One of the keys to successful medical treatment is asking the right questions.
My colleague “Josie” recently thanked me for steering her to a wonderful oncologist and for suggesting that she ask her doctor whether she would be a candidate for the FAST protocol for her newly diagnosed early breast cancer. This protocol, widely adopted in the UK but not as much in the U.S., involves short course radiotherapy –either once a day for five days, or once a week for five weeks – at a somewhat higher dose of radiation.
This type of radiation dosing is called “hypofractionated,” which means that patients receive fewer treatments with higher doses of radiation at each treatment, but the same total radiation dose as conventional radiotherapy.
Josie shared with me that she experienced few symptoms with the new regimen and was pleased that she went with this option: “It went very well – I can’t report any problems at all. What I learned is that yes, the “zaps” are more intensive, but my doctor told me that wouldn’t affect how I would feel compared to getting treated five times a week for a month. I was instructed in self-care to protect my skin (i.e. to use a moisturizer twice daily); and I was assigned PT exercises –but those relate to the lymph node biopsy not to the radiation. I was told to expect a sunburn in the targeted area and possibly some peeling and that the more intense radiation can result in firmer breast tissue.”
“My greatest concern was the chance of fatigue interfering with my ability to go about my life – but I learned that it would be no different (worse or better) with this protocol. You may know this, but I was surprised to learn that the fatigue is not flu-like (can’t function or get out of your chair), but more of a general feeling of having lower energy and feeling drained. That was incredibly reassuring to me. In other words – I could still cook dinner, exercise, walk my dog, be available for others, etc.”
Improved side effects with the shorter protocol
According to a study from the Journal of the American Medical Association, side effects are not as noticeable with the shorter protocol (except for breast firmness, which can be slightly greater): the women on the shorter radiation schedule noted less skin inflammation, less itchiness, less breast pain, less skin darkening and less fatigue. Overall, 47% had side effects compared to 78% with conventional radiotherapy.
Recurrence: according to that study, for patients with early breast cancer, hypofractionated whole-breast radiation after lumpectomy offers the same recurrence risk reduction benefits as conventional whole-breast radiation.
Clearly both the conventional and the shorter radiation therapy are successful, in the sense that both confer an equal chance of recurrence. But the fact that the shorter regimen is accompanied by fewer side effects is important. And the additional stress of daily trips to a medical center–particularly during a pandemic–is not to be underestimated, particularly for the older patient. Success should have broader connotations than simply cure. Side effects and psychological hassle are important considerations.
For all of these reasons, those with newly diagnosed early breast cancer may wish to ask their doctor about whether a shorter radiation therapy regimen is an option–particularly given that not all oncologists mention this possibility.
More resources:
https://www.cancer.org/cancer/breast-cancer/treatment/radiation-for-breast-cancer.html
https://www.breastcancer.org/research-news/accelerated-rads-has-same-effect-as-traditional
Medical disclaimer:
The suggestions given here are not intended as a substitute for the medical advice of your physician. The reader should regularly consult a physician in matters relating to his/her health and particularly with respect to any symptoms that may require diagnosis or medical attention. For additional questions, please call your healthcare provider for reliable, up-to-date information on testing and symptom management of all medical concerns.
All names are changed to protect patient confidentiality.
Photo credit: thank you to Sydney Rae, from unsplash.com.
