Monday, May 15, 2006

An Unwanted Journey: Day 0173 - Chemo Consultation

After a week at home working on recovering bladder function, my wife and I headed back to the Grand River Regional Cancer Centre for consultations about the next stage in my battle against rectal cancer - the chemotherapy cleanup stage. The point of this stage is to find and destroy any remaining cancer cells still lurking about, especially since the tumour pathology report confirmed that there had been some lymph node involvement in one to three nodes.

The medical oncologist was in for a surprise today. I was the first rectal cancer patient at the centre who cannot remain in a seated position for any serious length of time. I had the blood work done in the lab and then requested a bed to wait for the next 90 minutes. Sitting down in the waiting area in the chairs provided would simply have been agony. The bed alternative made the wait acceptable.

We agreed that pain management is a serious issue and that we shouldn't begin the recommended chemo treatment this week until we have a plan to manage the pain. Even more importantly, we need to know where the pain is coming from. I will be seeing the surgical oncologist this week to see about a CAT scan and another possible scope examination to see if there is any serious source for the pain; the most serious would be an abcess in the colon or rectum.

Assuming we make progress on pain management and there isn't anything seriously wrong internally, then by about May 26th, we should be ready to start chemo.

The recommended therapy is different from what I anticipated. It goes under the generic name FOLFOX. It will be a cycle of 14 days for 4 months and will require another PICC line inserted. The drugs include leucovorin, 5-fluorouracil, and oxaliplatin. Every 2 weeks, I'll spend four hours the first day in the chemotherapy suite infusing the leucovorin and oxaliplatin. At the end of that 4 hours, the PICC line will be hooked up to the 5-fluorouracil for 46 hours. On the 3rd day, a CCAC nurse will disconnect the 5-FU. Then, every day during the next 2 weeks, I will flush the PICC line myself (after being trained to do so, much like the self-catheterization).

Side effects will be cumulative during the entire cycle, but there may not be much nausea. A more likely side effect will be sensitivity to anything cold to the touch. But, if I've learned anything about side effects thus far, it is to be prepared according to what the literature suggests, and then wait-and-see.

One of the oddest things about this next stage is that oxaliplatin isn't covered by provincial drug plans. This means that my wife and I must fill in an application form to the federal oncology access assistance program about our finances. That agency then determines what level of funding they will provide. Then, the GRRCC will provide us with the oxaliplatin free of charge and we will ensure any federal reimbursement for the drugs goes back to the GRRCC. Ridiculous, but necessary, given the state of provincial coverage of drugs used elsewhere in the world as standard treatment. Oxaliplatin would certainly qualify as a standard treatment. Too bad OHIP doesn't think I'm deserving of coverage for a treatment that could save my life!

So, the next stage is just around the corner. There will be more tests, scopes, medications, and disruption of ordinary life.

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