Sunday, 11 May 2014

Decision made!

I haven't written anything for rather a long time.  Partly this was due to a very busy work schedule, but it was also because I was in the middle of one of those decisions that crop up regularly here in the land of New Normal.

It was a fairly long drawn out process but last month saw the decision made on whether or not I would continue taking the aromatase inhibitor for another five years.

I started the discussion back in December at my Year Five check-up with my surgical team.  They referred on to my oncologist and things (slowly) went from there, until eventually, in the middle of last month, the final decision came to me and my GP via the radiographer who did my DEXA scan.  Although trials have shown that 10 years of tamoxifen is more effective than 5 years, the trials for the aromatase inhibitors haven't yet reported, so the decision is less obvious here. A further complication is that, as they are 'newer' drugs, less is known about the long-term side effects of the AIs.

One side effect that is well known is that the AIs can have a negative effect on bone mineral density and as my previous DEXA scan had shown osteopenia I have been taking a weekly bisphosphonate.  Therefore part of the decision making with regard to continuing with the AI was how well the bisphosphonate was controlling the bone-trashing propensities of the exemestane.  The scan I had back in early March showed not just no further deterioration, but an actual slight improvement.  It was also an opportunity to discuss options with the radiographer as I can only take the bisphosponate for another 2 years before I have to have a 2 year break from it.  I came from that appointment fairly happy that continuing with the exemestane would not be dangerous for my bones and that checking again in 3 years (which would be a year after stopping the bisphosphonate) would be an additional safety measure.

As for other side effects, well although they are definitely present I am coping with them at the moment.  While I don't want to take anything for longer than necessary, I am not screaming to give up either AI or bisphosphonate.

The decision is that I will continue with the exemestane, with a view to taking it for another 5 years but able to review that at any time. That feels positive.  I will review in the light of trials data and the next DEXA scan results, but I can also go back for a discussion if I feel that side effects are becoming a serious problem for me.  And just knowing that I can do that is an encouragement.

The timing was just right as immediately after Easter I went on holiday and it was good to go in the knowledge that this decision had been made.  I have come home delightfully chilled and relaxed having been able to put cancer concerns and decisions to one side while I enjoyed a lovely holiday.