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[Brad the Impala]

Difficult call John. It seems that the hospital with the greater amount to gain gives you no reason not to have chemo. I would forget the chemo, and enjoy life as it is.

Have a bed bath instead? just kidding!

[PeterUK]

I fully understand your anxiety on the matter, John, but the last thing I would do is to seek advice here. Go to someone (better, several people) with the relevant medical qualifications and see what they have to say. If you don't know any, surely you can get recommendations at the Rotary Club?

[allieb]

It's a difficult choice and one that you have to make yourself. I personally think that leaving something unchecked is a bad idea, at least the chemo addresses the problem by attacking the cancer and the aim is to send it into remission. I would go for anything available to push up the chances of success however small . And don't listen to too many doctors in Pattaya they may only guessing.

If it is at all possible you should make a trip back to your country of origin for some more professional advise. After all Thailand is the third world where life is cheap and Mi Pen Ri always seems to crop up when things go wrong. By the way Where are you from?

[lonelywombat]

[quote="allieb"

If it is at all possible you should make a trip back to your country of origin for some more professional advise. After all Thailand is the third world where life is cheap and Mi Pen Ri always seems to crop up when things go wrong. By the way Where are you from?[/quote]

I have reproduced only part of allieb suggestion.. This part I totally agree with.

I would get back to the UK as fast as you can. Best of luck whatever you decide

[UncleSam]

So my question to board members is, what would you do?
First thing I would do is make sure I paid no attention to the uninformed anonymous opinions of posting board junkies like us. It's usually wise to get a second opinion, but asking for opinions here is a bit foolish.

We all want someone to help share our troubles and even hold our hand; but the kind of medical decision you have to make now about your life can only be answered by you, based on the opinion of competent medical experts.

Having said all that, if it was me, and I'm glad it's not, the one thing I would certainly ask the Bangkok-Pattaya hospital is whether their treatment is the same drugs and dosage as the Cancer Clinic and, if so, why it's twice the cost of the CC. I'd also ask them to say if they agree with CC's oncology estimate of the treatment's likely effect on survival rates. If they don't give you a satisfactory answer to both questions, go somewhere else for a third opinion.

No matter what you decide - chok dee krap !

Think I would pack up and make a trip back home and speak with a specialist. Just to be sure.

That decision John is one that at the end of the day, only one person can make. That person of course being yourself. I think that in the replies up to now, there has been some very good advice given, probably the best of all by PeterUK when he said: the last thing I would do is to seek advice here.

I also think the advice given by allieb and wombat, which was to get yourself home as soon as possible, carries a lot of merit. If you decide to stay, than I don't believe anyone could give you better advice as to what to do than that given by UncleSam, no matter how many replies your post receives.

To exit where I came in John, the decision you have to make is one big whopper of one, in which not only are you the only one who can make it, but one also that only you have the right to make.


Choc Dee as others have said, in whatever that decision is.



George.

[catawampuscat]

Maybe, John, a better place to pose your question would be a forum or message board of persons with
cancer. I imagine such message boards or forums must exist and that is where I would look as the
forum would be composed of members well informed and experienced in such matters.

For what it is worth, I would avoid chemo but that is from an uninformed person and not worth much in
making such a big decision as you have to make.. good luck :cat:

[lonelywombat]

John if you are to have chemo then you will need family and friends around you for support

You have mentioned your trip to the Uk to stay with family and your caring BF

From my experience with a friend that had extensive chemo, you need that close family support and that of your bf

at the same time. If he can join you in the UK and your family is supportive then that is where you should be.

The difference in costs in LOS is unimportant, it is the family support [ and lovers] when things get tough

that will mean most. Time is of most importance.

[ned kelly-old]

Have the prognosis verified in the UK. I have heard of two cases where the gloomy predictions of Thai doctors have been disputed in the home country (in these cases, Australia and the USA).....you have nothing to lose.
In these instances absolutely precise communication is vital and it is almost impossible to achieve this between a foreigner and a Thai doctor in Thailand, no matter who interprets.

The cost of the 12 cycle chemo treatment quoted by BKK-PTY hospital seems to me to be extremely high.

Secondly the quoted survival rates also seem high. Useful link is http://www.cancerhelp.org.uk/help/default.asp?page=135 where you can get a lot of information after selecting the appropriate page for your type of cancer. If an additional 10% survival rate is all they can predict after chemo, is that worth it in terms of the physical side-effects and distress of the chemo (which can be severe depending on what chemo is used) and also in cost?

