Which chemo?

[healingintent]

Hi everyone,

This is my first post. Thanks for this forum - it seems like a really good place for support and sharing. My wife was diagnosed a few months ago, had a resection and now being given chemo options (Stage 3a). The Onc is pushing for a (1) PICCline with the 5FU + Oyx combo (Folfox). The other option is (2) 5Fu + Folinic Acid as pills I think. The IV delivery option not being pushed is the PORT as is has about a 5 weeks waiting time for surgery - is that your experience?

It's been a lot of information to digest but my wife isn't sure which to go for (she doesn't like the idea of the PICCline). We were told (1) is slightly more effective (+5%), but lots more potential side-effects. Also need to take into account much more travelling each week (4hr round trip) to have the 3hr IV session (weeks 1,3 etc) and then the dressing change (week 2, 4). Just wondering on people's own views on this? Some people have said just go for the highest dose/best outcome option which is (2). I am still having issues with the whole idea of chemo, but we've not been told any other options.

Thanks for your feedback and experiences.

[O Stoma Mia]

... The other option is (2) 5Fu + Folinic Acid as pills I think...

Hi healingintent, would you be able to clarify what your Option #2 is? What is the name of the product, how often is it to be administered and for how long? Is it Xeloda that they are talking about?

[cashmere]

Hi healingintent,

If it were me, I would schedule a port install, but start chemo as they suggest with a PICC line as I would not want to put off chemo for 5 weeks. Although I had a port placed before I started chemo, I have heard the PICC line is a tough delivery and I believe would be more inconvenient.

Good luck with everything, Pearl

[NWgirl]

Ditto what cashmere said - just get the chemo started. I've heard the oxaliplatin can be rough getting it through an IV (Picc); but I don't have personal experience with it. Life will be much easier once she gets the port and can have chemo through the port.

[Bob_Weiss]

The standard post-surgical options usually offered to Stage 3 cases are:

Folfox- (Infused 5FU+Leucovarin+Oxy)
Infused 5FU+Leucovarin
Xeloda(pill)+Oxy
Xeloda

The major symptoms for most people develop from the Oxy, but the addition of this drug adds slightly to the treatment effect. Xeloda is the way to prevent the need for infusions, and the treatment value seems to be comparable to infused 5FU. I chose the Xeloda only option, and so far am pleased with the results.

[healingintent]

Thanks everyone. Just to confirm - the option are:

1) Xeloda (pill) - 2 weeks on, 1 week rest
2) FFOX - Flourouracil, Folinic Acid, Oxaliplatin - Day 1 is infusion at hospital (3 hrs), then 48 hrs with a pump at home, then 11 days rest

The things I am trying to work out are:

PORT

1) We didn't get much info about the PORT other than "it involves surgery" and "there's a 5 week wait". In reality what is involved?
2) Does it require a general anesthetic, or is it a local around where it is inserted.
3) How big it the part itself?
4) Is it something you can do at home or requires a hospital visit for infusion?
5) Would it likely be the same schedule as the PICCline

PICCline

There seems to be a lot of things that need to be done with the PICCline - like dressing change every week, potential for the line to move (and a-rays needed to confirm this), issuing with showering (i.e. can't get it wet).

1) Has anyone had one?
2) When you say "problems with delivery, do you mean (i) it is uncomfortable or (ii) the IV isn't very effective at getting the chemo into the system?
3) What was the experience like?

Thanks so much everyone

[CRguy]

just a quick reply here, will try to check in later, regarding PICC versus ports.
If in Canada ( Cowtown ??? ) check out this topic for more info.
viewtopic.php?f=1&t=30535

My own choice would be :
PICC = NO
power port = YES, but you may have to push for it in some places.
if Xeloda only is an option I would certainly look at that ( BTDT ) or Xelox with Oxy infusion as second choice for patient preference .... I have no idea which would be the best chemo for your wife's own medical situation.

