Patient decides on break from chemotherapy
by Paula Levy

source: southshorenow.ca
published: December 10, 2003

The first time we met Rosanne Himmelman on June 18, she was beginning a regimen of chemotherapy to fight metastatic colon cancer. Through periodic updates, Rosanne is sharing her experience. This is part five of her journey.

After five months of chemotherapy Rosanne Himmelman, 37, has decided it's time for a break. Following the advice of her Halifax oncologist Dr. Danny Rayson, she made the decision last week that it was time to give her body a rest from the toxicity of chemotherapy.

The side-effects from the 16 treatments of chemotherapy are becoming more evident to the metastatic colon cancer sufferer. As was inevitable, she is now experiencing everything from gastro-intestinal problems to thinning hair. Luckily, Rosanne had a lot of hair to begin with so thinning didn't result in baldness. But, her once thick curly brown hair is now showing subtle signs of thinning.

"I'm progressively getting more symptoms," Rosanne told her oncology nurse Joy Tarafuk. She said the symptoms are beginning to keep her up at night and this time she developed side-effects from treatment earlier than her first chemotherapy session in 2001.

Because of the progressive symptoms, Dr. Rayson said a break is her best option.

"I'm totally open to that [a break] now," she said, noting she has hot flashes, aches, heartburn, mouth sores, pins and needles in her hands and feet, water-blister rashes, frequently lacks appetite, tiredness and feverishness. All are caused by chemotherapy.

"I seriously thought about it and I'm comfortable with taking a break now and giving my body a break," Rosanne told Dr. Rayson.

Chemotherapy cannot distinguish between bad and good cells in the body. Because it attacks rapidly-dividing cells, it can also destroy good cells as well as the cancer cells. That's why many people on chemotherapy lose their hair. It also can have adverse effects on the skin, nails and lining of the stomach.

Since Rosanne also takes steroids to combat nausea, it has meant that she has retained a great deal of fluid. She comically calls her face, "chipmunk cheeks" and has gone up three sizes in her clothes.

However, chipmunk cheeks are a small price to pay to continue to feel better and live longer. But it's when she doesn't feel well because of chemotherapy that shrinking the tumours are at the cost of her quality of life.

And, it's not being able to maintain a certain quality of life that led Dr. Rayson to make the suggestion to take a break.

"Taking a break doesn't mean we forget about Rosanne," reassured Dr. Rayson. "We will continue to monitor her every two to three months."

     Dr. Danny Rayson reviews the results of Rosanne Himmelman's latest CT Scan. Paula Levy photo

He said treatment is often a delicate balance between the toxicity of the drugs and the overall quality of life. He said if he pushes treatment too far, the patient loses his/her quality of living and that's counterproductive.

"When you keep going [with chemotherpay] the side-effects keep building and so there's always a balance between what you're doing to the disease and what you're doing to the body," said Dr. Rayson of Rosanne's progressive increase in side-effects.

Rosanne's last CT Scan revealed her tumours have shrunk by a further 30 to 40 per cent. But continuing treatment for additional reduction isn't always the best option.

"There always comes a point where the toxicity starts to gain control and we end up causing more problems than actual benefits," said Dr. Rayson. "The goal is to keep Rosanne's quality of life and quantity as long as possible. Shrinking things by a couple of centimetres doesn't necessarily mean benefits."

He said for years oncologists thought as long as the cancer was shrinking patients were benefiting from chemotherapy. But he said that is no longer the case. Now, oncologists take into account many factors such as side-effects, overall health and degree of shrinkage.

Taking a break from chemo doesn't mean that all is lost, said Dr. Rayson. He said their hope is that the treatment has made the actively growing cancer cells dormant. After her first regimen of chemotherapy in 2001, the cells remained dormant for about a year.

Dr. Rayson suspects the cancer in her liver and lungs has once again reached that dormant stage. And, continuing to push the regimen one more round would only allow the cancer cells more time to develop a resistance. That's not what he wants to see happen. He said having regular CT Scans will enable the medical team to determine if the cancer cells are dormant or if they are continuing to grow. Comparing a new scan to her latest on November 26 will reveal whether there's been any growth. Dr. Rayson said if the cells are growing, they will restart chemotherapy treatments.

"These cells will always learn how to bypass. At some point they'll learn how to figure chemo out," said Dr. Rayson. "They get smart the longer they're exposed. So, in a sense, it's sometimes a benefit to stop ... in hopes that they will continue to listen when we do it again."

Each cancer patient uses a different mixture of drugs for their specific disease. For Rosanne, Dr. Rayson prescribes fluorouracil (5FU) and Camptosar (CPT11).

5FU and CPT11 destroy the cancer cells. Rosanne also receives leucovorin. Although it is not an anti-cancer drug, it increases the effectiveness of the 5FU. The drug is used to rescue normal cells.

Dr. Rayson said there is no question that Rosanne has benefited from chemotherpay this time around. Rosanne agreed. She said within the same day of her first treatment, she felt the pain in her liver subside.

But Rosanne's fight with cancer hasn't ended with a break from chemotherpay. While on her break, she will continue with naturopathic treatments.

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