Cycle 5 Wrap-Up

All the treatments for Cycle 5 are complete. Just two more treatments to go. I cannot express how much I am ready for this chemo stuff to be over. Have I mentioned that it sucks? It does. Both figuratively and literally. It sucks the energy right out of me.

While I was getting my Day 1 treatment, a visiting doctor from England stopped by, escorted by chemo nurse Connie. This doc was in town to learn about intraperitoneal chemo, which her practice -- and perhaps her country? -- does not yet offer. Somehow, between her somewhat desultory questioning and my tendency toward bravado, she got the impression that IP chemo was easy. Really, that's the word she used. Perhaps she was just trying to be supportive, or searching for something to say. At the time, I responded, "If this is easy, I don't want to do hard!" Later, I wrote an email to my doc for her to give to the visiting doc. I didn't want her going back to England with a false idea of how difficult this is for patients. I made two points. First, the only reason I can do the things that makes it sound 'easy', like taking long walks, is because I have the luxury of focusing pretty much exclusively on myself and my own well-being. I can do this chiefly because I have no day-to-day responsibilities for other people. I am not working, my kids are no longer at home, and we have financial resources to pay others to do some of the chores many people have to shoulder on their own. Moreover, I have a fabulous support system that starts with the ever-dependable David -- who, I think, has been waiting all our married life for me to accept his natural-born talents as a caretaker -- and extends to the many friends and family who supply meals, rides, conversation, and encouragement. The second point I made is that she was seeing me at my best, before the chemo took hold. Had she chanced to stop by my house on Day 2, she would have found me lying on the couch, inert, with my eyes closed because it simply took too much energy to process visual stimuli. On Day 3, she might have found me reading the paper, but only for the length of an article or two, and then I'd have to take a rest. No: this is not easy.

I asked my doc why the IP chemo is so much harder. (In one study, almost half of women who started this regimen completed just three or fewer of the six planned cycles. Needless to say, it pleases me that I am in the other half.) She said that the drug dosages are higher, and the drugs stay in the system longer than IV therapy. The trade-off for reduced quality of life during treatment -- and for a while after -- is a 20-25% bump to both progression-free and overall survival. Caveat: these data are for ovarian cancer patients. As far as I know, data don't exist for uterine cancer, but, as noted in my last post, my uterine cancer is acting much like an ovarian one, especially in that the metastases were scattered around the abdomen, where the residual cells left after their surgical removal are readily bathed by the IP drugs.

Of the possible side effects, most that I've experienced range from annoying to debilitating, but not of lasting concern. Fatigue wanes and waxes depending where I am in the cycle, and overall continues to increase. It's worst in the first 10 days. Unlike the earlier cycles, I'm not recovering as well after the first treatment so the second one hits me harder. Even in the second 11 days, I seldom have what I'd consider to be normal energy. Nausea is also increasing. After each treatment I take anti-nausea drugs on a prescribed schedule, and prior to this cycle I experienced few bouts of nausea. This time, I have had to take additional drugs on additional days to suppress nausea, and, lacking access to drugs, have on occasion had to use willpower to suppress the, um, bodily urges that follow nausea. My appetite remains remarkably good, except for the first two or three days of each cycle. Like fatigue, the ability to taste food wanes and waxes across each cycle. I don't think it ever gets back to normal, but that's hard to assess. Certainly, I've lost the disappointment I initially had at not being able to taste the complexities of a good recipe. My blood counts have, as expected, dropped, but never so much as to require transfusions or other blood-building treatments (beyond the scheduled injection to build up neutrophils once each cycle). Temperature regulation goes haywire following the Day 1 treatment, and for the next week I am annoyed by hot flashes that interrupt sleep as I constantly toss off the covers and then freeze. Hair continues to thin out, but, quite remarkably, has hung in there much longer than expected. With the advent of fall weather, however, I have been experiencing new sensations of cool wind blowing on my scalp.

The one side effect that is causing some concern, and that might ultimately modify or cancel my last scheduled treatment, is peripheral neuropathy: changes in the nerves that carry signals from the rest of the body to and from the brain and spinal cord. Unlike the other side effects, this one might not get better once chemo stops, so they watch it carefully. My symptoms have progressed from tingling in my feet to slight numbness in both my feet and hands. When I walk, it feels as though I am wearing extra-cushy socks. My hands feel slightly uncoordinated and weak, though luckily my right (dominant) hand is less affected. Patting the cat feels ... different. Chemo nurse Connie has me soaking my hands in hot water three times a day, while flexing and extending the fingers. I also decided this might be a good time to take up the piano again -- especially some of the scales and fingering exercises -- and to dust off pointing, flexing, and relevé exercises from ballet to remind the feet how to work well. I'm sure Connie will run me through my paces of buttoning my shirt and trying to pick up paper clips and coins before she approves me for my next treatment.