Breast Cancer Question

JentheRN05, RN · Sep 17, 2005

My mother in law has metestatic breast cancer, stage 4. Currently no treatments, had a fx to rt. hip last month d/t bone cancer. Oncologist wants to give Arimidex. He has told the family this is a "miracle" drug. Will both stop and reverse the cancer. I find this hard to believe.
Bone CA goes as follows: skull, cervical to sacral spine, both rib cage, pelvis, and rt. femur. Also looks like some lymph involvement.
Family did not know she had a tumor of the rt. breast, probably had the tumor for 7-10 years. Area is approx. 6 cm., ulcerated, according to her daughter, I have not seen the area. Also there is a possibility the sternum is involved.
I have tried to find information but am hitting a brick wall. Just need some thoughts and ideas. Is this a miracle drug? What do you think about tx. options? Do we try tx. or do we just make her comfortable?
Please help.

Alot of information can be found at http://www.arimidex.com It seems to be positive in early detected breast cancer. But here's something you want to ask yourself. If you were in her place, would YOU just want others to make you comfortable? How old is this person? I think, having been in this situation (pretty much exactly - into bone, hip fracture the whole thing) with my mom-in-law, she wanted to do what she could until there was no more to be done. Best thing to do is ASK her, does she want to try this treatment? I mean it can't hurt. If my mom-in-law were still around I would probably suggest it to her if she was wanting to continue trying. Just me.

pama · Sep 17, 2005

Jen,

Thanks for your reply. My mother-in-law is 74 years old. It has been difficult to ask her opinion, since coming home from the hospital she has been on MS Contin 30 mg bid and Lortab 10 mg bid for breakthrough pain. She has been extremely confused for more than three weeks.

She went back to the Oncologist on Thursday, he dc'd the MS and put her on a Duragesic patch. According to my sister-in-law she has been in a lot of pain. Her confusion is not as bad.

My mother-in-law is very private, will not discuss anything about the disease. She is still in denial.

My husband wants to find out if the Arimidex will reverse the CA as the physician said. I went to the website you suggested and from what I read it is good in early stages.

This is really difficult for all of us. Any other suggestions, comments, or personal experience would be greatly appreciated.

renerian, BSN, RN · Sep 18, 2005

Pama first let me say I am sorry your MIL and your family are going through this. I hate wearing that hat and hope I never had to ever again.

I have never seen anything reverse a stage 4 with boney mets. I don't want to hurt you.

My Ex MIL last year was diagnosed with stage 4 ovarian CA and the docs said they could help her, maybe cure her. My ex asked me straight up what I thought ( I worked hem/onc/bmt a long time). I told him to get ready and I am not a Dr. but I am guessing 9 to 10 months. She lived 8. The doctors were still at her until the end trying to get her to do more.

I know everyone is going to be looking at you for input/guidance and that is hard. I have been there personally 4 times. I have never been nothing but up front when family, friends or patients ask me what I think as a nurse. I guess that is my same nature here.

I have much faith and found for me praying for peace and no pain was the best I had.

Hugs and prayers for your family,

renerian

pama · Sep 18, 2005

Renerian,

Thank you so much for the validation. This is exactly what I have thought from the very beginning. Being an previous ER nurse, and now an administrator in a SON sometimes I question myself.

I am visiting my mother in law right now. She is not doing very well this evening, very anxious, c/o pain in left leg, anorexic and nauseous.

I really appreciate your thoughts and prayers.

Pama

ptadvocate81 · Sep 18, 2005

I am sorry to hear that you are having to go through this trying time. I will keep you in my thoughts and lift you and your family up in my prayers. My father has cancer, but it is in the early stages and slowly progressing, he does not want treatment and my family has agreed to follow his wishes. I think that you must make decisions based on what you know she would want rather than emotions. I wish we could keep our loved ones forever, but God wants them back eventually, and he will come for us as well. I will pray for you guys and let us know how the therapy turns out. I hope that it is the miracle drug for you guys.

renerian, BSN, RN · Sep 18, 2005

I am sorry your both going through this with family members. May you and your family find peace.

renerian

aimeee, BSN, RN · Sep 18, 2005

from Methodist Healthcare.org

four questions that must be answered:

What is my prognosis without treatment?

What are the treatment options available?

How will my prognosis be improved with treatment?

What are the risks of treatment?

If you can't get a straight answer on those four questions from your oncologist, you don't have what you need to make an informed decision.

What it boils down to is....how long is she likely to live without treatment, and what is that time going to be like for her? How long is she likely to live WITH treatment, and for how much of that time will she have INCREASED QUALITY of life?

One last note...when bony mets are involved, comfort is rarely achieved with narcotics alone...NSAIDS and or steroids are almost always needed.

doodlemom · Sep 18, 2005

Pama, is your MIL taking an antiinflammatory for the boney pain? When there are boney mets, there should always be an antiinflammatory on board. Some of our patients do well with the patch and some do very poorly. There are much better pain regimens available. I would ask for a pain consult. Good luck.

pama · Sep 18, 2005

Doodlemom, the only thing she is on for pain is the Duragesic patch and Lortab 10 mg 2 q4h per the oncologist. The orthopedic surgeon does not want her taking so much Lortab, this has been a battle between the two of them.

I'm sure there must be some better meds for tx. We continue to be frustrated with the care. Also, we do not have much of an option, we live in a rural area and only have one oncologist available. I'm sure she would not agree to go to a larger city for treatment, so we are sort of stuck.

Thanks to everyone. You all are really giving me some great information.

Pam

doodlemom · Sep 19, 2005

Pam,

I would tell her to ask her oncologist and orthopedist if there is some reason that she should not take ibuprofen or another NSAID. If there is no contraindication, then I would have her take ibuprofen around the clock. I am currently a hospice nurse and have worked on a pain team at a a major hospital as well. When a patient has bone mets, they need to have an NSAID added to their medication regimen. Ibuprofen is cheap and effective. Narcotics will not cover the bone pain, no matter how much she takes. I hope that someone will help her. It's bad enough that she has cancer, but she does not have to live in such bad pain. Also, are they giving her Zometa or Aredia for treatment of her bone mets? These drugs help prevent the loss of bone that occurs with metastatic lesions - they also help prevent hypercalcemia and help pain. They are given IV at the clinic or hospital. Taking these drugs can provide quality of life and possibly life extension. See zometa.com

pama · Sep 20, 2005

Doodlemom,

You have validated the very thing I have been saying since June. I have told the family they need to give motrin around the clock. There is not a reason she should not receive this medication.

I also know she is getting something IV to "strengthen" her bones. She was given one dose in the hospital, a dose last Thursday in the dr. office and she is scheduled to return for another dose this Thursday.

I am getting ready to call my sister in law and tell her what I have learned. Sometimes it is better hearing this from a neutral party. Thank you so much!

Pam