Direction?

The hard news is minimal, really.  Or maybe maximal, depending upon what you think hard news comprises.  Ed has shifted away from chemotherapy as of last week and is instead receiving Avastin once every three weeks.  His most recent CEA test produced a reading of 3.3, which is lower than the previous 3.4 and lower yet than the previous to that 3.5.  But we have no way of knowing whether these are meaningful or meaningless (because of measurement variations) distinctions.  In any case, it continues to go down which is the desirable direction.  So that's the data, such as they are.  The maximal data are that Ed continues to feel well, to work hard, to gain weight (soon, I'll be leaving the whipped cream off his morning cocoa), to be on top of things.  And if that's the best indicator of how things are going, they're going fine.

Back at the beginning (and from here on, I'm just pondering my own reactions to all this), one of the oncology nurses told me that people often are very reluctant to stop chemotherapy, even if it appears to be doing them no good.  I was amazed at this, since I regarded the chemo as mostly risk.  But now, with the ending of it, I was finding myself feeling, 'well, this is a worrisome development.'  Just like those people, I had slowly bought into the idea that the chemo was beneficial treatment, doing good work.  It was easier to slide into that, especially since the CEA numbers were going down and Ed was not having a lot of terrible chemo side effects.  So, you can imagine my surprise when Ed's doc said to him last week, with respect to his last CT scan, "Well, only 35-45% of patients who present like you don't benefit at all from the chemo." [Sorry about this error--now corrected--in the original post; I am really not learning that I am no longer reliable with numbers if I don't check them at least twice.] I just don't think that was part of the informed consent process.  Back then, we were getting median survival numbers, not response rates.

Ah, well, humans: even while paying attention, we are not paying attention, I suspect.  At some point, the doc says, the CEA numbers start to rise and then one must decide about second line chemo, or returning to the original chemo, or calling it quits with respect to therapy.  In his own experience, says the doc, there's big variation on how long that interval is...six weeks with some patients, more than a year with others.  News at 11.

Another item: there's been some reporting in the past month about Avastin being pulled from some cancer patients because of new research showing minimal effectiveness and great costs.  This research was on breast cancer patients.  We are operating in this decision to go with Avastin alone on a Spanish study involving about 450 patients with metastatic colon cancer who had all received primary chemotherapy.  In the maintenance phase, half received the equivalent of 5FU and Avastin, while the other half were given only Avastin.  Outcomes were the same for both groups.

It's fall here now, rainy and relatively cold.  Those of you who were here in the summer, would hardly recognize it.  We recognize it.  The attached shed/storage room at the Orchard House, for those of you who have observed or participated in its construction, is about to get its floor, to be followed by outside walls.  And we have to have the heat on at the Orchard House or it gets pretty cold there.  But the beds all have down comforters.  And there is heat to turn on.