Pills vs. Pump

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katieba
Posts: 1
Joined: Wed May 24, 2017 11:16 am

Pills vs. Pump

Postby katieba » Wed May 24, 2017 11:23 am

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!

Alessandria
Posts: 37
Joined: Wed Apr 06, 2016 3:18 am

Re: Pills vs. Pump

Postby Alessandria » Wed May 24, 2017 1:33 pm

Hi there! I have experience of both pills & pump and I found the pump much easier. I found the capecitabine made my the palms of my hands very sore, and along with the neuropathy from the Oxy it was pretty unpleasant. Plus I think you have to take the pills within a certain time of taking food which required extra thought. The pump was an inconvenience for the 48hrs it was attached, but once disconnected I could forget about it till the next round.
But others may have a different experience...Good luck!

Beckster
Posts: 438
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: Pills vs. Pump

Postby Beckster » Wed May 24, 2017 3:39 pm

Hi

I am on the pill instead of IV 5/FU. If you take Oxi and the pill form of 5/FU, you do not need a port if you choose. I decided not to have a port and good thing I did! I had a reaction to the Oxi on the first infusion and the onc told me I can no longer take it. Many people do not make it all the way through. I now only have to take the pill and see the onc every 3 weeks to check bloodwork. The pill was the right choice for my life style. I start my last cycle on 5/29.

By the way, there are studies that show Xeloda is superior to the IV form because it is absorbed through the intestines.
57/F
DX:(CC) 10/19/16
11/4/16- Lap right hemi(cecum)
CEA- Pre Op (1.9), Pre Chemo (2.5)
Type: Adenocarcinoma
Tumor size:3.5 cm x 2.5 x 0.7 cm
Grade: G3
TNM: T3N0M0/IIA
LN: 0/24
LVI present
Surgical margins: clear
MSS
12/27/2016 - Capeox, anaphylactic
1/2/17 to 6/9/17- Xeloda
6/17,12/17,6/18,12/18,6/19,12/19,12/20,12/21 CT Scan NED :D
CEA- 6/17- 3.6, 9/17- 2.8 12/17-2.8, 3/18-3.1, 6/18-3.0, 9/18 2.8, 12/18 2.5 3/19 3.1 6/19 3.1 9/19 2.6 12/19 2.8 6/20 3.0 12/20 2.7 6/21 2.9,[color=#000000]12/21 2.7[/color]
Clear Colonoscopy 10/17, 11/19,11/21 :D

mozart13
Posts: 158
Joined: Fri Dec 09, 2016 7:38 pm
Location: Toronto

Re: Pills vs. Pump

Postby mozart13 » Wed May 24, 2017 3:58 pm

I was on xeloda pills back in january, combined with radiation, was piece of cake comparing to folfox right now, and it wasnt choice, my oncologist just placed me on it.
Folfox is 5fu plus leucovorin, plus oxilaplatin, all infusion.
Found some studies from Europe that xeloda works better combined with radiation than 5fu infusion, but you know how it goes with studies, all depends who does it.
Right now I wasnt given choice either, my oncologist is younger one, aggresive, open mind, I trust her, she told me just before my third treatment , that some oncologist would stop therapy becease of my lab results, but not her.
Oxilaplatin gets infused together with leucovorin, for couple of hours, than bolus of 5fu, followed by 5fu infusion for 46 hours, its not big dose, only 5400 mg, my xeloda pills dose was 3500 mg /day, so no difference there, about same dose, now to question pills or no pills.

If I could take them all as pills I would, pump is not very convinient, but issue some people have is nausea and vomiting, that would create huge problem if one is on the pills.
Also stomach acid could come as problem with this drugs, pills could create further errosion of stomach liner.
Another issue is that some people need transfussion, picc line or port give eassy access.

