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Colorectal Cancer

Decisions about chemotherapy for bowel cancer

Chemotherapy is a treatment which uses drugs to destroy cancer cells. Because cancer cells are dividing quickly they are particularly susceptible to chemotherapy which disrupts the growth of cancer cells. It can be given in tablet or capsule form but more commonly it is given into a vein (intravenously).

Adjuvant chemotherapy is chemotherapy used in addition to other treatments, such as surgery or radiotherapy. Its aim is to prevent the cancer coming back once the original tumour has been destroyed or removed. Adjuvant chemotherapy may be prescribed if cancer has spread to the lymph nodes or if it is unclear whether, after the main treatment, any cancer cells have been left behind. 

People who are offered chemotherapy as a precaution have to decide whether the potential benefits of treatment outweigh the possible side effects. One woman describes the decision-making process she went through before choosing to have chemotherapy. A man, who supports other cancer patients on a voluntary basis, thought that the choice became obvious if you made a list of the pros and cons.

 

Describes how she decided to have chemotherapy.

Describes how she decided to have chemotherapy.

Age at interview: 74
Sex: Female
Age at diagnosis: 68
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I was given a choice and I even went to the, the abdominal surgeon and he was the one that said "Well Professor [name] likes to give chemotherapy after this, would you be prepared to have it?"

And I said "Well prepared to have it, this is a big question do I want to have it or not?" And he, he didn't really try to persuade me, I asked him what he would do (laughs) and that's a hard one, that's a hard one for any doctor.

And he did admit that he, he would and so I went on that and decided to do it. They couldn't tell me 100% that it would be successful or it would even be a better scenario than not doing it. It was a case of, you know, it's likely to be helpful.

A lot of people were, at that time saying that chemotherapy was not a necessary thing to do but he felt that it gave you a bigger, much bigger chance if you did have it, but then you had to go through all that problem of having it. So that was the only the only decision making thing, was it going to increase the chances of getting over this.

And the doctor that I saw thought, well, he couldn't say whether it was and he was very fair and said "Well I can't tell you that it's going to give you any more years really but there's a chance that it might be better to have the chemotherapy. So that's what I did.

 

He feels that making a list of the pros and cons of chemotherapy makes the decision obvious.

He feels that making a list of the pros and cons of chemotherapy makes the decision obvious.

Age at interview: 69
Sex: Male
Age at diagnosis: 65
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It's like when I go to talk to people about chemotherapy, this one person said she didn't think that she would go for it and I said "Well, that's, you know, your personal choice, whether you go for it or whether you don't but the hospital is basically saying uh, give you a choice".

And I said "Well what you do is you get a list, you get a sheet and you write out the, the bad things about chemo' that you're gonna have to travel to hospital 20 miles, you're gonna have to go every so often, you're gonna have somebody to bring you down, you're not allowed to drive."

You write all these things down, all against chemotherapy and then you write what's for. And I said "Well, when I was doing it I just wrote for, the first I wrote was it's gonna save my life," and I didn't have to write anything more, it's as simple as that.

So you take your choice and you don't, in my opinion you just don't have a choice.

 

Stephen describes the types of chemotherapy he had after his surgery.

Stephen describes the types of chemotherapy he had after his surgery.

Age at interview: 19
Sex: Male
Age at diagnosis: 15
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So then you went to see somebody about the chemotherapy?

Yeah so then discussions started about chemotherapy. There were two doctors involved, one who was a colorectal cancer specialist who was, who worked at a kind of adult hospital, and one was just a general oncologist who worked at the children’s hospital. But they thought it was important to involve them, them both in discussions which was very, very helpful for me. So various lines of chemotherapy regime that they wanted me to have, it was the Folfox regime, which is Oxaliplatin Fluorouracil and F5U no 5FU, it’s a long time since I’ve had them now so, so yeah but I had six months of that altogether cycle-wise, I had the one drug, Oxaliplatin that went in attached to a drip over about two hours, and then for the next forty eight hours I was hooked up to the other two drugs. So to begin with

So you were an in-patient?

Yeah to begin with I was an in-patient for those forty eight hours, so it, approximately it took three days out of every two weeks, and then that cycle repeated. In time they actually got this pump which actually held chemotherapy drug, and it meant I could have a forty eight hour drug at home. I just carried this pump around the house with me for example, which was very, very helpful.

While no one, we talked to, who had been offered chemotherapy refused it, several people who accepted, or agreed to continue with the treatment, had done so partly out of a sense of duty to others. One woman was so grateful for the help she had received from her medical team that she felt she would be letting people down if she refused. A man facing a decision about chemotherapy was moved by his concern for his wife.

