Miss a month of chemo, then what?

[Chelee]

What is the normal protocal...if there even is one if you miss a month of chemo?
My very first month I landed in the hospital due to a low "ANC" count. If you add the time in the hospital, plus the down time at home....I missed an entire month of my chemo and weekly herceptin.

They got me started as soon as they could...but I still have always worried about that month I missed with NO chemo of any type while my cancer had time to re-group and run rapid. (They told me when I first STARTED my chemo that whatever happened due to my aggressive cancer...they wanted no inturruptions.) Well..if thats true...I missed a month of chemo after being told NO INTURRUPITONS.

So since I got started after that second month OFF chemo and herceptin...it would seem to be I should of had an EXTRA chemo to make up for the one I missed? (Maybe not?) I really don't know?

I can't help but wonder what damage was done missing an ENTIRE month of chemo? Has anyone ever heard of this happening...and IF their oncologist gave them an extra full cycle of chemo to make sure they kicked some bc butt?

Had I NOT opened my mouth to my oncologist...I would of ONLY gotten five cycles of chemo verses the six I was suppose to get. (She TRIED to tell me the time I missed in the hospital and at home counted rather I had it or not.) I told her it did NOT work that way! She knew I was mad. Then she acted like it was all a mistake and that I WAS right and did get the sixth one. (I sure don't have much luck.)

I don't know what to think at this point?

Chelee

[AlaskaAngel]

Chelee,

The way chemo is thought to work is that you get a dose and it kills some cancer cells, and then before the next dose the cancer cells that weren't vulnerable at the time of the first dose (i.e., the cancer cells that weren't actively dividing at the time) are still increasing -- but there are less and less of them each time after each dose.

This is why it is considered important to get all doses, and to get them on time so that the numbers continue to be less each time.

I don't know what the effect of getting the missed dose "late" (at the end of treatment) would be, or if it happens enough that there is any good information about it. Very likely the best source of info on this would be any collection of data about those with bc who happened to be in the middle of treatment during the disaster in New Orleans. So see if you can connect with any research about those patients, or with cancer-related institutions in that area.

AlaskaAngel

P.S. I am just one single case, and I am stage 1 so keep that in mind, but I was supposed to get my chemo every 3 weeks and ended up getting all 6 treatments every 4 weeks, and I'm NED almost 4 years later....

[MJo]

I was stage 1, but decided to get chemo because of HER2. I took three adriamycin/cytox and got a bad respiratory infection. Didn't take No. 4 and oncologist gave me a month to recover. It was seven weeks since my last A/C chemo before I started Taxol and Herceptin. I finished four dose dense Taxols without too much trouble. I figure if any mets started growing in those seven weeks without chemo, the taxol and herceptin took care of them. I also have a year of Herceptin ahead of me to mop up any stray #$@% mets. I can understand how you are afraid. This cancer was the scariest experience of my life. I trust that all will be well for us. Mary Jo

[Chelee]

Hi Alaska Angel, Thanks for explaining how the chemo regimen works. After hearing that...I *can't* see that an extra cycle of chemo would make up for the one I missed. That kind of bothers me knowing I MISSED an ENTIRE month thanks to my oncologist. He is the one that said we wanted NO inturruptions...yet he caused it.

I even said to him when I was IN the hospital, "So whats this mean now...my cancer is running wild". Of course he didn't want me upset so he just said "No, your fine..you still have enough chemo in your body fighting the cells.".

I might of at the time we were talking in the hospital about it..but not by the time they had me sit at home and recover for another three weeks.

Nothing has went right for me since this nightmare started. I wanted my best chances like everyone else...now I am really concerned about that month without.

Well, nothing I can do to change it now. What will be, will be. I just will keep thinking positive and keep praying and going forward and see what comes my way. I sure wish that wouldn't of happened though.

Especially since I had node involvment and such an aggressive bc.

It sure sounds like even though you got your tx every four weeks...it worked well for you. NED for four years...way to go. That HAS to be a nice feeling. I am so happy for you.

Thanks so much for explaining that...I really do appreciate it so much. I can't find anything out at the place I go...and believe me...I try.

Chelee

[Chelee]

Hi Mary, I just wrote you a reply...hit some button and WHAM...it was gone! I hate when that happens. ARGH.

I will try again. lol I am sure you can certainly understand my concern at missing a month of chemo since you ended up missing seven weeks. Wow...you must of been stressed at that time. But at LEAST your oncologist sounds GOOD because he/she went ahead and followed up with four dose dense cycles to get the little buggers.

You had that AC...that is some nasty stuff from what I have heard. It must really do that job. I don't like chemo of course...but I wish they would of used that on me with my stage IIIA, her2/neu 3+++. But for SOME reason they just decided to use the herceptin, taxotere, & carb.

O'well...nothing I can do about it now. But with my aggressive cancer...you sure think they would of attacked it harder...especially since they only got me through ONE full cycle before he landed me in the hospital and made me miss a month of chemo. Then to start back up after a month of down time...I feel like I only had 5 cycles since my body had a month to recover.

How I wish I knew back then...what I know now. But I can't go back and change a thing. I trusted them! I was told my case was presented to a cancer board and my best interest was what they all wanted. I am really beginning to wonder sad as that is.

I have a year of herceptin like you do. Thats where I am at now. Of course I have to have a echo soon to make sure the heart is doing ok. It was last time...so hopefully that will stay up there enough. I don't need to miss anything else at this point. Then on to rads soon if all goes as planned?

Thanks so much Mary for your reply.

Chelee

[AlaskaAngel]

A very difficult thing to learn is that we can only go forward, not backward, and to get to where you give up less energy on being upset. As anyone can tell from some of my posts, I still get really angry at times.

Maybe you lost some advantage in not getting that one treatment. But I "just missed" the advantage of opting for dose-dense as I was too early for that choice. And I haven't yet had the big advantage of trastuzumab, whereas you will.

A.A.

[sabpri]

My original plan was to do chemo first to shrink down the Tumors and then surgery to remove at the end. I was to do 4 rounds of AC every 2 weeks and then 12 weekly doses of Herceptin/Taxotere. Ended up the Tumors shrank faster than originally projected, so we went ahead with surgery after 8 weeks of Herceptin/Taxotere. I was told I needed to wait for the surgeon to release me before I could start chemo again.

When I went to see my Oncologist about when to start the last 4 of the weekly infusions I missed, she said she was considering just letting me skip the remaining 4 and go right to radiation. I took it from her reaction that no one really knows what the "perfect" balance is between ensuring the person has enough chemo to get rid of the cancer for good, and making sure they do not have too much that it puts you at risk for lukemia. I told her I wanted to "make up" for my 4 missed doses and she knew what a big worrier I am so she agreed to go ahead. We ended up deciding to give me just one big 3 week dose treatment and while I felt worse than the weekly doses, at least I was done.

I guess my point is that there probably is no exact answer to where the line is for you, so without the exact science of it, you have to decide what makes you the most comfortable. Mine knew I would be anxious about skipping anything, so she agreed when I told her to finish it up. I would just worry about it so I am glad I did.

Hope this helps.
Natalie