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6th October 2006

Tamoxifen or Arimidex?

I returned to work part-time for the first couple of weeks then gradually started to augment my hours so that I was in by 10 am most days and working on all five days of the week by the end of September. Some days I was very tired and became increasingly irritable at home:house work was no longer a chore, it was a burden. I began to resent it in way that I had not experienced before. All this at a time when Bryan was building up to his busiest time of the year at his school and with Opera bookings. I was on my own with the children some week-ends and began finding it difficult to replenish my energy reserves. I became depressed at the thought of returning to the sort of treadmill existence I had prior to my diagnosis. Still, life is a series of juggling acts and in that sense our household mirrors countless others in the country. I was soon distracted by the looming prospect of the fourth and final part of my treatment for cancer. A hormone-based drug is often prescribed for five years and even though it is potentially life-preserving medication it did not appeal to me in the least.

At an earlier discussion with the oncologist two drugs came up in the conversation Tamoxifen and Arimidex. My cancer had been oestrogen and progesterone receptive this means that the tumour was being encouraged to grow by these hormones that I was producing. Some people who are diagnosed with cancer are offered Herceptin as this is a drug more appropriate to tackle a type of cancer that is evidently different to the one I was diagnosed with. However as this was not relevant to me the subject did not come up in discussions. I had to choose between Tamoxifen or Arimidex. Each has side-effects, some less pleasant than others but both seem to be well-tolerated by patients. They both also appear to have a very good track record where long-term survival rates are concerned. By long-term survival I mean five or more years. I reflected on my own circumstances. As chemotherapy has induced what appears to be an early menopause I wondered about the efficacy of these drugs as they work to counteract the production of oestrogen and progesterone. But hang on a minute. If I had little or no oestrogen or progesterone being produced by my body, why take the drugs?

Hair again

During late Summer as the wretched side effects of the chemotherapy began to wear off, my hair began to grow back. Slowly at first and then by the end of September I had a full enough head of hair to wave good-bye to the wonderful array of scarves I had been wearing since February. Also, just before I returned to work I took a particular interest in chemicals. All sorts of chemicals are added to our foods, creams, soaps, shampoo. Most are harmless enough however a couple of people I have spoken to have pointed me towards articles that suggest parabens may not be at all good good for us humans. I type the word into a search engine. Almost three million entries come up and the first two I come across make uncomfortable reading. I search for a shampoo that does not contain parabens (which incidentally has not been proven to be toxic) in some form or other and it's virtually impossible to find one that is parabens-free. In the end I find a website that sells what appears to be chemical-free shampoos, soaps and all sorts of other eco-friendly products : www.naturalcollection.com I order a big bottle of their Rosemary shampoo and conditioner. I am using such small quantities I can can see it will last a long time.

A bit of luxury

One of the possible side-effects of Arimidex is Osteoporosis. The oncologist and I agreed it would be a good idea for me to have a bone scan. If my bone density is low then this drug would be less attractive than Tamoxifen. We agree to revisit my choices once the scan has taken place and we have the results. In the meantime, and to take my mind off the prospect of long-term drug dependency, I decide to cash in a generous voucher for a facial in a posh beauty salon.The voucher had been given to me by friends who work at OneVu, the online billing company www.onevu.com The OneVu business team used to be located on the same floor as Voca's marketing department. That's how I got to know most of them although I never did fathom what they did tapping away at their keyboards all day. Perhaps they wondered the same about me? But they were friendly enough and we shared cakes a few times and chatted during coffee-breaks. Anyway, shortly after I was discharged from hospital I received the beauty voucher from OneVu. A thoughtful and sweet gesture. I decided to wait till most of my treatment was over before I went to the salon as I wanted to make the most of the experience. I made my appointment, put two hours worth of parking money into the metre and arrived at the salon with ten minutes to spare for my appointment. Relaxing music was being played on a CD: a cross between Tibetan monks singing and Indian music. Every now and then I heard wind-chimes as doors opened and radiant looking women emerged. I felt I had come to the right place. After a while one of the beauty therapists asked me to complete a form and appeared to discuss it with a colleague - I wondered if the medical section was the subject of their conversation. I was shown to one of the therapy rooms and before long warm, heavenly scented towels were gently pressed onto my face. As I lay on the table I knew that for once this treatment was removed from all things medical and that only gloriously scented lotions were going to be put onto my face. Then, my ear lobes were massaged. You know you are in a posh salon when your ears get a massage. I said nothing of course and lay there as if it was the sort of thing that had happened to me before. A facial scrub followed, cooling water was sprayed on, more soft towels applied. A face mask that smelled of cucumber was put on and washed off. I was left to doze for a bit and then sprayed again with more water. Hadn't anyone told them there was a hosepipe ban in the South East? Eventually it was all over and I left looking more or less the same as I did when I went in - but I felt wonderfully relaxed and happy.

Decision time

The appointment for the bone scan came up and it turned out to be a relatively stress-free experience unlike the CT scan and MRI which I can now see I was badly prepared for. The CT and MRI scans could have shaken my belief about my life expectancy. I remembered how, when I was putting on a brave face in November 2005 , I was a quivering wreck as I climbed onto the tables that hooked me up to machines that would reveal exactly what was going on inside. However the bone scan was uncomplicated and all that was asked of me was to lie still. And as I lay still I knew that I was cancer free . A much better state of mind than the previous year.The results came back relatively quickly accompanied by a note from my oncologist which showed my bone density was normal. I could take Arimidex if I wanted to. I then started to research the side-effects of both drugs in more detail: I found the following cancer charity websites helpful:


http://www.cancerbackup.org.uk

http://www.breakthrough.org.uk

http://www.breastcancercare.org.uk

But perhaps the most useful place was the National Institute for Clinical Excellence www.nice.org.uk. I trawled through the reports on the drugs I was being offered and the phrase "no statistically significant differences in overall survival rates" came up quite a few times in groups of patients that had taken these drugs. It was becoming clear to me that I could take these drugs for a period of years and be no better off than someone who had opted out of the drug regime. I was at then of this cycle of treatments and felt decidedly over treated. For all I know the surgery may have been all that was necessary, the chemotherapy was probably a good insurance policy and I remain unconvinced about the radiotherapy. Then there were the actions I was taking; less dairy, less red meat, more vegetables and fruit, more water, and juicing to name but a few.

I went back to see the oncologist and for once I did most of the talking. I went through with him the information that was influencing my thinking. My tumour had been removed, so had my breast and all the lymph nodes under my left arm. My body had stopped producing oestrogen and progesterone and I was limiting the intake of these hormones through my diet. He nodded quietly. I then asked him about what improvement in survival rate I could expect by taking of either of these drugs: he responded " between two and three per cent ". This was entirely consistent wit the reports at the national institute of clinical excellence . If survival rate percentages had been supplied to me in double figures I may have reached a different conclusion. However my mind was made up. I don't think I need these drugs. My view is that they will do me more harm than good and that I am better off without them. The oncologist responded by saying in light of the treatments I had been given this was a reasonable course of action for me to take. He added he was not worried by my decision. I smiled and stood up, we shook hands and I left the consulting rooms at the hospital. As I was driving away I noticed some rose bushes bathed in autumn sunshine. The colours of the flowers were surprisingly strong and showed no signs of fading.