• Intensity of Treatment In the past, chemotherapy was often omitted if the white blood cell or platelet counts
dropped moderately (even if there were no symptoms or significant risk) or when minor gastrointestinal or
other side effects occurred. Sometimes a dose of chemotherapy would be modified or postponed because of
holidays or inconvenience. It is now recognized that these practices are generally unwise.
For metastatic disease and especially for adjuvant treatment, it is important to give full doses and to avoid
postponing regularly scheduled doses for minor reasons or for less than significant toxicity.
Attempting to be "kind" to a patient by making toxicity as tolerable and minimal as possible can decrease
the chances of a good result from the treatment. The kindest thing a physician can do is make sure the dose is
as close to the theoretical maximum safe dose as possible and is also given on time. One study of the standard
CAF program (Cytoxan + Adriamycin + 5-fluorouracil), used as adjuvant therapy, showed that with
high-dose-intensity therapy, 75 percent were free of recurrence of the cancer three years later, compared with
only 64 percent of those given low-dose-intensity therapy.
Hormonal Therapy The lining of the ducts and lobules in the breast change under the influence of hormones , and hormonal manipulation and therapy play an important role in managing breast cancer. A variety of methods were once used to manipulate the hormone balance—removing the ovaries or adrenal glands and sometimes the pituitary gland, for example. Many women responded to these manipulations, others did not. Those who responded not only seemed to have disease that was less aggressive but if they relapsed they could be treated by another hormonal maneuver with an increased chance of response.
