Are other treatments replacing chemotherapy?
Fewer patients with early-stage breast cancer are undergoing chemotherapy to treat the disease, according to a new study published in the Journal of the National Cancer Institute.
Instead, physicians are looking at a tumor’s specific genetic makeup to develop treatment plans that target its unique characteristics. While chemotherapy, which has long been used to treat patients with early stage breast cancer, is still an option, oncologists are starting to look at whether its use is necessary in every case because the treatment’s harsh side effects can impact patients’ quality of life.
With advances such as the molecular subtyping of early stage breast cancer, oncologists can better predict the prognosis of individual cancers and the benefit from treatment.
“For many women with early stage disease, this means we can avoid chemotherapy not only because it is toxic and possibly harmful, but most importantly, because we understand it may not benefit a particular patient with a low-risk profile,” says Dr. Sigrun Hallmeyer, an oncologist at Advocate Lutheran General Hospital in Park Ridge, Ill.
Researchers found an almost 14 percent decrease (34.5 to 21 percent) in chemotherapy in nearly 3,000 women in Georgia and Los Angeles who were being treated for early stage breast cancer between 2013 and 2015. The study also found that oncologists were recommending chemotherapy less often to this set of patients. Recommendation rates dropped from nearly 45 percent to 31.6 percent over the course of the study.
The guidelines for treating early stage breast cancer, which can include surgery and radiation therapy, chemotherapy and hormonal therapy, haven’t changed, but as personalized medicine continues to advance, it’s likely patients’ treatment plans will be selected based on what testing confirms is the right treatment for the right patient at the right time. That treatment plan may or may not include chemotherapy.
“Despite dramatically lower utilization of chemotherapy, short-term and long-term survival rates for breast cancer patients have significantly improved in the last two decades – and that is because of better treatment selection, not more or less chemotherapy,” says Dr. Hallmeyer.
Dr. Hallmeyer says there are two tests, Mammaprint and Oncotype, commonly ordered in the U.S. that help oncologists determine which treatment options are most effective for a patient.
“When a low-risk profile is detected, physicians will recommend hormonal (anti-estrogen) therapy in lieu of chemotherapy – these are tablets that are taken by mouth typically for a duration of five years, with a very good side effect and tolerance profile,” says Dr. Hallmeyer.
Every case is unique. Consult with your physician to determine the best treatment plan for you.
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About the Author
Colette A. Harris, health enews contributor, is the public affairs and marketing coordinator at Advocate Lutheran General Hospital in Park Ridge, Il. She holds a Master of Science degree in journalism from Northwestern’s Medill School of Journalism and has nearly a decade of experience writing about health and wellness, which are her passions. When she’s not writing, you can find her practicing yoga, cooking, reading, or traveling.
I had six chemo sessions for ovarian cancer and can attest that it is a devastating and permanently painful course of treatment and I recurred anyways – I learned after completing it that statistically it increased my chance of survival by 5 percent. Doctors are no longer claiming that it saves lives but are claiming it delays recurrence when there is no proof of this.
I wish doctors would be more honest about the side effects of hormonal therapy. When Dr. Hallmeyer and her colleagues talk about “a very good side-effect and tolerance profile,” they are comparing hormone therapy side-effects to chemotherapy. Of course Tamoxifen and the other anti-estrogen therapies are not as toxic or debilitating as chemotherapy, but they are life-altering nonetheless – and not in a good, positive way. The oncologists also mislead patients of the efficacy of Tamoxifen by claiming it reduces recurrence by 30-50%. What they mean is that your chance of recurrence, assuming you’re willing to give up five years of your life, will be reduced from 12% to 8%, or from 15% to 9%, etc. So the reality is that after five years on Tamoxifen, you chance of recurrence is dropped a just a few percentage points. It’s unfortunate that doctors feel they have to mislead patients in this way.