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07/19/2006: "To Chemo or Not to Chemo?"

As you may know, my colon cancer has metastasized to my lungs and bones. This is very serious and almost always results in death within about two years. This fact, I try to keep from my thoughts as much as possible. I envision myself as healthy and see those nasty cancer tumors dissolving a little more each day.

My Oncologist insists that I be on chemotherapy at this time. Unfortunately, unlike the last time, there is no timetable. I would to be on chemo to prolong my life and would only go off it, if I get too sick to handle it. The problem is that chemo makes you really sick. At this time, I have chosen to stay off chemo. This is a very personal decision and one that is made by only a small minority of cancer patients.

Generally speaking, chemotherapy kills all fast growing cells. The hope is that the cancer cells will be killed off before the host (me) dies. My first round of chemo for advanced stage colon cancer was a mixture called FOLFOX 4. This is the standard regiment and includes the three drugs; Oxaliplatin, Leucovorin and 5-Fluorouracil (5FU). Oxaliplatin is a platinum based drug that was recently FDA approved. The toxicity is primarily to the nervous system and the kidneys. Side effects include feeling sick, fatigue, bone marrow damage and numbness in fingers and toes. I stopped this drug in November and still cannot feel my fingertips or the bottoms of my feet. Trials show that this drug has an effect on tumors but actually shortens survival rates of patients. Leucovorin can cause diarrhea, lightheadedness, sores in the mouth or throat, vomiting, and damage to the kidneys. 5FU drops your white blood cells and increases the chance of you getting infections. Four months into my first treatment with FOLFOX 4 I was hospitalized with severe dehydration and a blood infection that almost killed me. It is also possible for 5FU to drop your immune system so much that it allows cancer cells to spread.

Going into my first round, my scan showed no tumors anywhere else in my body. Two months after finishing the treatment, the scans showed the cancer had spread. So the recommendation is to go back on chemo to address these new tumors. For this new round that I started my oncologist added Irinotecan and Avastin. These are new targeted drugs or angiogenesis inhibitors that are designed to kill the tumor’s life support. Irinotecan trials show a 1.3 month increase in survival time of patients. And side effects include bone marrow damage, hair loss, fatigue, nausea and vomiting. After my first treatment, I was driven to the emergency room because I couldn’t stop vomiting. In clinical trials, Avastin when combined with the standard chemotherapy was able to extend the average patient’s life from 14.6 months to 17.9 months. That is a boost of 3.3 months on average. Side effects can include congestive heart failure, persistent hypertension, gastrointestinal perforation and the spontaneous splitting of wounds and organs.

So chemotherapy drug companies and doctors do not talk in terms of cures, but in terms of extending a patient’s life by a few months. That is, if they can survive the side effects. I often question my decision to stop chemo. It is a very personal decision and one that has to be decided after weighing the information available. Besides the research, I credit the three weeks I spent at the BioCare hospital in Mexico as the reason for my decision. I am glad I have found alternatives such as the care I received in Mexico, diet and elimination of unhealthy habits and toxins. I do feel better and Jeanette tells me that my disposition is so much better.

Within the next few weeks I will begin radiation to try and kill the persistent tumor in my neck vertebrae. This too is a tough decision to make. I am still researching and questioning this move and promise that there will be much discussion to come.

Hope you are well.