Chemo for IBC

Dear Phyllis,
 
Thank you for your story.  I agree that chemo first is
ideal.   The fact that 
chemo was given after, which is the way it was always done
until  more recent 
times still does not explain surgery without any chemo to
me.   Does anybody 
feel surgery without any chemo for ibc in a 81 years old
patient  with stage 4 
renal disease and heart disease is right?.  Especially in 
light of her being 
estrogen positive and older women's breast cancer tend to 
typically grow 
slower?  Her skin is more compromised being older and  IBC.
 
I still do not feel right with that unless more opinions are
given.
 
Sincerely,
 
Susan Anne in California

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Hi, Susan Anne -

First, one thing that happens sometimes is that older
patients with 
presumably slowly growing tumors, even if IBC, may be
closely watched 
and nothing at all done, much like certain types of prostate
cancer.  
I'm not arguing that this is a good thing to do, just that
it's 
sometimes done, particularly if the patient has multiple,
complex 
medical issues.

I would suspect that the reason more aggressive treatment is
not offered 
may be that the numbers for various tests, especially
creatinine, may be 
not good.   The reason I think this is that a push has been
going on for 
the past several years to treat older patients more
aggressively.  My 
observation is that, when the patient is reasonably healthy
and active, 
the course of treatment will be more aggressive, regardless
of age.

IV-type chemo is known to be exceptionally hard on the
kidneys.  For 
example, though I was relatively healthy when I was getting
my high-dose 
chemo, the INSTANT I gained more than 1kg (2.2 pounds) of
weight while 
in the hospital, the daily bloods started including all
manner of kidney 
function testing and resulted in my getting Lasix (not my
fave!) . The 
worst part was doing one of those "give us a gallon of
your urine" 
collections every third day! 

Additionally, we don't know what the specific heart problems
are. The 
ones I can think of that might make chemo in appropriate are
congestive 
heart failure, atrial fibrillations, and congestive heart
failure 
(CHF).  I'm sure there are others.

Though my great grandmother, grandmother, Mom, two aunts,
and brother 
all had or have atrial fibrillations which did not respond
well to 
treatment so I think the fact that I have them is probably
more a 
genetic thing, my oncdoc thinks my atrial fibrillations are
due to my 
chemo because Adriamycin is hell on heart function, though
my LVEF (left 
ventricular ejection fraction) measured by MUGA never
dropped below 60 
percent, even in the midst of the high-dose.

Finally, since CHF causes water retention and may add to
stress on the 
kidneys, that could be another heart-related reason.

HTH.

v
<>--
 / Virginia R. Hetrick, here in sunny California
0 Email: drjuicegte.net
Oo "There is always hope."
My fave: http:
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