Prolonged/Delayed Reactions to Capox

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kjeffers
Posts: 2
Joined: Mon Dec 04, 2017 6:09 pm

Prolonged/Delayed Reactions to Capox

Postby kjeffers » Mon Dec 04, 2017 6:19 pm

Hi,

My mother was diagnosed with rectal cancer in April 2017. She did 6 weeks of chemo/radiation with Xeloda and managed that ok. She then had her LAR surgery in August with a temporary ileostomy. She started her 1st round of adjuvant chemo on Nov. 6th. She had an infusion of oxailplatin and capcetiabine pills. She seemed to be managing that ok, but she started to feel very weak and nauseous towards the end of her 2 weeks with the xeloda pills. She was admitted to the hospital for dehydration on Nov. 22 and has been there ever since. She's not getting any better. They are trying to manager her nausea, and keep her hydrated. Her kidney function is off. She's hardly eating and drinking and now is refusing medicine. She is too weak to even stand at this point. The output from her ileostomy is huge, so they think that her gut has failed. I honestly don't know how so much is coming out when she has hardly put in anything in 2 weeks. Today, they inserted a PICC line for TPN. She is basically wasting away and I'm so scared. They tested the stool for C-diff, and that came back ok. Her blood counts are ok. They scanned her head and chest and found nothing. They won't scan her abdomen because they don't want to use the contrast for the CT scan because of her kidney function. So, my question is has anyone had this sort of delayed response to capox? All of the doctors say that this is a pretty well tolerated regime and this is really rare. I just don't know what more I can do, but I know that I need her to keep fighting. I'm not ready to lose her.

Also, it's clear that she is depressed, but she won't admit it. How can you help someone with that? I figure some of you may have been in this situation before and could offer advice.

Aqx99
Posts: 280
Joined: Fri Mar 31, 2017 7:28 am
Facebook Username: aqx99
Location: Pfafftown, NC

Re: Prolonged/Delayed Reactions to Capox

Postby Aqx99 » Mon Dec 04, 2017 6:42 pm

Make sure her oncologist is aware of this. They may want to decrease her doses. As for the depression, I suggest you find out if there is an oncology counselor available at her cancer center. She would have to agree to go, of course. I have been seeing the one at my cancer center for a couple of months and it has made a world of difference.
Anne, 40
Stage IIIB Rectal Cancer
T3N1bM0
2/21/17 Diagnosis, Age 39
2/21/17 CEA 0.9 ng/mL (Siemens Chemiluminescent Method)
3/23/17 - 5/2/17 Chemoradiation, 28 treatments
6/14/17 Robotic LAR w/ temp loop ileostomy, ovaries & fallopian tubes removed, 2/21 lymph nodes positive
7/24/17 - 12/18/17 CapeOx, 6 Cycles
7/24/17 Diagnosed w/ precursor ovarian cancer
9/6/17 CA 125 11.1 U/mL
11/27/17 CEA 2.6 ng/mL (Roche ECLIA Method)
12/5/17 CT showed NED
12/13/17 CEA 2.9 ng/mL (Roche ECLIA Method)
1/23/18 Reversal

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O Stoma Mia
Posts: 924
Joined: Sat Jun 22, 2013 6:29 am

Re: Prolonged/Delayed Reactions to Capox

Postby O Stoma Mia » Tue Dec 05, 2017 4:49 am

kjeffers wrote:... So, my question is has anyone had this sort of delayed response to capox? ... I figure some of you may have been in this situation before and could offer advice.

I'm sorry that this is happening to your mother.

Yes, this sort of thing happened to me after the fourth infusion of Capox. It was due to a rare kind of septicemia called Pseudomonas aeroginosa.

There are two kinds of bacteria that can cause this kind of problem. One kind is of type "gram negative" while the other is of type "gram positive". They require two very different kinds of test, and for one type they need to let the culture mature for over a week before they can determine whether or not the bacteria is present. Sometimes it's not enough to just test for C-diff with only a stool test. They have to test for all of the possible kinds of problems and use the appropriate kinds of tests for each. They may have to test different kinds of body fluids, e.g., urine, saliva, blood, cerebrospinal fluid, etc. Note. C-diff is a gram positive bacteria for which metronidazole (Flagyl) is the antibiotic of preference, but Pseudomonas aeroginosa is a gram-negative bacteria for which metronadazole (Flagyl) is next to useless.

Also, it may not be good enough to use only a PICC line for TPN. In my case, I had to have a central line port installed because the peripheral IV lines were too narrow to handle the thick, viscous TPN solutions. A central line port has a wider diameter and the viscous protein TPN can flow more smoothly there.

The bowel condition you are referring to is called 'paralytic ileus'. You can find out more about it on the Internet

As for your mother's dramatic loss in weight, you should check to see what her current Body Mass Index (BMI) is, because if it gets below 18.5 then it is in the cachexia danger zone:
http://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=46365&p=340274#p340274
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Useful Links:

How to Create a Signature
https://coloncancersupport.colonclub.co ... 97#p421597

How to Find a Board-Certified Surgeon
viewtopic.php?f=1&t=52349&p=410280#p410280

How to interpret a Pathology Report
viewtopic.php?f=1&t=51436&p=399172#p399172

Understanding TNM Staging
http://www.cancer.net/cancer-types/colo ... cer/stages

kjeffers
Posts: 2
Joined: Mon Dec 04, 2017 6:09 pm

Re: Prolonged/Delayed Reactions to Capox

Postby kjeffers » Tue Dec 05, 2017 7:23 pm

Thank you both for your replies. Her oncologist has been seeing her daily in the hospital. I will definitely mention the things you brought up. It's so difficult seeing her this way. It almost seems as if it is a guessing game of what is going to work to try to calm her symptoms. She is so sensitive to medicines, so when they load her up with 6 different ones at a time, it doesn't sit well with her.

I'll talk with the doctors in the morning and see what they say about these things.

Thanks again.


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