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Old 11-29-2007, 02:51 PM   #1
Lani
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I knew this was Tom's pet peave--lack of lymph node sampling in elderly

http://her2support.org/vbulletin/index.php?

but if it doesn't change treatment????
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Old 11-29-2007, 03:43 PM   #2
Hopeful
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Lani, this link just goes to the main forum board. Did you mean to link to something else?

Hopeful
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Old 11-29-2007, 06:49 PM   #3
Lani
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I told you I was no good at Links!

http://www.medscape.com/viewarticle/566692
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Old 11-29-2007, 09:43 PM   #4
SoCalGal
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Hi Lani,
The link asks me to log in. Do I need to register or have you posted the secret log-in info? I know in the past Joe has posted log-in info for members of the board. Also, who's Tom?
Tks. Flori
__________________
1996 cancer WTF?! 1.3 cm lumpectomy Er/Pr neg. Her2+ (20nodes NEGATIVE) did CMF + rads. NED.
2002 recurrence. Bilateral mastectomy w/TFL autologous recon. Then ACx2. Skin lymphatic rash. Taxotere w/Herceptin x4. Herceptin/Xeloda. Finally stops spreading.
2003 - Back to surgery, remove skin mets, and will have surgery one week later when pathology can confirm margins.
‘03 latisimus dorsi flap to remove skin mets. CLEAN MARGINS. Continue single agent Herceptin thru 4/04. NED.
‘04 '05 & 06 tiny recurrences - scar line. surgery to cut out. NED each time.
1/2006 Rads again, to scar line. NED.

