Review of chemotherapy

Open letter: Review of ECF chemotherapy

As the New Year begins I have just completed a three cycle [9 weeks] preoperative chemotherapy using the ECF chemotherapy protocol [Epirubicin, Cisplatin and 5-FluoroUracil] for the treatment of oesophagogastric adenocarcinoma. This is my first ever exposure to chemotherapy. No radiotherapy was used.
Overall I believe I have tolerated the treatment well; two weeks were missed. One because of unsatisfactory blood test results, the other because of severe inflammation of the skin on feet and hands. Total treatment was therefore only seven weeks.
The chemotherapy was under the medical supervision of Dr Desmond Yip, medical oncologist. It was administered with care and a good dose of wit by clinic staff at the Zita Mary Clinic, Calvary Hospital, via a chest implanted port which functioned perfectly throughout. ACT Community Nurses were available on call at home, but treatment was uneventful. The epirubicin and cisplatin were administered on Day 1 of each three week cycle. The 5-FU was administered continuously over the 21 days of each cycle via a portable infusion pump. Anti-nausea drugs were administered for the first 3 days of each cycle. I now look forward to a thorough review of the chemotherapy outcome and an assessment for surgery, using whatever tests and procedures that are available and appropriate.
Side effects
No nausea, no vomiting, no infection, no hospitalization, little fatigue, no hair loss, no hearing impairment. The difficulty in swallowing disappeared within days. My eating, appetite, taste and smell were only little affected. There was constipation at the start of each cycle, but was relieved without the need for medication.
The most unpleasant side effect has been and still is stomach ache. It was intermittent and at times quite painful. Sometimes all day, sometimes not at all, sometimes only on waking in the middle of the night. The ache was relieved sometimes by Panadeine Forte, sometimes by slippery elm bark, and otherwise by just drinking water.
The other major side effect was severe inflammation, drying, flaking and blistering of the skin on the feet and the hands. Red and purple blotches was the best description. At times walking was very painful. The inflammation appeared to be a recurrence of a previously existing condition, infection or immune reaction. Best relief was to stay off my feet or soak in iced water. Blistering was extensive and in some instances blood blisters.
Other side effects noticed were disfiguring, discoloration and banding of the fingernails; darkening and discoloration of the skin. Also dryness of the mouth and soreness and cracking in the lips.
Psychological profile
I feel I have coped well. I accepted the diagnosis with calm; I was not shocked, angry or dismayed. I do not seek to ascribe cause or blame or feel guilt for this disease or to seek a miraculous cure. I have had lots of good luck throughout my life, now it is my bad luck to be dealt this disease. I have had wonderful support from my wife, children, family, friends, neighbors, clinic staff, community nurses and cancer survivors. I welcome their thoughts, prayers and advice. I have very quickly appreciated that so many other people have been affected either directly or indirectly by cancer. I have read extensively on the topic, I have joined online discussion groups and established my own blog. I have cried and laughed as I read stories of survival and defeat. I have read a full description of the type of surgery I am facing [not for the faint hearted!!].
I am well aware of the many complimentary and alternative treatments for cancer. I trust my life to conventional medical wisdom and practice; I believe in the inherent professionalism and humanity of my doctors.
I am thankful for the excellent medical and support facilities right here on my doorstep in Canberra. I know the risks associated with surgery and recovery. I have met survivors and heard of people who did not survive. I am ready to proceed to surgery and be a survivor. I pledge my future support for any other sufferers…the ‘obligation of the survivors’ as Lance Armstrong puts it in his book.
May peace be with you.

Cc
Dr Desmond Yip
Dr Charles Mosse
Dr Michael Brown
Zita Mary Clinic staff


Peter S Davis
Canberra
Tuesday, January 01, 2008