Mop up chemo - Port vs non-port for Oxi?

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sinewaves
Posts: 11
Joined: Tue Dec 18, 2018 9:44 am

Mop up chemo - Port vs non-port for Oxi?

Postby sinewaves » Tue Jun 11, 2019 12:11 pm

I am going in to talk to my oncologist about my mop up chemo, which will be the XELOX regime.

One of the questions he asked last time was about a port - I had just finished my APR and wasn't looking for any more surgeries, so I said I didn't need one. However, in searching this board, I found a lot of people saying infusions without the port are terrible.

Is that the general consensus? What're the things that make the infusions without the port bad? Is it pain, or something else?

Thanks in advance!
DX @ 37, married, no children
11/2018 - Dx "MALIGNANT NEOPLASM of DISTAL RECTUM", greater than 3cm at the dentate line Rectal Cancer (Stage 3a, T3N1M0)
1/7/ - 2/14/2019 - Radiation + Xeloda (4,000 mg per day - 4 pills in morning and evening) - 28 days
4/16/2019 - MRI shows no lymph nodes, reduced to stage 2
4/26/2019 - APR surgery, removed rectum. Permanent colostomy.

Claudine
Posts: 52
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: Mop up chemo - Port vs non-port for Oxi?

Postby Claudine » Tue Jun 11, 2019 12:25 pm

Hey there Sinewave,

My husband had 6 cycles of Xelox last year. For the first one, he didn't have a port and got the Oxaliplatin directly infused into his left arm. It was pure torture, so he got a port implanted for the next 5, which made the process a lot less traumatic! Basically during the infusion his arm grew extremely painful (and he's not super sensitive to pain), and it remained so for several weeks afterwards. Based on his experience I'd say get a port!
Wife of Dx 04/18 (51 yrs old then). MSS, KRAS mutated G12A
No primary found, lytic tumor L4 vertebrae, CEA 10
Radiation 04/18
Resection small intestine 05/18 (activity on PET scan, but no cancer found)
Xelox * 6, 05/17 to 10/18
6.7 cm hypermetabolic left adrenal mass 03/14, 4.4 cm 05/21
SBRT L4 02/19
Folfiri + Avastin
CEA 58 03/15, 17 03/29, 10 04/12, 6.4 04/26, 5 05/10, 4.8 05/23, 4.2 06/07
Scan 05/21: Multiple small lung nodules shrinking or stable compared to 03/14 scan.

mpbser
Posts: 905
Joined: Wed Apr 19, 2017 11:52 am

Re: Mop up chemo - Port vs non-port for Oxi?

Postby mpbser » Tue Jun 11, 2019 1:21 pm

The chemo through a IV (PICC line) is supposed to be terrible on the blood vessels. My husband wrestled with the idea of a port. He really did not like the idea of it, made it feel like he was a cancer patient, and at that time he was having a hard time accepting the reality. So many people recommended against doing the chemo through IV/PICC line, fellow cancer patients and medical providers alike, that he went with the port. It was the right decision, I believe.
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
lymph nodes: 9 of 96
CEA: 2.9 to 2.2
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry Normal
Tumor: MTOR, APC, TP53
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI shows 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly hemorrhaged to death
6/10/19 5FU

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susie0915
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Location: Michigan

Re: Mop up chemo - Port vs non-port for Oxi?

Postby susie0915 » Tue Jun 11, 2019 1:43 pm

I did six rounds of Xelox without a port. I also didn't want another procedure. After my resection 4 weeks later was in the hospital with a bowel blockage and had to have surgery to remove scar tissue and also had my ileo reversed at the same time. I was in the hospital for 3 1/2 weeks so I asked my oncologist if I could try without a port. I figured it was only 6 rounds and if it was horrible I could get a port. The infusions on Xelox are every 3 weeks so you do have an extra week for your veins to recover, whereas folfox is every 2 weeks I believe. I did fine, just be sure you stay hydrated as it does make it easier to access your veins.
58 yrs old Dx @ 55
5/15 DX T3N0MO
6/15 5 wks chemo/rad
7/15 sigmoidoscopy/only scar tissue left
8/15 Pet scan NED
9/15 LAR
0/24 nodes
10/15 Bowel blockage. surgery,early ileo rev, c-diff inf :(
12/15 6 rds of xelox
5/16 Clear CT lung scarring/inflammation
9/16 clear colonoscopy
4/17 CT 4mm lung nod
7/17 no change lung nod
10/17 Clear pel/abd CT
11/17 CEA<.5
1/18 CT/Lung no change in 4mm nodule
5/18 CEA<.5, clear CT pel/abd/lung nod no change
11/18 CEA .6
5/19 CT NED, CEA <.5

Green Tea
Posts: 187
Joined: Mon Oct 24, 2016 10:48 am

Re: Mop up chemo - Port vs non-port for Oxi?