Also it must be remembered that the surivival rates are a broad brush prognosis based on past experiences treating other people and they cannot possibly be accurately applied to your case.

I my own case (with stage 2 stomach cancer) I was quoted a 50% survival rate after 5 years with a combination of chemo and radiotherapy and only 20% without such treatment. I opted for the treatment which was extremely uncomfortable and distressing - that was nearly 4 years ago.

Cancer survivability varies considerably depending on what type of cancer, how malign or aggressive it is and at what stage it is detected.

My advice to you is to seek more information and advice in your home country if you possibly can. You will need to get a medical report from the Thai doctors laying out the history of your diagnosis and treatment so far including the histology report of the tissue removed in your surgery.

As regards your question should you or should you not have the treatment - only you can decide that after seeking comprehensive expert medical advice and it is not something anyone on these boards can recommend one way or another.

Whatever you do, decide as soon as you possibly can and also you have my best wishes.

[Alaan]

Interesting that the first thing most posters say is 'don't seek advise from this forum'.
I don't understand why John should not seek opinions form here? He is looking for opinions and options it doesn't mean he will act on any of the replies... but maybe he might come across someone who has faced a similar dilemma [or maybe a family member] and can throw up something that may be of value to John.

In my experience......it is my mother who had bowel cancer two years ago at 72 years old. In the uk now,or to be more precise, the policy of North Scotland NHS is to give Radiotherapy and Chemo FIRST..this has the effect in most cases of vastly reducing the size of the tumor and then when surgery is carried out...to put it bluntly, there is less tissue cut out and less trauma to the bowel also allows them to take out a safe amount of surrounding tissue and makes the bits & pieces left inside easier to patch up/heal.. then they recommend Chemo for a period after the operation as more of a shoring up operation that greatly reduces the spread to the next vital organ..the liver. My mother has follow ups every 6 months.. after 2 years still healing fine. The bowel is checked and a scan for the liver.

So the NHS Scotland advise would be if you can afford it ok, and you are able to take it, is to have Chemo, the short term uncomfortable
feelings and side-effects give way to a longer term survival chance. This is the option my mother took and I would have also had it been me.

I give the above experience with bowel cancer on the basis that I visited all the consultants and surgeons with my mother, and all the above info is not any guesswork on my behalf but the policy and comments of the NHS Scotland specialists. I know policy differs from area to area and consultant to surgeon and all tumors are not the same, but this is based on a malignant tumor in my mothers lower bowel.

One thing I did learn from this experience is that preventative caution is best and that if cancer does develop, success in treating it is so much higher the earlier it is found.

So when I did have a change in bowel habits last year, just before a trip to Thailand as it happened, not a particularly serious change, just something that I knew not to be normal for me, being 51, I decided to have my anxiety acted upon and I visited the Samitivej hospital, Bangkok during my holiday visit when I was in BKK. Rather than make this post longer than is necessary by giving details, if anyone wants to know of my experience of my first visit to a Thai hospital I would be happy give the details.

When I returned home, I went to a private hospital for a colonoscopy [i went private for a quick result] to check and make sure that there was nothing, especially any polyps, and got the all clear. So while on the subject I would advise anyone over 50 years of age, if they have never done so, to have a colonoscopy... this was my very first stay in a hospital since getting my tonsils out 48 years ago, and all my anxiety of the procedure was in vain as I HONESTLY didn't feel a thing! i do remember watching a bit of the procedure on the tv screen, but the drugs had me doped up and it was like dreaming.

The only boring bit was the loss of a day having to stay close to a toilet as the system was cleared out the day before the procedure.

I feel that it is a good subject to cover on this forum, and would advise anyone who has any experience of bowel cancer to reply, I would say that if your reply is guesswork, then in that instance it would be better not to comment if you have no facts to act on or back up your advise.

If you really do not wish to return to the UK with its excellent free treatment and care provided by the NHS, and wish to seek further advice in Thailand have a read at this link

http://www.thaivisa.com/forum/lofiversi ... 37857.html (http://www.thaivisa.com/forum/lofiversion/index.php/t137857.html)

"Dr. Arkohom Siansin, a cancer specialist of the National Cancer Institute of Thailand has received the award "Eminent Scientist of the Year 2007 Asia" from the International Research Promotion Council (IRPC) for his outstanding research to minimise the side effects of chemotherapy and his dedication in arranging cancer control and prevention programmes for cancer patients"

Perhaps it is worth trying to get a third opinion from him - he seems to be one of the best oncologists in Thailand.

