Pump vs Pills

[DCB]

I was diagnosed with colon cancer December 2015 at the age of 37. I had surgery to remove tumor and respect my colon. I did 6 months twice a month of Folfox chemo. I finished in July. Oncologist had me get Ct scan and it showed another tumor. Just had another surgery in August. Oncologist wants me to now do 6 months of Folfiri but gave me option of Xeliri because I was upset to have to deal with a pump again as it was very inconvenient I am wondering if anyone has taken the pill version Capecitabine instead of the 5FU pump or has an opinion if one is better then the other. I would really like to go with the pill version.

[horizon]

When I was given the choice between Xelox and Folfox I asked which one was better. I was told if one performed better I wouldn't be given a choice. I knew with my personality that a pump would drive me nuts so I went the pill route. It was the right decision for me.

[WarriorSpouse]

My wife had the same decision to make because she is stage IV and is on chemo for life. After a year of Folfox and Avastin she is now on Xeloda pills for two weeks on and one week off (along with Avastin at the beginning of the treatment week). We hear that Folfox and Xeloda are pretty much the same for effect of tamping the cancer down, but with pills you get to lose the pump.

The biggest change we see are the hand and foot side effects of the pills. She always needs creams to keep her skin feeling better and has to remember to stay hydrated. Her dosage was reduced due to these side effects, but since then she prefers the pills over the pump for normalcy purposes.

[H is for Hawk]

Out of pocket costs could vary between the two. The pump is generally covered by your out patient hospitalizations plan. For pharmaceutical insurance plans, Unless you have a high end plan ( Union type), the copays for the pills could be a significant expense.

Some patients with liver lesions specifically ask for the pills, the thought here being the Xeloda pill is metabolized by the liver, and would provide a greater concentration of 5FU to the liver tumors.

[DCB]

Thank you for all the input. I will take this all into consideration to make my decision. I greatly appreciate the info.

[LeonW]

Some patients with liver lesions specifically ask for the pills, the thought here being the Xeloda pill is metabolized by the liver, and would provide a greater concentration of 5FU to the liver tumors.

Not to hijack the pump vs pills discussion . . . Very interesting . . . Can you elaborate on this? . .

On pills vs pump discussion:
I had pills, not my choice, pills+avastine was the only way forward that was discussed. Onc said she wanted to be as aggressive as possible and came with Capox+Avastin. With great results.

Although I have no experience with the pump, I believe I'd taken the pills anyhow. I feel that being hooked up to a pump for an extended period of time would have meant loosing even more independency. Would have hated to live 'hooked up' for an extended period of time. Did have serious (and still have some) neuropath effects though.

Whatever you choose, I wish you best results
L

[peanut_8]

Out of pocket costs could vary between the two. The pump is generally covered by your out patient hospitalizations plan. For pharmaceutical insurance plans, Unless you have a high end plan ( Union type), the copays for the pills could be a significant expense.

Some patients with liver lesions specifically ask for the pills, the thought here being the Xeloda pill is metabolized by the liver, and would provide a greater concentration of 5FU to the liver tumors.

Just a point of reference here. I took the generic form of Xeloda for adjuvant treatment, capecitabine, so my monthly co-pay was $15. I certainly wouldn't consider my insurance plan a high end, union type plan. Of course, it wouldn't hurt checking with you insurance company to see what coverage you have.

Best Wishes, peanut

[betsydoglover]

I have always used Xeloda. My onc prefers it and I certainly like the lack of pump. It is just as effective as 5FU - there are occasional studies that show it to be somewhat more effective. The effectiveness does not seem to be an issue.

With insurance there is a copay - mine was only $30 / copay. Now that I am on Medicare, it would be covered as a chemo treatment at 100%.

[DCB]

All very helpful. The pump was just such an inconvenience to deal with...wearing it to work, not wanting to go anywhere for two days with it on, having to go home to get disconnected, not being able to shower with it. I'm 95% sure I will opt for the pills.

[ktwmn]

I know this thread is over a month old. However, I am currently prescribed xeloda (my pump was removed due to migration of the catheter to azygos vein). My co-pay for capecitabine (generic form) is $100. Apparently BCBS does not cover it. It gets delivered via fedex from a company in Florida. Are there any other financial alternatives out there? $100 co-pay every 3 weeks seems rather high.

[CRguy]

When I had it, Roche had a patient support program which would cover some part of their brand "Xeloda"
... BUTT not sure about generics now ???? ( there was NO generic available when I took Xeloda )
... OR specific payment issues within the US medical health care system ?????

My condolences that you are also dealing with " SCREWED BLUE cross " which is who I had to deal with up here.
Worst company in health care IMO.

AND even with Roche support ( they paid about $700 total ) I still paid over $3500 or so out of pocket ...

We have some more experienced folks here who HAVE navigated the US system and hopefully they can chime in for you

Best wishes
CRguy

[Nik Colon]

When I had it, Roche had a patient support program which would cover some part of their brand "Xeloda"
... BUTT not sure about generics now ???? ( there was NO generic available when I took Xeloda )
... OR specific payment issues within the US medical health care system ?????

My condolences that you are also dealing with " SCREWED BLUE cross " which is who I had to deal with up here.
Worst company in health care IMO.

AND even with Roche support ( they paid about $700 total ) I still paid over $3500 or so out of pocket ...

We have some more experienced folks here who HAVE navigated the US system and hopefully they can chime in for you

Best wishes
CRguy

We have BCBS and they have been great, but then again, I had the pump (which I didn't mind at all, and knowing of the hfs, I would try the pill, but if issues with it, I would gladly go back to the pump). Also, another complaint people have with the pump is going back in for disco. My insurance (bcbs) paid to have a nurse come to my home...aka my disco nurse

[ktwmn]

Yes, BCBS was fine for covering infusions (after paying out of pocket max of $4K). But xeloda/capecitabine is not on the list of covered drugs. After my experience with my last port migrating I do not want port #3. I am in limbo right now (waiting to see if I qualify for an immuno trial) so in the meantime I am taking xeloda.

[ab123]

I wasn't given a choice to take pills, so my experience was with the pump. I used this thing that was a HUGE lifesaver in terms of living with the pump comfortably:

http://poppypocket.net/

I slept with it on and was able to roll around without getting caught up in the tubing, and it also made it easy to conceal the pump under my shirt. Super comfy and easy.