katieba wrote:I have stage IIIA colon cancer and am starting chemotherapy in 2 weeks. I am trying to decide between taking 5-FU via a pump (over 2 days every 2 weeks) or Capecitabine via pills (5 days a week). I'll have a port either way to get the Oxaliplatin. I saw two oncologists, one who recommended the 5-FU and was against using the Capecitabine and another who gave me a choice between the two and said both are equally effective (this is the oncologist I'm using). I have two young kids, so the pills seem preferable, but I'm worried since the one oncologist was against using them. I'd appreciate any insight!
katieba wrote:I have stage IIIA colon cancer and am starting chemotherapy in 2 weeks. I am trying to decide between taking 5-FU via a pump (over 2 days every 2 weeks) or Capecitabine via pills (5 days a week). I'll have a port either way to get the Oxaliplatin. I saw two oncologists, one who recommended the 5-FU and was against using the Capecitabine and another who gave me a choice between the two and said both are equally effective (this is the oncologist I'm using). I have two young kids, so the pills seem preferable, but I'm worried since the one oncologist was against using them. I'd appreciate any insight!
weisssoccermom wrote:This has been a debate for almost the entire ten years that I have been on this board. There ARE some reasons why an oncologist wouldn't want to give a patient Xeloda over 5FU.
1. The patient won't comply with taking the pill either because the patient won't remember or will refuse.
2. A patient can't swallow pills
3. A patient simply doesn't want to be bothered remembering to take the pills
That being said, there are oncologists who, for monetary reasons, don't want to Rx the pills.....simply because they don't have a monetary stake in this drug. When the patient takes infused 5FU, the drug is given in the doctor's office and that office has total and complete control over how much is charged to the insurance company. Note that infused 5FU is INEXPENSIVE yet the cost charged to one's insurance company is NOT the price the doctor paid for the drug. Let me clarify that I am NOT a conspiracy theorist....but even as long ago as 2006/2007 when I faced this same decision, my onc flat out told me that this was a huge discussion at oncology conventions that he frequented. Other people on this very forum had/have heard the same things from their oncs as well so it IS worth keeping that possibility in the back of your mind.
Every study that I have seen hasn't shown there to be any statistical difference between the two....and most studies show a minimal (statistically not significant) advantage to the Xeloda. However, each has its own drawbacks. Overall, studies seem to indicate that Xeloda is better tolerated than 5FU BUT....there are exceptions. The hand/foot syndrome tends to be more severe (if a patient gets it....I never did) with the Xeloda and the GI and other issues tend to be better with the Xeloda. Keep in mind that systemic chemo, such as the pump, affects ALL your body's tissues, not just the tumor. In addition, in order to make the infused 5FU remain in the body longer, another drug called leucovorin is added to the 'cocktail'. While the leucovorin is technically NOT chemo, it IS the drug that exacerbates the side effects of the infused 5FU.
There are drawbacks to both drugs. For me, the pump was horrible. I just HATED that thing (had it 24/7 during a part of my radiation....switched to Xeloda during my rad treatments). It was awkward, was always there with me, was a pain in the neck to carry around with you and, IMO, was always in the way. I despised that pump. Now, maybe it would have been different had it been for the 48 hours after the initial infusion but, in addition to the pain in the butt it was, I also hated the way it made me feel emotionally. When you are attached to that pump, you don't forget that you are sick.....it's with you constantly. In addition, I can only give you my experience, but when I was using the pump, I was more emotional, cried more often, felt more fatigue and overall, was just plain miserable. When I switched to the pill, I felt like I had taken back some amount of CONTROL....something a cancer patient loses when they are diagnosed. The physical, fatigue and emotional issues were all drastically different on the pill as well. I wasn't as tired and because I felt somewhat more in control, I felt emotionally a ton better. As I said earlier, I never had any hand/foot issues but then again, I was super proactive about protecting my hands/feet and didn't allow any problems to materialize.
Yeah, taking the pill is something you have to get used to....you have to remember to take it with breakfast and dinner (and no, it's not that big of a deal if the meals aren't 12 hours apart....seriously, whose are??) but you get used to it if that's what you want to do. You DO have to take it with food and you should be careful about eating too much carbs while on Xeloda. Other than that, I had no issues with the pills and if I had to do it again, there is NO way that I would pick the pump EVER over the pills. You have to consider your lifestyle as well. With young kiddos, the pills may be a lot easier for you....nothing to get tangled in, no needles, etc. In addition, most people have to go back to the clinic two days after the infusion for pump removal....which, IMO, would be a huge negative! Whatever route YOU choose has to be what YOU are comfortable with. I can give you my opinions, but your situation may be different. Trust your own instincts.....and do what you feel is best for you, your kids and your family.
weisssoccermom wrote:I have to be honest...in addition to hating the port, I had a HUGE problem with getting my blood drawn from it. It just gave me the CREEPS. Watching my blood come out of my arm...no big deal but watching my blood come out of my chest....right over the area where my heart is....there was just something about it for me that was just plain NASTY. It really bugged me...so much so that I told them to STOP drawing my blood from it...it just bothered me that much.
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