Lumpectomy Lounge....let's talk!
Comments
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That is interesting, Molly. i hate that I have to "join" and get mailings from that group just to read the article.
HUGS!
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I know, I read them all so I don't mind. I want to feel educated no matter what comes my way.
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Maybe after I get moved, unpacked and settled I will feel like reading them. Just not right now
HUGS!
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Peggy, I have the same Medigap plan as you. Love it
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- I will try to avoid neurotoxic chemotherapy in diabetic and older patients, when other options exist. Dr. Hershman et al examined the SWOG database linked to Medicare claims and determined that age and diabetes were predictors of the development of neuropathy (Abstract 10001).
- I will be recommending an exercise program for my patients who will be starting treatment with potentially neurotoxic chemotherapy such as taxanes and platinum drugs. Greenlee et al presented data from the Pathways Study (Abstract 10002) demonstrating a higher incidence of taxane-induced neuropathy in breast cancer patients who were obese and had a low level of physical activity. At the same session, Dr. Kleckner presented an analysis of a subset of 314 patients in the URCC CCOP/NCORP EXCAP study (Abstract 10000). Those randomized to the exercise program had a lower incidence of early neuropathy, highly significant in older patients. Although the majority of patients were women with breast cancer, there were also men, and drugs included vinca alkaloids in addition to taxanes and platinum.
- I will consider the combination of daratumumab (D), bortezomib (V), and dexamethasone (d) [DVd] as a treatment for relapsed or refractory multiple myeloma. Dr. Palumbo presented the results of the European CASTOR study at the Plenary Session, which demonstrated superiority of DVd over Vd even in patients previously treaded with V (Abstract LBA4). There was a significant improvement in response rate, progression-free survival, and time to progression, and responses were brisk, which is important in these patients, many of whom are quite symptomatic. Progression-free survival and time to progression were approximately 7 to 8 months in the Vd group but have not been reached in those who were treated with D as well.
- I will offer short-course radiotherapy with temozolomide (TMZ) in selected glioblastoma multiforme patients over the age of 65. Dr. Perry presented the results of a joint EORTC/NCIC study at the Plenary Session (Abstract LBA2). The addition of TMZ to radiation therapy resulted in an improvement in overall and progression-free survival, most dramatic in patients with MGMT methylated tumors. The regimen was well-tolerated, and there was an impressive improvement in 2-year survival rates. Median survival was increased from 3.9 to 5.3 months and in MGMT methylated patients from 7.7 to 13.5 months.
- I will use intermittent rather than continuous docetaxel in the treatment of metastatic prostate cancer (Abstract 5005). Although this German study, presented by Dr. Cash did not complete accrual, the intermittent regimen of docetaxel (12 weeks of the drug either weekly or every 3 weeks, followed by a drug holiday until progression) appears to be noninferior to the continuous regimen. Another approach to decrease toxicity in chemotherapy-treated patients in this population is to lower the dose of cabazitaxel in the second line setting. DeBono et al presented the results of their PROSELICA study (Abstract 5008), which demonstrated that the lower dose of 20 mg/m2 was noninferior to the standard dose of 25 mg/m2, and there was an improved overall safety profile!
- I will add capecitabine (CAP) to gemcitabine for the adjuvant treatment of resected pancreatic cancer while we await the results from ongoing studies of even more aggressive combinations. The ESPAC-4 trial results were reported by Neoptolemos et al (Abstract LBA4006), which demonstrated an improvement in median survival from 25.5 to 28 months when CAP was added to gemcitabine, with added but manageable toxicity. These were very high–risk patients. Most impressively the 5-year survival rates were increased by the addition of CAP from 16% to 29%!
- I will not use exemestane as adjuvant treatment for invasive lobular breast cancer in favor of one of the two nonsteroidal AIs, anastrozole or letrozole (Abstract 521). There are increasing data that exemestane is less effective in patients with this histology, which was confirmed by this review of the MA.27 study by Strasser-Weippl et al. Patients with invasive lobular carcinoma had improved overall survival when treated with anastrozole as opposed to exemestane (HR, 1.8; P = .55), consistent with the findings in the BIG 1-98 trial.
- I will be using more AC/T and less TC in patients with high-risk early breast cancer, based on the ABC analysis of three randomized trials presented by Blum et al (Abstract 1000). In this initial report, the non-anthracycline regimen did NOT demonstrate noninferiority to the anthracycline regimens. TC may be noninferior for ER-positive patients, however, but for receptor-negative patients, I will use anthracyclines in most cases.
