My wife Irene has cancer. It is stage 4 breast cancer, so we have a lot of things to worry about despite the excellent care and good results she has seen thus far. Paramount amongst these worrisome things is the quarterly testing regimen she is on.
What happens each quarter
Irene receives treatment with monoclonal antibodies (MABs) every month. She tolerates these well, but it is always a question mark exactly how long these will continue being effective. This question mark gets its answer from the testing that is done quarterly.
Irene undergoes several tests each quarter, most notably a full body CT scan and, after injection with a radioactive substance, a run through a nuclear medicine scanner. The injections are nerve wracking for Irene who has a severe phobia about needles. Thankfully, however, they have determined that the portacath she had installed for her chemo and MABs is a perfectly acceptable site to inject the radioactive substance as well.
The whole testing process takes the better part of a day: a couple of hours for the scans with three hours of waiting between for the radiotracer to circulate for the nuclear medicine scan. We usually do some shopping or something similarly distracting during the waiting time between imaging.
The results
Irene is contacted after the scans are complete, usually by the oncologist or the oncology ward nurse, with results. These results are also on the BC Health portal website. The magic words we look for are ‘unremarkable’ or ‘no change observed’, but the doctors also give their all clear sign based on the outcomes of the testing.
Thus far all of the quarterly results have been good: Irene’s various cancerous lesions are either not growing or have shrunk. This means she is doing well on the current treatment which is great: the current treatment is comfortable and we’d like to stay on it as long as practical.
If we ever see a change then the doctors will need to consider changing treatment which could be unpleasant. Irene already went through six months of chemotherapy at the start of her treatment before switching entirely to the MABs. Chemo is harder on the body, and causes things like your hair falling out. None of this is high on our list of desirable outcomes, but we have to be ready for it as a possibility.
The testing itself is not terrible. It is the uncertainty and fear of possible changes that breeds anxiety each quarter. Irene and I both try to downplay the significance of the tests and their outcomes, but they are truly meaningful for us. I don’t want the negative outcomes that logic dictates will one day come.
The word from the oncologist is that some patients go for a decade or more on monoclonal antibodies alone. And of courses there is always hope that a newer and better treatment will come along in the interim, something that won’t require a return to chemotherapy or radiation treatments. We are battling for time here, and it is sometimes frustrating to measure it in three month increments.