Dr. Grobmyer: Right. These days many patients need surgery, radiation, and chemotherapy, but not all do and that really depends on the type of breast cancer and the stage of breast cancer, which is usually determined at the time of surgery. However, patients respond to each phase of the treatment process differently so we try to help each patient individually through each of those phases.
Let’s talk about radiation. Chemo can take a lot out of a patient?
Dr. Grobmyer: Yes it can. Traditionally, after a patient has a lumpectomy, if it is decided that they needed chemotherapy then it would be surgery, chemotherapy, and then radiation therapy. In patients who do not need chemotherapy it would be surgery then radiation therapy.
In general, what does chemo and radiation do to a patient?
Dr. Grobmyer: It’s associated with a lot of fatigue. Certainly patients getting chemotherapy will often lose their hair. There may be periods of nausea and vomiting, great fatigue, and energy loss. There’ll often be periods of time where the patient will need a reduced work load or won’t be able to work at all for short periods of time around their treatment. Radiation therapy can be associated with changes in the skin and also makes people fairly tired as the body responds to the radiation treatment.
I think for a lot of women, they fear breast cancer and getting that diagnosis is hard, but your mind just automatically goes to losing your hair and being sick for months on end. I think that’s where most patients’ minds go when you say breast cancer.
Dr. Grobmyer: These days there are still many patients who do need all those treatments, but more and more we’re learning that all patients don’t need all treatments and we can get very good outcomes without the toxicity of a lot of these treatments that really aren’t benefitting people. We can identify many people ahead of time that we realize aren’t benefitting from the treatments and have an excellent prognosis without the treatment. So, we are able to avoid the treatments in those patients.
For the patients that can’t avoid the treatments, it can be a long process. Talk about what happens after the lumpectomy. What’s traditionally the course of action if you have to do all three?
Dr. Grobmyer: Well, you have surgery and then once all the surgical events are completed there’s usually a delay of a month to six weeks. Then chemotherapy would start, which would last in the neighborhood of four months or in some cases the medical therapy may continue for up to a year.
Dr. Grobmyer: Usually every three weeks or so, but this can vary depending on the regimen.
For how long?
Dr. Grobmyer: For four months, but this can very depending on the type of treatment given.
For how many hours?
Dr. Grobmyer: Each infusion may last up to several hours, and then there’s sort of a recovery time after that. However, there are a lot of different approaches to how chemotherapy is given and the dosing. So, the treatment schedule, the dosing, and the time really vary by the particular regimen that a patient has been placed on by the doctor.
Then how does radiation work?
Dr. Grobmyer: Radiation traditionally is given once chemotherapy is over for patients who have had a lumpectomy mostly. For those patients, radiation would occur every day during the week for anywhere between three weeks and five weeks. Some patients after mastectomy are also recommended to have radiation.
How long would those treatments take?
Dr. Grobmyer: Those treatments generally don’t take very long but every day the patient has to travel to the radiation facility, wait to be treated, they have a short treatment, and then they can go on. It can modify their daily life with having to go to the radiation facility every day.
Both chemo and radiation before this affected your whole body instead of just the area in the breast that needed treatment, right?
Dr. Grobmyer: Right. In terms of chemotherapy, one of the goals of treatment is to treat the whole body because radiation and surgery would only treat the area immediately around the breast. Chemotherapy is designed to treat the whole body so that in case any cells have broken loose from the breast, they would be treated. Radiation therapy was given to the whole breast and in doing so other parts of the body often received some dose of radiation, which obviously is less than desirable if not needed.
What’s the risk of radiation in other tissue?
Dr. Grobmyer: If you radiate normal tissue there can be chronic damage to that tissue. For instance, if you radiate the whole breast, which is sometimes necessary, then you have normal breast tissue getting radiation and there’s chronic radiation change, which is thickening of the skin, heaviness in the breast, and there can sometimes be chronic swelling in the breast related to that. Radiating other tissues like the lung and the heart which sometimes occurs when people get whole breast radiation can also result in some chronic changes to those organs and a decrease in function.
What could be the risk in that?
Dr. Grobmyer: There was recently a study in the New England Journal that associated the administration of whole breast radiation for breast cancer with an increased incidence of heart disease. That’s just one example of what we’re learning may be some of the side effects of traditional treatments. That’s not to say that in certain patients with certain stages of disease that whole breast radiation therapy isn’t beneficial, it’s just something we need to be aware of as we counsel patients about what their treatment options are.