78 year old deciding to have chemo or not

[betterchoicesnexttime]

Hello, I was hoping to get an understanding of other people’s experience regarding chemotherapy. My mother is 78 and has just had a mastectomy. The operation went well and removed the tumour and 6 lymph nodes - one of which contained cancer. Her care team have advised that as the cancer is hormonal (?) she should have chemo but have suggested she think about it given the impact chemo has on your body. She is having another test to check how effective (?) it will be, but I was hoping to get an understanding from other people about how it may impact her (given her age) so I can support her with her decision whether to go ahead or not. She doesn’t smoke and is very healthy and fit and has no other medical conditions.

Hopefully this all makes sense.

thanks in advance

Have they given her the risk percentage. With my DM they said with the mastetomy and the tamoxifen took her up to about 97% . As it was quite high and the benifits of chemo was under 3%% the cons out weighed the benifits so she didn't bother. Still here 20 years later.

When I had breast cancer I was told the different treatments all add a percentage to the benefits. The most effective part by miles was the surgery. The chemo, radiotherapy and others added really quite a small percentage. I was also told like your mum that most of the chemo was prevention but that it would likely "mop up" any stray cancer cells.
I was younger so it was a no brainer to take absolutely every possible treatment on off but if I was your mum's age I might reconsider.
Chemo is unpleasant but it varies and people react differently. I basically lost about 9 months over the treatment period.

It’s really quite shocking when you get you percentage improvement figure isn’t it? I thought chemo would improve my long term survival by 30% at least the actually figure was 4.6%. Like you I was in my 50s so went for it, I wouldn’t do it again though for a similar number.

You don’t need to use AI the predict tool is designed by clinicians specifically for breast cancer.

Same here. In my case I needed herceptin. It's a drug that's only licensed when given with chemo. My oncologist as good as said he wouldn't have recommended chemo if he could give herceptin on it's own.

Thanks all (again). This is all very helpful! X

My DM had chemo at the same age. She tolerated it well, of course it wasn’t easy but it wasn’t at bad as she feared and she’s delighted to have been cured and have hopefully many more happy years with us.

but the effects, and decisions, are so individual and personal

There’s different forms of chemo too including pill form, get all the information, all the options. Radiotherapy is often offered too

My DM was diagnosed with inflammatory breast cancer a year ago, at age 83. She had a course of chemotherapy to reduce the tumour before surgery, which was very successful and reduced the size by 50%. She never really had any nausea, just had tiredness and hair thinning though she didn’t lose it all. The surgery successfully removed all the remaining tumour and a course of radiotherapy removed traces of cancer cells in her lymph nodes. She has now been told there is no cancer detected. She coped very well with the treatments, just mainly feeling tired. I would advise your DM not to discount treatment due to her age. Modern chemotherapy is much gentler than it used to be.

I had a similar cancer and was only offered IV chemo though meds are evolving all the time so it might be there are more options now. Unless you cold cap you normally always lose all your hair with the breast cancer chemos.

If surgery goes to plan you are told afterwards the scan shows no sign of cancer, that's not the same as being cancer free and happens whether surgery is before or after chemo, there can be cancer cells they can't see. I had surgery first and was told no sign of cancer on scan but then had to do chemo, radio, 10 years Tamoxifen, offered 2 years of another drug which I turned down and a DIEP surgery. There was nothing gentle about the treatment especially the chemo and I don't think anyone who has gone through treatment themselves would describe it as such if being honest.

The steroids along with stress of treatment can cause severe mental health/psychosis/suicidal feelings in about 5% of patients (normally had mental health issues before and weekly chemos ones are higher risk as more steroids), neuropathy is common with the Taxol drugs and can lose feeling in feet and hands and can be permanent or get pain/burning, some people get admitted to A&E with infections/sepsis, some people get heart failure though they do their best to reduce odds of this and chemos have improved for that. Nausea is normally well treated. The side effects aren't something to be taken lightly and that's why there is a 24/7 helpline throughout chemo and their own A&E type section and why the oncologist say don't do under 3%. Some people aren't honest with relatives about what its like so not as to hurt their feelings though it does vary. Some people get the dose reduced to have minimal side effects but that does affect the chance it will work. Some people do chemo and still die though you do have the feeling of I did all I could and no-one can say it was my fault. I would describe my chemo as hell on earth for duration of it but afterwards the long term effects are annoying rather than stop me doing anything like my face has a constant burning, I can't feel my fingertips, teeth issues are common, obviously it put me into menopause and unable to use HRT and it leaves people infertile. People don't normally get all the side effects and you are closely monitored. You can also stop if you find it too difficult though they aren't keen on that.

I was diagnosed with TNBC aged 65. I elected to have chemotherapy as there are relatively limited treatment options for TNBC, although that is rapidly changing. The oncologist said it was v much my choice, and gave me % figures as others have described above. It was marginal but because of the breast cancer type I had, I decided to go for it, as I knew I would be overwhelmed by regret if it recurred and I hadn’t had chemotherapy

I was fit and well before it all started, and 3 years on am fit and well again. I found chemotherapy tough but doable, but was surprised by the lengthy and challenging recovery period.

Would I have chemotherapy in the future in similar circumstances, with similar figures? Probably not. Are you able to go to oncology appointments with your mum and really get a handle on those figures? If it’s just a few % I’d question the value at 78

Its’s difficult decision, and as v often with difficult decisions there is not one, perfect answer

And to add to above: do consider the logistics of it all. Rafts of appointments on top of chemo sessions. I mostly drove myself. How will your mum get there? How easy a journey is it to the unit? What’s parking like? How independent is she now? These are all things that add on the stress

I agree it’s a personal choice. I’ve chosen not to have screening tests and I wouldn’t have chemo.