HER2 Support Group Forums - View Single Post - Breast cancer treatment, novel H1N1 2009 pandemic, and risk

AlaskaAngel · 09-21-2009, 05:30 PM

I have a concern as a health care worker and consumer.
I have not seen much discussion anywhere in the breast cancer consciousness about the potential risks in regard to reduced immunity in this community as it relates to the novel H1N1 flu. I realize we still don't know how much of a threat this flu will actually be.

Should early stage breast cancer patients (the majority of whom are at low risk for recurrence of breast cancer if they do only surgery and perhaps radiation and possibly hormonal treatment, but who will be considered to be one of the group with "an underlying medical problem" if they do immunosuppressive treatment), be counseled about the risk of dying from the novel H1N1 2009 pandemic flu if they are considering chemotherapy? Especially early stage breast cancer patients who are borderline for doing chemotherapy, as well as those hormone receptor positive patients who would not have an underlying medical problem and would be at low risk for dying from the novel H1N1 2009 pandemic flu if they were to choose ovarian ablation and hormonal treatment instead of chemotherapy?

Given that those diagnosed with cancer now are the ones who undergo prolonged treatment that reduces immunity (i.e., an "underlying medical problem"), their risk for mortality by novel H1N1 could be high. Yet there is no significant public discussion about it in discussions with the medical providers responsible for this group of patients. The length of treatment/induced poor immunity indicates a need for planning farther in advance for these patients in regard to the novel H1N1 flu.

I realize that breast cancer affects primarily older adults. The majority of the confirmed novel 2009 H1N1 cases and the hospitalized cases have been very young, and it appears that those over 65 are least affected. However, it is not clear to me whether that age distinction holds true for mortality.

Here is a brief bit of info from the CDC on May 28:

"Next I want to go through a little bit of information about some clinical observations. And you've heard us talking about the hospitalizations and the idea that the majority of hospitalizations that we're seeing are occurring in people who have underlying health conditions, pregnancy or various underlying medical problems. This is what we see in hospitalizations with seasonal flu. And so we are seeing that hospitalizations are more often occurring among people with these underlying conditions. When we look at our deaths, we have information on 11 of the 12 deaths that have been reported to us so far. And it appears that 10 of those fatalities occurred in people who had an underlying condition that put them at greater risk for severe complications of influenza. Some conditions like asthma can make it harder for a person to fight off an influenza infection. And we're seeing that kind of pattern, that the more severe complications, hospitalizations or deaths, tend to be disproportionately in people with underlying conditions. Whereas the actual cases out there in the community are often in people with no underlying conditions at all. So we think these patterns suggest to us that it's important for people who have chronic health conditions, or people who are pregnant, to have special attention to warning signs to regarding when to seek care or receive medical treatment for a respiratory illness like influenza."

The logical question that arises is this: Since early stage breast cancer patients are not at high risk unless therapies are used that significantly lower their immunity, and since the vast majority of those patients are not likely to have breast cancer recurrence in the first place, shouldn't there be medical discussion happening now about the possible change in RISK vs BENEFIT to patients for any treatments that change their immunity status?

Please keep in mind that in 1918, such a large group of patients was not put at immunologic risk by the medical profession, and especially not put at risk for such a prolonged period leading into the fall season.

It seems to me that the summer 2009 ASCO meeting presented a geuine opportunity for the medical professionals who are most responsible for therapies that affect immunity to demonstrate their awareness and commitment to their patients through a well-thought-out, proactive presentation or discussion about this issue. I didn't see anything presented at that conference of people who prescribe treatment for breast cancer patients in regard to my question. How is this group of patients being monitored, and how long would it take for any trend to be recognized?"

In a different presentation by the CDC, this statement was made:

..."The vast majority of the fatalities that we hear of or that are officially reported to us do occur in people with underlying conditions. It's not 100%. It's more on the on order of three-fourths of them at this point." ....

I also found this rough estimate of the number of persons in the population at any time who are immunocompromised (AIDS, chemo, etc.):

"Immunocompromised status, either through cancer chemotherapy or other compromising conditions is about 13%."

Because I am not seeing any professional discussion about the risk of chemotherapy-caused immunosuppression in regard to the novel 2009 H1N1, it appears to me that oncology is proceeding as if the novel 2009 H1N1 flu and immunosuppression from chemotherapy are mutually exclusive conditions.

Again, my question is this:

Should early stage breast cancer patients (the majority of whom are at low risk for recurrence of breast cancer with only surgery and perhaps radiation and possibly hormonal treatment, but who will be considered to be one of the group with "an underlying medical problem" if they do immunosuppressive treatment), be adequately counseled about the risk of dying from the novel H1N1 2009 pandemic flu, if they are considering chemotherapy? Especially breast cancer patients who are borderline for doing chemotherapy, as well as those hormone receptor positive patients who would not have an underlying medical problem and would be at low risk for dying from the novel H1N1 2009 pandemic flu if they were to choose ovarian ablation and hormonal treatment?

How many are actually receiving this counseling as part of their risk assessment?