- I will recommend the continuation of aromatase inhibitor (AI) therapy for at least an additional 5 years in high-risk postmenopausal women with early-stage breast cancer. Many of these women have been reluctant to stop their AI at 5 years; I have generally made recommendations case by case, but mentioned that we will have data to help guide our decisions, once we had the results from the MA.17R and B42 studies. The initial results from MA17.R were presented at the Plenary Session (Abstract LBA1) by Dr. Goss. In patients treated with 5 years of AI, as initial therapy or preceded by up to 5 years of tamoxifen, extended AI treatment to 10 years (as opposed to placebo) significantly improved disease-free survival. The gains were modest, and there was an increased risk of osteoporosis; so, I don't plan on this approach in all of these women, but I will have the discussion, considering the risks and benefits, and probably recommend continuation in women at high risk of late recurrence. Data presented in Abstract 505 by Pan et al was an analysis of predictive factors for late recurrences in ER-positive patients (over 46,000 British women followed for up to 14 years), and its findings will help in advising our patients.
- Consider the use of checkpoint inhibitors for patients with refractory cancers as there is increasing evidence of efficacy in a number of diseases, including metastatic colorectal, with high microsatellite instability (Abstract 3501; Overman et al), squamous cell anal (Abstract 3503; Morris et al), and even metastatic bladder as first-line in cisplatin-ineligible patients (Abstract LBA4500; Balar et al). I predict that these treatments will become approved in the near future and may even be available in some circumstances under compassionate use programs.
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Thanks, Molly.
Sandy, it IS the best plan. The insurance guy who sold it to me said I'd never pay another medical bill and in 6 years - he's been right.
HUGS!
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Molly, I think he will do better now! I think I got up most respect from nurses, because they would come check on me, bring my pain meds promptly, and even though I couldn't do much, I never called for help and they would see me walking slowly up and down hall all night. Thanks for the info. I find that I love to learn anything new in regards to cancer research. So glad someone was there for your last surgery lol! It is kind of embarrassing for some reason if they don't see anyone there. I have had an insurance lady try to deny one of my patients a longer stay in rehab. He had a broken leg, could not do for himself and they were making us send him home. I told her that he has no family or friends to help, and her words were, " well, usually when someone ends up in a situation like that, there is usually a good reason for it!" There is a stigma attached nowadays that if no one is there for you, it means you are not a good person. A shame how society judges people!
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Thanks, Molly. But if I go from osteopenia to osteoporosis on letrozole, I think I will take my chances after 5 years--maybe adding a statin to mitigate the hyperlipemia of AI therapy, as well as lower the amount of circulating cholesterol that tumor cells use to synthesize their own estrogen analogues in the absence of estrogen
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Ugh. I think I may have some neuropathy in my hands. My hands keep falling asleep. I wake up at least once per night because my hands are asleep. It happens randomly during the day, mostly just the last 3 fingers and the outer palm. However, every time I drive both hands fall asleep, the whole hands including the thumbs.
I asked my MOs nurse about it and she suggested that it may be peripheral neuropathy or possibly carpal tunnel. I don't have any pain, just hands falling asleep. I see the PA next week, so I'll have her take a look before I go running off to the orthopedist. In the meantime, it is aggravating as heck.
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Could also be cervical radiculopathy or ulnar neuropathy--bone spurs or arthritic disks in the neck impinging on, respectively, the radial or ulnar nerves. That your whole hands fall asleep when driving might indicate the neuropathy is positional--and something’s getting scrunched that shouldn’t be.
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MLP - is it in the last 3 fingers or the whole hand? Could be swuished nerves. Push your shoulders waaaay back, and put arms at sides with backs of hands UP like a fairly. Then, gently stretch your neck to the side holding and pressing for 30 sec gently stretching the neck more and more to the side. Then, do the other side. This opens up the area where the nerves go down the arm. A lot of us have been babying our breast and arm, and we aren't stretching enough. This is especially helpful for anyone with big breasts as you tend to hunch forward, too. See if it helps!
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Could be. I've had lower back injuries, but no neck problems, ever. Hmmm, something to think about. I just remembered that my sister had similar stuff--hands falling asleep randomly. After fooling around for a YEAR with a chiropractor, she went to her doctor. Her MRI revealed a free-floating bone chip in the spinal canal. She was scheduled for surgery the following morning. I remember that when she woke up the first thing she noticed was that her hands weren't numb.
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I think I'm in information overload! I'm a little confused about my hormones. I just had total abdominal hysterectomy with ovaries and all taken out at 42 under suggestion by my 2 oncologists. I know that my adrenal gland and body fat will still produce some and that the tamoxifen won't block my bodies ability to use the hormones, it just blocks any cancer cells from using the hormones to grow. I'm wondering, how am I going to know if what my body is still going to produce will be enough to protect my heart, bones, blood vessels and to keep me from having memory loss? I'm thinking I'm just screwed no matter what? It's either take a chance of cancer recurrence or have all of the above problems? I'm not like most of the women I talk to on hyster sisters, they are going to take hrt and I can't. I have to live with full blown medical induced menopause. I feel kind of lost and wondering if there is anything I can do? Has anyone here had to deal with any of this while premenopausal? Did any of yal have ovaries out at such a young age?
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LG, you are not pre-menopausal now. You are lacking the necessary equipment. I asked my MO if there was a test to tell if Arimidex is working. Nope. I would ask your MO why he prefers Tamoxifen over Arimidex. There may be a good reason because post-menopausal women often go on it after using an AI. But sorry to say you are likely to have the usual menopause symptoms. At least I would be surprised if you didn't. And you're right, the choices suck. For me, I prefer to deal with the devil I know I am fighting - BC. Wish I could be more encouraging. Perhaps others in your shoes can help you and tell you how to cope with your sudden entrance into menopause. (And maybe you won't have hot flashes or anything!).
HUGS!
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LG having two docs suggest the same procedure, it seems like you did the right thing. I haven't gone down that hormone therapy path yet, I'm premenopausal so I'm assuming it will be Tamoxifen. Are there ways to check hormone levels? I am really clueless about this phase. But I find it reassuring that TWO docs recommended it, so I don't think you made a bad decision. I have an onc appt tomorrow, I am going to ask about this if I can.
Got a voicemail from the breast surgeon about my path report from my re-excision surgery NINE DAYS AGO (I find it unsettling to have to wait nine days for pathology.) Anyway, she said "great news, everything looks really really good," but that's all I've got. I called her right back, but of course, I'm still waiting for her return call. I need details! But at least it's good news. I admit I was worried I would need more surgery.
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fightergirl, I felt the same way after waiting 7 days for my news after reexcision. There was cancer on posterior margin with lumpectomy, right on the edge, yet no detectable cancer found with reexcision. I was a bit nervous despite the good news, thinking that surely if there were cells at the edge of the first, that the second one had to show SOMETHING! I think I still worry in the back of my mind, ask to see the results like I did. I also got a copy to keep in my records. So glad for you! I don't think my gynecologist would have done hysterectomy if I didn't already have bleeding problems and chronic cyst on one ovary, but I have heard that most insurance companies will pay for it with breast cancer patients. The tamoxifen also puts people at risk for cysts and uterine problems also. It might not hurt to ask. My oncologists didn't seem to care either way, I just asked their opinion because I was already going to have one ovary out and they just said, "if your having one out might as well take the other, and if you have both ovaries taken out, might as well take everything and you won't have to worry about any of that"
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fightergirl, GREAT NEWS!!! Nothing like being on pins and needles for over a week.
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Fightergirl, excellent news on the re-excision! Woohoo!
LG, sorry you have to get thrown into early menopause like this. Let it be additional motivation for weight loss. I believe the thinner you are, the more tolerable the hot flashes will be. I've had some, even as thin as I am, but they are easy to deal with. I don't get awakened by them. The menopause symptoms are just like all the others we have to deal with. You find ways to tolerate them and keep living your life. Don't let this be an excuse for weight gain, either. If you stay active (or even get more active) there is no reason to gain weight.
Sloan, I made a plum crumble! It is delicious and I'm having trouble leaving it alone
Please remind me when your next test or scan is scheduled.
Poodles, when did you start the AI? My hands fell asleep when I slept for about a week, shortly after I started my anastrozole. Then it went away.
Sandy and Peggy, thanks for the discussion about the Medicare supplement plans. It will help me choose one when it's time. DH is 63, so he will need to think about it pretty soon. I have 3.5 more years.
