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Ask Dr. David Your Own Question
Dr. David
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 46959
Experience:  Board Certified Oncologist
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Change chemotherapy drugs dosage

Customer Question

Hi,
I would like to know why my oncologist doesn't want to reduce the dosage of my chemo drugs and it's actually legal that she can refuse my request..after my first cycle of FEC-T for stage 2b breast cancer I ended up in A&E twice the first on the same day of treatment for uncontrollable vomiting and second time 2 weeks later for a sore throat and the blood test showed very low blood count. I'm currently taking penicillin orally and doing filgastrim injections which are giving me side effects..am I supposed to go through all if this at each cycle? I don't want more pills more medicines to weaken my body further..she says or you do the chemo at high dosage or you don't do it at all, I can't reduce it simply because you ask me so, in your case there is no reason to do it..can you please advise? Can't a patient be free of asking and getting a change in dosage? I'm so scared of long term side effects of chemo and that's one additional reason for it..
Submitted: 3 years ago.
Category: Oncology
Expert:  Dr. David replied 3 years ago.

Dr. David :

This is Dr. David

Dr. David :

I am sorry you are having to go through breast cancer therapy and chemotherapy.

Dr. David :

with reduced dosing of chemotherapy, it might be less effective at keeping your breast cancer from coming back.

Dr. David :

we know that breast cancer acts more aggressively in younger, premenopausal women.

Dr. David :

this first course of chemotherapy for your breast cancer often times is your best shot at being cured of breast cancer.

Dr. David :

these episodes of nausea and vomitting and drops in blood count are temporary side effects.

Dr. David :

and if your breast cancer is aggressive, like if it is ER negative and Her-2/neu negative or positive, then chemotherapy really is the only systemic treatment because hormone therapy can't be used if the tumor is ER negative

Dr. David :

so dropping the dosage of the chemotherapy might decrease your short term side effects, however, it might give room for your breast cancer to return in the future.

Dr. David :

is your chemotherapy being given before or after your breast surgery?

Dr. David :

is your breast tumor ER positive or negative?

Dr. David :

her-2/neu negative?

Customer: Hi Dr David,
Dr. David :

hi

Customer: My breast cancer is a self detected invasive ducal carcinoma right breast (39mm 2 sentinel nodes OSNA positive, but 0/18 nodes positive in ancillary dissection. ER/PR positive HER2 negative
Customer: I had surgery to remove lump and nodes first
Customer: Lumpectomy
Customer: Then I have been offered 6 cycles of FEC-T chemotherapy
Customer: Radiotherapy after chemotherapy
Customer: And adjuvant hormones
Customer: It just sounds too much to me and I'm so scared for the long terms side effects of all see treatments
Dr. David :

I can understand.

Dr. David :

39mm is close to 4cm, pretty big breast cancer in a 34 year old

Dr. David :

good that ER positive and her negative.

Dr. David :

people ask me what will I do when we find a cure for cancer.

Dr. David :

since I am a cancer doctor.

Dr. David :

and I tell them we have a cure for cancer.

Dr. David :

and we have a cure for breast cancer.

Dr. David :

but the cure doesn't come in a pill form.

Dr. David :

it is many treatments.

Dr. David :

and includes surgery, chemotherapy, radiation therapy and anti-estrogen hormone therapy

Dr. David :

and it is a long treatment course more than a year in many women.

Dr. David :

but we do know that it improves your odds of being cured.

Dr. David :

breast cancer is the most researched cancer in the world and we have the most data supporting each step in the process than almost any other cancer.

Dr. David :

it is always your right to stop treatment

Dr. David :

refuse cycles of chemotherapy

Dr. David :

or refuse radiation

Dr. David :

you can ask for a mastectomy if you don't want to have radiation of your breast.

Dr. David :

but you have to understand that you are decreasing your chances of cure when you have less cycles of chemotherapy

Dr. David :

or if you don't take the tamoxifen

Dr. David :

http://www.lifemath.net/cancer/breastcancer/therapy/index.php

Dr. David :

is a good website to look at your cancer statistics.