Send you my very best wishes.

[bao-bao]

I agree with those who say "get thee to the UK" and visit an oncologist (or two) for their opinions. I personally would want a couple of other opinions on staging, treatment possibilities, side effect probabilities and prognosis. Colon cancer can be beat, lymphomas are far more difficult to even control.

Everyone's body reacts differently to cancer progression and, let's face it, cancer in and of itself is a mutation and not often predictable to a great degree, but I think the main issue here is Quantity vs Quality. Is it worth 6 months of being miserable to add another few years? At 40 it's one thing, at 65 it's another; and everyone's individual circumstances, view of life and overall health status make that impossible to guess from here.

Do some serious research on competent cancer organization sites, speak to some people qualified to make an educated guess and go from there.

As for asking the board members: I'd guess their medical knowledge is limited to doing "probes", so you'd be wise to weigh the lion's share of their direct advice accordingly! :cheers:

I wish you the very best of luck with this, John.

Get more advise, whether in Thailand or in the UK. I spent a great deal of time with a friend at BNH in Bangkok and think highly of the facility. Also I had a physical there and saw an English doctor. So there might be some possibilities in Bangkok of seeing farang doctors. You might have to do some research on the various hospital websites. Best wishes for a full recovery.

Below you will see the latest interesting facts about Colon Cancer, apart from that, if I was in your place John and lets face it, any of us could be at any time, especially if your like me and hate doctors. I would contact any of the Voluntary Groups around who are living proof that you can survive Colon Cancer, they will not only be a listening ear and back up for you, but also can tell you the best treatments there are around at this time.

http://www2.newsquest.co.uk/lancashire/ ... fo/vo.html (http://www2.newsquest.co.uk/lancashire/colne/info/vo.html)

Latest Interesting Facts

http://www.medpagetoday.com/MeetingCove ... ng/tb/5835 (http://www.medpagetoday.com/MeetingCoverage/ASCOMeeting/tb/5835)

http://www.cancernews.com/data/Article/466.asp

http://www.sciencedaily.com/releases/20 ... 084854.htm (http://www.sciencedaily.com/releases/2004/08/040804084854.htm)

http://seniorjournal.com/NEWS/Health/20 ... Xeloda.htm (http://seniorjournal.com/NEWS/Health/2007/7-10-08-Xeloda.htm)

Basics of Each Colon Cancer Stage
There are five colon cancer stages (0-4). Colon cancer used to be rated using the Duke's system. For example, Duke's A cancer was the equivalent of stage 1 cancer. Sometimes you'll still hear people refer to their tumors that way, which can cause some confusion. The following breakdown should help clarify the basics of each colon cancer stage.
Stage 2 Colon Cancer

This used to be called Duke's B colon cancer. Colon cancer is considered stage 2 after it moves beyond the middle layers of the colon. Sometimes colon cancer is still considered stage 2 after it has extended into nearby organs.
Studies Find that Exercise Increases Colon Cancer Survival Rate

Researchers at the Dana-Farber Cancer Institute in Boston conducted two studies, both of which revealed that moderate exercise can significantly increase the survival rate of colon cancer patients.

How Much Exercise Are We Talking About?
Basically, the study participants reported the number of hours per week they participated in various types of physical activity. (Some examples include walking, jogging, taking the stairs, yoga, biking, and swimming.) Then, the researchers converted those activities into MET hours (metabolic-equivalent task hours). Basically, one MET-hour was the equivalent of walking for an hour at an average pace. So, if walking for an hour would "earn" patients one MET hour, jogging for an hour may earn them two or three MET hours.

The first study found that women with at least 27 MET hours/week fared better than women with fewer than three per week. The second study found that women with at least 18 MET hours/week fared better than women with fewer than three.
Take-Home Message.

One of the most frustrating things about life-threatening illnesses is having so little control over something that matters so much: life and quality of life. In my opinion, anything that provides an opportunity to take control is a welcome addition to a colorectal cancer survivor's arsenal. More research is needed (since both of these studies were conducted by the same lead researcher), but exercise is free unless you choose to pay for it. So, why don't you go take a hike - and I mean that in the nicest way!

