Wednesday, November 16, 2005

Month Three

It's November 16, exactly three months from the day we first met with an oncologist and David started treatment. He was diagnosed with lung cancer on August 12.

Months One and Two were hellish, but the second half of Month Three (November thus far) has been mostly bearable. The current weekly chemotherapy hasn't been as harsh as the drug combination given at the end of September, which wracked David with nausea, dehydration, and anemia and landed him in the hospital for 10 days on our wedding night. It wasn't the doctors' fault -- after all, they're trying to treat the spreading cancer as aggressively as possible, and small-cell lung cancer is the type that grows more rapidly than the other forms (squamous cell, adenocarcinoma, and large cell carcinoma; or collectively known as non-small cell lung cancer to distinguish them from small-cell lung cancer).

Fortunately this time, the doctors were able to calibrate the formulas to allow David some normal mobility while continuing to give doses of radiation and chemotherapy sufficient to keep the spreading under control. They monitor his blood counts closely, since too much radiation can lower David's counts below the point where chemo can be administered safely. However, discontinuing radiation is also dangerous as the tumours grow unchecked, which is what occurred while David was on his first bout of chemotherapy.

Being a much younger patient makes the fine-tuning more problematic, as most small-cell lung cancer therapies are geared to patients who are much older (60+) and whose cells are regenerating at a slower rate. Being younger may sound like an advantage to fighting cancer, but not if it means the cancer has a greater chance to spread.

Before August, I knew very little about cancer, especially lung cancer. But an uncle of mine in the Philippines had died of lung cancer recently without ever having smoked a cigarette in his life, so I knew firsthand that smoking isn't the only cause -- second-hand smoke and chronic exposure to environmental carcinogens such as asbestos and radon are also to blame. But certainly smoking is the most prevalent risk factor: 85-90% of lung cancers are caused by carcinogens in nicotine.

I've compiled some information about small-cell lung cancer from a book given to us at the Hemotology and Oncology Clinic, information which can also be found online at the U.S. National Cancer Institute's website:

100 Questions & Answers About Lung Cancer [Karen Parles, Joan H. Schiller]
U.S. National Cancer Institute []

Lung cancer is responsible for more cancer-related deaths than breast cancer, colon cancer, and prostate cancer combined.

Small cell lung cancer: an aggressive (fast-growing) cancer that usually forms in tissues of the lung and spreads to other parts of the body. The cancer cells look small and oval-shaped when looked at under a microscope. Also called oat cell cancer.

There are only two stages used for small cell lung cancer:

Limited-Stage Small Cell Lung Cancer: cancer is found in one lung, the tissues between the lungs, and nearby lymph nodes only.
Extensive-Stage Small Cell Lung Cancer: cancer has spread outside of the lung in which it began or to other parts of the body.

Treatment of extensive-stage small cell lung cancer may include the following:
  • Chemotherapy.
  • Combination chemotherapy (multiple drugs).
  • Combination chemotherapy with or without radiation therapy to the brain for patients with complete response.
  • Radiation therapy* to the brain, spine, bone, or other parts of the body where the cancer has spread, as palliative therapy to relieve symptoms and improve quality of life.
  • Clinical trials of new chemotherapy treatments.
Note that surgery is generally not an option, as small-cell lung cancer does not respond to surgery at this stage. David has had all of the above therapies except brain radiation and participation in clinical trials.

David was diagnosed extensive-stage on September 13, and the doctors have been trying to get the tumours under control for the past two months. Month Two (mid-Sep to mid-Oct) were some of the roughest days -- David was too weak to do little more than lie in bed. Getting him to the clinic was a major effort. Appetite was zero, it was a battle to make him eat, and he was losing weight at an alarming rate. The side-effects (vomiting, fatigue, pain) were far worse than we'd expected, culminating in low blood counts and hospitalisation October 1. It wasn't until the end of October, once David recovered enough to eat solid food and resume (modified) chemotherapy and radiation, that the downward slide began to slow. Month Two was terrifying, to put it mildly.

Since the end of Month Two, the cancer is looking much more controlled. The areas currently receiving treatment are his neck, left shoulder, and right hip. David's not using a cane anymore, but walking is uncomfortable, and he depends on a raft of painkillers 24 hours a day. Since they're radiating his neck, his voice is hoarse and swallowing is difficult. But at least David has an appetite, and the side-effects aren't as debilitating as they were in Month Two.

A couple of weeks ago I signed us up for a "Healthy Eating for the Holidays" workshop hosted by the radiation clinic's resident nutritionist and Dr. B (David's doctor). It was earlier tonight, and just happened to be scheduled just after David's treatment, so we didn't have to make a special trip to attend.

This is the first cancer-related group meeting we've attended, and I thought it would be worthwhile to hear what we can do to improve David's diet. During the discussion, we also heard what other patients do for fitness, how their diets have changed, and the variety of circumstances that brought us all into one room. People came with their family members, too; caregivers were encouraged to expressed their concerns.

As was expected, the group was mostly older, and also suffering from generational ailments such as arthritis. But we did come away with some tips on getting health care discounts at certain facilities, and this woman told us of a facility where there are onsite physiologists who monitor patients' vitals. Probably of most value to David was being given some pouches of a drink mix that's supposed to rejuvenate muscle, recommended by the nutritionist. It looks like 'Tang' -- orangey, but with an aftertaste, David says. (Although, David's tastebuds are on the fritz these days. I didn't notice any aftertaste.)

After the meeting was adjourned, a bunch of people approached us, showing interest in our situation. One lady who identified with David's problem of gaining weight told me that she lost her husband a month ago. She was there with her son, who was wearing a neck brace -- he said he had back surgery and was discussing the various painkillers with David. It made me wonder if her husband died in an accident, perhaps the same accident that accounted for her son's injuries. What strength she must have, to be going through all this at once. Also, the woman who gave us the fitness centre tip was diagnosed with Hodgkin's Disease in 1997 at the age of 40, but had to endure 18 months of chemo and radiation before she got better.

It was somewhat of a relief to be in a roomful of people who could relate to cancer issues, but truly sobering to consider how quickly and brutally personal circumstances changed to bring us together.

* radiation therapy: the use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy.