jsbsf wrote:The board met and the oncologist called today with his recommendation. Everyone wanted to stand by and monitor since they all feel quite optimistic. He dissented, and opted for “insurance”.
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DH was offered 3 months of adjuvant Xeloda, which he should start in a couple weeks. Even though they feel his cancer won’t return, this should seal the deal.
jsbsf wrote:I mentioned that our oncologist recommended 3 months of Xeloda. But yesterday the pharmacist called and said it’s 6 months. 1500mg for breakfast and another 1500 for dinner 2 weeks on one week off for 8 cycles. It does seem like quite a bit for “insurance”… We are taking the chemo though, mainly because he tolerated FOLFOX pretty well the first go around.
jsbsf -
Good luck on DH's upcoming Xeloda regimen! There are a couple of things I would like to mention, however. Six months on Xeloda might not be as smooth sailing as you expect...
Xeloda is somewhat different from FOLFOX both in terms of side-effects and in how it works. Unlike FOLFOX, Xeloda (capecitabine) is a pro-drug and it must be metabolized in the digestive system in order to produce 5FU at the cellular level. This has several implications, both for how the drug is administered and
how the side-effects unfold.
In terms of administration, it is very important to take the pills shortly
after having the morning or evening meal. You can't take Xeloda on an empty stomach if you want it to work. Furthermore, if you have had nausea to such an extent that you vomited up your meal, then you may not have enough food in your system for the metabolism mechanism to work. Also, if you vomit up the Xeloda pills, of course this will be a problem, because the pills need to be in your system long enough for the 5FU metabolism cycle to work.
Then there is the diarrhea problem. Diarrhea is one of the main side effects of Xeloda, and it needs to be monitored very closely. This may be a bit of a problem for DH since he no longer has a rectum and diarrhea has to somehow be defined in terms of frequency of emptying the colostomy stoma bag. DH must then be told by the oncologist about how to recognize a qualifying diarrhea episode and how to count how many qualifying diarrhea episodes have occurred on a given day, since an "
Increase of >=7 stools per day over baseline" is the official definition of Grade 3(Serious) diarrhea and this is what will suspend the Xeloda treatment regimen until further notice. But the thing to really worry about is the possibility of escalation of diarrhea to Grade 4 (Life-threatening), because if this ever happens, then the patient will be taken off Xeloda forever and will not be able to complete the expected 3-month or 6-month regimen. (This has happened to several people on this board already. It's not just a theoretical possibility.)
Here are the details for the special case of
diarrhea. In this case, an increase of more than 6 watery stools per day is considered serious and requires immediate doctor intervention to avoid termination of treatment. This is because severe diarrhea causes excessive loss of fluids and loss of electrolytes, leading to multiple problems like kidney damage, kidney and bladder stones, etc. It should be noted that chemo-related diarrhea is different from the common traveler's diarrhea that we are familiar with. Chemo-related diarrhea is more difficult to deal with and may require special measures in order to control it. Similarly for mouth sores. These sores are not the same as the canker sores that we have had in the past. They are much more virulent and will not just go away with the passage of time. They need to be treated properly with appropriate medical procedures. If not, the mouth sores will soon gravitate to throat sores, then to larynx sores, and finally to sores in the lungs (i.e., pneumonia). Simple mouth sores need to be taken very seriously as soon as they appear, otherwise they can soon escalate out of control if they are not treated appropriately.
Diarrhea A disorder characterized by an increase in frequency and/or loose or watery bowel movements.
- Grade 1 -Diarrhea Increase of <4 stools per day over baseline; mild increase in ostomy output compared to baseline
- Grade 2 - Increase of 4 - 6 stools per day over baseline; moderate increase in ostomy output compared to baseline; limiting instrumental ADL (Activities of Daily Living)
- Grade 3 - Increase of >=7 stools per day over baseline; hospitalization indicated; severe increase in ostomy output compared to baseline; limiting self care ADL
- Grade 4 - Life-threatening consequences; urgent intervention indicated
Reference:
https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=65882&p=510516#p510516
Therefore, what I would recommend is for DH to have a serious conversation with his oncologist to discuss the issue of Grade 3 (Serious) side effects of Xeloda and how to recognize and control them. This should be done before the treatment regimen commences.
For example, if DH's regimen starts in early July, then the build-up of chemo in the body will be at a level sufficient to produce Grade 3 adverse events around the beginning or middle of September, i.e., around the 3rd or 4th Xeloda cycle. The first couple of cycles may not seem so bad, but experience has shown that by the 3rd or 4th cycle things become much more difficult to manage.
Also, after talking to the oncologist it would probably be a good idea to
take a trip to the pharmacy and stock up on essentials that are likely be needed over the next few weeks. In DH's meeting with the oncologist, he could get some recommendations for the kinds of things that he will need to have close at hand.
Good luck! Take care ...