I monitor my breast cancer with a visit to the medical oncologist every three months. At this last visit, though, on December 6, 2022, I saw a PA (“Amber”) because the doctor was away at a conference.

No problem. I trusted that she is well-trained and capable of providing reliable medical care.

I wanted to discuss anastrozole, which I take daily. This medication is an aromatase inhibitor that greatly reduces (if not eliminates) the estrogen in my body. Without estrogen, the type of breast cancer I have cannot grow, so it is important that I take this drug every day. However, it comes with a list of side effects this long <<extending arms reallyreallyREALLY wide>>

I am most worried about the slow rise occuring in my blood sugar and hemoglobin A1c. These are predictors of diabetes mellitus. I never had this problem before; it started several months into my anastrozole treatment. I have no family history of this disease. I mentioned all this to Amber. . .

. . . who said, “that’s not a listed side effect ” and is “not often found.”

Maybe she thought that would reassure me.

It didn’t.

She advised that I continue taking the anastrozole anyway, even if I progress to full-blown diabetes. She declined making a referral to an endocrinologist.

Her response raised some issues that I realized would be futile to discuss with her, so I didn’t bother.

The first is, why is she unaware of any of the medical studies that have established a link between aromatase inhibitors and the development of Type 2 diabetes? As a physician’s assistant specializing in oncology, would that not be part of her continuing education?

Just a cursory Internet search produced pages of scholarly articles and study reports linking aromatase inhibitors, specifically anastrozole, to the development of diabetes in postmenopausal women taking the drug. Here are just a few:

1. From Cancer Medicine (Open Access), 18 December 2018, https://doi.org/10.1002/cam4.1911, Citations: 19: ” A general trend of increased glucose and insulin is seen and likely to be caused by weight gain and/or changes in body composition as a consequence of adjuvant [aromatase inhibitor] treatment of BC [breast cancer] (https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1911
2. From Clinical Breast Cancer, Vol 2, Issue, Jan 2022, pp. e48-e58: “The present study thoroughly reveals that adjuvant HT [hormone therapy with aromatase inhibitors] is a risk factor of secondary DM in primary female BC patients.” (https://www.sciencedirect.com/science/article/pii/S1526820921001749)
3. From Journal of the American Heart Association, Vol 11, Issue 20: ” . . . endocrine therapy [treatment with aromatase inhibitors] is associated with a higher risk of [cardiovascular diseases and] type 2 diabetes. Monitoring of cancer comorbidities after endocrine therapy is needed in younger and older patients. “(https://www.ahajournals.org/doi/10.1161/JAHA.122.026743)
4. From Cancer Research, Vol 80, Issue 4 Supplement: “Our data suggest an association of AET [adjuvant endocrine therapy, meaning treatment with aromatase inhibitors] with DM [diabetes mellitus] among postmenopausal women with early stage breast cancer. “(https://aacrjournals.org/cancerres/article/80/4_Supplement/P5-12-04/647349/Abstract-P5-12-04-Association-of-adjuvant)
5. From Breast Cancer.Org, Research News: “Women treated with an aromatase inhibitor had about a 4.3 times higher risk of diabetes than women not treated with an aromatase inhibitor.” (https://www.breastcancer.org/research-news/link-between-hormonal-tx-and-diabetes)

But, diabetes “is not a listed side effect” and is “not often found.” Well, duh. If you don’t believe it exists, then you wouldn’t look for it. Which clearly explains why it is “not often found” by Amber.

Anyway,

Listed or unlisted, isn’t it HER JOB to know about all the side effects associated with this drug?

The second problem had, really, very little to do with Amber and very much to do with my former medical oncologist, Ajay Dhakal, MBBS. As anyone who has read this blog already knows, that excuse-for-a-doctor almost killed me with incompetence when he was unable to recognize the life-threatening symptoms of typhlitis and instead figured I was some kind of chemo newbie who couldn’t take the side effects. His stupidity and arrogance still haunt me, even though nearly 2 years have passed and I have adjusted to living with a half-treated cancer and without 1/3 of my lower GI tract as best I can.

Anyway

When Amber said “that’s not a listed side effect,” that’s not what I heard. What I heard was Dr. Dhakal saying “This is only day 8. Wait 4 days. By day 12 you will feel much better.”

(By day 12 I had had 2 emergency surgeries and was in the critical care unit at UofR, where I stayed for 2 weeks, much of it on life support.)

I didn’t hear Amber shrugging off my concerns with “continue taking the anastrozole anyway.” What I heard was Dr. Dhakal shrugging off my concerns with “You’re 70 years old. You’ll be dead in a few years anyway.”

As if my survival meant nothing to him (it didn’t). Does it mean nothing to Amber as well?

I don’t want to judge Amber — or anyone else — on terrifying flashbacks from the past. They have nothing, absolutely nothing to do with my present care. But I am having a hard time disentangling her careless remarks from his. Certainly her failure to recognize the link between diabetes and anastrozole won’t kill me, because I am smart enough to pursue that aspect of my care with an endocrinologist even if I have to self-refer. But I am troubled how closely her callous dismissal of my concerns resembles Dr. Dhakal’s.

Different thoughtless remarks from different providers regarding different concerns with different outcomes — but originating from the same sort of ignorance, indifference, carelessness, insensitivity, and lack of concern.

How can I trust either of them?

At this point I can’t. And I won’t. Been there, done that, and almost died.

I wrote a note on my EMR for the office staff to schedule my future appointments with the doctor, and only the doctor while I sort things out.

Because I am DONE dealing with stupid. It should NEVER pass for medical care!