You call it

I know that herceptin is usually given for a year in the UK. I know that the decision about whether to permit herceptin to be made available through the NHS is down to NICE (the National Institute for Health and Clinical Excellence). I know that NICE has no say over the length of time that herceptin is given for – they accept the recommendation of the manufacturer, Roche.

I know that Roche recommend giving herceptin for a year and they have the stats to show why. I know enough about the pharmaceutical industry to be a little bit sceptical about drug-company-sponsored trials. I know that a study in Finland has shown herceptin to be effective when given for nine weeks. I know that trials are going on looking at the efficacy of herceptin when given for 6 months versus a year, and one year versus two years. I know that some small-scale studies have shown that 6 months works as well as a year.

I know that herceptin hasn’t been around for long enough for anyone to know what the long term effects of the collateral damage to the heart might be.

I know that herceptin has been shown to be mightily effective in preventing the return of breast cancer. I know that the trials that have shown this effectiveness has been where herceptin has been given at the same time as regular chemotherapy, rather than after it. I know that herceptin has been shown to be slightly less mightily effective when given subsequently rather than concurrently.

I know that “it is likely that patients with “small,” especially hormone receptor-positive, node-negative cancers, may derive little absolute incremental benefit from the addition of trastuzumab to chemotherapy ± hormone therapy.” I didn’t figure that out myself. Edward H. Romond, MD did, and he wrote about it in a punchily titled article “Adjuvant Treatment of HER2-Positive Breast Cancer: Refining Clinical Use of Trastuzumab in the Adjuvant Setting”. (Trastuzumab is the doctor word for herceptin.) As someone who had a hormone-receptor-positive, node-negative cancer I found this comment especially interesting, although I note that the definition of ’small’ varies and that Dr. Romond’s conclusion is that pending further information, a year of herceptin should remain the standard of care.

I know that many doctors take a belt and braces, better safe than sorry, herceptin’s not as bad as chemotherapy, it can’t do any harm approach with herceptin.

I know that I don’t want another PICC line, or a Hickman line, or any bits of bionic medical kit, if I can possibly help it.

I know that I get a little bit achier with every treatment that goes by. I know that the aching as not as bad as it was during the nadir of chemotherapy. I know that it’s starting to get in the way and I know that I’m starting to get a little bit snappy because I am in pain all the time.

I know that my heart often flutters and my chest sometimes hurts.

I know that I really, really don’t want another dance with cancer.

I know that I am concerned that because I am run down and in pain I could make the easy decision and not the right decision about whether or not to continue with herceptin.

I know I’ve got another 10 days before I see the oncologist to discuss this. I don’t know whether more time will help.

I still don’t know what to do. I don’t think any of us do, really. I feel as though flipping a coin will be as good a way of deciding as any other.

Heads or tails, anyone?