but it varies if the first letter refers to the medications brand or generic name. For example in the TC regimen the letter T refers to Taxotere, which is the brand name of docetaxel. The C refers to cyclophosphamide.
These medications are discussed individually below.
What Are The Risks Of Chemotherapy
Different chemotherapy medicines tend to cause different side effects. Many women do not have problems with these side effects, while other women are bothered a lot. There are other medicines you can take to treat the side effects of chemo.
Talk to your doctor about the type of chemotherapy medicine that he or she is planning to give you. Ask about any side effects that the chemo may cause.
Short-term side effects can include:
- Nausea and vomiting.
- Hair thinning or hair loss.
- Mouth sores.
- Increased chance of bruising, bleeding, and infection.
- Memory and concentration problems.
Long-term side effects of chemotherapy can include:
- Early menopause, which means not being able to have children anymore. It also can include symptoms like hot flashes, vaginal dryness, and thinning bones .
- Concentration problems that may last for many months after your treatments are finished.
- In rare cases, heart damage and a higher risk of other types of cancers, such as leukemia.
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How Often Is Chemotherapy Given For Breast Cancer
Chemotherapy for breast cancer is given in cycles, usually 2 to 3 weeks long, with a short break in between. This gives the body time to recover after receiving chemotherapy. Some chemotherapy is only given on one day per cycle, while others are given on multiple days per cycle. For example, gemcitabine is often given on day 1, day 8, and day 15 of an overall 28-day treatment cycle .
A chemotherapy schedule depends on the type of chemotherapy medications given. Chemotherapy is usually given over 3 to 6 months, or longer in some cases, depending on the type and stage of breast cancer. If you experience bothersome side effects or the treatment is no longer working, you may need to switch treatment to a different chemotherapy or therapy option.
Chemotherapy For Metastatic Breast Cancer
Advances in treatment are making it possible for women with metastatic breast cancer to live for many years. New drug therapies can not only slow down or stop a tumors growth but also keep symptoms at bay.
Which treatment your doctor recommends will vary based on your medical history, age, and breast cancer type, among other factors. Combinations of drugs are commonly prescribed for women with early-stage disease. Most women with advanced breast cancer generally receive only one drug at a time.
Chemotherapy drugs that MSK doctors commonly prescribe for advanced breast cancer include:
Women with advanced disease can also benefit from genomic testing. This is also called tumor sequencing or molecular profiling. It is offered to all MSK patients with metastatic breast cancer. Genomic testing involves looking at the cancer cells to see if there are any genetic mutations that could be linked to the specific type of breast cancer you have.
Our experts use a highly sophisticated testing approach developed by MSK researchers called MSK-IMPACT. The information gained from MSK-IMPACT can help us personalize your care. We can rule out drug therapies that may not work for you or sometimes recommend cutting-edge clinical trials designed to target the specific mutations in your tumor.
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Is Chemotherapy Necessary For Her2
Chemotherapy is typically used to shrink a tumor before it is removed from the breast with surgery. This is especially necessary when
- The tumor is so large that it cannot be removed by surgery. Once the tumor regresses with chemotherapy, it becomes easier for doctors to remove it without the risk of spreading to adjacent organs.
- Doctors want to check how well a particular medication works on your breast cancer. This helps them decide whether to continue the same drug after surgery or switch to another medication in case the previous one does not work.
Everyones breast cancer varies at the molecular level. The type of medications your oncology team prescribes will depend on what results are expected out of your treatment and the features of your cancer.
Where Is Chemotherapy Given
Unless youre having chemotherapy as tablets, youll normally be given your treatment at hospital as an outpatient or day case. This means youll be able to go home on the same day.
You may be at the hospital for a short time only. However, because of tests, waiting times and how long it takes to prepare and give the chemotherapy drugs, some people are there for most of the day. You may be asked to have blood tests a few days before you have your chemotherapy.
You might find it helpful to take things to help pass the time as well as snacks and drinks. You may be able to take someone to go with you to keep you company. Talk to your chemotherapy nurse to find out if this is possible.
In some areas chemotherapy may be given in a mobile treatment centre or in your home.
With some types of chemotherapy you may be given your first treatment as an inpatient and may need to stay in hospital overnight.
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