My decision to take the first-best medicine

My oncologist once said she'd worry if my tumour marker count doubled, but not if it just crept up point by point. Well, it quadrupled over a little more than six weeks. And a CT scan confirmed that the cancer has spread beyond my vertebrae and femur. It looks like the endocrine therapy I've been on for a while - the "mouse poop" shots and Tamoxifen, which together moved me into hot flash city - isn't working so well.

So a decision had to be made. Do I try another hormone therapy such as an aromatase inhibitor, which tries to further eliminate the availability of estrogen to my cancer cells, or do I skip that and head directly to chemo therapy?

Given that my cancer hasn't responded that well to hormone therapy, an aromatase inhibitor is a possibility, but unlikely to be effective. And given that my cancer is chemo-naive (I wish I could go back to being chemo-naive), walloping it with a combination chemotherapy might halt the spread of cancer cells and actually reduce the tumour burden I now have.

I've always had mixed feelings about chemotherapy. For that matter, I 've a lways had mixed feelings about taking any sort of medication. But chemotherapy carries with it an especially large amount of baggage. I don't like the idea of beating down my immune system just when I need it most. I don't relish the injection of stuff that's so toxic, health-care providers have to protect themselves from being in contact with it. And I don't think too positively about the chance of experiencing intense side effects that could well make me weaker, not stronger, in the face of a terminal illness.

I've also read a lot of journal articles that suggest chemotherapy often doesn't significantly prolong the lives of those of us with metastatic breast cancer.

Researchers in Canada and Australia have come up with a decision aid for people facing these sorts of choices. It is in the form of a workbook in which information and questions are presented, and a decision-making structure is suggested. This structure is based on identifying positive factors, such as the possibility of living longer (and why this is important), an improvement of symptoms and a sense of empowerment in terms of doing something to actively fight the disease. One's responses to these factors can be weighed against what many of us see as the negative aspects of chemotherapy - such as uncomfortable and sometimes dangerous side effects, needing tests and having to go to the hospital frequently - and the fact that there is no guarantee the treatment will actually work.

While I haven't seen the actual workbook (it is still being evaluated in anticipation of its adoption by at least some oncologists), I have read a discussion about it in the journal Health Expectations. It helped me organize my thoughts, and it was useful to put myself in the larger context of other women with metastatic breast cancer facing this sort of decision.

Even given all this, though, it really doesn't feel like I have much of a choice. I could stop all treatments and let the disease run its course. I could try an endocrine therapy that is unlikely to work. I could pursue alternative treatments, such as following the raw diet that is all the rage in a lot of popular cancer literature or taking lots of supplements and "natural" remedies when none of these has been proven or supported in the medical literature. Or I could pursue the treatment that represents the current paradigm in cancer medicine. And that's what I've decided to do.

I never thought I would agree to chemotherapy that is unlikely to cure my disease. But now that I have, I'm pretty committed to this course of action. Those of us born under the Aries horoscope sign tend to look for, and thrive on, challenges. My favourite astrologer, Jonathan Cainer, says that us Rams have the "tendency to create a life full of difficulty, just so that ... [we] ... always have something to sort out" ( www.cainer.com). He goes on to say that "there's nothing ... [we] ... can't tackle if ... [we] ... try." I'm now at a time when these traits, long bemoaned by those around me, should come in handy.

It feels like a fortuitous coincidence that, on the night before this challenge was presented to me, Dr. Robert Buckman was featured on CBC Radio's Ideas series. He is an oncologist who also lectures, and he wrote the book Cancer is a Word, Not a Sentence. Laughter, he says, is the second-best medicine. What is the first-best medicine, in his view? Medicine.

I'll have to remember that during my chemotherapy sessions, and as I try to keep my sense of humour intact throughout the next few months of treatment. My friend Margaret's daughter Anna has already offered to draw green eyebrows on my face to replace the ones I'll be losing. Maybe that will help in the humour department.

* Sue Hendler is a former member of the Whig-Standard's Community Editorial Board. She is contributing regular columns on her experiences while she travels her breast cancer journey.
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