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ask about (Fairly new) drugs: Avastin (Prevents creation of new blood vessels in the tumor, thus blocking the growth) & Erbitux (Blocks the effects of a (different) growth element. These are being administered alone or in combination with other drugs: depending on individual situations.
Lazar treatments are proving successful in treating certain types of tumors: cut off the blood supply to the tumor.
Good luck.

[Aunty]

As they say in Thailand, up to you.

Just a couple of points to consider when you are having a discussion with your oncologist or reading articles on the web. When a drug has been shown to provide a significant improvement in survival or has a significant benefit, be mindful about what the word significant actually means in this context. In terms of drug action this word's meaning is very different from its meaning in everyday language use. In terms of drug action, its meaning here is its mathematical meaning, i.e., a drug that was significantly better than another is one that showed a statistically significant difference between x and y. What it actually means is, is that the difference between the two was not due to chance, but was due to the actions of the drug. Statistical significance is a test to show that a number that is different between two or more things is unlikely to be just due to chance. Consequently although something may be statistically significantly different from something else, (i.e. the difference in survival times between two groups was not due to chance but the effects of drug A vs. drug B) it doesn't mean that the difference is actually important. For example if a new anticancer drug gave a significant improvement in survival rates over five years, but the actual amount of time it prolonged survival was four months say, is that important? So just be sure that you understand what they/websites/ pharma actually mean when they use the word significant.

And another issue to consider is that some of the very new drugs that Edith has kindly mentioned above may not be available free via the NHS at this time, and private treatment (if recommended) will be very very expensive. 20,000 -30,000 pounds. I'm not sure why the drug regimen you have been recommended is so expensive in Thailand? One of the drugs has been around for many years and is actually very cheap! If you went back to the UK, you would I presume get treated for free and you would have the reassurance you are actually getting full strength not-past-their-expiry-date drugs?

The drugs will either work or they won't. They will kill off any micro metastases that you may have, or they won't. You may not have any. With current technology there is no way of knowing just as there is no way of predicting whether or not your cancer cells are susceptible to the action of these drugs, or that they are already resistant to them.

If the drugs work against any remaining cancer cells and you take the chemo you are in a win lose win. If the drugs work against any remaining cancer cells and you don't take the chemo you are in a lose win lose. If the drugs don't work against any remaining cancer cells and you do take the chemo, then you are in a lose lose lose. If the drugs don't work against any remaining cancer cells and you don't take the chemo, you are in a lose win lose. If you have no remaining cancer cells and you take the chemo then you are in a win lose win. If you have no remaining cancer cells and you don't take the chemo then you are in a win win win.

Up to you.

[lonelywombat]

John I do not think the advice you are getting is relevant

You must decide whether you stay in LOS for treatment or return to the UK

All these medical references are confusing . You are not an expert.

No one on this forum is either. Me in particular.

Time is the big issue. Quality of treatment the next

Every day is important. Dont ignore it.

John: If you'd like some other input from an online forum, I recommend you post on the ThaiVisa.com "Health, Body & Medicine (http://www.thaivisa.com/forum/index.php?showforum=23)" forum. One of the admins there is a nurse named Sheryl, and she is revered on that forum as a font of medical knowledge and experience. She also won't hesitate to recommend physicians based on their credentials. I saw your post in one of the other ThaiVisa.com forums and wish you the best of success in all the aspects of this chapter of your life!

[Hmmm]

When a drug has been shown to provide a significant improvement in survival or has a significant benefit, be mindful about what the word significant actually means in this context. In terms of drug action this word's meaning is very different from its meaning in everyday language use. In terms of drug action, its meaning here is its mathematical meaning, i.e., a drug that was significantly better than another is one that showed a statistically significant difference between x and y. What it actually means is, is that the difference between the two was not due to chance, but was due to the actions of the drug. Statistical significance is a test to show that a number that is different between two or more things is unlikely to be just due to chance. Consequently although something may be statistically significantly different from something else, (i.e. the difference in survival times between two groups was not due to chance but the effects of drug A vs. drug B) it doesn't mean that the difference is actually important. For example if a new anticancer drug gave a significant improvement in survival rates over five years, but the actual amount of time it prolonged survival was four months say, is that important? So just be sure that you understand what they/websites/ pharma actually mean when they use the word significant.

