Dealing with the Side Effects of Treatment Now and Later
KRISTEN: Hi, I had kind of two questions. One is if you had nutropenia during your chemotherapy, which I unfortunately did, are you at any greater risk for leukemia or heart conditions later from the AC regimen. And the other concern I had is that, those of us who are pre-menopausal when we did chemo, I ended up with menopause which has some cognitive effects I understand, and the cognitive effects of the chemo brain thing. Is there anything known about which might be, what things might be due to menopause and what might be due to the chemo in this, this cognitive syndrome that shows up after chemo?
DR. BANU ARUN: Thanks Kristen. So the first part, having neutropenia or neutropenic does not increase the risk of leukemia or heart disease, because the neutropenia really is used by the suppressive effect of the chemotherapy, which then goes away and you are ready for the next cycle. So it is not a sign of, during the treatments, it is not a sign of leukemia. However, if the counts do not recover months after chemotherapy, then you know, one should evaluate the bone marrow. And again, there is no relation between neutropenia incidences during chemo and heart disease.
I think your second question, the first one; Janet asked that question as well. So we really don’t know what is really causing chemo brain. In pre-menopausal women who go into menopause, it gets even more complicated because we know that cognitive functions in post menopausal women, there’s a general population it changes and that’s for example, the reason why a number of women want to take hormone replacement therapy to overcome that. Then the thing with menopausal cognitive dysfunction is that once menopause is over, a number of women actually think everything is getting better. So I think that could be maybe a differentiating factor between chemotherapy induced cognitive dysfunctions and menopausal dysfunctions. But there are no tests or markers or blood work which can tell you and your doctor that if you’re having some cognitive dysfunction that’s from the menopause or from the chemotherapy. And maybe it’s a mixed bag.
KRISTIN: Just to follow-up on the neutropenia, I was thinking of the concern is the leukemia in the long-term, you’re saying there’s nothing that links or would increase the possibility of having leukemia 15 years from now related to the neutropenia?
DR. BANU ARUN: Having had neutropenia episodes during treatment does not increase the risk.
KRISTIN: Okay.
DR. BANU ARUN: The neutropenia get’s better after treatment.
KRISTIN: Okay. There’s no long-term damage?
DR. BANU ARUN: But there’s long-term damage from chemotherapy in general, that’s about 1%, but not more in women who have neutropenia versus who don’t.
KRISTIN: Thank you. That took my mind very much at ease.
FEMALE SPEAKER: All right, thank you for taking my call. Do you Doctor have any information on Arimidex induced high blood pressure? And how common is it, and what can be done about it?
DR. BANU ARUN: So the Arimidex and the aromatase inhibitors are new drugs, so they, I think the safety data we have is a little bit more than five years now versus the Tamoxin which we have for more than 20 years. So whenever we discuss the indications of the new drugs we obviously go over all of the side effects which is known. But then with time, we see that there might be some other new side effects. So hypertension is not a known side effect of Arimidex. However, I have seen some patients who develop hypertension on Arimidex. Now there can be many reasons. Age-related hypertension, again it needs to be worked out at first before saying its drug related. Once the diagnosis of hypertension is established, regardless what the cause is Arimidex or age-related or something else, the treatment of hypertension is pretty standard and we give the same drugs we give anyone with hypertension, with the help and consultation of our cardiology colleagues.
FEMALE SPEAKER: Thank you.
DR. BANU ARUN: Thank you.
ARLENE KALLICK: At this time we have to end this portion of our call and we’d like to thank you Dr. Arun for your really insightful and excellent presentation.
DR. BANU ARUN: Well thank you very much.
ARLENE KALLICK: In presenting “Dealing with the Side Effects of Treatment Now and Later” you covered a tremendous amount of material. I’m sure everyone’s going to be reading the transcript. Because of the generosity of healthcare professionals like yourself, it’s really possible for the Network of Strength to provide useful information and assistance through the breast cancer journey. I thank you very much.
DR. BANU ARUN: Thank you it was my pleasure and have a nice evening everyone.
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