Good luck!
Last edited by mozart13 on Wed May 24, 2017 7:37 pm, edited 1 time in total.
55 year at the time of diagnosis, male
Diagnosed with T1,T2 N0 M0 rectal cancer
Total neoadjuvant therapy or TNT (chemoradiation followed by systemic chemotherapy)
Negative since Feb. '17
No surgery
Watch&Wait approach 8)
I don’t come much to the forum , so if this is not updated it means I remain negative!
Wish good luck to all!

weisssoccermom
Posts: 5988
Joined: Thu May 10, 2007 2:32 pm
Location: Pacific NW

Re: Pills vs. Pump

Postby weisssoccermom » Wed May 24, 2017 4:54 pm

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.
Dx 6/22/2006 IIA rectal cancer
6 wks rad/Xeloda -finished 9/06
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 months Xeloda only Dec '06 - April '07
10+ blood clots, 1 DVT 1/07
transanal excision 4/20/07 path-NO CANCER CELLS!
NED now and forever!
Perform random acts of kindness

Beckster
Posts: 438
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: Pills vs. Pump

Postby Beckster » Wed May 24, 2017 6:32 pm

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!



Below is an article that discusses Xeloda vs IV 5/FU... this might help you make a decision

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2409640/
57/F
DX:(CC) 10/19/16
11/4/16- Lap right hemi(cecum)
CEA- Pre Op (1.9), Pre Chemo (2.5)
Type: Adenocarcinoma
Tumor size:3.5 cm x 2.5 x 0.7 cm
Grade: G3
TNM: T3N0M0/IIA
LN: 0/24
LVI present
Surgical margins: clear
MSS
12/27/2016 - Capeox, anaphylactic
1/2/17 to 6/9/17- Xeloda
6/17,12/17,6/18,12/18,6/19,12/19,12/20,12/21 CT Scan NED :D
CEA- 6/17- 3.6, 9/17- 2.8 12/17-2.8, 3/18-3.1, 6/18-3.0, 9/18 2.8, 12/18 2.5 3/19 3.1 6/19 3.1 9/19 2.6 12/19 2.8 6/20 3.0 12/20 2.7 6/21 2.9,[color=#000000]12/21 2.7[/color]
Clear Colonoscopy 10/17, 11/19,11/21 :D

peanut_8
Posts: 2340
Joined: Sun May 25, 2014 1:31 pm

Re: Pills vs. Pump

Postby peanut_8 » Wed May 24, 2017 7:31 pm

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!



Hi katieba,

Here's a link to a thread about differences between XELOX (capecitabine or Xeloda) vs FOLFOX (5-FU)

viewtopic.php?f=1&t=49930

there's some good points you may find interesting

Best Wishes,
peanut
female, diagnosed Jan 14, RC stage 2a, age 56
MSS
April 14, 28 chemo/rad with Xeloda
June 14 adjuvant Xeloda 6 rounds
currently NED

User avatar
horizon
Posts: 1670
Joined: Tue Apr 12, 2011 10:10 pm

Re: Pills vs. Pump

Postby horizon » Wed May 24, 2017 9:43 pm

I knew that with my personality wearing a pump would drive me nuts. I don't regret choosing Xeloda. For others not having to take a massive amount of pills is preferable. It's a personal choice.
I'm just a dude who still can't believe he had a resection and went through chemo (currently 13 years NED). Is this real life?

drebay
Posts: 220
Joined: Thu Mar 20, 2014 5:39 pm
Location: Oregon

Re: Pills vs. Pump

Postby drebay » Thu May 25, 2017 1:24 pm

I didn't sleep much the first nights with the pump. Too loud. I am a very light sleeper though. The 2nd night I was too tired so it was easier.
6/13 Age 45 mom of 11 and 13 yr old DX Stage IV liver mets
7/13 colon surgery
9/13 Folfox
11/13 Xeliri
3/14 more liver mets
4/14 Lung Met
4/14 Liver resect delayed;lung resect done
5/14 Surg not an option
9/14 Stivarga
3/15 Back to IV Chemo
6/15 Avastin
9/15 In Clinical Trial

Emerald
Posts: 51
Joined: Sat Jul 02, 2011 8:09 pm

Re: Pills vs. Pump

Postby Emerald » Fri May 26, 2017 5:04 pm

My dad, at 87 yrs. old, did very well on Xeloda pills (and radiation treatments).
After his morning pills and radiation treatment, we went golfing every day.

I'm glad that he didn't have a pump as it kept his activities normal.
A great success w/treatment and he is still golfing at 94 yrs. old.

