To Chemo or Not To Chemo...

Here's a quick review of yesterday's post... 

Short, sweet and straight to the point...
In the midst of this current pandemic,

Get yourself Home and Stay There! 

And that's just a start for everyone... During this time of unprecedented uncertainty with the COVID-19 pandemic, many cancer patients are struggling with decisions on their care and treatment.

It's not enough to just stay home and shelter in place... our pancreatic cancer patients are fighting their terminal diagnosis 24/7.  The cancer treatment plan does not take days off while we shelter-in-place.

I can remember a well-meaning friend stopping by to visit mom during the early months of her treatment.  The friend asked mom how long she would be on the chemo.  Mom, emotions still raw from the recent terminal diagnosis, bluntly stated that she would be on chemo until she died...  the proverbial pin could be heard for miles.  

Grief tore our hearts open wide to realize the truth of her words.  Mom's chemotherapy treatment was all we had to hold the pancreatic cancer at bay.  And the chemo's track record didn't foster a lot of confidence.

So... with that really terrible seque... (I just don't know how else to get from there to here!)  What's a pancreatic cancer patient to do during this prolonged and uncertain time?  It's hard enough to deal with the harsh side effects of the treatment, but what about the hit to your immune system... is it safe to even go in to the clinics/hospitals for the chemo and radiation??  On the flip side, is it advisable to postphone the treatment, perhaps the only thing holding the cancer in check??

The questions and indecision can turn a world upside-down.

Whenever mom was struggling with a problem, she would start researching the issue for pros and cons, taking the emotions out of the decision. It turned the churning chaos down a notch and allowed reasonable debate over a subject.   We can do the same...

And first up is to call your cancer team/doctors and discuss your questions and concerns.  If you don't know where to start, or what questions to ask, read on...

The National Comprehensive Cancer Network addresses many of these concerns in a recent report on Managing Cancer Care During the COVID-19 Pandemic. This article is a good resource to begin the discussion for each cancer patient.

While the article is very detailed, the authors' share a very compassionate and honest review about the effects this novel coronavirus is having on cancer care today:

"The potential threat of COVID-19 to our immunocompromised patients as a result of their disease or the treatment we provide is thought to be significant, tipping the usual risk/benefit balance in extreme ways.  There are limited data on immunosuppressed hosts, but early published reports from China on the outcomes of patients with cancer infected with COVID-19 indicated a 3.5 times higher risk of needed mechanical ventilation or ICU admission or dying compared with patients without cancer."

This is difficult to read, let alone absorb... cancer patients are likely to be impacted by the virus much more significantly than patients without cancer.  Especially when the chemo/radiation treatments have hollowed out their immune system.

Cancer Health also shares this concern in a recent article on their website, appropriately titled Should I Continue My Cancer Treatment During the Coronavirus Pandemic?

"Oncologists ask themselves, 'Should we continue to give immune-system-suppressing cancer treatments to patients during the COVID-19 pandemic?' On the other hand, patients ask, 'What happens to me and my cancer if I stop treatment altogether?"

Exactly!!  There are no easy answers for the cancer patient!

Cancer Health continues,  "The problem is, chemotherapy drugs damage healthy white blood cells, which are the body's defense against viruses like the novel coronavirus.  But stopping treatment could also put people living with cancer at risk for even more problems, including tumor progression and shorter survival times."

The American Society of Clinical Oncology has issued a comprehensive guideline entitled COVID-19 Patient Care Information.  It covers many of the questions that cancer patients and their loved ones might have.  I would encourage you to read through their information and keep checking back as they are updating their COVID-19 reports as new data emerges in the ongoing pandemic we are facing.

The ASCO has made the following recommendation (as of March 26, 2020) for cancer patients:

"At this time, there is no direct evidence to support changing or withholding chemotherapy or immunotherapy in patients with cancer.  Therefore, routinely withholding critical anticancer or immunosuppressive therapy is not recommended."

However, while encouraging the cancer patients to continue their treatments during this uncertain time, the ASCO also recommends that health care providers make treatment decisions based on each individual as well as factors such as cancer stage, chemotherapy type and the risk of cancer recurrence (or spread) should treatment be delayed.

And that circles us back to our very first point... it's imperative for each one of us to talk with our cancer team, discuss our individual case with the doctor that knows us best...

I am beginning to believe that this Coronavirus pandemic is the health care challenge of our generation.  And for those of us in the cancer trenches, it is a challenge that our modern cancer treatments have never had to face.  We are all on untried, unproven ground.  What we do today may have ramifications on all future steps.

So, talking it a step at a time... Today's Goal:  Talk with your Cancer Team!

And then wash your hands ;-)

Love you!

Jane

A Cancer Patient's Response to COVID-19

By now, the news of a novel Coronavirus pandemic is actually old news... and yet, every day, the reports seem to get worse.  COVID-19 will be the war that is remembered from our generation.

We are putting worrisome precautions to a test, such as social distancing and sheltering in place... We are learning about flattening a curve and the unruly rules of a pandemic unchecked... We are panic buying canned goods and toilet paper!

Truly, at every turn, this pandemic is creating a growing panic in our hearts.  Especially for a cancer patient.  The pictures coming out of our major cities are grim and cause increased anxiety.  Compound this news with the frightening prognosis many cancer patients are already shouldering and it can just be too much!

Some say the media are blowing it all out of proportion, others are saying we are not doing nearly enough!  What's a cancer patient to think?

To begin, let me share a cautionary tale from our own experience.  You may remember some of the details, but for those who are new here, perhaps this part of mom's story will lend some gravity to the events of today.

On November 16, 2011, Mom passed her one year cancer anniversary and we celebrated!

It had been a hard year... the chemotherapy and radiation had been grueling, the mental anguish and anticipatory grief a nightmare to wade through, the weight loss, digestive ills so heartbreaking to watch... But she walked each day with grace and a fight that would not quit.  We seemed to be finding our stride in this cancer journey, daring to believe she could beat this cancer back.

Just the week before marking this one year anniversary, her oncologist had given us the good news that tests confirmed the pancreatic tumor was still confined to her pancreas, and had not begun to spread.  The combination of chemotherapy and radiation seemed to be holding the cancer at bay.  This was a huge relief and added to the air of celebration.

We turned our attention to the Thanksgiving festivities with renewed joy and optimism.

On Wednesday, November 23rd, I took mom to her weekly chemotherapy infusion.  Afterwards we enjoyed a light lunch out and then stopped at our favorite Whole Foods grocery store for a few last minute items for next day's Thanksgiving feast.  The day was ordinary.  All seemed well.  Really, beyond good! The smiles would not be stopped...

The next day the house filled with noisy, happy family members.  Thanksgiving was a day deeply saturated with gratitude.  Walking through cancer with mom the past year had given us a new perspective.  Life was fragile, and we cherished her so.

I look back at the laughter and fun and chatter we all shared that day, and wonder at the moment our world began to fall apart.

2 days later mom was flattened by a horrific case of double pneumonia.  Admitted to the hospital on Saturday, November 26th, we didn't know it then, but we were beginning the journey to the end.

In shock, our naive belief that she was holding steady, cancer stable, no metastases, was blown apart in the days to follow.

For although the cancer had not spread, there was one thing that had happened, and it changed everything...  Mom's immune system had been badly compromised by the effects of the brutal treatment to hold the cancer in check. She fought as hard as her weakened body allowed, but a moment came when there was no fight left.

She lost the battle 7 days later.

The death certificate said Pancreatic Cancer.  But it's just not so simple.  That virulent strain of pneumonia was the ultimate reason.  And it ran rampant through her body because of her weakened immune system.

And we wonder so often, when did she pick up that virus/bacteria?  The Wednesday we stopped for a bite to eat at our favorite restaurant? Or maybe when we ran in for that last minute shopping trip at Whole Foods?  Or perhaps during our large and joyous Thanksgiving gathering?

I wish so often we could have kept her bundled up safe and sound at home while she battled out the ravages of the chemo.  Waited out the drop in her blood counts, the loss of immune strength.  Encouraged her to rest, eat well, gain strength.

