Saturday, November 10, 2007

Getting Ready for my Next Chemo Cycle

A female friend of ours FINISHED the New York Marathon last Sunday. Congratulations CB on the training and the accomplishment! There was a great picture of her on the Internet with Katie Holmes (Tom Cruise’s wife) running just behind her about two thirds of the way through the race.

My next chemo cycle begins in 2 weeks and 2 days, not that I’m counting. I will begin my training today for this other type of marathon. I just recently learned the following about cancer treatment, fitness and survival. I guess I knew it before as it is intuitive, but had never seen any studies on it until yesterday.

A little background it is order. The physical fitness of patients is rated by their doctors. A number of “performance scales” can be used in this measurement process. One popular rating scale is the ECOG / WHO / Zubrod score. It rates patients on a 0 to 5 scale as follows:
0 - Asymptomatic (showing no evidence of disease)
1 - Symptomatic, but completely ambulant
2 - Symptomatic, <50% in bed
3 - Symptomatic, >50% in bed, but not bedbound
4 - Bedbound
5 – Death

Most people try to avoid being a 5. A little gallows humor. I would rate myself currently at a 2 level. During heavy periods of chemo or following more significant surgeries, I have been in the 4 category. I have also been in the 3 category, bordering on a 4, for more than a month at a time during the latter stages of some of my chemo treatments. Aggressive chemo can be very debilitating.

More background - I received the newsletter from my cancer center yesterday. In it was an article titled, “Fatigue as a predictor: advanced lung cancer.” As you know, I don’t have lung cancer, but Head & Neck cancer is so far down on the list of types of cancer (and therefore receives relatively little funding) that much of what my doctors model their treatment plans on are the success of lung cancer studies. They feel there is a high enough correlation between lung cancer and Head & Neck cancer that there is validity in this approach. Based on the newsletter article I did a little web surfing and found other articles backing up the one in my cancer newsletter.

Okay, it’s taken me a while to get to the point in this blog entry, but here it is… there is a high correlation between one’s fitness going into chemo and their prognosis. In one study of treatment-related death (TRD – it seems like there is an acronym for everything), 2.3% of the patients died from chemo toxicity. It’s not a big number, but is would suck to be in that 2.3% group. TRD for patients with a Performance Score of 4 were 36 times (yes, 36) more likely to die from chemo toxicity than patients with a performance score of 0. Patients with a performance score of 2 were almost twice as likely to die from chemo toxicity than a patient with a performance score of 1. Going back to the article in my cancer newsletter, the conclusions made there was more qualitative. But their bottom line was that those with a better PR scores could tolerate their chemo treatments longer and were therefore more likely to complete them. That in turn led to a better prognosis.

Many of you probably remember from a few months ago when I threw in the towel and couldn’t complete my last round of chemo cycle 8. I was too fatigued and honestly felt like the chemo would kill me before my disease. As such, I still don’t regret not moving forward with that last round. I have reached the conclusion though that if something is going to save me, it is going to be a systemic solution (like chemo) versus a point solution (like surgery). That’s not to say that surgery doesn’t have a place in my future treatment options, but I’m convinced surgery is not going to cure me whereas I still have the hope for a cure with some systemic type treatment.

I will workout today and will try to do some type of workout everyday going forward to move from a 2 to a 1 on the performance rating scale in preparation for my next chemo.

Have a good weekend and take care everyone.


Fran in Pgh said...

Glad to hear your resolve here, Ed. As Barry just said, "What a great attidtude. That's great data, keep it in mind and keep reminding yourself of it. Get to work and keep it going'!

Love you, and see you soon

justme519 said...

As usual you seem to have a great plan. Thank you for the useful data. You sound strong and that makes me smile. Hope your having a good week-end.