Cycle 3 is a go!

 

So thankful that my body is able to receive my next infusion of KADCYLA.

But still channeling my emotional support animal today. Keep on swimming!

Residual Cancer Burden

  

 Residual Cancer Burden (RCB) is part of the pathology report and has been proven to be a good prognosticator (predictor) of disease recurrence and survival after neoadjuvant (pre-) chemo. This disease recurrence and survival is called Event-Free Survival. 

 Event-free survival (EFS) is a measurement of how long a cancer patient remains free of certain complications or events after treatment. These events may include the return of the cancer, the onset of certain symptoms, or the progression of disease that would prevent surgery. 

 This calculator was developed to have a standardized way of predicting the RCB.

 My results are as follows:

 Due to my HR+/HER2+ status, this puts my 5 year EFS at 76% and 10 year EFS at 64%.

It's OK to Slow Down

 

 I just realized it has been a bit since I last posted. I've been returning to work and truly looking at where I am at this stage and with everything I have going on. 

 Radiation is going well. Three days in. It'll be over before I know it. Hopefully without any burns!

 

 One thing that never crossed my mind is the impact cancer would have on my career trajectory. Here are a few links to peruse in case you're in your working years and find yourself at a crossroads during/after fighting the biggest fight of your life:

Cancer and Careers

How a Diagnosis Changed Survivors
Returning to Work after Cancer

 I am stepping back from my role in formal healthcare leadership and returning to the bedside as a physical therapist, so I can find my balance and provide the best care to my patients possible. 

CT Simulation Day for Radiation Treatment

  I had my CT simulation to set up for my radiation treatments today. I have one more simulation run through Friday. My actual radiation therapy start date is next Monday, August 19th and will be Monday through Friday for 30 twenty minute sessions.

 The following information was found on a great site by MD Anderson, but adapted in content for my specific situation:

 The CT simulation will produce a scan for the team to plan the angles and shapes of the radiation beams for treatment. These plans are designed by medical dosimetrists, who carefully plan and calculate the proper radiation dose for each treatment. Simulation often takes 30-45 minutes.

 During simulation, the table will move forward and backward to different positions. The lights in the room will be turned on and off. You will see laser lights on each wall.

 While you are on the table, the staff will take CT scans. The radiation oncologist will use these scans to pinpoint the exact treatment area to target during radiation therapy.

 Here are some other things to expect during the simulation:

• Skin markings/tattoos
• The therapist will draw on your skin with a felt marker to create a marking. These marks act as landmarks to help position you for treatment. If permanent markings are required, the therapist will use a sterile needle to deliver a pin-size drop of ink. Three permanent markings were required for me.

• Breath-Hold or 4DCT technique
• If you are receiving radiation near rapidly moving organs such as the diaphragm, your team will show you how to do the breath-hold or 4DCT technique. This is done several times during the planning process and treatment. You use a snorkel looking device to take as deep of a breath as you can without moving. That is used each time to ensure your organs are out of the radiation field, for me it is the heart.

 

From my consent, here is the list of early reactions that are possible:

1. Skin changes, redness, irritation, scaling, blistering, ulceration, discoloration, thickening and hair loss in the treated area
2. Breast changes including swelling, tightness or tenderness
3. Lung inflammation with cough
4. Inflammation of heart sac with chest pain and palpitations

Here is the list of late reactions that are possible:

1. Changes in skin texture and/or coloration, permanent hair loss and scarring of the skin
2. Breast changes including thickening, firmness, tenderness, shrinkage
3. Swelling of arm
4. Stiffness and discomfort in shoulder joint
5. Rib or lung damage causing pain, fracture, cough, shortness of breath and/or low grade fever
6. Nerve damage causing pain, loss of strength or loss of feeling in arm
7. Damage to heart muscle or arteries or heart sac leading to heart failure
8. Second cancers may develop in or adjacent to the irradiated area - 1-3% chance in 10-20 years

This just makes me smile so I wanted to share.

Chemo Brain

 

Great cards for challenging circumstances: https://thoughtfulhuman.co/collections/challenging-circumstances-1

Cycle 2 is a go!