Cheers from BC
CRguy

[justin case]

In some instances(most), you can take the pill form of 5 FU, Xeloda, If your oncologist wants Oxiloplatin in your treatment plan, a PICC line or port, may be recommended. I have friends who have been on the PICC line with no problems. I chose the port for ease of maintenance.
Regards,
Michael

[Voxx66]

What country are you being treated in? I was told I needed a port Monday and the surgery was scheduled for that Thursday - tomorrow actually. (I live in the US - St. Louis Missouri btw) I wasn't offered a picc line and in reading about it I can see why. I think the port is probably the way to go if possible.

[chemo sabe]

I don't know where you are, but here on the east coast of the US, my surgeon installed that port a few days after my Onc ordered it (just like vox66 said). I was mildly under but the whole procedure was very short. I spent more time waiting. The port itself is perhaps a 1/2 inch or so diameter disk that is perhaps 1/8 inches thick. A plastic tube runs away from it and is inserted into a large vein that goes to your heart. You could see the outline of the port under my skin. It hurt for a day or two after the install but then it was unnoticeable. The outer side of the disk (where they put the needle) is a self healing membrane and the back side is titanium.

[healingintent]

Thanks for the info on the PORT. It doesn't sound quite as bad as I expected. We're in Canada and I guess every hospital is different in terms of waiting times. I also think a PICC might be pushed as it must be far cheaper. I also heard today that PORTs take longer at the moment as August is holiday season, so things can get backed up a bit. Good to hear that some people have had no problems with PICCs. They do sound more hassle, but the nurse mentioned today that they are designed to last the full course. They said they are taped down well when not in use and also something about a sleeve that can go over them.

[Lena]

I would have to agree. Schedule for a power port and use the PICC line for chemo until you can get the port placed. Five weeks is too long to wait for treatment.

Please keep us posted, and best of luck for you!

Lena

[O Stoma Mia]

Thanks everyone. Just to confirm - the options are:

1) Xeloda (pill) - 2 weeks on, 1 week rest
2) FFOX - Flourouracil, Folinic Acid, Oxaliplatin - Day 1 is infusion at hospital (3 hrs), then 48 hrs with a pump at home, then 11 days rest

Hi healingintent - Have you decided which chemo option and which delivery option you will go with? In case you want to compare, here are links to side effects involved in the two regimens (XELODA vs. FOLFOX):

XELODA (pill)
Xeloda side effects
http://cancerinfo.cancer.iu.edu/cancerportal/public/treatment/Capecitabine.php#5
http://www.drugs.com/sfx/xeloda-side-effects.html
http://chemocare.com/chemotherapy/drug-info/Xeloda.aspx

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FOL-F-OX (infusion)
FOL - Folinic acid (Leucovorin) side effects
http://cancerinfo.cancer.iu.edu/cancerportal/public/treatment/Leucovorin.php#5
http://www.drugs.com/sfx/leucovorin-side-effects.html
http://chemocare.com/chemotherapy/drug-info/Leucovorin.aspx


F – Fluorouracil (5-FU) side effects
http://cancerinfo.cancer.iu.edu/cancerportal/public/treatment/5-Fluorouracil.php#5
http://www.drugs.com/sfx/fluorouracil-side-effects.html
http://chemocare.com/chemotherapy/drug-info/fluorouracil.aspx


OX - Oxaliplatin side effects
http://cancerinfo.cancer.iu.edu/cancerportal/public/treatment/Oxaliplatin.php#5
http://www.drugs.com/sfx/oxaliplatin-side-effects.html
http://chemocare.com/chemotherapy/drug-info/Oxaliplatin.aspx

[mstults]

I had my port installed one month after resection and had a treatment the same day. I was sedated. I wouldn't want to be awake during the procedure. If you have it within a couple days of when your treatments start the surgeon that installs it can leave a needle in it to allow access when the treatment is given. That keeps them from having to press on it before it to access it before it is healed. Mine was only a bit sore. In fact I've had 2 and neither one was sore. Get all that going ASAP.