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Dec 3, 2018 08:39PM
There are also a few additional variables to consider. One is where we live. Many of the treatments in Canada differ from the US, to a large extent due to drug approvals. For instance, Faslodex is not approved under general health coverage here so it is often only prescribed if the patient has access to extended health (I suspect similar situations arise in the US depending on which health insurer the patient has).
In terms of starting with chemo, an MO may often start with a more aggressive treatment to deal with symptoms. As a example, my MO started me on Taxol as he was hoping it would beat back the plueral effusion. As it turned out, it wasn't particularly effective so we stopped after three treatments.
Beyond this, as JFL indicates, most MOs take into consideration your age and what they consider the options are for the best quality of life. My MO is a firm believer that the best medicine is maintaining as normal a life as possible. To that end, he leans towards treatments that will allow me to continue working full time, saving the more toxic treatments until later.
4/2001, IDC, Right, 1cm, Stage IIA, Grade 3, 1/10 nodes, ER+
5/11/2001 Lumpectomy: Right; Lymph node removal: Right, Sentinel, Underarm/Axillary
12/17/2001 Whole-breast: Breast
12/20/2001 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
1/2/2007 Femara (letrozole)
10/22/2007 Arimidex (anastrozole)
1/3/2017, IDC, Right, Stage IV, metastasized to bone/lungs, ER+/PR+, HER2-
1/27/2017 Taxol (paclitaxel)
3/29/2017 Arimidex (anastrozole)
4/20/2017 Ibrance (palbociclib)
10/12/2017, IDC, Right, Stage IV, metastasized to other
10/21/2017 Xeloda (capecitabine)
11/15/2017 External: Bone
1/19/2018 Faslodex (fulvestrant)
8/2/2018 External: Bone
11/5/2018 External: Bone