Waiting period before new treatment started - 1268130

drgoogle
Posts:24

What would I do without you fine folks ?

Can you advise, if oncologist says growth not 'clinically significant ' but stops Pemetrexed treatment if there is a 'waiting' period before another treatment may be given.

Note..husband has anemia from pemetrexed and is on Eprex. Last injection on Friday.

Oncologist was to take recommendation of Tarceva to board but we have yet to hear back - over a week since they were expected to convene. Wondered if time is required to pass before new plan is executed. Thanks

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Reply # - January 18, 2015, 12:05 PM

JimC
Posts: 2753

Hi drgoogle

If your husband's doctors have stopped Pemetrexed because of his anemia, then they may want to wait until that is resolved before starting any treatment, whether it is a return to Pemetrexed or a new agent.

My question would be whether the progression is significant enough to warrant a change in treatment, or perhaps any treatment at this point. If he has otherwise been tolerating Pemetrexed well and the progression is very slow, then a short treatment break before resuming it might be in order. As Dr. West has often said, it's a good thing to maximize the benefit you get from each treatment option.

JimC
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Reply # - January 18, 2015, 02:24 PM

Dr West
Posts: 4735

There are no formal rules except in clinical trials. Unless we know that the cancer is progressing at an unusually rapid rate, it's very typically to take 2-3 weeks, and sometimes more, to decide on and plan for a next line of therapy. There is rarely any urgency, especially when a patient has had issues with low blood counts.

Good luck.

-Dr. West

Reply # - January 19, 2015, 07:53 AM

drgoogle
Posts: 24

Thank you both. If it wasn't for reading a column you wrote, Dr. West, on clinical significance, it would not have been a question I would have asked the oncologist when he described a nodule at 1 cm in January that they had been watching since my hubby's November scan (and described as suspicious at that time.)Oncologist certainly seemed surprized I asked! Thanks for the education!

Do you have any suggestions to offer up as to how patients or their advocates can get Dr.'s to provide a more thorough explanation of scans, significance of what is seen , what is being proposed, etc. Being so busy the time spent with us is short, sometimes hurried and many times leaving us with more questions than answers. Than God we have GRACE.

What do you like to see from patients/advocates towards making good use of an appointment with you ? Thanking you in advance...

Reply # - January 19, 2015, 08:16 AM

JimC
Posts: 2753

I think you've pretty much answered your own question. By showing that you are knowledgeable, your oncologist is more likely to engage in a dialogue about those issues. Patients who have self-educated often forget that doctors get plenty of questions that display a lack of fundamental understanding of the situation, the response to which would require so much background information it would be impractical to give a detailed answer. But the more you can speak at the same level (more or less) as your doctor, the more willing they are to spend a little more time answering, knowing that you will understand the answer.

JimC
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Reply # - January 19, 2015, 02:10 PM

drgoogle
Posts: 24

Thanks again. Seems that approval was granted early last week for Tarceva but no one called us and prescription not called into pharmacy. Thank God I called to check on status. Prescription has been called in and Oncologist wants hubby to start today.

Thanks Jim/Cat.. am going to continue reading/learning and if required asking questions of you my GRACE friends when I need clarification or just reassurance. And I am going to make darn sure that every appointment is a meaningful exchange between us and oncologist!

Reply # - January 19, 2015, 03:15 PM

catdander
Posts:

Great to hear. It's important to know what to expect when changes are made like you did with the prescription for tarceva. I don't know if you'll be able to get it today though. If you normally use a specialty pharmacy maybe it will be available but usually it takes a few days and must be picked up or mailed from a specialty pharmacy.

All best,
Janine

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