Thursday, October 26, 2006

An Unwanted Journey: Day 0338 - Choosing Your Poison

I continue to read Leroy Siever's My Cancer blog every day. He is an amazing individual who has suffered far more than I have endured during my treatment for rectal cancer. Right now he has to decide whether to continue his current chemotherapy regime or give his body a rest for a couple weeks before embarking on another cycle. Avastin is a major part of his treatment protocol. Unfortunately, that alone tells you a little bit about what he faces. Avastin is primarily used in treating metastatic colorectal cancer, something I hope never to experience.

It seems that a lot of the current research in colorectal cancer studies has to do with metastatic cancer, especially in chemotherapy. One report I read today is an excellent example. It's about Vectibix, a monoclonal antibody that lengthens the time to disease progression or death from 60 days to 96 days. When viewed in terms of percentages, it seems remarkable - a survival time approximately 50% greater than with standard treatments. But when viewed in terms of overall efficacy, it hardly seems worth the effort - 36 more days, days that are probably marked by nausea, fatigue, and the whole host of chemotherapy side effects. But, I suppose when faced by death, having an extra month isn't such a bad proposition.

Cancer patients dealing with chemotherapy are often faced with decisions that cast a twist on that common phrase "choosing your poison". Very often, especially in the case of metastatic disease, the medical oncologists cannot state unequivocally whether one or another treatment regime will produce beneficial results for the individual patient. There are simply too many variables to be sure about the outcome. That means that the decision to participate in a regime becomes a guessing game, one in which the patient has to assume even weightier decisions.

Another recent study from Denmark casts a light on how patients make these kinds of decisions. Normally, when faced with a choice of taking a drug orally or submitting oneself to intravenous therapy, patients will choose the oral medication. But the Danish study indicates that many patients chose to take 5-FU (fluourouracil) and leucovorin intravenously rather than Xeloda orally, primarly because they experienced less toxicity from the standard 5l-FU treatment.

This rings true with me. When faced with a choice between two types of drugs, most cancer patients will choose the one that is less toxic, even if the administration of the drug is less appealing. But when faced with a choice about taking a treatment or doing nothing, most will choose the treatment, no matter how toxic the results. I hope never to have to make choices like that, but my thoughts and prayers are with those like Leroy Sievers who is faced with such decisions regularly.

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