A different path

Yesterday, I returned to the fork in the road with its choice of two different paths to follow. On Tuesday, I'd chosen one road to journey down, but I second-guessed my selection after only a couple of steps and re-traced them to return to the fork and weigh the two options again.

After conducting Internet research, writing pros and cons lists, and talking with Dr. W, Michael and my sister, I've decided which path to follow for my treatment plan. In my gut, I think it's the way I wanted to proceed, but my logical mind required a thorough assessment of both options before making my decision.

I've chosen to receive the Carboplatin and Gemcitibine chemotherapy combination (as opposed to Carboplatin and Paclitaxel, which is what I've been treated with twice in the past). I asked a bunch of questions during my appointment with Dr. W yesterday afternoon, which only confirmed my gut feeling.

He said my choice seemed a reasonable way to proceed. In fact, the answers to some of my questions prompted him to say, "that would go on your pro list" for choosing Gemcitibine. I'm 95 per cent happy I'm going this route, while five per cent of me wonders if I've made a mistake. But I have to go with my gut and my mind, get going on the treatment and move forward. None of us can always be 100 per cent sure our choices are the right ones, but we have to do our homework and trust our instincts.

So here are the pros and cons of proceeding with the Gemcitibine/Carboplatin combination:

PROS

1. Gentler side effects - less nausea, no neuropathy (tingling and loss of feeling in hands and feet), etc.
2. No need to take steroids to counteract the nausea - I'm still leery of steroids considering they could have caused the perforated bowel and resulting surgery. And if I don't take steroids, we can avoid the appearance of Bitchy Tina, which is always a good thing.
3. I've tried the Carboplatin/Paclitaxel combination before and I know it works. But perhaps this chemo combo will work better and give me longer between reoccurences.
4. Over time, cancer's response to Paclitaxel becomes less effective. By not using it this round of treatment, I wouldn't be diminishing its effectiveness to use in the future.
5. Clinical trials I've heard about often use Paclitaxel by itself or in combination with another chemotherapy and a clinical trial drug. If my cancer develops a resistence to it, these types of clinical trials won't be viable treatment options in the future.
6. Another way to treat ovarian cancer involves using Paclitaxel by itself via weekly infusions. It's been proven to be effective and less toxic. Again, if my cancer is resistent to this chemo, I wouldn't be able to pursue this option.
7. There's a better synergy with Gemcitibine and Carboplatin in its cancer fighting abilities. So they work together more effectively. I also read on the Internet, Gemcitibine can also enhance the effectiveness of drugs used previously to fight the cancer. So I guess if there are residual drugs still in my body, Gemcitibine can use them to help fight my cancer cells.
8. Carboplatin is infused over 1-1/2 hours, Gemcitibine over 30 minutes, which means I'd be able to receive my treatment in about two hours. In the past, the Carbo/Taxol combination had me in the cancer suite for five to six hours. This option significantly cuts down on my time in the cancer centre. (But see point 5 on the cons list.)
9. Gemcitibine is tolerable over a longer period of time than Paclitaxel. Usually by the end of six treatments, women must stop using Paclitaxel because the toxic side effects are too bad. While my treatment regime with Gemcitibine would be for the same six cycles, I could probably keep taking Gemcitibine for longer, if needed. (Of course, this is only if I tolerate the drug well. In approximately five per cent of patients, the side effects are intolerable.)
10. Over time, patients develop a resistence to Carboplatin, which eliminates some treatment options. Dr. W said some research indicates Taxol increases the risk of developing Carboplatin resistence sooner. I want to be able to use Carboplatin as one of the chemotherapy agents as long as possible.
11. I wouldn't lose my hair. Yup, vain Tina saves this pro for the end. While I've read reports of thinning hair and the side effect sheets talk about loss of hair, I've got a far better chance of keeping my silky strands with this treatment option.

CONS
(Of course, this is the flip side of the coin and the pros for using Paclitaxel.)

1. I've never used Gemcitibine before and I don't know if my cancer will respond to it.
2. I also don't know which side-effects I'll experience from this chemotherapy.
3. Side effects could include a reduction in red and white blood cells, increasing the risk of infection, anemia and bleeding. As a result, I may need a blood transfusion. Others side effects include: flu-like symptions (fever, chills, aches), fatigue, mild nausea, skin rash, vomitting and lack of appetite.
4. To reduce the toxicity of the Gemcitibine/Carboplatin combination, the Carbo dose must be reduced. Dr W said he doesn't think this reduces the effectiveness of this treatment option, but it does provide less of the cancer-killing Carboplatin. (Or perhaps less Carbo slows down the time before the body develops a resistence to this drug.)
5. The treatments are more often. I'd head to the cancer centre week one to receive the combination of Carbo and Gemcitibine, the following week, I'd go again for a 30-minute infusion of Gemcitibine, then I'd have a week to recover before starting all again. So I'd have to head to the cancer centre for treatment twice in a three-week period; albeit for shorter periods of time. (See 8 on the pros list.)
6. Carboplatin and Paclitaxel is the gold star standard treatment for ovarian cancer. They're considered the big guns. Am I making a mistake not pulling out the best known treatment for this reoccurence?
7. This chemo combo worked for me before, so why not set it lose on the cancer again?
8. I'm familiar with the side effects of Carboplatin and Paclitaxel, know when to expect them and generally know when I'll start to feel better again. I know how bad they are and how to get through them. Gemcitibine is an unknown, but all the literature says its side effects are gentler. (This is a wishy-washy con, I know, but I wanted to put it somewhere.)

Studies report the two treatment options are equally effective, so that's not necessarily a deciding factor. Dr. W said if I try one and we determine it's not working (via CA-125, ascities production and CT scans), we can switch to the other - or perhaps a new option available at that time.

I'm happy to have options and to be moving forward. The day I receive chemo next week will probably change. I'm trying to schedule my appointment so the really bad side effects hit me while my kids are at school. With the Paclitaxel/Carboplatin treatment, those occured on days three to six. Dr. W said the Gemcitibine/Carboplatin side effects tend to hit right away. So I've asked for a Wednesday appointment so I can be through the tough stuff before spending the weekends with my kids. For now, I'll leave most of next week open so when I get the phone call on Monday confirming my appointment, I'll be ready.

Oh, and just to answer Sandra's comment on yesterday's blog: I have a tube in my abdomen through which the ascities drains into a collection reservoir. I empty the reservoir regularly because it collects approximately 300+ mL of ascities a day. If I didn't drain this way, my abdomen would continutally fill up with the fluid produced by the tumours in my abdomen, which is extremely uncomfortable. When too much ascities has built up, paracentisis is required (sticking a long needle into the abdominal cavity and siphoning off the accumulated ascities). The proccesses of filling up and getting drained are both extremely uncomfortable, and considering the amount of ascities my cancer produces daily, I'd have to have paracentisis every week, which comes with its own risks. The drainage tube (with which I have a love/hate relationship) eliminates the need for paracentisis. Dr. W withdrew ascities directly from my reservoir to send to the lab - a painless procedure.

I know today's blog conveyed lots of semi-complicated information. Please feel free to contact me if you have questions or need clarification. I now know far more about ovarian cancer, its treatments, and the ups and downs of the journey with this disease than I ever dreamed.

But at least I'm still here to educate myself - and as a result - you too.

Tina