Hormonal Therapy (Part 2)

Hormonal therapy is a very effective weapon with which to fight breast cancer; I was told from the start that I was lucky to be ER+ so that I could benefit from it. From the offhand way that it was mentioned by my doctors and others, I got the impression that it was sort of like a multivitamin, a pill that I would pop each morning that would keep me healthy. I didn't do much independent research about it because I thought I wouldn't be starting it until after I had finished my adjuvant chemotherapy in October, and I was trying to stay focused on the next step and not get ahead of myself.

But last week Dr. Hurvitz said I should start immediately, not in October, so all of sudden hormonal therapy is the next step. And when I started doing my own research, I found that it is nothing like that innocuous multivitamin that I been picturing; many women suffer from side effects, sometimes very debilitating ones. The available information about side effects is not consistent, but many sources indicate that AI/OFS is associated with osteoporosis, bone fractures, muscle and joint pain, decreased sex drive, vaginal dryness, and painful intercourse, while tamoxifen is associated with irregular period, vaginal discharge, and urinary incontinence. Hot flashes, headaches, fatigue, and mood swings are associated with both treatments. In the SOFT trial, 50% of both cohorts reported depression. Anecdotally, there was even more, including reports of feeling "off", "in a fog", "not myself". And symptoms tend to be more severe among younger women like me, who are many years away from natural menopause. Not surprisingly, in a large-scale 2010 study of early-stage patients undergoing hormonal therapy (some taking AIs, some taking tamoxifen, and some taking both), 51% did not complete their treatment, citing side effects and comorbidities (other health problems) as the reasons.

I stayed up most of Thursday night, reading articles, studies, and discussion boards and getting more and more upset. I had been so focused on October as the endpoint of my treatment; it was devastating to realize that I would have five more years of pills and injections, managing symptoms, seeing doctors, taking tests, still being a cancer patient when I had thought I would be well, still trying to simply maintain a level of functionality when I thought I would be actively building my new post-cancer life. I was particularly unhappy that the five years of treatment coincide with Ike's first five years, the most critical time in his development. "I need to be done - I need to move on with my life," I kept thinking. "I can't put Seth and Ike through five more years of this." I started seriously considering declining treatment, started feeling that the higher risk of recurrence was a risk I could take, when weighed against the risk that I wouldn't be an good mother to my baby because I was depressed, the risk that I would break a leg running after him at the park, the risk that I would never be able to enjoy sex with my husband again, the risk that I would no longer be able to function in my career because I was too fatigued - and so on, and so on. I started thinking that no matter what I do, there is always a chance that my cancer will recur, so maybe the worst regret would not be declining treatment and having a recurrence - it would be doing it, going through five years of hell, and then still having a recurrence. By early Friday morning, I was in a pretty dark place - the only peace I could find was when I thought about not doing the treatment. I felt that I didn't care if it would take five, ten, fifteen years off the end of my life, as long as I could have my life back now. At that moment, I truly would have made that deal with the devil if I could have.

But life is seldom that easy, and as the sun rose that morning so did my courage; I decided that I had to at least try. I'm young, I'm strong, and I have everything to live for. Both my tolerance of chemotherapy and my recovery from surgery have far exceeded everyone's expectations; there is no reason to believe that I wouldn't be one of the lucky ones who are relatively unimpacted by hormonal therapy. And if I'm not and the side effects are too severe, I can always stop treatment then. Fortunately, any amount of hormonal therapy is better than none, so I can only benefit from trying.

Information from webmd.com and ww5.komen.org.