Tuesday, April 22, 2014

Watch and Wait in Follicular Lymphoma....Yet Again

A couple of weeks ago, I wrote about an article from The Lancet that compared Watching and Waiting to an immediate treatment with Rituxan, and those two to Rituxan plus Rituxan Maintenance. According to the authors of the study, Rituxan Maintenance won across the board, not only in holding off the disease best, but also in measures of Quality of Life such as "Mental Adjustment to Cancer" and "Illness Coping Style."

That Quality of Life measurement is pretty important. That choice of first treatment for an advanced Follicular Lymphoma patient with no obvious symptoms is pretty important -- if there's no immediate physical need for a treatment, then being mentally ans spiritually satisfied is important. Quality of Life measures like "Mental Adjustment to Cancer" and "Illness Coping Style" have to be taken into consideration.

So R-Maintenance is the clear choice, right?

Well now, just hold your lymph nodes, partner.

A few days ago, Lymphoma Hub published a summary of an article from the European Journal of Haematology that looked at Health-Related Quality of Life in Follicular Lymphoma patients who had received treatment or who had watched and waited. The patients had received either R-CVP, R-CHOP, R-Chlorambucil (another type of chemo not commonly used in FL in the United States), radiotherapy (not sure what that consisted of) or watched and waited. The patients took two Quality of Life surveys a year apart, and their responses were compared to non-cancer patients' responses.

The survey found that those taking chemo had a lower Quality of Life than the comparison group, but the watch and waiters (and those receiving radiotherapy) had a Quality of Life in line with the comparison group (though they did report more fatigue).

So Watch and Wait won that round, right?

Really, the studies can't be compared. Chemo isn't Rituxan Maintenance.

But comapring the two studies does say something interesting about the relative nature of Quality of Life for Follicualr Lymphoma.

Call it a "grass is always greener" thing. "I might be tired, and I'm worried about when I'm going to need treatment (again), but golly, I'm doing better than that guy who had chemo."

And it all, once again, emphasizes the need to talk to your own doctor, and to really think carefully about your own mental and spiritual needs. I don't know if getting Rituxan right away is the best answer. It wasn't for me. But there are plenty of Follicular Lymphoma patients who will benefit, physically and mentally, from doing something right after being diagnosed.

There are not too many easy answers with cancer, and the messed up version of it that we are affected by has even fewer easy answers. When do I treat? What do I choose to treat with? Do I consolidate and follow up immediately with a second treatment? What do I do for a second treatment when I do need one? Do I consider a trial?

How the hell should I know?

The important thing is to make a decision that feels right now, that is approved by your oncologist as likely being effective, and don't look back on your decision.

Because the thing that affects Quality of Life the worst is regret. We have enough to worry about already.

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