Chemotherapy for Advanced Breast Cancer: Options and Insights - Oncology

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Chemotherapy


Hello Dr.
Chen, I believe this will be the last time I consult you.
My mother has been diagnosed with metastatic breast cancer, and the surgeon has stated that surgery is no longer an option.
She has been referred to the oncology department.
The oncologist has prescribed chemotherapy with carboplatin and vinorelbine, administered as two injections every three weeks for a treatment cycle, which is known to be effective for lung cancer, typically for four cycles.
The doctor mentioned that my mother's case is rare, with fewer than twenty cases reported in each hospital over the years, and that her cancer, high-grade mucoepidermoid carcinoma of the parotid glands, is aggressive and highly malignant.
The doctor expressed a lack of confidence in controlling her condition, stating that there is only a 20% chance of a response to chemotherapy, and suggested that she may have six months to live (currently, she is able to eat and walk, but she experiences pain from the neck cancer and relies on painkillers; it is hard to imagine her condition has reached this stage, and she herself cannot believe this reality...).
My mother received her first chemotherapy treatment two days ago, and so far, there have been no side effects.
It is said that chemotherapy is often ineffective and can make patients weaker; is this true? Are the medications she is currently using appropriate? In hopes of treating her in this limited time, my sister has taken her to see a traditional Chinese medicine practitioner, hoping that a combination of Eastern and Western medicine will help her.
Will this have any impact on the chemotherapy? Does my mother really only have six months to live? What will happen then? Are there other treatment options available for her? Is there a way to make her more comfortable? Are there any successful cases in Taiwan that we can refer to?

kommy, 20~29 year old female. Ask Date: 2005/06/30

Dr. Chen Sirong reply Oncology


Hello:
1.
The effectiveness of chemotherapy varies depending on one's perspective.
Chemotherapy can slow the rate of tumor spread, thereby reducing the suffering caused by metastasis, so it is beneficial.
However, since patients will ultimately pass away, some may argue it is ineffective.
Yet, can family members bear to let their loved ones undergo no treatment at all?
2.
The suitability of chemotherapy drugs is limited due to the small number of cases, and even fewer require chemotherapy.
Therefore, given the current advancements in medicine, there are still no highly effective chemotherapy drugs available to control this type of tumor.
However, I believe that physicians have reviewed the literature to identify the most appropriate medications available.
3.
Since Western medicine can no longer cure your mother, I personally do not oppose a combination of traditional Chinese medicine and Western medicine.
However, the choice of Chinese medicine should prioritize improving the patient's physical strength, having no side effects, and being affordable.
Do not believe in miraculous cures that promise eternal life.
4.
The interaction between Chinese medicine and chemotherapy is uncertain.
It may be advisable to only take health-preserving Chinese medicine now and to start taking anti-cancer Chinese medicine after completing chemotherapy.
5.
Six months is an average estimate; some may live a bit longer, while others may not.
It is important to go with the flow and maintain a relaxed mindset.
6.
What will happen next depends on the sites of metastasis.
7.
Western medicine cannot cure the condition, but it aims to alleviate suffering.
8.
There should be no successful cases in Taiwan; it is advisable to cooperate with the physician's treatment plan.
Respectfully,
Dr.
Chen Sih-Jung, Oncology

Reply Date: 2005/06/30

More Info


I'm sorry to hear about your mother's situation. It sounds incredibly challenging, and it's understandable that you have many questions regarding her treatment options and prognosis.
Chemotherapy is often a critical component in the management of advanced breast cancer, especially when the disease has metastasized and surgical options are no longer viable. The chemotherapy regimen prescribed for your mother, which includes carboplatin and vinorelbine, is indeed used in various cancers, including lung cancer, but it can also be effective in treating certain types of breast cancer. The choice of chemotherapy drugs often depends on the specific characteristics of the cancer, including its grade and receptor status.

In your mother's case, the oncologist's mention of a 20% chance of response to chemotherapy reflects the reality that not all patients will respond to treatment, especially in advanced stages of cancer. High-grade tumors, like the one your mother has, tend to be more aggressive and may not respond as well to standard treatments. However, the goal of chemotherapy in such cases is often to prolong life and improve quality of life, even if the chances of a significant response are limited.

It's important to understand that while chemotherapy can have side effects, it can also provide benefits. The side effects can vary widely among individuals and may include fatigue, nausea, hair loss, and increased susceptibility to infections, among others. However, some patients tolerate chemotherapy better than expected, and your mother's initial lack of side effects after the first treatment is a positive sign.
Regarding the prognosis of "six months," this is often an estimate based on statistical data and individual patient factors. It's crucial to have open discussions with her oncologist about what this means for her specific case. Prognosis can be influenced by many factors, including overall health, response to treatment, and the specific characteristics of the cancer.

As for the integration of traditional Chinese medicine (TCM) with Western treatments, many patients explore this option to help manage symptoms and improve overall well-being. However, it's essential to communicate with her oncologist about any TCM treatments she is considering, as some herbal remedies can interact with chemotherapy drugs and affect their efficacy.

In terms of other treatment options, palliative care should also be considered. This approach focuses on providing relief from symptoms and improving quality of life, regardless of the stage of the disease. Palliative care teams can offer support for pain management, emotional support, and assistance with navigating the complexities of advanced cancer care.

Lastly, regarding success stories in Taiwan or elsewhere, it's important to remember that every patient's journey is unique. While there may be cases of patients who have had positive outcomes, these are often not the norm in advanced cancer cases. The focus should be on what can be done to support your mother during this time, both medically and emotionally.

In summary, while chemotherapy may not be a guaranteed solution, it can still play a vital role in managing advanced breast cancer. Open communication with her healthcare team, exploring palliative care options, and considering complementary therapies can help improve her quality of life during this challenging time.

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