surgery or no?

[Epinto]

hi all. I have been treated for stage 4 breast cancer with mets to the t2 and axillary node since 2016. Been on ibrance and faslidex since and doing well. I recently took a bad fall and fractured my upper arm in several places. From X-rays and Ct. scan so far it does not appear cancer related. Had two orthopedic consults and one is for doing shoulder surgery and one stated due to my diagnosis let it heal and go for therapy but most likely will not have full range of motion. I am 70 years old and independent. Any thoughts? I am afraid of the surgery as it will delay my cancer meds while healing .

[HelenWi]

How long would you have to be off Ibrance? I would ask your oncologist what they think about a break from cancer meds. I’d also wonder how long shoulder would take to heal after surgery and compare the quality of life between the alternatives. Get as much info as you can to help make your decision. Best wishes to you.

[Hazelgreen]

I agree with Helen's comments.

Is it really necessary for you to be off cancer meds while going through the surgery, or healing from the surgery? It seems very important to me that we retain our full range of motion as long as we can! I am 78, and, in your shoes, I would make the surgery a priority.

You didn't mention taking Zometa. Is it the medication you would have to stop taking while having surgery, or is it your Ibrance as well?

[friesianfan]

Greetings! I agree with Helen’s approach to discuss with your oncologist taking a short break from Ibrance and weighing that against the recovery and rehab from the shoulder surgery, which I know from experience can be long and complex. See below for my wife’s experiences with three surgeries.

You’ve had a great run on Ibrance, better than most, and I know that many women on this site have successfully taken a few weeks off Ibrance before and after surgeries, including my wife, who had both knees replaced a year after her de novo MBC diagnosis in March 2017. With apologies for repeating this, our oncologist from Dana Farber, Dr. Nancy Lin who has presented on this site and at major conferences attended by many on this site, said at the time, “I can’t tell you how long you are going to live…but I CAN tell you that you are going to live long enough that you will be glad you did the knee replacements!” Six years later, she was absolutely right!

To add a little more to the story that may be relevant to you, my wife actually had a shoulder replacement as well, but this was about three years before her MBC diagnosis (Mets to bones only but mostly spine and pelvis.) She didn’t have much choice as she had fallen right on her shoulder on a hard surface and broke her shoulder into many pieces, so she needed the replacement. As with the two knee surgeries, she worked really hard at the physical therapy, and had good outcomes in all three cases—but it took hard work and some months of PT in each case, especially the shoulder. For the knees, she was right back on Ibrance a few weeks after each surgery, same as many other women on this site. Just FYI, she was 57 at time of shoulder replacement and 60 for the two knee replacements, six months apart. So in summary, confirm with your onc that a short break from Ibrance hopefully would be ok, and focus your decision on the orthopedic benefits and risks of surgery and rehab on your current and future quality of life. Sorry for the long response, but hope it’s helpful. Good luck!

Dave

[U2Rocks in reply to friesianfan]

You recently spoke to me about the knee replacement surgery. I’m going in on Sept 27. Been off Ibrance for 2 weeks. Like you said to me the quality of life is so paralyzed with bone to bone knees that I must do this for my body. Thanks for your advice about your wife a few weeks ago! Hope her quality of life remains good!

[Epinto in reply to friesianfan]

Thank you for sharing. I know it’s a long road after surgery but I do want my life back. I too fractured my shoulder in fragments from a fall and landing on the sidewalk. I went to therapy today and it was very painful snd I’m not sure that I will have enough range of motion after that.

[13plus in reply to Epinto]

The shoulder surgery is a strenuous recovery but then again, if you don’t have it done your range of motion will likely be very severely limited. I would seek more information from both doctors and ask if you can talk to someone around your age who has had the surgery done - might be more informative that way

And you have had a fantastic run on iBrance so that bodes very well for you going forwards (cancer wise)

[Epinto in reply to 13plus]

Yes that’s good advise

[U2Rocks]

Hi. I’m going through this right now. I’m 69, been on Ibrance and Anastrozole since my MBS diagnosis in 2020. If I didn’t proceed with knee replacements, I can hardly walk now with bone to bone in both knees, I’d be in a wheelchair. This is what I did. 1: talked it over with my oncologist. 2: She told me my scans have been stable for 2 years. 3: She ordered a new scan after I booked the surgery for Sept 27. 4: New scan showed no change. 5: She told me to skip Ibance for 2 weeks before surgery but never the Anastrozole because that is my drug keeping the estrogen depleted. 6: Getting a blood test this Friday to see what my platelet and white blood count is since I have been off Ibrance now for 2 weeks. 7: If platelets are still low they will give me a platelet infusion early next week before the surgery on the 27 th. 8: My oncologist has sent all my results to the orthopedic dr so he knows I’m ready. I’m nervous but must do this as I can’t exercise or walk well and always have knee pain. My son said if I fall I could really hurt myself. Main idea: Take these necessary steps to be sure surgery is a possibility. I will be off Ibrance for about 2 weeks after surgery but never stop taking the anti estrogen pill (Anastrozole). Hope this helps. Since we will be on these drugs the rest of our lives, sometimes we need to make tough decisions for better quality of life concerns. Best of luck.

[Epinto in reply to U2Rocks]

Yes thank you. I sent my reports to my oncologist and they will review with orthopedic team

[Light74]

Four years ago, I had a hip replacement. Because my neutrophils and platelets are always very low when I’m on medication it was necessary to quit letrozole, Xgeva and Ibrance prior to the surgery. A few days after the replacement, I resumed the Ibrance and letrozole. Quality of life is extremely important to me and I have never regretted surgery because now I can walk without pain!

[NPmary]

If you have family physician, internist who knows you well I would ask their opinion on how you might do undergoing anesthesia, surgery and rehab; I eould ask your oncologist the same question. People are living longer than ever before and undergoing surgeries like hip replacements and doing well. If you're otherwise healthy, can walk well an for dome distance and anesthesia and others think you are a good risk then surgery done by someone who specializes in this area should lead you to more full function. Good luck - let us know how it goes. Wishing you the best. 🌺

[Kerryd22]

Shoulder surgery is problematic. I know two people who have needed it after workplace accidents and one didn’t get back his range of movement even after surgery and rehab. The other did better but it was a long protracted process.

Whatever you decide to do, I hope all goes well for you.

All the best

Kerry

[viennagirl]

I agree with Helen. Ask your doctor if you can safely go off meds for a while. I have heard that going off meds for a few months has actually helped a woman whose Ibrance was no longer working. Her doctor took her off Ibrance for, I think it was seven weeks, and then reintroduced the meds and they started working again. So a break in the medication might not hurt and it might even help you. But definitely ask your Oncologist and go with whatever they tell you. Of course I think getting your bones repaired is very important and I think I would be inclined to have that mobility as possible as you age. You are still young - I think at 70 - and so get surgery as soon as possible. You want as much mobility as possible as you age. I am 80 years old and of course afraid of breaking bones. So I take great care not to fall but of course sometimes that isn't enough and down you go. I hope you heal up completely. I send the best wishes. Hugs Marlene

[Epinto in reply to viennagirl]

Thank you for your response

[mariootsi]

Hopefully you can do without surgery. I had simple carpal tunnel, cubitunnel and another surgery to my forearm. I have been suffering ever since. .

[Epinto]

I am trying to avoid it . Going to try therapy but I realize my range of motion will most likely be limited.