 

 It’s always a win when your labs are spectacular. Thank you, body, for recovering so I can keep on track. 

Next Dose, Here I Come

 

 Hoping to have my next dose of KADCYLA tomorrow afternoon! Still pending results on my skin biopsy but my rash is healing. 

Let’s not be rash

  So I’ve been holding off on this post in anticipation of having answers, but unfortunately, one medical oncologist and one dermatologist later, we’re still not sure. 

 I woke up Saturday morning with a rash of pustules on my arms, trunk, and upper legs. They didn’t itch, but instead were tender to the touch. I instantly went to Dr. Google to see if it was due to my chemo or targeted therapy, but nothing was definitive. It wasn’t anything glaringly obvious to my medical oncologist as a KADCYLA side effect although 12% of people in one of the clinical trials developed a rash. The dermatologist thought it presented as be swimmer’s itch, but I haven’t gone swimming in years and was not near any lakes or other bodies of water. He took a punch biopsy so we could see what was going on and hopefully come up with an answer. Meanwhile, in the risk vs. benefit category, this rash isn’t so debilitating that we’re going to hold my treatment Thursday, so for now, I just get to find peace in not knowing what caused it. 

 

Side Effects and Exercise

 

 KADCYLA, like other treatments for cancer, have certain side effects. 
My current side effect inventory:

✅tiredness
✅fatigue
⛔nausea
⛔liver problems
✅pain that affects the bones, muscles, ligaments, and tendons
⛔bleeding
⛔low platelet count - pending next labs on August 8th
✅headache
✅weakness, numbness and pain in the hands and feet
✅joint pain
✅rash

 I'm fascinated by cancer-induced fatigue as it is real. I know I've written about this before, but this is a very interesting article if you want to geek out: https://www.cancernetwork.com/view/journal-cancer-related-fatigue-outcome-measures-in-integrative-oncology-evidence-for-practice-and-research-recommendations.

 Some snippets from this article: 

• The National Comprehensive Cancer Network (NCCN) guidelines define cancer-related fatigue (CRF) as “a distressing, persistent, subjective sense of tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning.”
• Diagnosing CRF is challenging due to the condition’s multifactorial quality, which may be further complicated by how clinicians measure and assess CRF. Researchers recommend that diagnosis be informed by 4 criteria: 
• (1) Indicators of symptom presence should be persistent for 2 or more weeks; 
• (2) there should be evidence of distress or impairment; 
• (3) the distinction should be made that the condition is related to cancer or cancer treatment; and 
• (4) there is absence of any previous or existing psychiatric disorder.

Another article which found that "exercise and psychological interventions are effective for reducing CRF during and after cancer treatment, and they are significantly better than the available pharmaceutical options. Clinicians should prescribe exercise or psychological interventions as first-line treatments for CRF."

 There is an app for iPhone called Cancer Exercise. It could be a good resource for anyone who is not familiar with gradating exercise. Blending research with resilience, Cancer Exercise is spearheaded by Dr. Anna L. Schwartz, a celebrated oncology exercise researcher. Her life’s work has been centered around the powerful link between physical activity and cancer recovery.

 Time to get my exercise on.

Reminders

 

 Happy Friday! I’m looking forward to a restful weekend. 

 My last two weeks of work have reminded me to:

CIPN and Radiation

  I’ve written about chemotherapy-induced peripheral neuropathy before, but now it’s in full force. Both of my feet are numb and my fingers often have trouble with fine tasks. I’m very much hoping this goes away someday but one of the side effects of KADCYLA is numbness. The two chemotherapy medications I had before, Carboplatin and Taxotere, are also reasons for this, so at this point it’s just compounding. Next dose of KADCYLA is August 8th.

 I am to begin radiation sooner than I originally thought. They will do the CT simulation to set me up on Monday, August 12th and then I’ll start my first session on Monday, August 19th. It is daily, Monday-Friday for 6 weeks. It will be good to get another part of my treatment started. This site from Mayo Clinic is a great overview of radiation. 

 I will need to hold my breath at times during treatment to get my heart and lungs out of the way. 

  I keep reminding myself: