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To chem or not at 80

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Help, help. I have grade 3 triple negative invasive ductal bc. Lumpectomy. 10 mm tumor that I caught after negative mammogram and negative exam by my PCP months earlier. Pathology negative margins and 4 negative lymph nodes. Had 5 days local radiation. Surgeon says no chemo, 90-95% likely cured and says chemo too hard at my age (79.5 years old). Oncologist #1 says do it…but could have terrible time even death. Oncologist #2 ran algorithm based on age, diagnosis and lifesthat says 45% likely 10 year survival and chemo may change by 1-2-%. Left decision to hubby (who supports whatever I decide) and me. Has anyone my age with this same tumor had chemo? What was it like. I’m scared either way and I might not even still have cancer if surgeon is right. What to do? What did YOU do?

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  • lw422
    lw422 Member Posts: 1,412
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    Hello MissBlueEyes and sorry that we meet under these circumstances. I'm not your age and I don't have the same diagnosis, but I wanted to say that I'm sorry that you have this difficult decision to make. If I understand correctly, there's only a 1-2% improvement in your survival rate with chemo. That doesn't sound like much, but each of us has to weigh the options and do what we feel is right for ourselves.

    I did have chemo and it was no picnic, but if you are relatively healthy (except for cancer of course), you can probably handle it. You can start the treatment and if it's too harsh you always have the option of stopping treatment or having the dosage adjusted.

    Sorry I'm not any help to you, but I wanted to acknowledge your post and say that I wish you the very best outcome no matter what you choose to do.

  • mountainmia
    mountainmia Member Posts: 857
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    That's a tough call, and it is yours to make regardless of doctors' or our advice. My diagnosis in 2019 was quite like yours with TNBC, 15 mm, 3 nodes negative, etc, but I was 58 and otherwise very healthy. I had a short course of 4 chemo cycles, with only adriamycin and cytoxan (AC). I didn't do the T part taxol because I reacted to taxotere. (Long story, not needed.) It was hard but manageable.

    The surgery has most likely removed all the cancer. What it didn't remove, the radiation has probably killed. The reason to use chemo is to deal with cancer cells that have spread in your system. The negative nodes means that that is less likely (but of course not impossible.)

    If you have comorbidities (diabetes, cardiac problems, family history of strokes in your 80s, etc) then it seems like a very big risk to do chemo. If you are very healthy and your family history is of people living into their 90s and beyond, it might be worth it.

    You can try running the Predict tool (which might be what onc #2 used) to see more information on this. When you get to the point of how the information (Results) is displayed, for me it's easiest to see when I use the icons option. https://breast.predict.nhs.uk/tool

    Good luck.


  • threetree
    threetree Member Posts: 1,478
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    Hi MissBlueEyes - I don't know if this will be helpful at all, but for what it's worth, my mother had chemo when she was 82, but it was not for breast cancer. She had a uterine sarcoma that was known to be fatal, but chemo was going to buy her time (and it did!). This was in 2005 and I only know that she had cisplatin and one other drug combined with it, if I remember correctly (I wasn't nearly as aware of these drugs, etc. then as I am now). Like with anyone of any age, it was no picnic for her, but she got through it. She was exhausted and would come home an just go to bed (I often did too, when I got my AC-T at 67). She needed the neulasta shots and got those every day too. Although very fatigued as many who get chemo are, she was able to continue the whole course and she did live about another 1.5 years and they had only thought she'd make it about 6 months. Again, I know this is a completely different situation, but she was 82, it was rough chemo, but she did fine with it - better than some who are younger.

    At the time she was getting her treatment, I looked up things about age and chemo and saw references to studies that suggested that even people 90+ can handle chemo just as well as a younger person, but that doctors often write them off due to age. A friend of mine who is 69 with stage 4 lung cancer, could not tolerate the chemo they were giving her and had to stop, so she is left with whatever else they can do. My sister-in-law got Hodgkin's (age 71) and also could not tolerate the chemo they gave her at all. She landed in the hospital for a month with pneumonia after 1 or 2 chemo sessions. Again, these are not breast cancer, but they are younger age cases where the chemo couldn't be tolerated, compared to my mother at 82 who got through it like any of us who are younger. Hard, but "doable" as they say.

    I agree with those above and the dr who told you that chemo likely would not give you a lot of benefit, so that would be a real consideration to me. If you had negative margins and a relatively small tumor and no nodes involved, I think there is a good argument for you not to get the chemo. I suppose you could try it and stop if it was seeming intolerable. It is a real hard call to make, and only you can make it. I just don't like seeing people "written off" simply due to age, when there is evidence that older people can tolerate a lot of these procedures. If it just isn't actually needed or set to do you much good, then why bother? I wish there was an easy way for you to make your choice, but I just don't think there is. Best of luck with this!