Best adjuvent plan for stage IIB

[Sontryingtohelp]

Any thoughts on going for port and 5fu with oxi, OR Zeloda alone OR 5fu alone for t4n0m0 After successful surgical resection in an 81 year old woman? Oncologist recommending adjuvent treatment but my mother is obviously concerned about the side effects and risks of all, especially Oxi as we are too. Maybe too much for an 81 year old? Thanks.

[Jachut]

Wow, yes I was T3N0M0 which of course makes a difference but really, the main reason I had the adjuvent treatment (which was 5FU/Leucovorin weekly) was simply due to my age - 42 at the time. It was considered not to add an awful lot in terms of chances of survival but that given I was young, worth the side effects if there were going to be any - no oxi though, so I wasnt considering that. As it was chemo cause me multiple bowel obstructions and I stopped a bit early. For an 81 year old with no lymph node involvement, I would imagine its certainly valid to consider NOT having any post operative chemo. 5FU alone was really pretty gentle on my though, it was just the darn bowel issue - and I had an ileostomy at the time - but otherwise it was pretty easy to take, mild nausea easily controlled with Zofran, and little else. The main thing I notice now though is I still have chemo brain, I really have struggled with being vague, losing stuff, not being able to remember things, not being able to find the right word for something etc.

[SkiFletch]

If I was 81, I wouldn't even bother with the Oxali. I'd consider TRYING the 5FU though.

[RixInPhx]

Xeloda pills would be more convenient, but they MUST be taken at 12-hr intervals, about 1/2 hour after eating.
Many seniors have great difficulty following such a rigorous schedule with meds.

[justin case]

I'm on 5Fu weekly. I get 5FU for 6 weeks, off for 2 weeks, then 6 more weeks and done. I can't remember the exact specifics of another regimen, I was offered, but I think it was this. 5FU for 5 days, off for 2 weeks, then 5FU for5days, and done. I didn't take this regimen, as I had been off work for 9 weeks, and I really needed to instigate some cash flow. I would talk to your oncologist, as he or she would be more qualified to answer this question.
By the way, on the regimen I am on, I personally have not had much in the way of side effects, also I have already done the equivalent of 9 treatments of FOLFOX, before surgery.
Regards,
Michael

[AngieN]

I was also t4n0m0 and I'm 55 years old. I started treatment with the Oxi/5fu and did 9 treatments that was with minimal side effects - so I thought at the time! I did develop DVT's in my arm after treatment 1 and have been on Coumadin ever since. Had another port malfunction at the end of #9, and then went on Xeloda pills alone. The Oxi neuropathy hit me hard, but not until AFTER it was discontinued. It's been nearly 2 months and I've got numbness in my feet all the way up my calves as well as my hands. I find that my balance is off and I'm unsteady on my feet.

I personally wouldn't go the Oxi route with someone 81 years young as they are more prone to falling and breaking bones. The Xeloda pills alone might be a better option if the person is able to keep track and take them as directed. I've found them MUCH easier to deal with than the IV infusion was, and way less stressful mentally. Good luck!

[Slug]

My wife was also staged T4N0M0 at 48
She did the full folfox regimen and after about round 7 she started getting neuropathy, and the oxi was reduced by 50% for the last 2 rounds
other than the neuropathy, and fatigue for about 2 or 3 days during the treatment, the side effects were not very bad...but now close to 7 months fater her last chemo, the neuropathy is still with her and has not improved...

[waw4]

I think y'all are correct to be concerned about the side effects and risks of all and at 81 and a stage IIB would be tempted to decline the chemo altogether (both oxy & 5FU).

Maybe you could discuss an alternative monitoring system.

[Kathryn in MN]

Not a medical professional - this is only my personal opinion after having done FOLFOX and having issues with it. I was only age 47, and otherwise very healthy, and FOLFOX almost killed me. I have had the discussion with my family that if I were older and had already raised my children and met my grandchildren, I absolutely would not do FOLFOX, and probably would not do any chemo - just surgery.

I would suggest talking with her oncologist and asking for the actual benefit of adjuvent chemo for her staging, and see if she really feels it is worth the risk. I might also go for a second opinion to another oncologist. I realize that some 81 year olds are in fantastic physical shape compared to others. My own grandmother is turning 100 in a couple weeks, and is still in pretty good health - she was doing great at 81. But chemo really affects quality of life, and especially Oxaliplatin can affect quality of life permanently - not just for the treatment duration. You really have to weigh the risks and possible benefits and decide on an individual basis. After watching what I went through, my own mother who is 72 said that she would not do chemo if she were dx'd with cancer now. She would do surgery, but no chemo at this point in her life. But she also said that at my age and with children to finish raising, that puts a whole different spin on things, and she would do it.

Also, if your mother does decide to do 5-FU or Xeloda she could try it and if it is too hard on her, she could stop. There is no rule that says if you agree to do it that you have to finish any specific number of tx. (I really am surprised if any oncologist would suggest Oxaliplatin for stage IIB at age 81, and would personally dismiss that idea. Just my opinion, but I know it is my oncologist's opinion too from conversations we have had.)

[Sontryingtohelp]

Thanks very much for your input. I do think she is going to get a second opinion as she is young for her age but we recognize the risks and want to thnk about quality of life going forward. Your support is appreciated. Another question- how long can one wait before starting adjuvent therapy and how long is to long?

[pog451]

Xeloda pills would be more convenient, but they MUST be taken at 12-hr intervals, about 1/2 hour after eating.
Many seniors have great difficulty following such a rigorous schedule with meds.

Ermm, no they mustnt. Its not that bad. I take mine twice a day after meals and the meals bit is just to reduce possible digestive issues, not to increase/decrease effectiveness. Sometimes its 10 mins, sometimes its 40 mins. Its generalöly approx 12 hours, but I dont stress about that and its often only 10 hours am to pm.

One thiong about Xeloda - If you get on with it its a MASSIVE advantage in life quality not having to trundle into the hospital every three weeks.

[Olivia]

My mother was diagnosed with colorectal cancer at 81 in July '09. She was a type 2 diabetic on metformin as well as a low dose of meds for high blood pressure. She underwent a sigmoid resection and after a few weeks of healing began Folfox. She tolerated it pretty well: only a little nausea, but not enough to take additional meds for. When she had the tell-tale signs of neuropathy her Oxi was reduced. Now, after 3 years, she still has some lessening of sensation in her feet and toes, but not enough to keep her from putting metal to the pedal when she gets behind the wheel of her car!
We thought getting Folfox with clinic infusion and disconnect from the pump was the better option for her as she could be checked more often by the pros. Since she lives alone I worried that if she was taking the Xeloda pills she might not be so timely and compliant with the regimen.
Just our experience........