Postby Green Tea » Tue Jun 11, 2019 1:45 pm

I would choose a port, if given the choice. There are different kinds of ports. Some can be used also for other purposes, like blood draws for blood tests, or for antibiotic administration, or for infusions for Total Parenteral Nutrition (TPN) whenever necessary. Ask what kinds of ports they have available at your hospital:

https://www.mskcc.org/cancer-care/patient-education/your-implanted-port

Good luck on your infusions and your Xelox regimen! Xelox is not easy -- that's for sure -- but it's doable.

Claudine
Posts: 52
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: Mop up chemo - Port vs non-port for Oxi?

Postby Claudine » Tue Jun 11, 2019 1:55 pm

If you're on the fence, maybe go without a port for the first infusion and see how it goes? Like Susie0915 said, you get 3 weeks between infusions, which is enough time to get a port inserted should you react strongly to direct vain infusion.
Wife of Dx 04/18 (51 yrs old then). MSS, KRAS mutated G12A
No primary found, lytic tumor L4 vertebrae, CEA 10
Radiation 04/18
Resection small intestine 05/18 (activity on PET scan, but no cancer found)
Xelox * 6, 05/17 to 10/18
6.7 cm hypermetabolic left adrenal mass 03/14, 4.4 cm 05/21
SBRT L4 02/19
Folfiri + Avastin
CEA 58 03/15, 17 03/29, 10 04/12, 6.4 04/26, 5 05/10, 4.8 05/23, 4.2 06/07
Scan 05/21: Multiple small lung nodules shrinking or stable compared to 03/14 scan.

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Jack&KatiesMommy
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Location: Columbus, OH

Re: Mop up chemo - Port vs non-port for Oxi?

Postby Jack&KatiesMommy » Tue Jun 11, 2019 3:50 pm

I did six rounds without a port. I did not have any issue at all. I did it in my arm at inside the elbow joint.

Cynthia
Cynthia
Mommy to Jack (8) now (16) and Katie (4) now (12)
(My Most Precious Things)
Dx 8/11 Stage IV CRC (liver mets) CEA 2,600+
9/11 Folfiri 2/12: Failed Liver Resection
5/12 HAI pump/removed primary
4/13 Liver Resection
8/13-12/15 (10) RFAs lungs
5/17: Upper Left Lobe of lung resected.
02/18: 3 new mets lymph nodes lung:
05/18: Keytruda (MSS w/Intermediate TMB): CEA: 66.4, 39.2, 23.8, 13, 3.5 1.8, 1.0, 2.8 3.9, 5.0, 5.6, 1.5, .8, .8, 1.1, 1.1, .7
7/18; 9/18; 11/18; 2/19 Clear CT scans

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LeonW
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Joined: Sun May 03, 2015 4:59 pm
Location: Amsterdam, Netherlands

Re: Mop up chemo - Port vs non-port for Oxi?

Postby LeonW » Tue Jun 11, 2019 5:09 pm

Jack&KatiesMommy wrote:I did six rounds without a port. I did not have any issue at all. I did it in my arm at inside the elbow joint. Cynthia


Same here. Found it very doable, switching arms/elbows each cycle. I believe the hot packs that the nurses diligently applied may have made the difference. Keeping the receiving arm warm, was to keep the veins wide open, they said, allowing the Xelox to disperse quickly

.
Dec 2012 - CC, 2 unresect liver mets, CEA 41.8 (MM 65yrs)
Jan 2013 - colectomy @ spleen, 2/26 nodes, IVa T3N1bM1a MSI-low
Feb-Aug - 1x Xelox-7x Xelox/Avastin, shrinkage from #3
Sept - 2 failed PV embolizations
Oct 2013 - R liver resect 28d hosp (liver failure/delirium, lung emboli, encephalopathy), cancer dead (pCR)
2014/15 - recovery, scopy: 2 polyps
2016 - new town, new life
June 2018 - 5 yr mark, scopy: 2 new polyps
1.3-1.4 CEA/clean CT: 4x2014, 6x2015-17, 2x2018-19 :D next June 2020

boxhill
Posts: 242
Joined: Fri Apr 06, 2018 11:40 am

Re: Mop up chemo - Port vs non-port for Oxi?

