Triple negative breast cancer: chemo or not at 81?

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I am 81 and usually fit and well. I had a lumpectomy in August with no lymph or surrounding tissue cancer involvement. My cancer is grade 3 Triple negative. 
I saw the Oncologist yesterday who totally confused me with his use of the Predict Tool. I was left feeling like a statistic who shouldn’t bother having chemo because of my age and the low % increase in survival rate for the over 80’s after cancer. 
I know this is an aggressive cancer and want to be rational about a treatment plan. My Surgeon told me that chemo and radio offered the optimum chance of no reoccurrence so I wasn’t expecting such an academic and Impersonal approach from the Oncologist. 

I now don’t know what to do, whether to take the risk of just having the 5 day radio treatment which is one option or to undertake both the 8 cycle chemo plus radio which is the next option or to do nothing and rely on mammogram annually to check for any further cancer. 

  • It’s a shame he wasn’t more empathetic but he probably meant to give you the information and give you the control of what treatment you decide on as you know how strong you are both mentally and physically perhaps your breast care nurse can help you? 

  • Chemo is a tricky balance of risk and benefit. With the same diagnosis but at 65 I was offered, and chose to have chemo even though it was only going to add around 6-8% to my chances of not dying of my cancer in the next 5 years per the Predict tool. It’s normally a 24 week course of chemo for TNBC when delivered adjuvantly, and it does affect your quality of life during and possibly beyond the treatment. I thought long and hard about it and was initially minded to turn it down, because it seemed closely balanced when I built a model of how many quality years of life I would likely have with and without chemo bearing in mind the risks and implications of chemo itself. I am fairly sure I would have decided the other way if I had been a few years older. I am sorry the oncologist came across the way they did - bedside manner isn’t always great - but he was probably trying to get across that your risk of recurrence isn’t that high and that chemo potentially  has marginal benefit and a fair amount of risk/ consequence for you.

    Radiotherapy generally prevents recurrence in the breast, whereas chemo is aimed at mopping up anything that’s escaped to anywhere else.

  • Thank you. I remain confused and unsure about the risk/ benefit at my age. 

  • I am 83, diagnosed with TNBC in March, had a mastectomy and removal of lymph glands in April.  I was told I had Grade 3 aggressive as well.  After surgery, the pathology report was that the breast was clear of cancer but there was evidence that 3 out of 4 lymph nodes were cancer connected.  I then had 15 rounds of radiotherapy, which finished in early June.  I was also told that chemotherapy wasn't offered because at my age, the side effects would outweigh any benefit.  I would not have wanted chemotherapy so I did not mind not being offered to have it.  However, I do feel sort of in limbo now because TNBC is rare and nothing more is happening!  I have an appointment to see my consultant next April and, of course, I have breast care nurses to contact if I have concerns.  I wish you luck with what you decide to do and hope it goes well for you.

  • My thanks to everyone who has replied, I am so grateful. After a further consultation with the Oncologist, I have decided to go ahead with 8 cycles of chemo with a 2 week interval and a change of medication half way. I have decided to do this because of the aggressive nature of triple negative breast cancer and also because, in the end, it was offered to me with no indication that my age was a deterrent. I am taking the precaution of a general health review with my excellent GP prior to treatment. McMillan Nurse was superb and gave me excellent information and links to Cancer Research U.K., all of which have proved invaluable. 
    i will post my progress in 5be hope of helping others. 

  • It is a challenge whatever decision you make. Like you I have used the MacMillan nurses to chat things through.  It gives a check and balance whilst on the journey. I have also learnt to know my body and not to be afraid to ask the questions. I have 5 more cycles of Paclitaxel left to go.  The 4 cycles of EC were hard going. I look forward to seeing your posts regarding progress.  Do consider a PICC line as it does save your veins.

  • Thank you so much for replying. I had a portacath fitted today in advance of starting chemo next week. The surgeon and staff  were wonderful and I am relieved to have this method of delivering the  chemo. I can only take one step at a time and I will judge my response as I go. 

  • I am 82. with colon. They have no treatment suggested except another scan. And then what?

    3 months with nothing, and all the while IT is growing>? I could cope if I know I have 6 months / 3 yrs / but they are not helpful

  • What is the Predict tool? No one has told me about that?

  • Thank you codfish - I have learned more from your post than 2 yrs of NHS