Guest blog: Treatment during the COVID-19 crisis
This week I’ve invited Abigail to tell us about having her breast cancer treatment (for secondary breast cancer) during this COVID-19 crisis. We’re reading lots of different reports about some people having their cancer treatment cancelled or postponed and some people who’s treatment is carrying on as it was before. This is Abigail’s experience…
By way of introduction, I was diagnosed with primary breast cancer (ER+, HER2-) in February 2017. I was 43. It was a relatively small tumour with no nodal spread, and therefore considered to be caught early and entirely treatable. I had a lumpectomy, followed by 20 sessions of radiotherapy, avoided chemotherapy thanks to a genomic predictive test and was sent on my way, by the end of the summer with a plan to take Tamoxifen for five years. I started to recover and went back to work. The following February I was called in for the first annual mammogram and check-up. Everything looked clear and I was declared cancer free. Except, I wasn’t feeling great so I talked to my consultant about the fatigue and low energy. He ordered blood tests and within a very short space of time, following a bone scan and liver biopsy it was confirmed that my breast cancer had spread to multiple bone sites and my liver. I am now living with stage 4, metastatic breast cancer. I am 46.
Two years on from that, I have had targeted therapy, five more sites have had radiotherapy, oral chemotherapies and various hormone therapies, all of which have provided some stability but have all ultimately failed, after about six months. I started IV chemo in September 2019 and whilst the tumours were responding well, the rest of me was somewhat battered by the treatment. My bloods could not hold up against the effects of the chemo and were seriously compromised. I received three blood transfusions, had one week in hospital due to neutropenia and countless prescriptions of antibiotics. My white blood cells, haemoglobin and platelets were regularly seriously low.
I had my 8th session of chemotherapy on 18th of February this year (just before life in the UK changed dramatically due to the arrival of COVID-19) and I was due to have the 9th session on the 17th of March. This had already been delayed by a week to allow my bloods to pick up. Blood tests on the 17th showed that my white blood count was low, but at a level that normally the treatment would go ahead. I was told however, that due to the risk of the Coronavirus, they needed my white blood cell count to be considerably higher than normal to go ahead. We know that my counts drop within a week of the dose, and so it seemed sensible to plan for the inevitable.
By the 2nd week in March I was essentially self-isolating, and the cancer centre told me to continue to do this. I was quietly told that I must not, absolutely must not, get Coronavirus, because I didn’t have the immunity to fight it off. I am a single girl living alone, so complete isolation is relatively easy to achieve. But it’s not a lot of fun.
The plan was to go back the following week for a blood test to check whether the white blood cell count had improved sufficiently. During that week the crisis on a wider scale ramped up significantly and I was called to be told that chemo would not go ahead that week, irrespective of my blood counts. Instead the full body MRI that was due after chemo 9 was brought forward, with a view to the results enabling my oncologist to make a clinical decision on whether to continue with chemo, thereby risking my chances with the virus, or halting chemo for the time being.
Emotionally this was a really difficult time. Whilst I absolutely despise chemo and don’t tolerate it well, I hated the thought that I wouldn’t be able to have it, thereby risking my tumours progressing. When your timeline is limited, and you have a window of stability, anything getting in the way of that is unbearable.
In the end, the results of the MRI took away the need for a decision. The chemo had stopped working and the tumours in my liver are progressing again. There is therefore no point continuing with the current treatment. Whilst in “normal” circumstances my oncologist would suggest we try a different chemo, he is not prepared at this point to put me in danger of Coronavirus. For now, I will try a new hormone therapy whilst we wait for the crisis to pass. I will go to the cancer centre every two weeks for six weeks, and then once a month for injections.
That week I was expecting to receive the vulnerable/shielding letter from the Government, I didn’t receive it and on investigation it seems having stage 4 cancer and on chemo per se, does not fit the qualifying criteria.
During the crisis I have travelled by car to a major cancer hospital for the MRI, the cancer centre where I receive treatment and also the private hospital where I met my oncologist to discuss the MRI results and agree next steps.
I wore a mask and gloves. Whilst I recognise the guidance is not clear on how effective these measures are, it felt like the sensible thing to do. I will always err on the side of caution. I waited in the car in the car park until the actual time of my appointment so as to reduce my time spent with other patients and staff. I tried not to touch anything. I was asked to either wash my hands or at the hospital was asked to use 5 squirts of the antibacterial foam upon entry. At the cancer centre the nurses are now wearing masks, gloves and aprons. Other than that, measures are in place to keep us as distanced as possible and all my appointments have felt calm. As always, the nurses are doing a brilliant job to make us feel safe.
Here’s hoping the curve is flattening and we can return to some sense of normality soon.
Should you be interested to learn how I try to live well with Stage 4 cancer, I write a regular blog: Abigail’s Blog