09-21-2009, 05:30 PM	#1
AlaskaAngel Senior Member Join Date: Sep 2005 Location: Alaska Posts: 2,018	Breast cancer treatment, novel H1N1 2009 pandemic, and risk I have a concern as a health care worker and consumer. I have not seen much discussion anywhere in the breast cancer consciousness about the potential risks in regard to reduced immunity in this community as it relates to the novel H1N1 flu. I realize we still don't know how much of a threat this flu will actually be. Should early stage breast cancer patients (the majority of whom are at low risk for recurrence of breast cancer if they do only surgery and perhaps radiation and possibly hormonal treatment, but who will be considered to be one of the group with "an underlying medical problem" if they do immunosuppressive treatment), be counseled about the risk of dying from the novel H1N1 2009 pandemic flu if they are considering chemotherapy? Especially early stage breast cancer patients who are borderline for doing chemotherapy, as well as those hormone receptor positive patients who would not have an underlying medical problem and would be at low risk for dying from the novel H1N1 2009 pandemic flu if they were to choose ovarian ablation and hormonal treatment instead of chemotherapy? Given that those diagnosed with cancer now are the ones who undergo prolonged treatment that reduces immunity (i.e., an "underlying medical problem"), their risk for mortality by novel H1N1 could be high. Yet there is no significant public discussion about it in discussions with the medical providers responsible for this group of patients. The length of treatment/induced poor immunity indicates a need for planning farther in advance for these patients in regard to the novel H1N1 flu. I realize that breast cancer affects primarily older adults. The majority of the confirmed novel 2009 H1N1 cases and the hospitalized cases have been very young, and it appears that those over 65 are least affected. However, it is not clear to me whether that age distinction holds true for mortality. Here is a brief bit of info from the CDC on May 28: "Next I want to go through a little bit of information about some clinical observations. And you've heard us talking about the hospitalizations and the idea that the majority of hospitalizations that we're seeing are occurring in people who have underlying health conditions, pregnancy or various underlying medical problems. This is what we see in hospitalizations with seasonal flu. And so we are seeing that hospitalizations are more often occurring among people with these underlying conditions. When we look at our deaths, we have information on 11 of the 12 deaths that have been reported to us so far. And it appears that 10 of those fatalities occurred in people who had an underlying condition that put them at greater risk for severe complications of influenza. Some conditions like asthma can make it harder for a person to fight off an influenza infection. And we're seeing that kind of pattern, that the more severe complications, hospitalizations or deaths, tend to be disproportionately in people with underlying conditions. Whereas the actual cases out there in the community are often in people with no underlying conditions at all. So we think these patterns suggest to us that it's important for people who have chronic health conditions, or people who are pregnant, to have special attention to warning signs to regarding when to seek care or receive medical treatment for a respiratory illness like influenza." The logical question that arises is this: Since early stage breast cancer patients are not at high risk unless therapies are used that significantly lower their immunity, and since the vast majority of those patients are not likely to have breast cancer recurrence in the first place, shouldn't there be medical discussion happening now about the possible change in RISK vs BENEFIT to patients for any treatments that change their immunity status? Please keep in mind that in 1918, such a large group of patients was not put at immunologic risk by the medical profession, and especially not put at risk for such a prolonged period leading into the fall season. It seems to me that the summer 2009 ASCO meeting presented a geuine opportunity for the medical professionals who are most responsible for therapies that affect immunity to demonstrate their awareness and commitment to their patients through a well-thought-out, proactive presentation or discussion about this issue. I didn't see anything presented at that conference of people who prescribe treatment for breast cancer patients in regard to my question. How is this group of patients being monitored, and how long would it take for any trend to be recognized?" In a different presentation by the CDC, this statement was made: ..."The vast majority of the fatalities that we hear of or that are officially reported to us do occur in people with underlying conditions. It's not 100%. It's more on the on order of three-fourths of them at this point." .... I also found this rough estimate of the number of persons in the population at any time who are immunocompromised (AIDS, chemo, etc.): "Immunocompromised status, either through cancer chemotherapy or other compromising conditions is about 13%." Because I am not seeing any professional discussion about the risk of chemotherapy-caused immunosuppression in regard to the novel 2009 H1N1, it appears to me that oncology is proceeding as if the novel 2009 H1N1 flu and immunosuppression from chemotherapy are mutually exclusive conditions. Again, my question is this: Should early stage breast cancer patients (the majority of whom are at low risk for recurrence of breast cancer with only surgery and perhaps radiation and possibly hormonal treatment, but who will be considered to be one of the group with "an underlying medical problem" if they do immunosuppressive treatment), be adequately counseled about the risk of dying from the novel H1N1 2009 pandemic flu, if they are considering chemotherapy? Especially breast cancer patients who are borderline for doing chemotherapy, as well as those hormone receptor positive patients who would not have an underlying medical problem and would be at low risk for dying from the novel H1N1 2009 pandemic flu if they were to choose ovarian ablation and hormonal treatment? How many are actually receiving this counseling as part of their risk assessment?