Postby boxhill » Tue Jun 11, 2019 6:52 pm

I have lousy veins, and every IV is a torture. I can't imagine having gotten through 12 rounds of FOLFOX and now Keytruda every three weeks, not to mention countless blood draws, without my port. I love my port. :D I get my scans done at a place where they can't access my port, and thus have to have an IV. The latest was last week. Nasty, painful, and took 2 tries. Reminded me of how much I appreciate the port.

ETA: if I thought I were only going to have, say, 6 infusions, 3 weeks apart, I *might* have chosen not to have a port. But I've heard that oxy does a number on your veins, and the degree of certainty regarding ongoing treatment varies, naturally.
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemicolectomy
11 of 25 nodes,5 of 5 mesentery nodes
5mm liver met removed
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/4/18 FOLFOX
Neulasta 6/28
7/9/18 CT NED, 2mm indeterminate lung nodule
11/20/18 CT NED, Lung nodule calcified granuloma. Enlarged spleen.
12/20/18 Liver MRI 5mm liver met and 2 lymph nodes in porta hepatis, CT review shows progression on FOLFOX
12/31/18 Keytruda
6/5/19 Triphasic CT LNs shrunk to normal, Liver node stable

margiej
Posts: 82
Joined: Sat Apr 14, 2018 8:46 am

Re: Mop up chemo - Port vs non-port for Oxi?

Postby margiej » Tue Jun 11, 2019 7:14 pm

LeonW wrote:
Jack&KatiesMommy wrote:I did six rounds without a port. I did not have any issue at all. I did it in my arm at inside the elbow joint. Cynthia


Same here. Found it very doable, switching arms/elbows each cycle. I believe the hot packs that the nurses diligently applied may have made the difference. Keeping the receiving arm warm, was to keep the veins wide open, they said, allowing the Xelox to disperse quickly

.


I did six rounds without a port also. The first infusion in my hand was painful but we moved the infusion site up to my elbow joint for subsequent rounds and it wasn't a problem after that. We alternated arms and kept heat on before and during infusion. The oncology nurses were all so great.
Best of luck whichever you choose.
Margie
Dx CC 12/2015, age 57 at Dx
Stage IIIb: T3N1b
Adenocarcinoma, sigmoid colon, 2.5 cm - low grade, moderately differentiated
3/6 positive lymph nodes
laparoscopic colectomy 1/20/2016
Capox started 3/4/16 - Six rounds
CT-suspicious lymph 2/22/16
PET scan 2/24/16 clear
CT 6/8/16 clear
Clear Colonoscopy 3/17
CT 10/3/17 clear
CT 10/17/18 clear
CEA 12/17 1.7
5/16 3.8
7/16 1.9
3/17 1.3
10/17 1.2
4/18 1.6
11/18 1.2

Rock_Robster
Posts: 100
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Mop up chemo - Port vs non-port for Oxi?

Postby Rock_Robster » Tue Jun 11, 2019 7:39 pm

Seems like everyone has different experiences with this - I did two rounds of FOLFOX without a port, and it was pretty rough. My veins did NOT like it at all, and my arm looked like a roadmap for a couple of months after. I actually think the long 5-FU infusion was tougher than the oxi - it’s just such a long exposure to a mildly corrosive drug. I also think I may have had some mild extravasation on the first cycle. I ended up having the port replaced just to finish the last 2 treatments of neoadjuvant chemo.

Having a port really is no big deal for me; I rarely notice it now.

That said, there’s definitely things you can do to make peripheral more tolerable - be well hydrated, choose a big vein (ideally higher up the arm - we ended up doing bicep), a big cannula, keep the site warm the whole time (heat pack); and as you’ve seen other folk seem to have had no issues.