To shelter in place... until it was safe again.

And that is exactly where we are today.

All around, officials, doctors and health authorities are urging us to shelter in place.  Until we are safe again from the COVID-19 virus.

Especially those with weakened immune systems, those who are medically fragile... like cancer patients.  Pancreatic Cancer patients, who have been hollowed out by chemo and radiation.  There is just not enough fight left to attack a virus on top of the cancer.

As Cancer Centers and Doctors grapple with all the implications of treating their cancer patients midst the contagious reach of COVID-19, many are tightening their policies and protocols.  Reducing unnecessary visits, treatments, as well as limiting exposure for their immunocompromised patients.

So, what is a cancer patient to do?

First and foremost, talk with your  cancer team and doctors... it's so important to be in communication with your team.

And then, as much as possible, Shelter in Place!!!  Far, far away from that Corona Bug!

While you're putting up your boundaries and keeping yourself safe at home, there are some smart  things you can be doing (besides panicking!):

Wash your Hands! (Momma was right along!)  Use soap and water and wash for at least 20 seconds.  If soap isn't available use a hand sanitizer with at least 60% or greater alcohol base.

Avoid touching your face (eyes, nose and mouth) with your hands.  (Hard! Believe me, I know... but with thought and discipline you can do it!)

Clean and disinfect objects and surfaces you frequently touch.

Obviously, avoid contact with people who are sick.  Be a techie and use virtual tools to visit with friends and family... even I have learned how to Face-time!  You can do it!

Boost your immune system.  Again, talk with your team and see what your doctor is recommending.  Many in cancer research are suggesting we support our immune system with an increase in our Vitamin D... here are 2 studies:

Epidemic Flu and Vitamin D and

Vitamin D to Prevent Acute Respiratory Infections

One of our favorite cancer survivors shares his thoughts on Vitamin D here . . . Chris takes 10,000 IU per day during the winter months and is doing so now during this coronavirus outbreak.  And again, say it with me, talk with your cancer team and see what your doctor is recommending for you.

 Another immune booster that mom used is Wheat Grass or the Barley Life supplement.  All together: check with your cancer team before using!

As you settle in to your Sheltering in Place, it's time to let go of the control and the pride and really let your loved ones take care of you.  And this is a hard one too!  So many cancer warriors are proud and have found it's difficult to ask for help.  Trust me... your loved ones want above all else to help you!!

If they've offered to pick up groceries, let them.

If they've offered to help with childcare, let them.

If they've offered to make a meal, let them.

It is a gift that will ultimately bless them more than you!  There's just one thing... when your loved ones offer to help, keep those boundaries up... groceries and meals can be left on the porch, children dropped off at the front door... as hard as it is to restrict visitors during this time, it is so very important!

We can do anything for short periods of time.  Especially if it keeps the virus at arm's length.  A virtual hug works for now, time is coming when we will be able to hug in person!

Mom's story, above, is an urgent reminder that your fight is limited. Do everything in your power to protect your precious strength and fragile immune system!!

Tomorrow we'll tackle one of the Big Questions for every cancer patient ... Do I continue chemotherapy and radiation during this unprecedented time of uncertainty?  Hard questions for every cancer warrior and their cancer team... we're unpacking the research that's out there and grappling with the hard stuff...

For Today, may you find an overwhelming peace replacing the fear as you control what you can, and make plans to Shelter in Place while you gain strength for the fight.

Even when we feel like our world is coming apart, God has never let us go! He walks right through the midst of every struggle and holds us safely in His Hands...

My Love, Always,
Jane

Finding Peace Tonight

Today would have been their 60th!

And for the first time in a very long time, there is peace tonight.

Dad has missed mom these past 9 years with an intensity we could never ease.  It was if he was incomplete, just half of a whole without her by his side.

He loved us and lived life well, but there was always the shadow of her passing holding his heart hostage.

Tonight they celebrate together, and there is a genuine joy in remembering their happiness.

The stranglehold of grief is released in the remembering...

So. Much. Love.

Peace for this heart tonight.