Just before my chemotherapy for breast cancer started -- when I was fantastically frightened by the toxic drugs that were about to drip into my veins -- I was told by doctors, nurses, survivors, friends that I would be just fine. I was young and strong and tough. I would easily tolerate the beating my body was about to take. This is what I was told and actually came to believe myself. I had no other choice really than to approach chemotherapy with a fighter mentality. And so I did. And I did pretty well for my first three doses of Adriamycin and Cytoxan -- given every two weeks instead of three in a dose-dense fashion -- followed by one injection of Neulasta 24 hours later to maintain normal blood counts. And then something happened. And I did not end up tolerating the chemotherapy my gut told me was a scary endeavor.One week after my fourth dose of chemotherapy and after my shot of Neulasta, my body plummeted. My skin lost its color. My energy disappeared. My mind was foggy. My thoughts and words seemed incoherent. My temperature rose. And my white blood counts dipped to 700 -- 4,000-10,000 is normal. I landed in the hospital, spent five days on IV antibiotics to fight off infection, and received a blood transfusion to replenish my blood supply that would not recover on its own. And then for two weeks, I was better. Until my blood counts dropped again -- this time to 1,200 -- and my fever returned and new symptoms surfaced too. Like sore gums and a sore throat and a headache.
It was somewhat of a mystery at the time -- why my body crashed a second time after my first hospital stay -- when I had not received any further chemotherapy. My doctor arrived at the opinion that it was delayed reaction to chemotherapy. And maybe it's just that simple. Maybe it's not a mystery after all. Maybe chemotherapy is just hard stuff and there's no real prediction for how it will affect the body -- or for how long. Maybe it's just the price I paid for consenting to a treatment that is now believed to strike harder those who are younger than 64. I was 34.
A study released on Tuesday marks the first of its kind for attempting to calculate the real-world risks of chemotherapy for 35,000 breast cancer patients under age 64. Researchers studied a massive database of insurance claims to determine how often breast cancer patients under 64 were hospitalized in the year after diagnosis and how often chemotherapy side effects were blamed. They found that 16 percent of these patients needed hospital care for serious side effects -- more than previously thought. Some side effects, like infection, low blood counts, dehydration, and nausea, occurred three to four times more often than earlier research predicted.
For some reason, chemotherapy strikes young women harder than older women. And in the ultimate of strikes, many women do not even need chemotherapy. Surgery, radiation, and hormone treatment may be enough. But there is no way to accurately determine who will benefit from chemotherapy so in the spirit of caution, chemotherapy is over-prescribed. And the price -- hospitalization -- is high. But if we can survive chemotherapy -- like I did -- then perhaps it will also save our lives.
1. This is a very important study. The news story was well written. You have to wonder about what the study addressed. Published clinical trials enroll the "best" patients. What really happens when less than the best patients are enrolled?
With respect to toxicity and efficacy, most studies purport to show a benefit of one form of chemotherapy versus another that show really minuscule benefits. For instance, A/C + Taxol versus A/C alone required a randomized trial in thousands of patients to show a minuscule improvement.
If the "real world" side effects are so markedly greater than reported in the clinical trials, it could well be that in the "real world" the putatively improved chemotherapy is actually worse than the "old fashion" chemotherapy, if, as in the case of A/C + Taxol, the putatively improved chemotherapy is more toxic, more than canceling out the putative benefits seen in the "non-real world" setting.
And if the A/C is resistant to the tumor? What do you think happens?
Posted at 12:03PM on Aug 19th 2006 by Gregory D. Pawelski