Friday, 20 January 2012

Decisions, decisions...

One problem with having a relatively rare form of cancer is that there is very little information available about it. When combined with the unpredictable nature of LMS this means that there is always a good deal of “decision making under uncertainty” involved in treating and managing the condition. I have really appreciated the openness of my doctors on this point; they have always been prepared to admit what they don’t know and when there isn’t enough clear evidence to dictate the best course of action. I find myself with just such a situation now.

Following my scan earlier this month my oncologist has given me three choices:

1) Have no treatment now whilst waiting until the end of March for another CT scan. Use the results of that scan to determine the next steps.
2) Start a new course of chemotherapy immediately.
3) Start a new course of chemotherapy at a time of our choosing between now and the end of March.  

There is no strong information available on which to select from these alternatives. Option (1) has the advantage of giving me another two months of feeling well. It runs the risk however that the tumours could grow significantly during this period. Option (2) is attractive because it offers the potential to shrink the tumours further before they have had chance to grow back to the size they were prior to my original chemotherapy course. The downside of option (2) is that the chemotherapy may cause me to feel quite unwell and is far from guaranteed to have any beneficial effect on the cancer.  Option (3) is a compromise and, in my view, only makes sense if we were to start the treatment sooner rather than later.

Katie and I plan to decide on our next steps over the weekend. We are currently favouring option (3) with a start date for the chemo of mid February. This will give us chance to to do one or two fun things that we've been planning before I start treatment and represents only a two or three week delay over option (1).

Away from treatment decisions we had a great time last weekend with a group of old friends getting together for dinner at our place. We had a lot of laughs; I have to admit to having a very juvenile element to my sense of humour and some of the attendees certainly know how to play to that!

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