reoccurrent treatment questions

[stage414]

.My mother had stage 4 OC 14 years ago; a reoccurance in 2002.  In Feb 2006, it was back in lymph nodes around her lower aorta.  She's been on maintenance chemo ever since.  In October, tests showed her cancer was growing again and the main tumor is now 5 cm.  Last week, she started treatment with Gemzar.  I've read that the FDA approval for Gemzar was against the panel's advice since it did not increase a patient's longevity.  Her oncologist is a terrible communicator and only told us about chances of increased swelling and affects on blood counts.  Later, nurses casually told us that this treatment would be every week instead of every 3 and that she no longer needed to 2 medicines.  My mother is 76, has extreme arthritis, and other medical issues.  Her doctor gave her a low dose of Gemzar last Thursday and she is still extrememly weary and had mild nausea.  If Gemar is not going to lengthen her life expectancy and will have toxic side effects 4 out of 7 days, when is it not worth continuing treatment?  Her doctor avoids my questions of what  she can expect to happen, what symptoms to look for, and where it might spread.  I had to figure out what and where the lower aorta was and had to ask if the tumor could eventually affect her circulation.  Is it rediculous to change doctors now?  Is what I read accurate, that patients normally live only about a year with Gemzar?  Where does advanced OC spread?  If she can not get weekly treatment, will Gemzar even be effective?  How will he monitor the cancer's progress?    Her spinal stinosis, arthritis and cancer all cause lower back pain, how do we get her doctors to communicate about what is the best pain medications?  Do any practices have both oncologists and primary care doctors to enhance communication about overlaping and competing symptoms.  My mom has already beaten the statistics and is not "average" but we need to get better information.

[Annekathryn Goodman, M.D.]

Hi There,
Thank you so much for your important question. I apologize for my delay in responding.
I would recommend that you get a second opinion. Here are some ways to find another doctor:

You can call the American Cancer Society (ACS) chapter in your community and ask for the names of gynecologic oncologist in the area.
if you live in an area that does not have a gyn oncologist, you could ask the ACS for the names of medical oncologists who are known to specialize in ovarian cancer.

Finally, if there are support groups for women with ovarian cancer in your community, very commonly the women who go to those groups will be able to tell you which doctors or practices are good about communication and information and also (very important) tender loving care. Another place of good gossip and information is in the chemotherapy infusion unit . You will see other women getting chemo. Ask them about their doctors and how things are going. It may take a little sleuthing but there are lots of resources.

As far as gemzar goes, it is a good drug and very useful for someone people. It is given weekly for 2 out of 3 weeks or 3 out of 4 weeks depending on how well a person's counts can handle it.

It sounds to me like you and your mother need to have a big picture discussion about what is happening with this cancer, what is the overall prognosis and what are the various choices.

please let us know how things go
take care

[stage414]

Dr. Goodman, Please respond to these older questions also.  I am most of us would still appreciate your opinion.  Thank you.  Stage414