Example Notes (de-identified) - for illustration purposes only
SITUATION
Infiltrating ductal carcinoma breaks through duct membrane and invades breast tissue.
Your closest margin is 0.5 cm, others are 2.0 cm.
CHOICES
No chemotherapy
Stay on Arimidex, maintain weight, exercise
Come to UCSF once every 4-6 months for monitoring, have mammograms done here
Chemotherapy
- 4 cycles of Adriamycin + Cytoxan (AC): 1 dose every 3 weeks, each dose takes about 90 min
OR
- 4 cycles of Taxotere + Cytoxan (TC)
We can try to get authorization for you to receive Neulasta on day 2 at home. Depends on insurance and cost (oftentimes insurance requires that Neulasta be given at an infusion center).
Tests
No further tests anticipated. If you do decide to go on AC, we need to do an echocardiogram or a MUGA scan on your heart to determine how well it squeezes.
OBJECTIVES
Gather enough information to make an informed decision about whether to undergo chemotherapy.
PEOPLE
Oncologists in your area for Neulasta shots: Dr. X and Dr. Y
The practice assistant will contact you to schedule chemotherapy if you decide to do it at UCSF
EVALUATION
Chemotherapy vs. no chemotherapy
Ten-year risk estimate – based on cases similar to yours from various databases
24.5% risk of recurrence without any treatment besides surgery and radiation
12.5% risk of recurrence if taking aromatase inhibitor
9.4% risk of recurrence if taking chemotherapy plus aromatase inhibitor
So an overall 3.1% reduction in 10-year risk from chemotherapy
Adriamycin + Cytoxan (AC) chemotherapy effects:
Side effects from adriamycin: hair loss, nausea, vomiting, fatigue
Small (1%) chance of damaging the heart by affecting strength of muscle responsible for contractions
Taxotere + Cytoxan (TC) chemotherapy effects:
Possible side effects: hair loss, body aches, fever, neutropenia (low blood counts) = risk of infections.
Neulasta causes bone pain.
DECISIONS
Are you comfortable with idea that you have 12.5% risk of recurrence in next 10 years without doing chemotherapy? Is it worth it to do chemotherapy for a 3% benefit in recurrence? That is the key issue.
I would recommend chemotherapy, since you are young and healthy.
We usually start chemotherapy within 6-8 weeks of surgery but would definitely want to start within 3-4 months after surgery