Chemo for a senior citizen

[krishnansh]

Dear Doctor,

My mother (71 years) is detected with Grade 2 ERPR + ; Her2 nue - ki-67 : upto 50 % breast carcinoma. CT scan revealed left breast lesion with 1 auxilary lymph node 3.1 x 1.3 cm with preserved fatty helim. No other metastasis was observed.

We underwent a radical mastectomy + auxullary lymph node sampling. Out of 12 nodes , 1 was +ve. (pT2pN1).

She suffers from Hypertension(ESPIN AT 0-0-1), Diabetes(Glycomet GP2 1-0-1) and also thyroid (Thyronorm 1-0-0).

(High values of thyriod and diabetes resulted in postponing the surgery by a week untill brought down by higher dosage).

As 1 node is +ve, oncologist suggests Chemo.

She is already on nonadjuvent tamoxifen ; with good response. Doctor suggests to shift to Letreozole, which should be OK.

However, we are unable to decide if the benefits of chemo will outweigh the side effects, given her age and history.

Request your expert advice on this. Thanks in advance.

[roxboxfox RadiationOncologist]

This is surely a very difficult call to take simply over a forum.

One needs to understand patients condition, review her history assess her fitness,

Then estimate the risk of relapse

Calculate the benefit of adjuvant chemotherapy which at best would appear to be modest and not huge, esp since she is Hormone sensitive

The third pillar is to balance with patients expectation and it's families attitude...and the risk taking ability of the family....

This has to be balanced after counselling patients about the possible risks of chemo, it's cost and exploring things what if things go wrong...

Some may say..let's try and see how it goes, if it's troublesome abandon it there...

Some may be desperate for every opportunity thrown at them...

Some may be very reluctant for chemo and don't wanna spend money or don't wanna go thru the hardships of chemo.

Oncology thus is tailor made...and for the same patient with similar characteristics...one patient may decide to undergo treatment...

Other may not.

Please seek a further consultation with ur medical oncologist....if they don't spend time with u..go to another medical oncologist who can give time.

At the end whatever decision u make, should be to the best of your satisfaction and tomorrow u should not feel guilty about the same.

All the best

Dr Rohit MALDE MD, DNB, FRCR (UK)

Consultant Clinical Oncologist

[sumeet_shah Administrator]

I agree every word with Dr. Rohit Malde.

These decisions cannot be given online. You need to sit with your Oncologist and discuss pros and cons and then take a call. A detailed assessment is needed.

I would wish to add, that many of my patients who are above 70 and who warranted chemo, have undergone the same and are fine. It is up to the Oncologist to assess, considering the complete picture, whether the risk benefit ratio of chemo is favourable or not, and whether any particular lady at old age, is likely to tolerate chemo or not.