Before I had breast cancer, I had very little knowledge about chemotherapy. My only vague understanding of it was that chemo filled your entire body with toxins in the hopes of ferreting out and killing any cancer cells. That was about all I knew, and frankly I was extremely negative about it. I used to say that I thought chemotherapy seemed like killing a mosquito with a bomb. I didn’t even realize that you had to go to a specialist called an oncologist to receive chemotherapy, since no one in my family had ever had cancer and I was completely unfamiliar with the process.
After I was diagnosed by my breast surgeon, she told me that I would learn whether or not I needed chemotherapy by an oncologist. I then talked to my hospitals breast cancer coordinator to understand how I would choose my oncologist and what their role in my treatment plan would be.
My breast cancer coordinator told me that it was important that I got along well with my oncologist because she said I’d be spending a lot of time with him, and boy was she right. I actually switched oncologists before I started chemotherapy, because my first one wasn’t explaining things very clearly and I wanted to be more involved than I think he expected. I told my breast cancer coordinator that I wasn’t happy with the first oncologist and she kindly intervened to switch me to another one who I felt very comfortable with and who is still treating me now, 5 years later.
When we first started discussing my treatment options, I kept asking why he was suggesting such a strong and powerful chemotherapy regimen since my breast cancer was only Stage 2. He explained that my Oncotype DX test results showed that I had a 24% chance of distant recurrence, at which point I asked, “What does distant recurrence mean?” He said, “Distant recurrence means that there’s a 24% chance that the cancer will spread to other organs in your body.”
Hmmm…as the Wizard of Oz said, “Now that’s a horse of a different color.” 24 %…that’s like 1 in 4, right? Holy crap.
Then he said that the only time they can actually kill the other cells that might have migrated from my breast into other areas of my body is right now, this one time, and that breast cancer that migrates to another organ is not curable.
Another long pause. Then we started talking about regimens, and I began to slowly realize that I was in for a long and scary ride.
He originally recommended a very aggressive course of treatment called ACT (Adriamycin, Cytoxan and Taxotere – all 3 together for 6 treatments every 3 weeks) but I decided that I wasn’t willing to do something quite that strong as I was concerned that my body wouldn’t be able to handle all 3 of those very toxic drugs all together at one time.
So he suggested the series I decided to go with, which is a newer regimen that he said was just as effective as ACT but much more tolerable: 4 bi-weekly treatments of AC (Adriamycin & Cytoxan combined together) and then 12 weekly treatments of Taxol. Although it’s a little longer (5 1/2 months vs 4 1/2) I ultimately think it was the right decision for me and my body handled it pretty well.
Each of the 3 drugs did something slightly different; the combination of all 3 provided the best option to eradicate any cancer in my body, given my specific type of breast cancer.
Adriamycin (or Doxorubicin) kills cancer cells by damaging their genes and interfering with their reproduction. It was the strongest, most toxic of all the chemotherapy drugs I received and can cause a toxic effect on the heart, so you must be monitored before and during treatment. It was scary to get the Adriamycin, it’s red and the oncology nurse has to pump it manually into your IV, it takes about 15-20 minutes. It doesn’t hurt when it’s administered but afterwards, I would get pretty sick. There are a host of different side effects that you can have from Adriamycin, but the one I was most concerned about is that my red blood cell count would drop very dramatically after each treatment which made me very susceptible to infections. If you’re going to be receiving this drug, try to stay away from large groups of people, as your resistance will be very low to any infections that might be circulating within large groups of people. I was very relieved when I received the very last of the 4 Adriamycin pumps, and I know the nurses were, too.
Cytoxan weakens or destroys breast cancer cells by damaging the cells’ genetic material. Since it was administered together with Adriamycin, these first 4 treatments were very difficult for me and I had to really dig deep to manage the first set of chemo. For me, the worst side effects were the extreme nausea, flu like symptoms and the loss of my hair which happened about 3 weeks after my first treatment.
I would get my treatments on a Friday morning and would feel pretty sick for the next few days but by the following Tuesday, I’d start to feel normal again. Each of the Adriamycin/Cytoxan treatments continued like that and I also noticed that I became progressively more tired over time.
Taxol interferes with the ability of cancer cells to divide. I received Taxol intravenously on a weekly basis for 12 weeks starting 2 weeks after my last Adriamycin/Cytoxan cocktail. I tolerated Taxol pretty well, with no nausea at all. My side effects from Taxol were weird things that happened to my fingernails and toenails, fatigue and numbness or neuropathy in both my fingers and toes. I was very relieved (and am very fortunate) that the neuropathy went away after about 6-9 months in both my fingers and toes.
My oncologist also told me about a site called www.chemoregimen.com where you can go and click on your particular type of cancer, then search through the various chemo regimens available for it, and read through them for details. There are even links to actual clinical studies and results.
Since I’m not a medical professional, I didn’t fully grasp all of the information, but it listed the drugs in each regimen, what their side effects were, % of people that experienced each of the various side effects, and the success rates. It was a piece of the puzzle that I found very helpful in making choices about my regimen above. Of course all of this can be very confusing and you’re sure not in the best frame of mind while you’re going through breast cancer, but for me, knowing I had access to this information gave me a much needed feeling of control during this time.
I’m glad I switched oncologists, I really like my current doctor. He’s helpful, empathetic, works with me as if we’re true partners and has a good sense of humor. Believe me, after all my hair had fallen out, my finger nails had turned black and sore, my toenails were starting to fall out and I was exhausted all the time, it was nice to have an oncologist who could make me laugh once in a while. I was very lucky to find a team of physicians that I could trust, it made a world of difference for me.
So, here I am on my soap box again: Be informed. Read everything you can. Be your own advocate! No one knows your body like you and you have the right to be an active participant in your treatment options.