I hope that you will make the best decisions for your treatment.

Prayers for you (and to all reading this).

justin case
Posts: 4269
Joined: Sun Sep 04, 2011 8:26 am
Location: Katy, Texas

Re: Pills vs. Pump

Postby justin case » Tue May 30, 2017 7:21 pm

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.

Everything Weissoccermom has said is quite true, although, I don't think I would want OXI mainlined !
7/11 diagnosed Stage 2 colon and rectal cancer
chemo/rad
lar/temp ilio
Reversal & port removal
21 round of chemo Folfox 9tx, 5fu 12 tx
Last treatment July 2012

weisssoccermom
Posts: 5988
Joined: Thu May 10, 2007 2:32 pm
Location: Pacific NW

Re: Pills vs. Pump

Postby weisssoccermom » Tue May 30, 2017 7:45 pm

Let me clarify.... I absolutely HATED my port, it flipped slightly on me and was very uncomfortable. I DID try the oxi via IV and it was PAINFUL so yeah, if I had continued the oxi for a long term, I probably would have had another port put in. It was the PUMP (and yes, the port) that I really hated. The catheter sticking out, the obvious noise, the adhesive on that covering (which I later found out I was allergic to...that was awful as well), that ever present pump with you always and being a pain in the butt to take a shower/sleep/drive with (I would always forget...set the dang pump down on the floor between the seats and then it would pull when I got out of the car....OUCH)...well, I just despised that THING (pump).

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.
Dx 6/22/2006 IIA rectal cancer
6 wks rad/Xeloda -finished 9/06
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 months Xeloda only Dec '06 - April '07
10+ blood clots, 1 DVT 1/07
transanal excision 4/20/07 path-NO CANCER CELLS!
NED now and forever!
Perform random acts of kindness

User avatar
horizon
Posts: 1670
Joined: Tue Apr 12, 2011 10:10 pm

Re: Pills vs. Pump

Postby horizon » Fri Jun 02, 2017 9:09 am

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.


I always would tell the techs to tell me when they were about to insert the needle because my eyes were going to be closed the entire time!
I'm just a dude who still can't believe he had a resection and went through chemo (currently 13 years NED). Is this real life?

recruiter
Posts: 82
Joined: Thu Feb 11, 2016 12:01 pm
Facebook Username: Bill Wilson

Re: Pills vs. Pump

Postby recruiter » Fri Jun 02, 2017 9:21 am

I absolutely hated the pump. I felt like people were staring at me the entire time I wore it. Very self-conscious about it. I wore a jacket over it all last summer, and died from the heat just to keep people from staring.

As for the port ... the surgeon who installed mine didn't do a perfect job. I had a lot of discomfort for about six months, and all they could offer to do about it was take it out and try it again, which I wasn't wild about.

At this point, though, it appears to have shifted a bit and it's not a big deal. I get Avastin through it now while taking Xeloda orally, and it's working out pretty well.
DX Stage 4 2/16 with lung mets
4/16 CT, PET show "marked improvement" in size and number of lung mets, rectal tumor.
8/16 "Great report" from scans, lung mets continue to shrink in size and number, CEA 1.6, cancer "in remission" but surgeon believes tumor remains too large.
10/16 Xrays for constipation problems reveal tumor occupies 25 percent of rectal canal: Occupied 80 percent upon diagnosis 2/16
12/16 Back on Avastin; tumor can be removed, but need better margins.

User avatar
chemo sabe
Posts: 444
Joined: Fri Mar 09, 2012 9:01 pm

Re: Pills vs. Pump

Postby chemo sabe » Sat Jun 03, 2017 6:35 pm

I totally agree with Justin Case on the cost / profit comments. Prescribing pills does not increase the revenue stream at a clinic. So ask your doctor straight out why. remind the doctor you are aware of profit motives. put them on the spot, get the reaction and then you will know.
64 year old male
Diagnosed Stage 3 Rectal Cancer - T3N1M0 - Oct 2011
28 radiation treatments with xeloda
Colon resection with ileostomy Feb 2012
8 Rounds of Xelox completed Sept 2012
Ileostomy reversal surgery Oct 2012
Incisional Hernia Repair Nov 2013


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