Molly, thank you for the info on the ASCO conference. Of course, now I'm wondering - when is TC appropriate instead of AC-T. My cancer is not considered aggressive so I'm not too worried, but then again, aren't any actively dividing cells (that chemo will kill) inherently aggressive? I was not disappointed that I wouldn't get the A component because of the heart issues, but now I wonder.
I am starting to feel fairly normal, 9 days out from first infusion. I got my weight back up into the 120's and my appetite is returning. I'm worried I might catch the cold my DH has, but only time will tell. I saw my MO yesterday. I'm not sure about her grasp of nutrition. My GP ordered an abdominal ultrasound which revealed I have a sludgy gallbladder. I was discussing with the MO how to modify my diet to help this condition, and she told me that the fat in dairy will not affect bile production and I only needed to avoid "oily foods". Gosh, I have not heard that term since my mother was alive! I asked her what oily foods were, and her example was KFC. So according to her, I can eat all the ice cream and cheese I want.
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LG, on the Hystersisters forums you can post in the No Ovaries No HRT forum in Menopause and Hormone section. There is a lot of women posting who can't use HRT due to cancer. I was premenopausal when my ovaries were removed. I was 50 and barely in peri menopause. My surgeon recommended the BSO due to my family history of breast cancer. Your concerns have been mine which is why I used estrogen for three years until breast cancer hit. Now on an AI I worry about bones, heart disease and my family history of Alzheimers. But I have a genetic mutation that makes me higher risk for a new cancer. So diet, exercise and supplements will have to do.
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Great news, fighter girl!! Moondust, glad to hear you are getting back to normal. Hugs everyone.
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Yay, fightergirl!
LG, unlike AIs, Tamoxifen doesn’t weaken bones--SERMs may even arrest the progress of bone loss, putting you at an advantage should you eventually have to switch to AIs.
Alice, I too had a somewhat sludgy (“sandbag”) gallbladder. Two attacks 6 years apart (at 37 and 43)--and they both came early the next morning after having had particularly greasy ribs & fries. First time, ultrasound showed nothing--but a HIDA scan after a medically-ordered big bacon-eggs-hashbrowns breakfast down in the hospital cafeteria showed a veritable Mongol Horde of isotope particles marching out of my liver into & out of my gallbladder. Second attack was followed by an ultrasound that showed “multiple small stones too numerous to count.” Laparoscopic cholecystectomy was a breeze. I call my absent gallbladder my “fat cop,” because if I overdo the dietary fat, I end up being an extremely “regular gal.” It helps me be moderate on my low-carb diet.
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Thanks everyone!
So got the details - I had 8 lymph nodes removed last week, 3 had what they call a "treatment effect" where they see scarring, it's possible that there was cancer there before that was killed by chemo. There was no cancer in the breast tissue removed. In other words - there is no evidence of disease. Pathological complete response. I am feeling lucky, thankful, and could not be happier today!
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Way to go, fightergirl! You rocked that re-excision!
Moondust, I started on letrozole in March 2016, so it's been 3 months. I'm not sure when the numbness started, exactly, but I have definitely noticed it since January (chemo ended in Dec 2015). My sister suggested that I might have ulnar nerve entrapment (cubital tunnel syndrome). It makes the ring finger, little finger, and side of the hand go numb. It's caused by bending your elbows. Certainly, some of my symptoms fit the profile, but there are other times when my thumbs and forefingers are affected and they are served by the medial nerve, which goes through the carpal tunnel (radial side).
I'm probably just gonna go ahead and call my hand orthopedist tomorrow. I don't think this is too serious (yet) but you have to be careful with hand issues. I probably need some wrist splints to sleep in, to keep me from flexing my wrists in my sleep. And maybe a short course of steroids, I'm guessing.
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fightergirl - yay, I'm happy for you, too!
Moondust - I just picked the last of the plums, and I'm going to make a crumble for my dad before I go up to see him for Father's Day. Glad you are feeling better. Have you been taking advantage of this gorgeous weather? I want to get out of the 110 degree stuff next week, so I'll do a little hiking with my dad. I have some tests coming up next month before I leave for Chicago, but I'm trying to keep that out of my mind. When is your next treatment? What are your thoughts on the TC based on what Molly posted?
Molly - thanks for posting the info from that site. I love it when someone else is the editor! I am just so tired of reading cancer journals and studies, so I very much welcome the highlights!!!!!! Are you reconsidering the exemestane?
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fightergirl, so happy for you!! Waiting is so hard, glad it was good news.
moondust, glad you're feeling back to normal.