Customer: That's reassuring from one side...from the other I'm still amazed that a cure has to be as well so damaging with chances of leaving you with another cancer and chemo itself is toxic or leaving you with chemo brain for life or putting you damaging radiation or making you 20 years older like for the tamoxifen
Customer: Thank you for the statistics will give it a good read
Dr. David :

you are welcome

Dr. David :

best of luck to you

Dr. David :

you have to put in your age and cancer size and tumor statistics into the calculator to get stats.

Dr. David :

let me know if you have other questions.

Customer: Ok will do but did you read the above?
Dr. David :

if done for now, please consider leave positive feedback below the chat box .

Customer: My concerns will all these treatments..maybe it's repetitive
Dr. David :

no, the treatments are not repetative.

Dr. David :

we know all the steps help and are needed.

Customer: But if u had to choose for yourself what u would absolutely do and what u would avoid
Customer: Honestly
Dr. David :

just because you have chemotherapy does not mean you don't need radiation.

Dr. David :

I would do all of the steps if it was me or my wife.

Dr. David :

I know it is a long therapy, but it is all needed.

Dr. David :

we use to do bone marrow transplants for women with breast cancer, but that was proven to not be effective and was proven to be too much treatment for women.

Dr. David :

so that is not done anymore.

Dr. David :

all the steps are needed if you want your best shot at cure of your breast cancer.

Dr. David :

medical research showed that bone marrow transplants were not benefitical for women with aggressive breast cancer.

Customer: But what if with my diet Ia try and stop estrogens in my life that's what I'm already doing...what I'm really scared of is radiation and the hormones I really don't want that
Dr. David :

you can't effectively stop your estrogens with diet changes.

Dr. David :

your ovaries continue to make estrogen.

Dr. David :

radiation is not to stop estrogen.

Dr. David :

it is to decrease the chances of your breast cancer coming back in your breast from 30% down to less than 5% in your breast after lumpectomy

Dr. David :

if you don't want radiation, you can have the rest of your breast removed surgerically for a mastectomy.

Dr. David :

the tamoxifen does not lower your estrogen levels.

Customer: Except if I loose my fertility permanently after chemo I guess...
Dr. David :

it is a estrogen receptor blocker, and has less side effects than chemo

Customer: Ok...it's just that I read lots of forums
Dr. David :

chemo can cause your ovaries not to produce much estrogen afterwards

Dr. David :

talk to your cancer doctor experts

Dr. David :

forums are not good.

Customer: And many women can't finish the 5 years of this pill because of the side effects
Dr. David :

that is not true.

Dr. David :

I have many women who finish 5 years of pills.

Dr. David :

those in the forums are the ones who are complaining.

Dr. David :

many cancer patients finish 5 years.

Customer: But no one is sure if they are really cancer free after all anyway..but Ia understand..it's about increasing my odds
Customer: Last question for now
Customer: Have you heard about fasting anch chemotherapy?
Dr. David :

no have not heard about fasting anch chemotherapy.

Customer: Apparently reduces side effects and increase the effectiveness of chemo as well
Customer: I asked my oncologist but they never heard of something like this
Customer: But again there are many trials at the moment and again many forums and people finding it helpful through their chemo
Customer: It's ok then just wanted to know if you would advise it or not
Dr. David :

http://www.medicalnewstoday.com/articles/241518.php

Dr. David :

fasting might help increase effectiveness of chemo

Customer: Ok that's good
Customer: Thank you very much for your time, will read your links I feel a bit more reassured but I'm still scared of the future..will try and keep positive. Have a nice day
Dr. David :

best of luck to you

Dr. David :

hang in there with your treatments.

Dr. David :

please consider leaving positive feedback below the chat box

Dr. David :

we only get credit for helping clients after positive feedback

Dr. David :

you can always reach me as Dr. David if you have other questions.

Dr. David :

http://www.justanswer.com/medical/expert-dr-david/

Dr. David :

is my website if you need to reach me again

Dr. David :

thanks for using JustAnswer.com

Customer: Will I always have to pay to ask you more questions in the future?
Dr. David :

if they are unrelated new questions, then we recommend starting a new question series.

Dr. David :

but I am here always to answer related questions.

Customer: Ok thank you
Dr. David :

you are welcome

Dr. David and other Oncology Specialists are ready to help you