Advanced bowel (colorectal) cancer usually means the disease has spread from the large bowel to the liver or lungs. Treatment with chemotherapy is unlikely to cure advanced bowel cancer, but improvements in surgical techniques and drug treatment can improve outcomes, and chemotherapy can help to control the symptoms, shrink the tumours, maintain a reasonable quality of life, and prolong life in some cases. This is called palliative chemotherapy. Sometimes drugs called monoclonal antibodies (biological therapy) are also given in combination with chemotherapy and this too can help improve quality and length of life.
For some people chemotherapy is the only treatment available, so deciding whether to have it can be straightforward. However, when chemotherapy is given over a long period of time, balancing the benefits of the treatment against the unpleasant side effects can become increasingly difficult.
One man described his generally positive feelings at the prospect of having chemotherapy. However, for another man who was much farther into his treatment, the decision making had become more complex:
Explains that he was happy to have chemotherapy as it was his only option.
Explains how deciding on which drug to use became more complex over time.
For almost everyone we talked to who was receiving treatment for advanced bowel cancer the availability of their drugs had been an issue. Two people were being treated privately and were aware that their drugs might not have been available on the NHS. One NHS patient had to travel to a different hospital in her area for treatment until it became available closer to home. Another woman being treated on the NHS became involved in a high profile campaign for the right to receive treatment in her area rather than having to travel to another part of the country.
She campaigned for the right to receive her chemotherapy at her local hospital.
The availability of some drugs for advanced bowel cancer has improved since these interviews and only certain drugs are limited to people taking part in clinical trials.
The use of Hickman lines, PICC lines and portacaths (central lines for administering drugs that are inserted and then left in place) or tablet forms of chemotherapy meant that people were not necessarily spending long periods of time in hospital and could enjoy a reasonable quality of life. Knowing their patterns of recovery from chemotherapy also allowed them to plan their activities.
Describes his cycle of reaction to and recovery from chemotherapy.
The side effects of palliative chemotherapy are different for each person and everyone develops their own ways of coping with them. One woman describes her efforts to live as normally as possible despite the obstacles. A man whose illness was more advanced found his side effects increasingly difficult to live with despite his determination to do so.
Describes her strategies for dealing with the side effects of her chemotherapy.
Describes the debilitating side effects of his chemotherapy.
Stephen had a rare form of advanced bowel cancer. His cancer had spread to form tumours in his leg. As part of his treatment he had an unusual form of chemotherapy called isolating limb perfusion chemotherapy.
Stephen describes having isolating limb perfusion chemotherapy.
Sometimes the side effects cause problems that cannot be ignored and decisions must be made about further treatment. One woman describes balancing the effects of drugs against the problems caused by side effects and explains how her choices are becoming more limited:
Her side effects have become serious and future options are limited.
All patients were aware that at some point they would not have any more options for treatment, but they tried to focus on what was possible and maintaining their quality of life.