If someone had told me there would be a tutorial on the meaning of "p < 0.05" on this board, I wouldn't have believed them. Although had they added that Aunty would deliver it, I'd have been less sceptical.

I think that you should explore every avenue. My first action would be to go to the Bumrungrad Bangkok for another opinion - also they are often cheaper then Bangkok Hospital Pattaya.

A trip to the UK - NHS or private would be my second move.

In between do lots of research on the Internet. Many people with the right attitude and healthcare seem to beat the odds by quite a margin.

Best wishes whatever you choose.

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You can bet that Folfox 4 is more profitable for the hospital, and that is why it was pushed on me.
As a resident you should not be at all surprised at that! Sadly it seems that all farangs are considered fair game if there is a chance for a Thai business to make some extra money, even if that could mean risking the farang's life !

P/S. I don't know what the side effects of the alternative oral drug recommended to you are but in my case I was given an oral take-at-home drug called Capecitabine (Xeloda). Whilst I did not suffer the hair loss or most of the other symptoms associated with the drug, I was extremely nauseous for the whole period of treatment (12 weeks) - to such an extent that at one stage half way through I seriously contemplated giving up on the treatment altogether. The severity of my reaction to the drug surprised my oncologist and treatment team. The point being that these chemo drugs have varying side-effects on different patients.

However as I see it oral medication is far preferable to intravenous treatment any day !

If you opt for the treatment stick with it whatever the side-effects. Again, best wishes.

I beg of you to find a Cancer Center (preferably in your home country) NOW.

There are many in the US and I am certain the same is true in the UK and many other countries. You need to find one that is on the leading edge of new discoveries. So much is changing with available drugs. Chemo has changed so much in just the last few years. For some types of cancer there is specific chemo treatment that cannot be compared with chemo drugs that were used just a few years ago. My friend of many years has undergone chemo for Bone Cancer that is specific just for that type of cancer. For him, few of the usual side effects that were so dreaded by patients in years past. He is in Palm Springs California which is one of many leading facilities with specialists for each type of Cancer. For his cancer, the inconvenience of setting in an IV lounge monthly, as needed, receiving the "specific chemo drugs (he calls it a cocktail) for his type Bone cancer" is a small price to pay for a comparatively good quality of life.

I am very impressed with Bumrungrad International Hospital in BKK as I just had a physical there in December. However, for cancer, find a Cancer Treatment center in the UK, if that is your home country, and do not delay.

I would guess that most every large city in the UK has Cancer Centers with far more experience in your specific cancer. I know this is true in the US where we have higher cancer rates than Asia probably due to our terrible eating habits, lazy lifestyles, and chemical pollution of forty years ago. My father had Lymph system cancer, my mother colon cancer, and my brother Pancreatic Cancer. Each is totally different and specialized treatment exist for each. Treatment available today in the leading centers if far superior to that available just a decade ago.

You have received some good postings here. A common thread of those that seem to know is to get back home and find a medical center that is specifically a Cancer Center and then find a Cancer Specialist doctor for your specific type of cancer.

Cancer is apparently in my family genetics. If and when diagnosed, my first action is a ticket to a big city treatment center that has specialists in my type of cancer. My advice is obviously for you to do the same.

Do it now. And please keep us updated with your progress. Be positive and look forward to returning to LOS as a cancer survivor!

It's interesting that most posters' advice is limited to "Get the diagnosis confirmed (and by the way don't trust a Thai doctor to do it)". No-one seems to have addressed what would be the issue for me, which is "Chemotherapy will only add 10% to your life-span". Given the horror stories I hear about how god-awful the side-effects are, I'd be avoiding the chemo, making sure I lived life to the full while I could, all the while determining what my options are when that's no longer possible - that is, when it's clear I'll be dying shortly. Personally I'm a believer in euthanasia so I (probably) wouldn't be living in Thailand by then. I believe the Thais have at last got to the point of being willing to turn off a life support system in some cases - I don't even want to get to that point; anyone who assists a suicide is likely to end up behind bars so that's probably not an option either. I'd be heading off home around then

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[lonelywombat]

[quote="homintern"]It's interesting that most posters' advice is limited to "Get the diagnosis confirmed (and by the way don't trust a Thai doctor to do it)". No-one seems to have addressed what would be the issue for me, which is "Chemotherapy will only add 10% to your life-span". Given the horror stories I hear about how god-awful the side-effects are, I'd be avoiding the chemo, making sure I lived life to the full while I could, all the while determining what my options are when that's no longer possible - that is, when it's clear I'll be dying shortly.[quote/]

Colonel we are both bald fat old cunts almost double [ in my case over] the age of young Botting

What might be suitable for you and I might be the opposite for a man 30+ years younger.

