Saturday, November 25, 2006

No More Herceptin

I was scheduled to have my second-to-last Herceptin treatment today, but I decided to skip the rest of my treatments. I’ve been on the drug for almost a year now, so I can’t see how one or two doses more or less can make any difference. Luckily, my oncologist agreed with me.

According to her, the clinical trials for Herceptin were done with one-year courses, so that became the recommended treatment period. There have been no comparison studies for Herceptin for six months, nine months, or more than one year, so nobody knows what the most effective treatment period is. It’s all just a crap shoot, really. My doctor told me that in the 1970s, people had adjuvant chemotherapy for two years. Now it’s just six months. Who’s to say the same won’t happen with Herceptin?

Fortunately, I had no problems with Herceptin -- none of the side effects, other than insomnia just after the treatments. I even looked forward to getting my treatments because it allowed me to just lie back and rest for two hours without feeling like I had to do anything, since I couldn’t really move around while hooked up to the IV drip. So my reason for skipping the last two doses wasn’t because of pain or discomfort, but because of cost.

The cost of the two doses of Herceptin I’m skipping will pay Josie’s school tuition for a semester. We’ve already spent about US$30,000 on Herceptin alone this year. Add to that the cost of the chemotherapy, radiation therapy, plus three surgeries, and there isn’t a whole lot left over for non-essential spending. I’m grateful we can afford to pay for my treatment. So far.

This cost issue has gotten me speculating. What if I have a recurrence and there’s an experimental treatment that may extend my life for a few months at best? The treatment costs half a million dollars. Would I take the treatment? Would the mere chance of having a few more months of life be worth wiping out our family savings?

This could be more than speculation. Now that my Herceptin treatments are finished, the next step to fend off a potential recurrence is a new drug called Tykerb. Apparently, patients for whom Herceptin doesn’t work or has stopped working after a period can take Tykerb as back-up. Unlike Herceptin, Tykerb penetrates the brain, and 40% of cancer spread in patients who took Herceptin goes to the brain. My doctor says Tykerb will probably be released next year and that I’m a good candidate for it. That’s good news. But I wonder what it will cost? If it costs half a million for a year’s course, for example, will I bankrupt the family for a treatment that doesn’t even have a track record to prove its efficacy?

Of course, people will automatically tell you to ignore the cost and think about prolonging life. But it’s a stark reality that cancer treatment costs money. Lots of money. And it’s an equally stark reality that there are no guarantees even after you’ve invested the money. What a dilemma.

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