| Joined: Aug 2012 Posts: 6 Member | OP Member Joined: Aug 2012 Posts: 6 | My father has been diagnosed with stage 4A throat cancer and is currently in his 6th week of combined radiation (35 sessions, 5 times per week) and chemo (3 sessions, every 2 weeks.
The treatment has been very hard on him, in particular, the second chemo session. He is constantly nauseous, can not eat (sustaining himself on ensure type drinks alone), lost his voice, pain in his throat and sores developing.
His next chemo session is scheduled for next Monday and he doesnt think he can handle it. My question is:
1) I know there is no way of knowing for sure, but anyone have any insight into the necessity of doing the third chemo session and if it has proven to have significant benefit??
2) Is it absolutely necessary to strictly follow the every two weeks timeline? If my father has to do it, he would prefer to do it in the very last week after all his radiation sessions are finished with, this would be the the third week, a week off schedule. The doctor is insisting he stick to the schedule and can not delay.
Any thoughts, insights or personal experiences would be invaluable. Thank you, Audrey | | | | Joined: Jun 2007 Posts: 10,507 Likes: 7 Administrator, Director of Patient Support Services Patient Advocate (old timer, 2000 posts) | Administrator, Director of Patient Support Services Patient Advocate (old timer, 2000 posts) Joined: Jun 2007 Posts: 10,507 Likes: 7 | Welcome to OCF, Audrey.
What type of chemo is your father getting? Is he being treated at a cancer center where the docs are going by NCI guidelines? Your questions would be addressed by the whole team of specialists having a weekly meeting to discuss whats best for your father.
Its unusual for chemo to be given every other week. Most OC patients who get chemo with radiation will either get cisplatin every 3 weeks or smaller doses weekly.
My situation was chemo to be every 3 weeks. The third dose was cancelled for me and also a few other OCF members who had the same treatment plan. It did not negatively affect my treatment prognosis. The 3 week chemo cycle was rough as the doses are higher making them harder to handle. ChristineSCC 6/15/07 L chk & by L molar both Stag I, age44 2x cispltn-35 IMRT end 9/27/07 -65 lbs in 2 mo, no caregvr Clear PET 1/08 4/4/08 recur L chk Stag I surg 4/16/08 clr marg 215 HBO dives 3/09 teeth out, trismus 7/2/09 recur, Stg IV 8/24/09 trach, ND, mandiblctmy 3wks medicly inducd coma 2 mo xtended hospital stay, ICU & burn unit PICC line IV antibx 8 mo 10/4/10, 2/14/11 reconst surg OC 3x in 3 years very happy to be alive | | | | Joined: Apr 2012 Posts: 111 "OCF across the pond" Senior Member (100+ posts) | "OCF across the pond" Senior Member (100+ posts) Joined: Apr 2012 Posts: 111 | Hi Audrey, Welcome to the forum. Very sorry to hear about your father. He is entering the worst part of the treatment. It is a very horrible time. I was exactly like that at the same stage of my treatment. I can't advise on whether he should drop the last session or not, but it is important to speak to the doctors about this. It is also important to ask about trying other medication for nausea as they are lots of different options. The chemo is not as essential as the radiotherapy. The chemo makes the tumour more susceptible and so enhances the effects of the radiation. The symptoms you mention are also due to the accumulating effects of the radiation, which will not start to improve for at least a couple of weeks after the radiation stops. Sorry if this news does not help much.
It is really, really important that he keeps his fluid and calorie intake high, as his body is fighting hard to deal with the treatment. Dehydraton will make him feel a lot worse. Does he have a PEG? It is importnt that he keeps swallowing some fluid throughout the day so that he keeps his swallowing muscles active. I could only sip fluids at this stage as I had a very sore mouth and nausea. I found that an infusion of a small piece of root ginger with honey and cooled to a tepid temperature was the best thing to drink, which helped with the nausea. I had a complete nutrition food via my gastric tube for all my nutrition intake. I think I also ate natural probiotic yoghurt as much as possible.
