Shoulda, Coulda, Woulda....

When diagnosed with cancer, choosing your oncologist is the most important decision you make. Your life is literally in his or her hands. And when you have stomach cancer, a disease without a standard treatment protocol, it makes things even more difficult. You may go with a doctor who chooses the drug regimen with the most side effects. Or you may go with a doctor in which "quality of life" is the most important, and chooses the drugs that have the least side effects. When diagnosed, my mom had the option of going with EOX, a 3-drug regimen comprised of Epirubicin, Oxaliplatin, and Xeloda, or Cisirino (cisplatin and irinotecan). We went with the two-drug combo. The doctor said that while EOX had a better outcome, it was only a difference in 1 or 2 months. In addition, no one knows how someone will respond to the drugs until they do it. There are companies like Rational Theraputics that can test a "live" tumor sample with chemo drugs, but it is costly and doctors remain skeptical of how effective it is. Having said this, I probably would have gotten it done.

Choosing the chemo regimen is tricky. Drugs with the more aggressive side effects do not not correlate to a better outcome. Just because you're suffering horribly does not mean you're also killing the cancer. Do you go with a doctor who manages your expectations and tries to prolong your life as much as possible without diminishing your quality of life? Or do you go with the one that believes you can be the exception and goes as hard as possible? I'm sure people may think, "I'd go with the doctor that will fight as hard as I will," but what does that mean? Especially since chemo for stage 4 patients is considered palliative. You're told they can treat the disease, the drugs may prolong your life, but they won't get rid of it entirely. There are people that go through chemo upon chemo without much success. At the same time, there are people who have great success from chemo and reach NED status (no evidence of disease). There are also people that just decide to live the rest of their life without treatment because they know one day, the disease will begin to outsmart the drugs and get sneaky. For many that choose chemo, despite being told it's palliative, you still hope it can cure you. And it does happen. But for the majority, it does not.

It's a conundrum. And throughout this journey, it does not get any easier. The longer you fight this disease, the longer you think about what you could have done differently. 

What I would do differently:
Disclaimer: these are just my thoughts going through my head

1. Have tumor sample tested against various chemo drugs, using Rational Theraputics, to determine the most effective protocol. By having a chemosensitivity test, your cancer is exposed to many possible treatments.
• At this point, my mom has had so many drug regimens that I don't think it would be worth it. It's also very expensive and not covered by insurance. In addition, doctors remain skeptical of this.
2. Bring my mom to Dr. Ajani at MD Anderson in Texas. 
• He's the leading expert in stomach cancer.
3. Consider a clinical trial early on.
• At this point, my mom is only able to do phase 1 clinical trials because she's been through several lines of treatment. With phase 1 trials, there is limited evidence behind the drugs that it will be effective. The limited evidence may be promising, but you really don't know. Phase 3 trials have already gone through phase 1 and phase 2. Since treatments are very limited, it may give you the opportunity to take advantage of drugs that are on the verge of FDA approval. And adds another drug to your arsenal.