 

Her decision to have chemotherapy was connected to her gratitude to her medical team.

Her decision to have chemotherapy was connected to her gratitude to her medical team.

Age at interview: 68
Sex: Female
Age at diagnosis: 67
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"You've got to think about this," he says "it can be eh 50 to 100 that it could come back elsewhere but you could go for chemo to be on the safe side but you'll need to talk it over with your family." He said "If you go for chemo it jumps and, he says, it's 80% it won't come back, but that is entirely up to you."

Well I felt that my own doctor, the surgeon, everybody had, did their best for me. I was getting told that if I took chemo it could help me so there was no way I wasn't going to take it after all of what they had done.

I mean what was the sense of that, saying no I'm not gonna take chemo and then sit in a big chair and say, maybe I should have took the chemo. No, I made that decision there and then.

 

Continued with chemotherapy to help reduce his wife's intense worry about him.

Continued with chemotherapy to help reduce his wife's intense worry about him.

Age at interview: 60
Sex: Male
Age at diagnosis: 60
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I started into chemotherapy in the January. I'd seen the oncologist previously, I was a bit astray in my brain at the time, I was finding it hard to cope. My wife wanted me to continue.

The guy I was talking to explained the symptoms that might happen, that did happen. Nausea, mouth ulcers, diarrhoea, all these things. They're in smaller doses. You don't have them all day every day, you have them some of the day some days in my particular case.

I did contemplate not having the chemotherapy. I had to go back for a second visit because I couldn't clearly make up my mind that did I want another six months out of work, did I want to drag this all out, I wanted it to end.

It was explained to me that the chemotherapy would give me a better chance of survival. Like everyone I wanted to survive but at the same time I didn't know if I could have another six months of being pulled about, in my mind of course.

I came home from the oncologist and I looked at my wife and she was falling apart. She couldn't cope much more. I had to say yes deliberately purely to see my wife's face brighten, not be so unhappy.
 

Two younger patients faced difficult decisions about chemotherapy because of its potential impact on their families and future lives. One woman had been pregnant at the time of her illness and faced chemotherapy with a new baby at home. She explains how she chose a course of action. Another young woman describes her distress at the prospect of chemotherapy leaving her infertile, and how a second opinion offered an alternative.

 

She had to choose a course of action that would suit her as a new mother.

She had to choose a course of action that would suit her as a new mother.

Age at interview: 35
Sex: Female
Age at diagnosis: 32
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He said that almost certainly it was in, that the cancer cells were in my blood stream so I definitely needed chemotherapy. He said the fact that, oh it had actually spread as well from my large bowel into my small bowel, that was obviously the pain that I was getting across here, that it had spread and it had it affected the lymph nodes as well. He said that taking that all into account your chances of not having a recurrence were about 30% at the time.

Taking my age into consideration he said it was about 50'50 of having a recurrence and I hadn't realised it was as serious as that.

He explained that I had two options. One was 5FU which would have, was one injection a week for 30 weeks or there was a new drug that they were trying out which was a much more aggressive one which I think would've only have been about eight weeks worth of treatment I think.

I know it was much more, had much more severe side effects but really I took his advice he said "You know you've got a young child," she was only about nine weeks old at this point, nine, ten weeks old you know he said "You want some quality of life. So I think, I think if I was in your position that's what, I would go for 5FU. There isn't particularly any proof to say that this other drug has better results so you're probably better off going with the one that's been sort of tried and tested." So that's what I did.
 
 

She feared that chemotherapy would leave her infertile until an alternative drug was proposed.

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She feared that chemotherapy would leave her infertile until an alternative drug was proposed.

Age at interview: 33
Sex: Female
Age at diagnosis: 28
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When I was still in hospital after the operation I saw an oncologist there and he said that I needed a particularly strong kind of chemotherapy treatment because of my age basically, and because of the type of tumour and that would have made me infertile.

So for about a week that's what I thought I had to have and I thought that I was never gonna be able to have children and that was a really devastating time actually. But again I was persuaded to go for a second opinion, which I did, more locally because my surgery didn't take place close to home, it took place in another area so then I sort of came back to nearer where I lived, to a specialist cancer hospital and saw somebody who, who just didn't, who had a very different opinion about it really. 

And was again somebody who was quite, doing a lot of research in the field and thought that I could have this, this type of chemotherapy which would make me stop ovulating, but temporarily and that, you know, it was thought that my fertility would go back to normal again after the treatment.

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Last reviewed August 2016.

Last updated August 2016.

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