Saturday, July 16, 2011

Hindsight

It's something all of us do.  Hindsight.  The what ifs.  What if I had done this or that differently?  It can make you crazy.

When you have faced a cancer diagnosis, and survived CANCER TREATMENT, especially if you are left with collateral damage from it, sometimes you mull this stuff in your head and think, if only we had...  Even now as I swallow another daily dose of Tamoxifen, which I will be on the next five years, I wonder will I be one of those affected by its worst side effects?

I had a talk with The Good Witch about this recently, had an appointment with her to touch base and have her check a little rash on Mopsy I was slightly concerned about.  Turns out it was just a heat rash, but after a breast cancer diagnosis, you gotta have every single thing checked to make sure all is ok.

As part of my appointment we discussed my continued neuropathy in my right foot, and slight neuropathy in my hands, as a result of the chemo drug Taxol.  Just as a refresher, I had four rounds of AC, or adriamycin cytoxan, over eight weeks.  One week on, one week off.

That was followed up by Taxol, also known as Paclitaxel, weekly infusions for 12 weeks.  I was doing FABULOUSLY on the Taxol, and had even returned to work a night or two a week.  Nine weeks in the neuropathy started.  I had to stop working again, and it progressed to the point of right foot completely numb, hands stiff, and eyes twitching.

It did get considerably better but I am still left with right toes that never woke up, hands that get stiff and/or numb frequently, and occasionally now, since returning to work, the tips of my left toes are painful and prickly.

Sometimes I wonder, what if we had stopped the Taxol right when my neuropathy began?  Would I still have what appears to be permanent nerve damage?

Recently I read an article that floored me on this very subject.  It was published in Internal Medicine News, and this is from the article:

Researchers have identified a genetic biomarker that can predict a patient’s likelihood of experiencing taxane-induced peripheral neuropathy.


Older people and blacks, the same study found, are at elevated risk of developing neuropathy, which affects up to a third of people receiving chemotherapy with taxane drugs such as paclitaxel.

The marker in the RWDD3 gene, if developed into a blood test, would allow clinicians to identify patients vulnerable to peripheral neuropathy, which is characterized by a pain and numbness in fingers and toes and can keep patients from receiving the intended amount of their therapy, complicating treatment.


The findings, released at a press briefing in advance of the American Society of Clinical Oncology’s annual meeting, came from a large genome-wide association study of 2,204 early-stage breast cancer patients enrolled in a clinical trial that used weekly paclitaxel for 12 weeks in all arms. This marked the first time a genetic predictive biomarker has been reported for taxane-induced neuropathy.

So to paraphrase, they will develop a simple blood test to identify those with a genetic marker most likely to suffer neuropathy so that a different treatment plan can be chosen or modified with this in mind.

The Good Witch said that with every patient, she also has some hindsight.  Regarding my neuropathy, she said "I didn't have the clinical studies to back up if you had received only 85% of your treatment, but I have looked back on it and wondered, just like you, should we have done things differently?"  In other words, if we had stopped the Taxol when the neuropathy kicked in at week nine, would it have made a difference?  Would the neuropathy have gone away?  Would receiving only 9 treatments instead of 12 have compromised the fight to kill my cancer?

Every single day the landscape of how we diagnose and treat cancer changes, and I am happy to see the tide shifting towards placing greater importance and consideration on a patient's quality of life.  Don't get me wrong, I know I got the best there was for what we knew AT THE TIME, but it's hard to live with the damage of cancer treatment, especially when the new studies come out and you are on the wrong side of progress.

This is why it is important to support and fund research for a cure, BUT IN THE MEANTIME, for new protocols to promote the quality of life during and after treatment for anyone facing a cancer diagnosis.  I used a quote in my blog once, and it seems appropriate again.

Cancer treatment is like beating a dog with a stick to kills its fleas.

Some days, that stick feels like it was a club.

I pray for the time when no Mother, Sister or Daughter has to hear "You have breast cancer."

In the meantime, I pray for the Sisters who will follow me,
that the stick gets smaller and smaller and smaller.

2 comments:

Mimi said...

What a beautiful post, as always. My mother had a mastectomy 2 years ago, but was lucky enough to need no further treatment. We felt like that was a huge blessing knowing how hard these treatments can be.

Hugs & love,
Mimi

Anonymous said...

Nice post. We talked about this a bit. My friend is getting neuropathy, from another chemo drug, her Onc Is gonna lower her dosage her next treatment to lessen it, hopefully. I was thinking of our chats when she told me.
Hugs & prayers,
Laurie Jean.

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