Linda really did like Egypt, but she wasn't overly fond of camels.
Linda was treated with taxol- and platinum-based drugs. Her first course of chemo was successful, in
that it knocked down her CA125 level to a number well within the normal
rate. For six months she felt
great. It was during that time that we
went to Egypt. She enjoyed that trip
very much; much more than she had expected to do. Even the camel ride didn’t faze her. However, there was one lingering result from
chemo that wasn’t so pleasant –chemotherapy-induced peripheral neuropathy. In keeping with all medical articles I have read, I will now introduce an acronym - CIPN.
During her first course of chemo Linda’s fingers tingled and, I think, sometimes hurt. (Brave and loving as she was, she wouldn’t always tell me how she felt.) She had CIPN. CIPN affects 20 – 30% of cancer patients. Sometimes it goes away (it did with Linda), but sometimes it doesn’t. Occasionally, it gets worse. Cancer patients have enough to contend with, without having to deal with unnecessary pain. That’s why this news is important. During Linda's time with CIPN it was hard for her to quilt - but, of course, she did. Her courage was amazing.
A randomized clinical trial (sponsored by whom? – it doesn’t say) reported in the NCI Cancer Bulletin found that a drug (duloxetine; sold as Cymbalta) reduces discomfort from CIPN to a statistically-significant extent. If I understand the article, duloxetine is approved for PN caused by diabetes, but not for CIPN. Let’s hope this study prods the FDA to get its bureaucratic butt in gear.
During her first course of chemo Linda’s fingers tingled and, I think, sometimes hurt. (Brave and loving as she was, she wouldn’t always tell me how she felt.) She had CIPN. CIPN affects 20 – 30% of cancer patients. Sometimes it goes away (it did with Linda), but sometimes it doesn’t. Occasionally, it gets worse. Cancer patients have enough to contend with, without having to deal with unnecessary pain. That’s why this news is important. During Linda's time with CIPN it was hard for her to quilt - but, of course, she did. Her courage was amazing.
A randomized clinical trial (sponsored by whom? – it doesn’t say) reported in the NCI Cancer Bulletin found that a drug (duloxetine; sold as Cymbalta) reduces discomfort from CIPN to a statistically-significant extent. If I understand the article, duloxetine is approved for PN caused by diabetes, but not for CIPN. Let’s hope this study prods the FDA to get its bureaucratic butt in gear.
I had forgotten about that side effect. She was so brave, so matter-of-fact with acceptance, but I know the thought of not quilting was very difficult for her. Hopefully future chemo patients will have relief, but I hate the thought of yet another drug being put into an ill body.
ReplyDeleteYes, but sometimes another drug is the lesser of two evils. I do wish, however, that the guys prescribing the drugs would also tell you when to stop taking them. They don't always do that. Left unchecked this could result in more drugs than your cabinet will hold. Mine is getting there.
ReplyDeleteGreat picture! I'm so glad you & Linda went on that trip. I know she had a wonderful time, inspite of the camels!
ReplyDeleteAs if you needed another reason not to get cancer….. CICI.
ReplyDeleteIn addition to PN, there is the matter of “chemo brain”. When I first heard about it I thought it was a joke, a myth, or something in between. It turns out that it’s real. The correct terminology is “chemotherapy-induced cognitive impairment”, so let’s do the biomedical thing and refer to it as CICI. Not everyone who undergoes chemo gets CICI, and those who do may see it gradually dissipate. However, for some it is permanent and for all who have it, it is unpleasant, disturbing and an annoying interference with the necessities of daily life. Some therapists think that CICI is caused by anxiety, depression, stress and/or fatigue, but others cite compelling evidence that it represents real biological changes in the brain. Lack of estrogen seems to be implicated in CICI experienced by women who have had ovarian and/or breast cancer. Men also get it, and a hormonal imbalance seems partially implicated there as well.
There are two articles published in the NY Times by Jane Brody that concern chemo-brain: The Fog that Follows Chemotherapy (published 8/4/2009), and Taking Steps to Cope with Chemo Brain (8/11/2009). With a little ingenuity and our friend Google you can download both. I learned about them from the NCI Cancer Bulletin.
I don’t think that Linda had to suffer from CICI, expect perhaps during her final dreadful few weeks.
Today as I was riding the Fred Hutch shuttle I observed a rather large woman, with very short hair, come out of the SCCA building – that’s where they administer chemo and radiation therapy. She had on a pink T-shirt that said “I HAVE CHEMO BRAIN. WHAT’S YOUR EXCUSE?” I thought to myself, what a good attitude. Don’t take it lying down. Spit in its eye!
ReplyDeleteThe trouble is that there’s no obvious eye into which to spit. There’s nobody or nothing to blame, only brute biology. (Let’s not bring God into it.) I confess that I tend to anthropomorphize ovarian cancer. I visualize it as a living being, endowed with free-will. Then I imagine it dying a slow, painful death. I must be sick in the head.
More on “chemo brain”.
ReplyDeleteI am at the Hutch (10/1/12), trying to stay awake. I just proof-read a scholarly publication by one of our own, and managed to catch a few typos. I have also drunk a large cup of coffee and eaten a gooey sticky bun-like thing, managing to smear about 10% of it on my pants. Now it is time to buy some soup for lunch, take it outside to a bench, and enjoy the autumn sunshine for a few minutes. Afterwards I will come inside, attend our weekly Monday meetings – then take the shuttle home and begin serious drinking. (Just kidding.) But, about chemo brain…
I ran on a study by Dutch scientists working out of Erasmus MC, Rotterdam, dealing with chemo brain. They investigated 196 women who had undergone standard (I think) breast cancer chemo more than 20 years earlier. They were compared with a group of 1,509 women who had never had breast cancer. The women in both groups were 50 to 80 years of age and had other things in common. The two groups exhibited the same incidence of dementia, but the chemo groups scored more poorly on tests for verbal memory, mental processing speed, and psychomotor speed (whatever that is.) Oddly, the chemo groups had lower incidences of depression. (I think I can guess why.) So in some women chemo brain is effectively permanent. What a drag!
Ah, actually having READ the article I see that the chemo women had been treated with what HAD been the standard in the 1990s. However, it consisted of three drugs, two of which still are in common use today.
More on CIPN.
ReplyDeletehttp://www.cancer.gov/news-events/cancer-currents-blog/2016/peripheral-neuropathy-falls?cid=eb_govdel