3/07 Heartbreaking news - mets! lungs.sternum. Try Tykerb/Xeloda. Tykerb/Carbo/Gemzar. Switch Oncs.
12/07 Herceptin.Tykerb. Markers go stable.
2/8/08 gamma knife 13mm stupid brain met.
3/08 Herceptin/tykerb/avastin/zometa.
3/09 brain NED. Lungs STABLE.
4/09 attack sternum (10 daysPHOTONS.5 days ELECTRONS)
9/09 MARKERS normal!
3/10 PET/CT=manubrium intensely metabolically active but stable. NEDhead.
Wash out 5/10 for tdm1 but 6/10 CT STABLE, PET improving. Markers normal. Brain NED. Resume just Herceptin plus ZOMETA
Dec 2010 Brain NED, lungs/sternum stable. markers normal.
MAR 2011 stop Herceptin/allergy! Go back on Tykerb and switch to Xgeva.
May-Aug 2011 Tykerb Herceptin Xgeva.
Sept 2011 Tykerb, Herceptin, Zometa, Avastin.
April 2012 sketchy drug trial in NYC. 6 weeks later I’m NED!
OCT 2012 PET/CT shows a bunch of freakin’ progression. Back to LA and Herceptin.avastin.zometa.
12/20/12 add in PERJETA!
March 2013 – 5 YEARS POST continue HAPZ
APRIL 2013 - 6 yrs stage 4. "FAILED" PETscan on 4/2/13
May 2013: rePetted - improvement in lungs, left adrenal stable, right 6th rib inactive, (must be PERJETA avastin) sternum and L1 fruckin'worsen. Drop zometa. ADD Xgeva. Doc says get rads consultant for L1 and possible biopsy of L1. I say, no thanks, doc. Lets see what xgeva brings to the table first. It's summer.
June-August 2013HAPX Herceptin Avastin Perjeta xgeva.
Sept - now - on chemo hold for calming tummy we hope. Markers stable for 2 months.
Nov 2013 - Herceptin-Perjeta-Avastin-Xgeva (collageneous colitis, which explains tummy probs, added Entocort)
December '13 BRAIN MRI ned in da head.
Jan 2014: CONTINUING on HAPX…
FEB 2014 PetCT clinical “impression”: 1. newbie nodule - SUV 1.5 right apical nodule, mildly hypermetabolic “suggestive” of worsening neoplastic lesion. 2. moderate worsening of the sternum – SUV 5.6 from 3.8
3. increasing sclerosis & decreasing activity of L1 met “suggests” mild healing. (SUV 9.4 v 12.1 in May ‘13)
4. scattered lung nodules, up to 5mm in size = stable, no increased activity
5. other small scattered sclerotic lesions, one in right iliac and one in thoracic vertebral body similar in appearance to L1 without PET activity and not clearly pathologic
APRIL 2014 - 6 YRS POST GAMMA ZAP, 7 YRS MBC & 18 YEARS FROM ORIGINAL DX!
October 2014: hold avastin, continue HPX
Feb 2015 Cancer you lost. NEDHEAD 7 years post gamma zap miracle, 8 years ST4, +19 yrs original diagnosis.
Continue HPX. Adding back Avastin
Nov 2015 pet/ct is mixed result. L1 SUV is worse. Continue Herceptin/avastin/xgeva. Might revisit Perjeta for L1. Meantime going for rads consult for L1
December 2015 - brain stable. Continue Herceptin, Perjeta, Avastin and xgeva.
Jan 2016: 5 days, 20 grays, Rads to L1 and continue on HAPX. I’m trying to "save" TDM1 for next line. Hope the rads work to quiet L1. Sciatic pain extraordinaire :((
Markers drop post rads.
2/24/16 HAP plus X - markers are down
SCIATIC PAIN DEAL BREAKER.
3/23/16 Laminectomy w/coflex implant L4/5. NO MORE SCIATIC PAIN!!! Healing.
APRIL 2016 - 9 YRS MBC
July 2016 - continue HAP plus Xgeva.
DEC 2016 - PETCT: mets to sternum, lungs, L1 still about the same in size and PET activity. Markers not bad. Not making changes if I don't need to. Herceptin/Perjeta/Avastin/Xgeva
APRIL 2017 10 YEARS MBC
December 2017 - Progression - gonna switch it up
FEB 2018 - Kadcyla 3 cycles ---->progression :(
MAY30th - bronchoscopy, w/foundation1 - her2 enriched
Aug 27, 2018 - start clinical trial ZW25
JAN 2019 - ZW25 seems to be keeping me stable
APRIL 2019 - ONE DOZEN YEARS LIVING METASTATIC
MAY 2019 - progression back on herceptin add xeloda
JUNE 2019 - "6 mos average survival" LMD & CNS new single brain met - one zap during 5 days true beam SBRT to cord met
10/30/19 - stable brain and cord. progression lungs and bones. washing out. applying for ds8201a w nivolumab. hope they take me.
12/27/19 - begin ds8401a w nivolumab. after 2nd cycle nodes melt away. after 3rd cycle chest scan shows Improvement, brain MRI shows improvement, resolved areas & nothing new. switch to plain ENHERTU. after 4th cycle, PETscan shows mostly resolved or improved results. Markers near normal. I'm stunned but grateful.
10/26/20 - June 2021 Tucatinib/xeloda/herceptin - stable ish.
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Old 11-29-2007, 10:02 PM   #5
Bev
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Flori, you can look up Tom on members list. Good reading. He was a caregiver extrordinaire for his elderly Mom. She died from other causes.

When, I saw the post title, I remembered and said to myself, Oh I miss Tom. Bev
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Old 11-30-2007, 12:29 AM   #6
Joanne S
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Smile Flori---

Flori, I didn't have any trouble linking to the article---so I posted it here for you.

Breast Cancer Patients Overlooked for Lymph Node Assessment

<!-- POST TITLE -->
<!-- If AUTHOR -->Allison Gandey <!-- /If AUTHOR -->Medscape Medical News 2007. © 2007 Medscape



