Chemotherapy: Is it Always the Best Choice?

Patient Expert

When I was diagnosed with stage II breast cancer nearly 9 years ago, I vowed I'd do everything in my power to beat it. Surgery, radiation, chemo, drugs" whatever it took, I'd do it.

After all, I was leading a great life. I had a wonderful job; we'd just bought a house after renting for 10 years; my son was a happy-go-lucky 15-year-old" things were good.

Then suddenly, death appeared at my door. "Cancer? Impossible. Not me."

Which quickly changed to "OK, what do I have to do to beat this?"

I pulled up my socks and got on the treatment treadmill, deciding I wouldn't get off till I'd done everything possible to kill cancer - so it wouldn't kill me.

Lumpectomy? Sounds good. Oh shoot, that didn't work? OK, mastectomy - fine. You say the cancer has spread to my lymph nodes? And spilled out of my lymph nodes, too? So, what does that mean? Radiation - sure, no problem.


Oh, no" OK, tell me the odds with and without chemo. Chemo will reduce my risk of recurrence another 8%? Sure, let's go for it. I know it won't be easy, but it's only 4 months. I can put up with anything for 4 months.

Little did I know that, 8 years later, I'd still be feeling chemo's after-effects - both mental, and physical.

There are times I can't remember my own phone number. I can't juggle as many tasks as I used to; and my vocabulary has shrunk alarmingly - which for a writer, is devastating.

After years of up to 20 hot flashes a day, they've finally faded. But I still wake up many mornings with scratches up and down my torso, the result of an intense itchiness that wakes me out of a sound sleep many nights.

Is chemo responsible? Itching isn't a known side effect, but it started when I had chemo"

Before cancer, I was an aging jock, climbing New England's tallest mountains with a 25-pound pack on my back. Now I have trouble with basic daily exercises. My bones and joints are stiff and painful. Is it menopause? Age? Arimidex?

Or is it chemo?

Many of us face the chemo question. With certain diagnoses - cancer that's spread to multiple lymph nodes, HER2+, triple negative - chemo is pretty much a given. Your oncologist may say s/he "recommends" chemo, but you know it's a strong recommendation; she's not really giving you a choice.

But for others - an unaggressive cancer with microscopic spread to one lymph node; a more aggressive cancer confined to the breast - chemo is presented as an option. Your oncologist is noncommittal, offering it as a possibility, but not strictly necessary.

You face one of those uncomfortable "your decision" moments. Lumpectomy, or mastectomy? Single mastectomy, or bilateral? Standard radiation, or brachytherapy?

Chemo, or no chemo?

Are you facing this decision? Here are some things to consider.

-Do you have children at home? Then I'd guess you'd choose chemo. I don't know of a single mother who wouldn't do anything - ANYTHING - for her children. And staying alive is task #1.

-Are you aged and infirm? If you feel you're nearing the end of your days; and/or if you're dealing with other debilitating health issues, you may decide that chemo, even in the short term, isn't worth the side effects. You'd rather live out the days you have left without added pain and suffering.

-Are you on the fence? Ask your doctor if you're a candidate for the Oncotype DX test, which assesses how likely you are to have a recurrence without chemo.

If you score over 30, you're very likely to have a recurrence, and chemo would probably be a good choice. If you score under 18, you're unlikely to have a recurrence; foregoing chemo is a viable option. And if you score between 19 and 30, and you're STILL on the fence:

-Is the difference chemo might make worth it? How do you balance survival benefit and side effects, when you don't truly know the extent of either?

Your doctor can give you 5-year survival rate statistics - but those are averages; they're not you. And you can study the list of side effects, but until you actually have those infusions, you won't know if you'll experience half of them" none of them" or all of them, plus more.

This is when you take a deep breath, and choose what feels right for YOU.

If you're someone who constantly second-guesses herself, you might lean towards chemo. If you're a glass-half-full personality, you might lean away from it.

If I ever have to face the chemo decision again, I'll be thinking very long and very hard about it. I no longer have a child at home. I know the lasting effects of my first experience with chemo. I'm not very old; I SHOULD have lots of years left. But balancing the good, the bad, and the ugly of chemo, against its possible benefit"

I think this time I'd give it a pass.