Doing the Chemo Dance

I was going to title this:  The Chemo Dance, doing the dance of death… but thought that title might be off-putting and giving the wrong idea!

Recap:  The day of Kevin’s surgery at the University of Michigan, Dr. Bradford, the primary surgeon, talked to me immediately following her part in the surgery.  I know that stress causes memory problems; I know that my brain continues to simply stop for short moments, and my memory bank is not what it once was.  But in ALL  matters of all things “Kevin’s Cancer”, I have the sensitivity of a hunting dog, poised for every single nuance, word, facial expression, or body language; I am acutely aware of all that is said, left unsaid, and intimated by an expression or an eyebrow lift… so … I know EXACTLY what she said to me.

 She said she was able to get clear margins with the tumor (excellent news), but that one of the dissected lymph nodes was suspicious; but we wouldn’t know for certain until the path report returned. Even so, she felt confident there was lymph node involvement.  When I asked what this meant; she responded, “We will be more aggressive.”  When I asked what that meant, she said, “Chemotherapy.”  She then said, “There is a clinical study on the combination of chemo and radiation that I would like to put him on if it is in your area.”  Period.  Full Stop.

At our follow-up visit on February 24, she confirmed that out of 38 dissected lymph nodes, 4 were found with tumor.  (We already knew this from our radiologist.)  She went on to say, she wanted him on the clinical study which treats with radiation concurrent with chemotherapy, IF IT WAS AVAILABLE IN OUR AREA.  When I asked, what if it is not, she said she would not sanction any other chemotherapy, and when asked why not, she said there was “no definitive evidence” that this made an impact on recurrent disease vs radiation alone.  The “I will not sanction…”troubled me, but until we knew whether or not this was an issue…I let it be.

Thinking perhaps this was an insurance issue; that, if our surgeon didn’t give her approval, coverage would be denied, Kevin contacted his insurance company, and found them extremely supportive. saying it was NOT a procedure that required pre-certification, and even if it did, they would look at the recommendation of the oncologist if it was differing from the surgeon.

Back in South Bend, we learned the study is not open in our area.  Both our radiologist and our oncologist believe chemo is definitely indicated.  Our radiologist suggested that he have a conversation with Dr. Bradford after he consulted with our oncologist.  We agreed; but, after our conversation yesterday with our oncologist (who stated that while he fully supports this study, the reason combining chemotherapy with radiation isn’t considered the “standard of care”, it is only because a clinical study has not been done previously, providing evidence that is should be.  However, he has been (administering the chemo in patients with this type of tumor, in combination with radiation, and the results in his practice have been a 50% less rate of recurrence.  SOLD!

To be perfectly honest, I spent 11 years working in a Clinical Cancer Center for a gyn oncologist who was a dedicated researcher, and who developed multiple protocols that became clinical studies, and went on to become first and second line treatments for gynecologic cancers.

 A clinical study is usually randomized, and blind; there is no guarantee that the Human Subject will get drug or a placebo.  I love science, I am grateful for all of those who have gone before and were willing to do this.  Frankly, I am just not ready to see Kevin donate his body to science, so I am perfectly happy knowing he is not part of a clinical study.  I remember well the Greys Anatomy story when the blind clinical study Meredith was conducting on Alzheimers, and the Chief’s wife was in that study.  He BEGGED Meredith to find out whether or not Adele was getting drug or placebo, and when it was found that she was assigned placebo, he begged Meredith to switch her file, and she did.  I got it then; but I REALLY get it now!

He will be having radiation therapy daily for 15 minutes for 6 weeks; weekly, he will then go to the Infusion Center at the Hematology Oncology center, and will undergo cisplatin infusion for 3 hours, followed by another 3 hours of infusion of “medication”.  I will be attending the one hour information session on Tuesday so will be much smarter about this at that time.  Cisplatin is a “mid-range” drug as far as side effects go.  It’s not free and easy as some are, nor is it the worst.  He will “most likely” lose his gorgeous, thick hair (but it will grow back!) and will probably experience some degree of nausea and possibly vomiting, but there are drugs to ease that.

Our oncologist also explained to Kevin the difference in staging the tumor found in an organ, or in other head and neck areas, and a gland.  MUCH less scary.  Once again, he confirmed that this is TREATABLE.

After carrying these questions around in my head for awhile, the relief to  finally have a course of action that feels “right” has lifted my spirits.

What IS that STRANGE sensation in my body?  OH!  I believe it is called “appetite”!  Who knew stress could kill that!