Sandy writes, of her chemotherapy experience with adriamycin:

"The drugs I was on were Adriamycin and Cytoxan, very commonly used for tx
of breast cancer. The longest half life of the two was the Adriamycin, which
has an AHL of 17-30 hours."

I also had adriamycin ("The Red Devil") for chemotherapy for breast cancer.
When you read the information available on the internet and from the package
insert, you find wildly different estimates of the half-life.  For example,
a quick check just now using Google found 20-48 hours as well as 6-12 hours
from two different sites.

I wasn't breastfeeding at the time I had chemo, so that wasn't an issue for
me, but my oncologist said that *most* of the adriamycin is excreted from
your body the first time you urinate after your intravenous administration
of chemotherapy.  The IV usually takes 2-3 hours, so you are raring to go
pee by the end, and your pee is bright orange because of the adriamycin.
Even the next time you pee, you won't see any unusual color, because the
color (and the adriamycin) are gone in that first urination.  The adriamycin
does its nasty business of killing rapidly dividing cells within five
minutes of administration.

Sandy also writes:

"It is hard to know what she will be getting- frequently Taxol is given for
a second session, but there is no reason to guess. I don't imagine that
there will be any choice about which drugs are used. Each one is chosen for
its specific properties, and my understanding is that there wouldn't be any
room for negotiation."

There are ALWAYS choices about which drugs to use, and room for negotiation.
  Unfortunately, just like labor/delivery and post-partum care, oncology is,
for the most part, NOT evidence-based.  Or, perhaps I should say "Some
oncologists make their decisions based on some evidence, while other
oncologists use other evidence."  When I had 5-fluoro-uracil as one of my 3
IV chemotherapy agents (in College Station, Texas in 1999), it was presented
to me as "This is state-of-the-art chemotherapy."  One month later, a
graduate student of mine started her chemotherapy for breast cancer in
Houston and was not given 5-fluro-uracil because her oncologist said "Oh, no
one uses that anymore because of its nasty side-effects."  Houston and
College Station are only about 90 miles apart, and we're talking only one
month apart in time.  My oncologist insisted my extreme bad reactions to
chemo were not because of the 5-fluro-uracil, while my student's oncologist
said that was why "no one" used it any more.

Oncologists have local culture, depending on their personal backgrounds,
where they went to school, their peers, etc.  You can get completely
different treatment depending on which doctor you go to, what hospital,
which HMO, which part of the country, etc. etc. etc.  And it has nothing to
do with your type or stage of cancer, your age or general health, etc., and
nothing to do with evidence.  It has everything to do with the culture of
oncology.

When I was first diagnosed in Texas, I was given the option of mastectomy or
lumpectomy/radiation -- both of which were presented as having equivalent
outcomes.  I chose lumpectomy/radiation so that I'd be able to fulfill a
series of speaking obligations to La Leche League immediately after the
surgery.  :)

When I moved to Delaware and was talking to my new oncologist (after all my
treatment was over), he told me he was glad I had had the
lumpectomy/radiation option because "That's what we do in Delaware.  We
don't do mastectomies."  He also told me that they never use
5-fluoro-uracil.

Tamoxifen is another drug commonly prescribed for breast cancer survivors
once chemo and radiation are done.  I declined to take it.  There wasn't any
"negotiations" -- I just said "No, thanks."  What are the doctors going to
do, come into my home and insist I swallow a pill every day?

Even with something as serious as breast cancer, patients need to know they
have choices and options and the right to more information than the doctor
is likely to give them on his/her own.

Recommended reading:  Patient No More by Sharon Batt, and Teratologies by
Jackie Stacy.

Kathy Dettwyler


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