Chemo port leading to emergency. Can we remove it during severe anemia?

[Saipb]

My mother in law is 60year old and was diagnosed with a stage1- 1inch malignant lump with h1+ in her right breast. We moved forward and had her right mastectomy done within 2weeks of detection. After one month we started chemo with docetaxel, carboplatin and trastuzumab as suggested by medical oncologist. For the first chemo, she is administered with daunorubicin instead of docetaxel. Is this okay?

After her 3rd chemo, she is suggested by the surgical oncologist to have a chemo port to avoid frequent puncture. after 4 days of installing it near the neck region, she had an emergency condition with high fever and chills for about 4 days where she required a blood transfusion. The organism is identified as burkholderia cepacia. In the discharge summary they also mentioned that there is a bone marrow supression and the chances are 50%. Now after 2weeks of blood transfusion, again she had mild fever. The surgical oncologist is suggesting immediate removal of the chemo port. Is this a business trick??

That is fine even if we loose money not because we have plenty of it but We are afraid if it leads to severe anemia again and any other complications.

Someone please suggest.

We don't want to loose her at this age as she is really a good person and my daughter is 2 year old and loves her a lot. Also I can see her struggle and desire to live. I am really feeling the pain I never did before both physically and mentally.

[MsLockYourPosts TeamBCI]

It is not uncommon for some patients to develop an infection related to their port. Friends who have had a port have had to have the port removed and received antibiotics to treat the infection. Her doctors may also delay her next chemo treatment to give her bone marrow a chance to recover. Please let us know how your mother does. I hope that she feels better soon!

[sumeet_shah Administrator]

Few points:

1. You have mentioned 'stage 1'. This is not stage 1. Confirm the stage with your Oncologist, so that you are not in a wrong impression of this being stage 1.

2. Ports can get infected, but not sure, if it can get infected so early, just a few days after insertion. The fever could very well be because of chemo related issues.

3. Port is NOT the cause of anemia (chemotherapy is the cause). Removal of port does not mean, it will not cause anemia again, the chemo could very well cause it again if net cycles continue.

I am not happy to state this, but I can clearly see a disconnect between you and your doctors, unfortunately (lack of trust as well, since you mention - business trick). I sincerely suggest you, that you sit with them and understand what exactly is the issue. Tell them to give you time and make you understand. And if need be, please take one second opinion on the situation by consulting another Oncologist in your area. Dont go for online opinions, as it is impossible to judge the situation online - it needs a detailed assessment of reports, detailed assessment of your mother in law including port site, assessment of all recent reports (including serial counts), to judge what is going on and to decide.

I do hope your doctors explain to you in detail all the issues and your mother in law comes out of this in a good manner and finishes her chemo. You are absolutely not going to lose her, she will be fine soon.Don't worry, it's a difficult phase, I understand, but she will come around. Just discuss with your docs on the next step.

[Saipb in reply to sumeet_shah]

Thank you for your kind and detailed response. I do trust doctors and I myself am a pharmacist by profession. I am struggling to explain these to my other family members who are in a belief that chemo is unnecessary. I wrote it out of my current situation.

[sumeet_shah Administrator in reply to Saipb]

I fully understand. Whether chemo is needed or not, will be decided based on the histopathology report and the general condition of the patient. It does happen some times that patients tend to get severe Immuno suppression due to chemo and then, either the dose is reduced or the drugs are changed. But that decision, only your Medical Oncologist can take. They consider the stage and severity and take a call. If margin of benefit of chemo is not much, sometimes they consider discontinuing it if the patient is not tolerating it.