Sherryl spoke with her oncology nurse practitioner, Nancy, by phone this morning and was invited to meet with her any time today. So, following her MRI at 10:00 AM, Sherryl headed to the Marin Cancer Institute to see her favorite nurse practitioner.
Nancy explained to Sherryl that her case was reviewed yesterday by the oncology team, a group of physicians, nurses, and other healthcare providers who meet once a week to assess the status and prospective treatment plans for individual patients. The team agreed that since so many vertebrae are involved, the best approach is not to "chase each tumor individually with radiation," but rather to preserve bone marrow. The group also agreed that Femara and Tamoxifen had not yielded any results, so those medications were ruled out. Instead, the team concluded that, in addition to continuing with Zometa, a different form of chemotherapy is the best approach.
The team agreed to prescribe for Sherryl the oral chemotherapy, Xeloda. She will begin today or tomorrow taking pills with or immediately following meals that are spaced 12 hours apart. Oral medication is taken each morning and each evening for 14 days, none are taken for 7 days, then the 3 week cycle begins again. Nancy told Sherryl that if there is a positive response to this treatment, it will continue indefinitely.
Nancy also told Sherryl that Xeloda either works 100% or does not work at all in cancer patients. How Sherryl's cancer responds to this therapy will be measured through ascertaining the tumor marker each month, by the results of PET scans that will be performed every 2 - 3 months, and by how Sherryl is feeling relative to any form of pain. Nancy advised it will take about 6 weeks to measure how Sherryl is tolerating this treatment; a low dosage will be prescribed initially and monitored closely to ensure all is going well.
Side effects for Xeloda are different than those experienced from chemotherapies that are infused into a patient's bloodstream. Using Xeloda, reactions may include redness and swelling in the palms of the hands and soles of the feet. This side effect is gradual rather than sudden and will be monitored during Sherryl's weekly appointments. Another side effect may be indigestion and/or mild nausea, which is why it is important to take the medication with some food in the stomach.
The good news is that Sherryl will not experience any fatigue or hair loss as a result of this treatment. Sherryl can also continue physical therapy and she can continue to work at day care. Her next appointment with Nancy is next Tuesday when she'll learn the results of the MRIs that were performed this week.
Clarification: Yesterday's update indicated cancer spots were found on both lungs when it fact they were found on only one lung: the lower right section of the right lung. Both calcification and active cancer have been found in that area, but this is also the region that responded positively in the past to chemotherapy.
As for Sherryl's spirits, she feels good. She's glad radiation treatments have concluded, is happy to know she will not experience fatigue with the current treatment plan, and enjoyed spending time today with Nancy. She knows the news that cancer is active is not great, but she is not devastated by her prognosis. Following her meeting with Nancy, Sherryl's immediate attention was getting to Peet's Coffee at Bon Air Shopping Center. It was past 12:00 noon by the time her conversation with Nancy concluded and she really, really wanted a mocha!