Greetings everyone, I'm a newbie. My father has Stage IV inoperable oropharyngeal cancer. He was not offered chemotherapy as they said it was due to his age (82) and ability to tolerate. So, he started Rad Theray in July and what a summer it has been. 30 treatments over 6 weeks. Today is his last day (yipeee!!!). He has all the 'usual' side effects (trouble swalling, redness to head and neck area, facial hair loss, sore throat, voice hoarseness). However, just yesterday he began vomiting and consistently now coughs up a yellowy-mucosy substance. Has anyone else had this reaction? Does this mean the Rad therapy is working?
Your comments would be very much appreciated.
- Cindy

Cindy,

Welcome to this site. I'm sorry your father has to go through this, especially at his age. I was 39 and otherwise in good health when I was diagnosed, and even then I found the latter stages of radiation really tough. Frankly I'm a bit surprised that your father got this far along before the nasty mucus started -- for many of us, it became a problem at an earlier point.

How is he doing in terms of getting enough daily nutrition/hydration? Is he still able to eat by mouth or is he using a tube? What kind of pain management assistance is he getting from his doctors? Is it possible that he had any recent medication change that could have caused the vomiting? Is there someone who is living/staying with him all the time to monitor his condition?

Cathy

Cindy, if you are his caregiver, I suggest you are on the phone daily with his Docs or nurses to report what is going on and ask for help. At his age he can't afford to fight too many side effects at the same time. Be strong and insistant about attention for him. Best luck, Amy

His side effects are to expected. I threw up a lot post Tx - actually polished my teeth with stomach acid. In a few weeks the thick mucous should get better. Like Amy said though at his age you can't afford to let things away from you. Make sure that he stays hydrated -2-3 liters of water a day. If he throws up he will have to replace those fluids. The chemo makes it worse so I would hazard that he will make a faster recovery since he didn't have it. I had access to an oncology advice nurse and she had a hot line to my oncologist who was my PCP for about 6 months.

Thank-you everyone for your kind words and helpful advice. Cathy - my father is on 5 cans of liquid nutrition through a feeding tube and on morphine (he hasn't reached the maximum amount yet in order to be transferred over to the fentanyl patch and he claims he is not in pain).

My dad actually started a fever yesterday. I'm not his primary caregiver but thank goodness his wife telephoned the oncology nurse and I have just driven him back to the hospital on the nurse's advice. He is currently underoing some bloodwork and X-ray. I'm assuming a chest X-ray to check for a possible pneumonia. It has been difficult to try and be an advocate while trying not to interfere with his wife but I think she is starting to realize that we all love my dad very much and want the best for him. I'm walking over to the clinic now (I work in a different area of the hospital) to keep them company and to try and keep on top of things.

Thanks again. I'm not sure where to say this, so I'll just say it now... this is an Excellent site! I'm just sorry I didn't find it sooner!

- Cindy

Cindy,
His pain management is a little unorthodox. There are 2 types of pain management: "Short term" and "long term" and the opioids are distinctly different for either indication.

"Long term" opioids are prescribed when an individual is antipated to be in pain some a relatively long period of time - a month or longer anyway. These will take the form of a time release tablet or patch and will provide continuous pain relief to manage the pain threshold to a tolerable level. Typical meds would be Oxycontin or Fentanyl (AKA Duragesic) Sometimes they even prescribe Methadone.

"Short term" opioids are prescribed for pain lasting less than a month or for "breakthrough pain", when the pain threshold exceeds that managed by the "long term" opioids. Typical "short term" opioids are Morphine Sulphate, Codeine, Percoden (AKA Oxycodone)and it's weaker brother Vicodin (AKA Hydrocodone).

It is quite normal to have both types of opioids available at the same time.

Orally taken, Morphine is the fastest acting, reaching full effect in 30 minutes. The other "short term" meds take about an hour for full therapeutic levels to be attained.

Post op patients will often be given a Demerol or Morphine drip by IV which they can self administer with a pushbutton (dose rate and intervals regulated by the equipment to prevent OD), but here again this is a 1-3 day short term application and IV reaches the full therapeutic dose instantly.

Here is a link to the NCCN guidelines for cancer pain management
http://www.nccn.org/professionals/physician_gls/PDF/pain.pdf

He is very vulnerable to infection while his immune system is compromised. You were wise getting him to the hospital immediately. The rule is any fever exceeding 100.5 degrees requires an immediate ER visit. His temperature should be taken several times a day. A log should also be kept so any trends can be identified.

Hi Gary,
My understanding is that they won't prescribe the fentanyl or switch him to the 'long term' opiod until he has reached the maximum intake of morphine or 'short term' opiod as you described. This is also consistent with a recent recommendation made by the Institute for Safe Medication Practices (http://www.ismp-canada.org/download/ISMPCSB2006-05Fentanyl.pdf).

The physician has prescribed tylenol to reduce the fever. He had a chest x-ray which did not show anything (on Monday) although it is common for a pneumonia to not show up for a few days on an x-ray film. His temp has dropped from 102-103 on Monday to 99-101 currently with the tylenol. He sees his oncologist again today for further management. His wife is also keeping a temperature log.

He has a CT Scan scheduled for Sept 27th which they tell us will reveal if the Radiation therapy has worked at. I'm keeping my fingers crossed

Thank-you again for your advice. It has been immensely helpful.

- Cindy