From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Anyway of testing forreactions to chemo?
Date: 29 Apr 1998 08:45:40 GMT

In <6i6jem$qma@hippo.ru.ac.za> ankj@hippo.ru.ac.za (Ms K.J. Juul)
writes:

>A friend of mine died recently due to poisoning by chemotherapy.  She
>had had a masectomy and was having the chemo just as a precautionary
>measure as she was clear.  My question is :  Is there a method of
>testing a patient to find out of they are allergic to chemo before
>giving them a course of therapy?  The specialist who treated her has
>told the family that it does happen that people die from chemo and not
>from cancer.  The whole issue concerns me as her daughters are now
>facing a future where they are in the high risk category as both their
>mother and grandmother had breast cancer.  Obviously the way in which
>their mother died is of extremem concern to them.

    Usually when this happens it's not a true allergy, but rather an
extreme sensitivity to the chemo that some people have.  It wipes out
their marrow, they get septic, or bleed, and die very fast.  I suppose
incidence of this could be decreased by starting with even smaller test
doses, to make sure that isn't going to happen--- but that's expensive.
It blows one whole cycle of chemo, or more, on treatment that isn't
killing cancer.  People don't want to pay for it.  Or rather, they
don't want to pay for the high end insurance, but they want high end
coverage when they get sick.  Same thing.  Tell the family to do it the
careful way, and pay for the insurance that will let them pick the
oncologist they want, not whoever they get on the plan.  If that
happened to them this time, they perhaps got rooked.  It all depends on
the details, though.  People who die of infection after this kind of
chemo, on the first dose, usually weren't being watched carefully
enough.  As for people who die of true allergies and shock, there's not
anything I know of to catch them, since even much smaller doses of
chemo would do the same.  Perhaps an oncologist will answer with better
info.

   Adjuvant chemo in breast cancer is not given to people who are
"clear".  It's given to people who LOOK clear, but we know from other
studies are not.  Big difference.  Doesn't help your friends, but they
should know that the procedure does save lives overall, as proven by
several studies.   The problem is that it kills some people who would
have lived, and saves some people who would have died (a larger
number).  And we only know about the first group directly.  The second
group we know about statistically, but the survivors (those who chemo
saved from recurance and death) never know exactly who they are.
That's a bad situation, because we do know who the first group is (the
few that chemo kills).  In organ donation situations and others in
medicine where one person gains at the expense of another, you can have
one group talk to and try to comfort the other, but in this case, you
can't do that as easily.

   There are now medications which decrease the chance of people
getting breast cancer, such as Tamoxifen.  In this high risk family,
the women might consider it when they reach 40 or so.  For 5 years it
cuts cancer risk in half.   It raises risk of lung clots and uterine
cancer, but women can take aspirin and Ticlid and get regular uterine
cancer screens.   The new drug Evista is expected to act similarly,
with fewer side effects on the uterus.

                                       Steve Harris, M.D.