The post re Thai visa I thought very worthwhile

I think young John should ignore this thread and do what he feels is best for him.

Colonel we are both bald fat old cunts almost double [ in my case over] the age of young Botting. What might be suitable for you and I might be the opposite for a man 30+ years younger.So, given the fact that John's life expectancy would be the same as mine if we both suffered from the same condition, what is your point, exactly? That at 63 I should consider my life to be over anyway? Yes, it's his decision; I don't believe I was being at all prescriptive

[lonelywombat]

Colonel we are both bald fat old cunts almost double [ in my case over] the age of young Botting. What might be suitable for you and I might be the opposite for a man 30+ years younger.So, given the fact that John's life expectancy would be the same as mine if we both suffered from the same condition, what is your point, exactly? That at 63 I should consider my life to be over anyway? Yes, it's his decision; I don't believe I was being at all prescriptive[/quote]

Your life expectancy say 73 or 10 years, is substantially different to a man still not 40 who in normal circumstances

could hope for another 35 years. My suggestion is that because of your difference in age you could have an opposite

approach than he might.

[dorayme]

Have they mentioned the difference in the quality of life?

John:

First, I wish you the best in making a decision regarding chemotherapy.

Twelve months ago I completed chemo, surgery, radiation and am still participating in a trial drug research project at UCLA Medical Center receiving doses of Avastin through a port just below the sternum.

The side effects of the chemo series were severe but limited in length of time following each treatment. My experience, counter to that of some and comments by my medical team, was that the severity never decreased from cycle to cycle. The 30 consecutive days of radiation therapy following surgery were relatively simple and symptom free.

This is my third bout of cancer, all in different parts of the body, over a 15 year period. The first two cancers went into remission following extensive therapy. As pancreatic cancer survival rates are extraordinarily low - I can only say that I would not be sitting here writing this note if I had not received treatment including chemotherapy, I would not have enjoyed my career for an additional 15 years or my family or traveling to Thailand and other places.

With my history of cellular invasions, and at my age, I will never again achieve a state of freedom from cancer - but I live well and am pain free and able to do everything that I want in the way that I prefer.

As many have noted, you are in control of decisions regarding your body and health. Posters are correct in suggesting multiple opinions (including those in your home country) and reviewing web sites that contain discussions of colon cancer patients and survivors, their responses and reactions to chemo - and other treatments that may have worked for them.

I can only conclude in wishing you the best and in reminding everyone that 10% is significant by any standard of calculation.

So, given the fact that John's life expectancy would be the same as mine if we both suffered from the same condition, what is your point, exactly?And your point is yet to be made. If we both suffered from the same condition then we would both have the same life expectancy ie. 10 years

[lonelywombat]

So, given the fact that John's life expectancy would be the same as mine if we both suffered from the same condition, what is your point, exactly?And your point is yet to be made. If we both suffered from the same condition then we would both have the same life expectancy ie. 10 years

I refer to Johns posting earlier


The survival rate for my cancer is 75% - 80% over 5 and 10 years (without chemo). I actually don't have cancer now. Its been cut away. The chemo is just a precaution in case some undetected minute amount of cancerous tissue escaped and is presently running around my body.
.

I believe that the without chemo option might be more attractive for an older man, than to a young man

There is never a guarantee that cancer will never return, which would make the chemo difficult to reject at 36

Those who've had chemo might care to comment on its effect on their sex life. The brother of a friend of mine has a wife who's had both breasts removed (first one and then four years later the other, chemo in between) says he hasn't had sex with his wife in all that time. Apparently the non-chem drugs suppress the libido completely

Those who've had chemo might care to comment on its effect on their sex life. The brother of a friend of mine has a wife who's had both breasts removed (first one and then four years later the other, chemo in between) says he hasn't had sex with his wife in all that time. Apparently the non-chem drugs suppress the libido completely
I think in this case it is more of a psychological hang-up for the wife who, with both breasts removed, now considers herself deformed and unattractive and is ashamed of her appearance. It is a quite common trait for such unfortunate women.

Having had both chemo and radiotherapy I have to say that it has not had any noticeable effect in that department for me !