Late Effects of Treatment
Posted 8/24/2012
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For a number of years now, increasing attention has been paid to late effects of cancer treatment and other issues for cancer survivors. Until fairly recently, this was not seen as a particularly important area of interest, partly because many people died before any of these problems might occur. Since, blessedly, many of us are now living long and healthy lives after cancer, this all matters. There are the very obvious treatment effects: chemically-induced menopause, changed/missing/reconstructed breasts, different hair, and there are the more subtle and potentially dangerous effects that may come later. As an aside and as a reminder (to me at least) of the importance of these possible problems, let me tell you about a woman whom I met yesterday.
She is a very articulate, pleasant, thoughtful, intelligent woman in her 50s who has been recently diagnosed with a triple negative breast cancer. She has been through surgery, a wide excision and sentinel node dissection, and has been told that she needs radiation therapy and chemotherapy. She is willing to accept the radiation, but absolutely rejects the possibility of chemotherapy. Why? Because she does not feel that the statistical improvement in her survival odds (from 70 pecent without chemo to 85 percent with) are worth the "miseries" (her words) of four months of treatment and the possible medium and late-term side effects. She seems more worried about the late effects than about anything that might happen during treatment. Her doctor spent two hours with her, and I spent another hour with her, and she remains firm in her convictions. Of course, she is entitled to make whatever decision feels right to her, but it was surprising to me that a 15 percent improvement in survival didn't seem enough (so many of us take treatments that will buy us only a few percentage points) and that the list of possible side effects was so frightening that it became the pivotal reason for her refusal.
This is an excellent summary from the Komen Foundation about these issues. Here is the beginning and then a link:
What can I expect? Late effects of breast cancer treatment
With continuing advances in treatment, an increasing number of people diagnosed with breast cancer will live for many years. Today, there are more than 2.9 million breast cancer survivors in the United States. As survivors live longer, we are learning more about the late effects of breast cancer treatment. Treatment saves lives, but some treatments may lead to health concerns in the future. And while some late effects of breast cancer treatments are known, many are not well understood.
Managing (and when possible, preventing) these late effects of treatment is an important part of followup care. Here, we discuss some of the late effects from chemotherapy, targeted therapy and hormone therapy. Being aware of potential health effects may help you discuss your followup care with your health care provider.
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