Good luck
Male 37 years; Melbourne, Australia
10/2018 Dx: 3.5 cm rectal adenocarcinoma, 10 cm from verge. Well/mod diff (G1-2), T3bN1bM1a.
3 enlarged local lymph nodes and 4 liver lesions.
MSS, MMR-proficient, mutated in NRAS (G13R).
CEA: Oct-18 = 12; Nov-18 = 14, Mar-19 = 2.4
11/18 - 6 cycles neoadjuvant FOLFOX
12/18 - DVT, started clexane
3/19 - Liver resection, R0
4-5/19 - Long-course pelvic chemoradiation (45 Gy w/ Xeloda)
07/19 - Planned restaging scans and ULAR w temp ileo

sinewaves
Posts: 11
Joined: Tue Dec 18, 2018 9:44 am

Re: Mop up chemo - Port vs non-port for Oxi?

Postby sinewaves » Wed Jun 12, 2019 8:31 am

Thank you for the feedback everyone!

This board is such a great resource and I appreciate you sharing your experiences.
DX @ 37, married, no children
11/2018 - Dx "MALIGNANT NEOPLASM of DISTAL RECTUM", greater than 3cm at the dentate line Rectal Cancer (Stage 3a, T3N1M0)
1/7/ - 2/14/2019 - Radiation + Xeloda (4,000 mg per day - 4 pills in morning and evening) - 28 days
4/16/2019 - MRI shows no lymph nodes, reduced to stage 2
4/26/2019 - APR surgery, removed rectum. Permanent colostomy.

Deb m
Posts: 491
Joined: Tue Jan 14, 2014 10:08 am

Re: Mop up chemo - Port vs non-port for Oxi?

Postby Deb m » Wed Jun 12, 2019 11:50 am

I didn't even think they would do it without a port. The surgery for putting on in is very simple. A port is the way to go in my opinion!

Unitool78
Posts: 3
Joined: Thu Jun 13, 2019 1:47 am

Re: Mop up chemo - Port vs non-port for Oxi?

Postby Unitool78 » Thu Jun 13, 2019 2:22 am

I had several rounds of oxaliplatin through my arm and would not recommend it. It's nasty stuff which will chemically burn the veins in your arm. With a port it goes in a much larger blood vessel and so is diluted much quicker avoiding this damage. Any error in placing the iv or if it withdraws during the infusion can have serious consequences - may need skin grafts.

I have a port for my second go round, wish I'd had it back then.
Stage 3 diagnosis Oct '17
Signet ring
12" sigmoid resection Nov '17
5 positive nodes
8 rounds CAPOX
NED June '18
Liver mets + Peri node found Oct '18
7 rounds FOLFIRI + Avastin for 5
PVE followed by right hepatectomy April '19
Resumed FOLFIRI June 6

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DocSavage
Posts: 45
Joined: Wed Jun 08, 2016 5:00 pm

Re: Mop up chemo - Port vs non-port for Oxi?

Postby DocSavage » Sun Jun 16, 2019 7:54 pm

For what its worth - I would be a strong proponent for a port as well. It made the infusions so much easier and less uncomfortable (and you need all the less uncomfortable as you can get).

The procedure to implant it was as easy as pie - I don't think it took longer than thirty minutes or so. It was just a little incision with a steri-strip over it. They used propofol to knock me out like a colonoscopy and then poof I was back in recovery.

In addition you get a cool bracelet to wear and card that shows you are in the club.

The removal was also a breeze - in the surgeons office with a little local. We chatted about things the whole time. It was a bit weird feeling when he pulled the catheter out.

Now that I have to go through this for the second time I will for sure get another one installed...

-Andy
Embrace The Suck
Diagnosed at age 61 - Male
DX: CC 05/19/2016
Tumor Location: sigmoid colon
Tumor type: Adenocarcinoma
Tumor size: 3.9cm
Tumor grade: G2: Moderately differentiated (intermediate grade)
TNM code: T3N2aM(N/A)
Stage: Stage IIIc
Positive lymph nodes: 4 out of 26
Mets: N/A
Baseline CEA: 1.7
Surgical margins: clear
Primary surgery type: laparoscopically assisted sigmoid-colectomy 06/01/2016
FOLFOX started 06/22/2016
NED: 12/14/2016


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