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Alaska Angel said:
Again, I have to ask, if you have 2 populations in which treatment makes no difference, (as Barbara wondered too) is it because none of the treatments that are used are of benefit (or are of very little benefit)? If the question is focused only on "does the treatment make any difference if it starts sooner?" then you miss entirely the question "does the treatment itself make any difference?"
Debbie now: Hi AA, nice to be having a discussion again. I'm not sure I'm understanding the question. It seems to me to be two entirely different questions. I've beaten the first one to death and had better not go there again.
The second one, "does the treatment itself make any difference?" is a question only answered with hindsight, right? Usually yes, the treatment makes a difference. Sometimes a huge, near-miraculous difference, sometimes a small one, sometimes (alas) apparently not any difference.
This working/not working has to do with some things that we know (HER2, ERPR, etc) and probably many many things that we do not (yet) know. In general, each successive successful treatment works less well, or at least less long.
In fact, relevant to this thread, it could be argued (and is currently being argued on the bcmets list by those much more knowledgeable than me) that there is benefit to waiting for symptoms of progression even with mets, rather than relying on TM's or scans, to know when to change treatments. This is not true when a treatment is causing significant side effects because it's best to abandon it soonest so as not to cause suffering or inflict damage while providing no benefit. But metastatic disease that does initially respond to treatment can be left unmonitored except for symptom report, just as the guidelines recommend for after primary disease. Why? Because that is the best way to extend each "tool". Some women with mets look at their options as tools in a toolbox. They prefer not to use each tool until they are absolutely forced to do so, because that way the limited supply of tools will last longer. This is not an approach that suits everyone's temperament, but it's one perfectly reasonable approach.
Debbie Laxague
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