<!-- /POST TITLE -->
<!-- Main Table -->November 29, 2007 — A startling 11% of those in a 200,000-patient national sample did not receive a lymph node assessment while undergoing surgery for early-stage breast cancer. The recommended practice promotes disease staging and appropriate treatment selection. But researchers report significant disparities in care, predominantly among black patients, those with no health insurance, and those living in areas where residents are known to have less education. The findings were reported in Atlanta at the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved meeting by the American Association for Cancer Research.
"This is very worrisome," lead author Michael Halpern, MD, PhD, strategic director of Health Services Research for the American Cancer Society, told Medscape Oncology. "Lymph node assessment is an important part of breast cancer care."
During an interview, Dr. Halpern said that he doesn't believe physicians are purposely withholding care from particular patients. But, he noted, "these findings may be signaling important barriers that physicians need to take into account when treating patients to make sure they fully communicate the benefits and risks of treatment to all patients."
The investigators used the National Cancer database, a hospital registry jointly sponsored by the American Cancer Society and the American College of Surgeons. They included records for all women diagnosed with early-stage T1a, T1b, T1c, and T2N0 breast cancer.
Researchers explored the impact of patient race and ethnicity, insurance status, and age on their receipt of axillary lymph node assessment. They controlled for other sociodemographic and clinical factors using multivariate logistic regression.
Nonclinical Factors Influencing Quality of Care
The group found that women without insurance were 24% less likely to receive a lymph node assessment than those with private insurance. Women who lived in areas with low levels of education were 13% less likely to have the procedure than those in areas reporting high levels of education. And black patients were 10% less likely to have the procedure than white patients.
"We were really surprised by the number of nonclinical factors associated with patients not receiving an assessment," Dr. Halpern told Medscape Oncology.
The group also found that age was a major factor in determining who received a lymph node assessment. The researchers reported that women 73 years or older were 3 times less likely to receive the procedure than were patients 51 years or younger.
But Dr. Halpern said he was less concerned by this finding, considering practice guidelines for axillary node dissection during lumpectomy or mastectomy surgery suggest the procedure is optional for elderly patients, for those with other serious illnesses, and for patients in whom lymph node results wouldn’t affect choice of therapy.
Dr. Halpern pointed to a number of limitations to the study, including its reliance on a database. "Roughly 25% of cancer patients would not be included in the national data and would be at other hospitals, so we clearly do not have everyone here," he said. "We also don't know why the patients' lymph nodes were not assessed. Was this a patient-driven phenomenon? Or was this coming from the surgeons? We don't know what factors were influencing the decisions," he added.
Other studies have suggested that disparities in care result from different sources, including structural barriers such as health insurance; type of hospital, physician, or clinical factors; and patient factors.
"All of these may be important in the disparities we observed for axillary node dissection," Dr. Halpern said. "We need to find out why these disparities exist and what to do to make sure that everyone is receiving excellent cancer care."
The researchers have disclosed no relevant financial relationships.
The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved: Abstract A-65. Presented November 28, 2007.
<!-- /Main Table -->

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__________________
Aug06...Dx Age 50, IDC Left Breast, 6+/16 lymph nodes, Stg 3, ER+/PR+/HER2+
Sep06-Jan07...Mediport. Chemo: AC x 4, T x 4
Dec06-Nov07...Herceptin
Feb12,2007...Surg MRM Left & SM Right, reconstruct w/expanders
Mar07-Jun07...Saline Exp
Jun07...Start Tamoxifen
Jun07-Aug07...Rad x 25
Jun07-Oct07...Persistent fevers-unknown origin
Jun07-Nov07...PT for Severe PMPS & Capsular Contracture
Nov07...Surg Capsulectomy, Gel Implants, PMPS pain gone instantly.
Feb08...NED 1st CANCERVERSARY!!!!!
Feb08...2 months post surgery Caps Cont again :(
Mar08...Stop Tamoxifen. Start Arimidex.
Apr08...Sudden high fever, Hosp ICU 10 days, staph infect, emerg surg, implants removed. Outpt IVantibiotics Daily x 6 weeks
Feb11...NED 5th CANCERVERSARY!!!!!
Feb12...NED 6th CANCERVERSARY!!!!!
Aug12...Spotting. Surg=D&C
Sep12...STAGE IV = RARE BC METS TO UTERUS ILC ER+/PR+/HER2-Negative) (Different BC than originally diagnosed = IDC ER+/PR+/HER2+).
Sep12...Stop Arimidex. Start Afinitor & Aromasin.
Jan13...MRI = no progression no reduction
Apr13...Progression. Stop Afinitor & Aromasin.
Apr13...Start Chemo: Taxol & Carboplatin.
Nov13...Scans & Pelvic 95+% Reduction. Nueropathy>Stop chemo start Fareston.
Jan14...PET scan = no progression stable.
May14...Pelvic > Bleeding & cramps. TMs up.
May14...PET scan = uterine progression :(
May14...Stop Fareston. Start Chemo: Xeloda.



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