LG, I asked my MO what would happen when I went into menopause, would she take me off the tomoxifen? I'm 52 and still pre-menopausal but I'm assuming I'll go thru menopause in next few years. She said I'm still young (I really like her
) and she would most likely keep me on the tomoxifen.
Well, I'm at day 4 of 21 rads. Doing ok, no se that I can tell. Still struggling with tightness/soreness in armpit & underarm. Putting post it notes everywhere to remind me to stretch. Glad tomorrow is Friday. Looking forward to weekend.
Hugs
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LG, Don't second guess yourself, with your history you did the right thing. Discuss your concerns with gyn and MO, to get options to manage the side effects and protect your health. There are definitely non hormonal options, perhaps they could recommend a naturopath if they do not have the expertise. I'm a decade older but having the BSO and Hyst. actually allowed my MO to keep me on Tamoxifen to lessen bone loss, I have mild osteopenia and muscle and joint pain as I already had neuropathy. My Variation of Unknown Significance in the Lynch syndrome, increases risk of uterine and ovarian cancer plus others, would have meant Tamoxifen was unadvisable because of the risk of uterine thickening. If you find out something for memory let me know, this is probably my most challenging issue. The hot flashes picked up after BSO and hyst, gyn said to give it a chance to even out, if it didn't then she would prescribe something to help. I prefer to take fewer drugs, so waited and they did lessen to a tolerable level. For me they don't come on suddenly, it usually involves being in a too warm environment to begin with. I think I have the perfect storm for memory loss, menopause, chemo, and tamoxifen. Ugh, I used to have a great memory but to be fair, my memory issues started before bc. My short term memory is weird, sometimes I remember things completely, sometimes if my memory is jogged I recall, and sometimes it's like it didn't happen. I'm trying to figure out a strategy to cope, I try to take notes and put important items in my calendar and set an alert.
Fightergirl, congrats on the PCR for the re-excision. It's nice to have confirmation that the chemo did work.
MLP Hope you resolve the numbness issues.
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I had a lumpectomy clean margin and clear lymph nodes.and refused radiation. Don't be bullied.
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Moondust, thanks for the advice. I'm already on my way to losing some weight and I will start back at the gym again as soon as get the ok from gynecologist. Definitely want to stay as healthy as possible
Fightergirl, can't say enough how happy I am for you!
Molly, it's always nice to hear from someone with the same type of problem. I figure ill have to suck it up too with diet, exercise and supplements too lol!
On a side note, picking LOTS of tomatoes, cucumbers and dug up some new potatoes (well, the hubby dug them for me) enjoying my vegetable diet for as long as I have them fresh!
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tbalding, definitely stretch! The cording is no fun to get but mine isn't bad enough to need therapy. Hope you do as well as I did with rads. I'm a month out and skin is getting back to normal.
Mjs, thanks. I too already have some memory problems. I think it's the many Yeats of such a stressful job I have to post it note everything, keep a running calendar and currently have 40 reminders on my phone. I find I have to tightly organize things. I only assume I will be worse now. I may eventually have to change to a less stressful job!
Think I'm going to have a friend egg, toast, and tomato sandwich for breakfast. I'm craving one now, but it's too late (yawn!) Night everyone!
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Sloan, this weather has been unbelievably nice! I mowed the grass today and did some other yard work. I'm planning to go up to the Ponderosa area for a short hike Saturday. Yes, the study Molly referenced from the ASCO conference left me questioning when TC is appropriate over AC-T. A woman on the June chemo forum was asking for advice about tumor marker tests because her MO wants to do them. I told her not to get sucked down that hole! My next treatment (assuming good blood counts) is Wednesday June 29. It will feel much better to have two of them done! My last day at work is this coming Tuesday.
Fightergirl, such awesome news! That's the good thing about HER2+. How did you get the Perjeta after you already had surgery? I heard they will only approve it for neo-adjuvant.
Trish, glad you are hanging in there with rads.
I definitely have memory problems also. Of course, once you are over 60 you have an automatic excuse
I have some word recall senior moments, and also lose my focus pretty easily. Multi-tasking always leads to getting nothing at all done. I use my phone calendar, alarms, lists, timers, etc, to help my memory.
My weight is coming back up. Lesson learned for the next round of chemo -- don't worry about losing weight the first week. It will be much more fun to overeat the second week when the appetite comes back!
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