Is there any evidence that the order in which treatment is carried out has an impact on outcome? For example having chemotherapy before surgery or vice-versa?
From the surgeon’s perspective, there are two factors that are considered when deciding if surgery is the right thing to do.
The first one is clinical fitness of the patient. Often women are clinically unwell by the time they are diagnosed. So we need to try to get the patient fitter for treatment.
The second factor is, after looking at the scan results, whether we feel that all visible disease can be removed at the time of operation. It is well published that if at the end of surgery there is no visible disease, the outcome in terms of survival is considerably improved.
In some cases there may be disease in places that cannot be removed.
So fitness, or doubt about the possibility of removing all visible disease or often a combination of the two, will suggest that an individual will benefit from chemotherapy first, so that’s really the deciding factor.
The order of treatment does not appear to impact on survival. If there is complete removal of the tumour then it probably doesn’t matter when it’s done.
There is evidence emerging on a year-on-year basis as to what the right thing to do is, and there is still debate around the country about this.
What we know is that not one size fits all when it comes to treatment. It’s not just about your disease, it’s also about you and your choice, and what treatment you feel would be best for you in your personal situation.
All of those things are really important because your quality of life throughout your treatment and beyond is also one of the most important things, and we must consider that when we’re making these really big decisions together.