- Question from June: Can I take a break from my Taxol treatment this summer? I have a wedding and Relay for Life coming up. I was diagnosed with mets to my liver and bones December, '04 and am in my sixteenth week of Taxol. With the warmer weather, I have a rash all over my head and face, my lymphedema is very bad, and I am bruising easily. My tumor markers are down to 351, and my oncologist says it is up to me.
Maria Theodoulou, M.D.
A chemotherapy vacation is not uncommon, and it's something that has to be decided by the patient with her treating physician. The response to the chemotherapy needs to be balanced by the side effects.
There has to be a period of time when you can look forward to going to that wedding with your skin as good as it can look. There are so many treatment options today that sometimes borrowing from another treatment might be appropriate if your doctor doesn't want you to stop treatment. But it's not uncommon to take a vacation from chemotherapy for family occasions, and if the treating physician deems it safe, then that's very doable.
But, and I emphasize the but, it's a decision that needs to be made with the physician who knows you, the pace of your disease, and what would be safe for you. There are multiple treatment options available, so you and your doctor together will be able to find the appropriate treatment that will keep the disease under control while minimizing side effects. Also, in that period of time you wish to lessen side effects, if it's not an appropriate time for a vacation, it may be safe for you to reduce the dose for that short one-to-two week period.
Treating a patient with breast cancer is not treating just one disease. Different women present with different types of breast cancer at different stages, and so treatments can be very different for different women. Metastatic breast cancer is often a diagnosis that requires long-term chronic care, just as any chronic disease like diabetes or heart disease does. With so many treatments for breast cancer, the options are many and the choice of treatment is based on the goals that are established between the patient and her treating physician.
For example, a goal may be to decrease as much of the cancer as quickly as possible. A goal may be to treat the patient and optimize her quality of life with fewer side effects. A goal may be to decrease the disease burden and reach a point where a milder treatment can keep it in check for as long a period as possible. The treatments are so varied today.
You mention Taxol, but there are many others. All chemotherapy drugs such as capecitabine (Xeloda) which are fairly easy to take today but may have side effects may be appropriate for one patient and not another. With the advent of targeted therapies such as Herceptin and Avastin and other small molecules that target breast cancer cells, the choices that are made between the physician and the patient are very custom tailored and quite individual.
There is a difference between treating a patient over a long period of time for a stage of disease that will be long-term, and having to balance the side effects of those treatments with as excellent a quality of life as one can offer. The other side of this is treating a patient with an early breast cancer diagnosis when the treatment is only for a finite period of time, with the goal of treatment being a long term remission or "cure". In that setting, a brief period of chemotherapy, even with higher side effects, may be an appropriate goal for that physician and patient. Many of the drug therapies, chemotherapy, and targeted therapies, and various hormonal therapies that are used in advanced breast cancer are also used today in an earlier setting to prevent metastases.
One of the major contributions that not only scientists but the excellent patients that have participated in clinical trials in the advanced setting have allowed us in the medical arena to gather sound clinical proof that smaller and more diverse treatment options are now available to help save lives. Where a drug like Herceptin is sometimes used indefinitely in a patient with metastatic disease (when I say metastatic, I'm talking about disease outside the breast and local area of the breast, in a site outside that area), the continuation of treatment may be broken up with rest periods, knowing that treatment will soon resume.
If an earlier setting, when a patient has early breast cancer, adjuvant chemotherapy is prescribed for a short finite time with a goal of cure, fewer treatment breaks are recommended to be as sure as we can that our goals for getting rid of any cancer cells that might remain after surgery are not compromised. In breast cancer, with so many varied treatments in the metastatic setting, we can often successfully tailor a regimen of therapy by trial and error. These treatments will keep the advanced disease in check and allow the patient to get on with as much of the regular activity of her life as possible. In that setting, yes, allow a break here and there, or when the drugs become too toxic, it's a good idea to back off and switch to another regimen.
In the early setting, you the patient with your doctor want to do everything you can, as safely as you can, to eliminate or greatly decrease any risk of recurrence. And knowing that this period of going into battle to do everything you can do to keep you as safe as you can be for your future will in most cases give you the courage to get through that one less-than-great summer—the summer that seems like it passed you by. But your goals are huge, and that's what you look forward to—that period of treatment time early on that has a beginning and an ending.
- Marisa Weiss, M.D. If the goal of your treatment regimen conflicts with a prepaid vacation, ask your doctor for a letter to help you get your money back or move the vacation to another time that doesn't conflict with your therapy.
- Tamara Shulman, Ph.D., FAACP When you're in treatment, it's very important to focus on future summers and future pleasures, and be as hopeful and optimistic as you can be. Don't let the diagnosis and fears about breast cancer scare you into thinking this is your last summer, so you need to do everything this summer. This summer you are in a difficult and temporary time, and for most women in treatment, there will be many happy times ahead when treatment is finished. That perspective—that this is a time you're doing battle with a serious disease—means it's important to concentrate your energies on getting well. This time will pass, and you will be able to do many of the things that you're perhaps missing this summer in future summers.
- Maria Theodoulou, M.D. For the women who have advanced disease who are looking towards a long future with ongoing therapies, it's important to be hopeful that your next summer will have smarter therapies with less side effects that will allow you to spend your summer with your family as you did in the past, because of the new breakthroughs. So don't look at this summer as your very last one.
On Wednesday, June 1, 2005, our Ask-the-Expert Online Conference was called Summertime Issues: Treatment and Personal Care. Maria Theodoulou, M.D., Tamara Shulman, Ph.D., and moderator Marisa Weiss, M.D. answered your questions about the various summertime issues that relate to breast cancer treatment and personal care.
The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.
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