Please tell him to tell him to stay strong, it will get better and will be worth it. Please keep posting with any more questions. There are lots of people here who will help you and your father through this.
Best wishes, Sally
Last edited by saxicola; 08-31-2012 11:38 AM. Reason: grater clarity
Dx 10/11 51yrs LBOT Stage 4 2nodes HPV16+. Non-smoker mod alcohol. 10/11 Induction chemox2 (Docetaxel, 5-Flu, Cisplatin) then Cisplatinx2 IMRTx30. Ended 01/13/12. 12/07/11 RIG. RIG removed 05/05/12. 4/12 CT scan clear. Visual scope checks clear as of 10/13. Learning to live with eating challenges.
| | | | Joined: Sep 2006 Posts: 8,311 Senior Patient Advocate Patient Advocate (old timer, 2000 posts) | Senior Patient Advocate Patient Advocate (old timer, 2000 posts) Joined: Sep 2006 Posts: 8,311 | Forget the PEG, at this stage in the treatment he should consider getting a nasal tube. It is just fed through a nostril down into his stomach (I had one) and x rayed to make sure it's positioned correctly. Then the thin metal stip included in the tube for the purpose of giving the tube ridigity so it can be inserted and for the positional x ray, is merely pulled out. Took them 2 mins or less to insert and I kept it for 2 weeks and it saved my stubborn butt. He would most likely have to keep it a tad longer but it will be well worth it.
Re the 3rd chemo of I assume Cisplatin, many have not had it but this definately needs to be discussed with his chemo and rad doc. As has been said the last of the rads are more important than the chemo but let's see what the docs say. Some have been switched to Carboplatin for the last one so inquire about that if it's not brought up.
The few weeks POST radiation are usually the worst time for everyone so be prepared. IMO that's why it's critical to get that nasal tube in now. He needs at least 3000 cals and 48 ozs of water each and every day and the tube makes acheiving that goal soooo much easier.
Welcome to this site. It will be worth it's weight in gasoline.
David
Age 58 at Dx, HPV16+ SCC, Stage IV BOT+2 nodes, non smoker, casual drinker, exercise nut, Cisplatin x 3 & concurrent IMRT x 35,(70 Gy), no surgery, no Peg, Tx at Moffitt over Aug 06. Jun 07, back to riding my bike 100 miles a wk. Now doing 12 Spin classes and 60 outdoor miles per wk. Nov 13 completed Hilly Century ride for Cancer, 104 miles, 1st Place in my age group. Apr 2014 & 15, Spun for 9 straight hrs to raise $$ for YMCA's Livestrong Program. Certified Spin Instructor Jun 2014.
| | | | Joined: Jul 2011 Posts: 945 "Above & Beyond" Member (500+ posts) | "Above & Beyond" Member (500+ posts) Joined: Jul 2011 Posts: 945 | Hi, Audrey I didn't find any studies comparing the large 2 to 3 cisplatin doses (like DavidCPA, I am assuming this is your father's protocol), but I did find a comparison of the lower dose, weekly option and it indicates that total dosage doses make a difference: http://www.headandneckoncology.org/content/1/1/17/This is a small, single institution study, so take the numbers with a grain of salt - but they do indicate a better result with the full dosage. Your father's doctors should be carefully monitoring his bloodwork to determine if it safe for him to continue the treatment. It is dreadful to watch a loved one go thru this, but sticking to the protocol (both chemo and radiation) as closely as possible will give him the best chance of a cure. Maria
CG to husband - SCC Tonsil T1N2M0 HPV+ Never Smoker First symptoms 7/2010, DX 12/2010 TX 40 IRMT (1.8 gy) + 10 Cetuximab PET Scans 6/2011 + 3/2012 clear, 5 year physical exam clear; chest CT's clear of cancer. On thyroid pills. Life is good.
| | | | Joined: Aug 2012 Posts: 56 Supporting Member (50+ posts) | Supporting Member (50+ posts) Joined: Aug 2012 Posts: 56 | There are several main types of throat cancer, and factors such as the pt's age and overall health status also need to be considered as well. In addition to discussing options such as delaying, reducing dosages, or omitting remaining chemo with his doctors, a second opinion might offer some reassurance as well. I suspect you will hear from the doc's that there will be some increased risk of recurrence if the chemo is not completed, although it may be minimal or hard to quantify. Ultimately the decision is the pt's. It is very challenging treatment to endure, with periods of discouragement and feeling very sick tending to be the norm, but it does end and recovery (from treatment) begins.
