October 1, 2019

Do you need chemotherapy? Sometimes, the choice is a 'nightmare.'

Daily Briefing

    When Jenifer Wana learned that she wouldn't need chemotherapy for her Stage 1 breast cancer, instead of relief, she was plagued by anxiety and grappled with whether opting against the "toxicity" of chemo would carry repercussions later on, Wana writes in the New York Times' "Well."

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    A low score and high anxiety

    After Wana was diagnosed, her oncologist ordered the Oncotype DX genomic test to determine Wana's chance of recurrence. When her doctor called to deliver the news, she told Wana, "You have a low score of 16 and won't need chemo. Congratulations!"

    But despite the seemingly good news and an initial feeling of relief, Wana soon grew more anxious about the decision.

    Wana spent hour researching her condition and learned through the TAILORx study that 70% of women with her type of early stage breast cancer could avoid chemotherapy. Wana also learned that her score was right on the border of needing chemotherapy, and that, if she decided to undergo the treatment, her chances of the cancer progressing to another part of her body would decrease by 1.6%.

    Wana's oncologist assured her that the small potential benefit of chemotherapy did not outweigh the risk of the toxic treatment's side effects. But even with her doctor's assurances, Wana struggled with the decision.

    "I wanted to relish being spared the toxicity and side effects of chemo," she writes, "but if it could help me potentially live longer, spend more time with my kids, shouldn't I do it anyway? Or was I insane to even consider chemo if my doctor recommended against it?"

    Wana writes, "Now, in addition to the nightmare of cancer, I had the nightmare of having to make a decision."

    Wana's husband, a family practice physician, also advised her against doing chemotherapy. "One-point-six percent is insignificant compared to how it could weaken your immune system, cause permanent nerve damage, osteoporosis—it could even give you another cancer or kill you," he told her. "You should trust your doctor. And your husband."

    Her friend went for chemo

    Still, Wana dove into a "rabbit hole of news articles, breast cancer website, and community forums" to figure out whether she should undergo chemotherapy. She eventually learned about another test called MammaPrint, and at her next appointment, her doctor performed the test, which also suggested she did not need chemotherapy, Wana writes.

    With those test results, Wana decided to forgo chemotherapy. But just as things seemed settled, Wana had a "cancer friend date" with another mother who had a similar "single digit, slam dunk no-chemo recurrence score," but her friend had opted for chemotherapy anyway, Wana writes. "It wasn't easy," the friend said, "but I wanted to know I did everything I could to be there for my kids when they grew up."

    A few days later, Wana writes that she woke up her husband in tears and told him she changed her mind and wanted to do chemotherapy. "You know I'm behind you whatever you do, but chemo will affect you physically and emotionally for the rest of your life," her husband responded, and reminded her that her first radiation appointment was scheduled for the following day.

    Wana writes that she spent one more night researching. She created a pro and con list, and again,  decided to forgo chemotherapy, and instead went to radiation.

    "I will never be 100% confident about my decision. But I have faith that forgoing chemo doesn't mean I don't care about seeing my kids graduate from college or start their own families one day," Wana writes. "It could be the reason I'm able to do those things. I know that I made the best decision I could under the circumstances with the information available to me at the time. Cancer or no cancer, that's really all we can ever do" (Wana, "Well," New York Times, 9/24).

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