Ed H, NE Ohio SCC BOT with lymph node involvement, HPV+, diagnosed 7/12 Radiation and Cisplatin
| | | | Joined: Apr 2012 Posts: 47 "OCF across the pond" Contributing Member (25+ posts) | "OCF across the pond" Contributing Member (25+ posts) Joined: Apr 2012 Posts: 47 | Hi Alau I wanted so much to skip or reduce my last chemo session, but the doctors said no. last chemo was 12 days ago last rad today so hopefully its onwards and upwards. This is a ugly monster of a treatment for hopefully a bright tomorrow. Ihad to go into hospital as I could not keep fluid or feed in.what helped me was a good mouth rinse routine, using a nebulizer to clear gunk. I stopped trying to eat by mouth as this just left rotten food in my windpipe. using gylecerine suppositories with nothing coming out my nausea was greatly increased. My 3rd Chemo was the one that knocked me for a 6 by four I was raedy and went into survival mode.Good luck to you and your Dad. CubanKeith
21st March squall cells.Endescopy not oesophagus, ENT .April endo nose CAT MRI general Panendoscopy prim-HPV 16 base of left tongue one node-stage 2.23rd of May.14/5/12 9 teeth out.8/6/12 PICC inserted.11/6/12 1st Chemos 25/6/12 2nd Chemo Cisplatin5FU:27/6/12 PEG23/8/12 Radiation finished 1/9/12.
| | | | Joined: Aug 2012 Posts: 6 Member | OP Member Joined: Aug 2012 Posts: 6 | Hi Everyone,
Thank you for your responses. Its been both helpful and inspirational to hear about your experiences and successes.
We are still deciding what to do about the last chemo, we have until Monday. I was mistaken in my original post, he is supposed to do the large Cisplatin dose every 3 weeks.
My dad will definitely be going for a PEG or Nasal Tube (whichever will be less painful or uncomfortable), we are thinking of starting this next week as he finishes up the radiation treatments.
Will undoubtedly be checking this board regularly for the next couple of weeks and will be sure to share his experience later on.
Thanks and good luck to everyone!
Audrey | | | | Joined: Apr 2012 Posts: 111 "OCF across the pond" Senior Member (100+ posts) | "OCF across the pond" Senior Member (100+ posts) Joined: Apr 2012 Posts: 111 | Hope all goes well with the chemo decision. and that things start feeling a bit better for your father soon. Keep us posted on progress. Sally
Dx 10/11 51yrs LBOT Stage 4 2nodes HPV16+. Non-smoker mod alcohol. 10/11 Induction chemox2 (Docetaxel, 5-Flu, Cisplatin) then Cisplatinx2 IMRTx30. Ended 01/13/12. 12/07/11 RIG. RIG removed 05/05/12. 4/12 CT scan clear. Visual scope checks clear as of 10/13. Learning to live with eating challenges.
| | | | Joined: Aug 2012 Posts: 6 Member | OP Member Joined: Aug 2012 Posts: 6 | Hi again -- thank you for the encouragement and advice on the last chemo session. We have decided to do it.
Another concern my dad has is nostril tube feeding: 1) he sometimes vomit the protein drinks in the evening. would tube feeding prevent or reduce the chances of vomiting?
2) what about fluids? would that still be taken thru the mouth?
3) his throat is very sore and dry -- what are some methods to soothe the throat while the tube is in?
thank you for helping!
Audrey | | |
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