Is it medical negligence?

I know a bowel cancer patient who went through the conventional treatment
for primary cancer i.e. chemo, radio followed by lower bowel resection and a
little more chemo. After the operation the patient was informed by the
surgeon that cancer cells were found in the lymph glands nearby. However,
after the operation for 4 years appx, the patient received no cancer
treatment whatsoever (excepting a few weeks chemo immediately after the op),
then during a gap of 4 years or so no treatment at all and then the bowel
cancer came back as metastatic bowel cancer.

I now read articles that Xeloda is very beneficial in continuing the cancer
treatment immediately after the bowel resection. One article I read said
that it could bring about a 'cancer free outcome'. The doctor was reported
as saying that Xeloda was used as an 'insurance' as it was not always
certain that cancer cells remained. However, when during the re-section
operation the surgeon discovers cancer cell spread to the lymph nodes, then
to abandon cancer treatment in the knowledge that there are active cancer
cells in the lymph, would be negligent, would it not?

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NEWS HOME > HEALTH NEWS > HEALTHWATCH
Tuesday Apr 24 18:13 AEST

New drug raises bowel cancer cure hopes
Monday Dec 5 18:00 AEDT
Xeloda comes in pill form (Channel 9)
By Sheryl Taylor
National Nine News medical reporter


Bowel cancer is the second biggest cancer killer in Australia, but now a new
treatment approved for use here raises the chances of a cure, and it comes
as simple, easy to take pill.

The Therapeutic Goods Administration has approved the oral chemotherapy
agent Xeloda as follow-up treatment, post-surgery for bowel cancer, but only
if the cancer was found in lymph nodes. Previously only used for advanced
cancers, Xeloda is designed to stop them spreading.

RELATED LINKS

* VIDEO: New medication raises survival hopes

Sydney man Denis Crawford found a strange lump in his abdomen when doing up
his belt. He thought it odd enough to check out, but never imagined it could
be bowel cancer.

The sizable tumour was surgically removed last November, but instead of
facing months of conventional intravenous chemotherapy, his specialist put
him Xeloda.

"Compared to the old chemotherapy, it reduces relapse by 14 percent", says
Dr Nick Pavlakis, a medical oncologist at Sydney's Royal North Shore
Hospital.

Xeloda was so effective in treating advanced bowel cancer that its now been
moved up to the front-line, and prescribed for use after tumours are removed
surgically.

"This is treatment given us an insurance," says Dr Pavlakis. "We don't know
if there are residual cancer cells still lying around, and the best time to
cure a patient is in that circumstance."

Taken in pill form, Xeloda is absorbed into the gut but only activated when
its particles reach the liver. From there it's "switched on" to fight cancer
by destroying the DNA of cancer cells wherever they may be in the body.

Doctors say patients love the freedom that a pill gives them since they
don't need to be hooked up to intravenous drips in a hospital, sitting for
hours on end.

Mr Crawford, who's about three-quarters of the way through his treatment,
says "It allows me to live a completely normal life and I don't have to go
anywhere near hospitals, which is psychologically wonderful as well as
physically."

Doctors expect that with regular checkups, scans will show in five years
that Mr Crawford has been cured. For the moment he says he's been able to
resume work, and golf.

"I'm surprised at how well I've been able to get back," he says. "I've
gradually done it from five holes to 10 holes to 15, and on Sunday I did 18,
so I'm back!"

So far Xeloda has cost up to $4000 per six-month treatment, but it's
expected to be added to the Pharmaceutical Benefits Scheme early next year.

In the interim, patients will be able to access the drug through a Special
Patient Program, allowing patients in the new approved category to receive
it for free.
© National Nine News 2005


9 NEWSWATCH

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Other Side of Story wrote:

> I know a bowel cancer patient who went through the conventional treatment
> for primary cancer i.e. chemo, radio followed by lower bowel resection and a
> little more chemo. After the operation the patient was informed by the
> surgeon that cancer cells were found in the lymph glands nearby. However,
> after the operation for 4 years appx, the patient received no cancer
> treatment whatsoever (excepting a few weeks chemo immediately after the op),
> then during a gap of 4 years or so no treatment at all and then the bowel
> cancer came back as metastatic bowel cancer.
>
> I now read articles that Xeloda is very beneficial in continuing the cancer
> treatment immediately after the bowel resection. One article I read said
> that it could bring about a 'cancer free outcome'. The doctor was reported
> as saying that Xeloda was used as an 'insurance' as it was not always
> certain that cancer cells remained. However, when during the re-section
> operation the surgeon discovers cancer cell spread to the lymph nodes, then
> to abandon cancer treatment in the knowledge that there are active cancer
> cells in the lymph, would be negligent, would it not?

The (cancerous) lymph nodes were probably removed.
In theory, the adjuvant chemo mops up the stray cancer cells, so he had the appropriate treatment.

There's no point in (being on chemo long term) and toxifying the body and getting chemo-resistant.
Don't believe everything you read in the news.
Xeloda is basically the same as the long established chemotherapy drug 5FU, but in a form which can be taken orally and gets converted to 5FU in the body.
A survival benefit over 5-FU/LV has not been demonstrated with XELODA monotherapy.

So longterm chemo, when lymph nodes are involved, is one of those "darned if you do" and "darned if you don't" situations. Except you can get mighty sick on long-term chemo trying to mop up cancer cells that are no longer there. See my point?
J

"Other Side of Story" <replytogrouponly@notthis.com> wrote in message
news:462dbcb1$0$13365$afc38c87@news.optusnet.com.a u...
>I know a bowel cancer patient who went through the conventional treatment
>for primary cancer i.e. chemo, radio followed by lower bowel resection and
>a little more chemo. After the operation the patient was informed by the
>surgeon that cancer cells were found in the lymph glands nearby. However,
>after the operation for 4 years appx, the patient received no cancer
>treatment whatsoever (excepting a few weeks chemo immediately after the
>op), then during a gap of 4 years or so no treatment at all and then the
>bowel cancer came back as metastatic bowel cancer.
>
> I now read articles that Xeloda is very beneficial in continuing the
> cancer treatment immediately after the bowel resection. One article I read
> said that it could bring about a 'cancer free outcome'. The doctor was
> reported as saying that Xeloda was used as an 'insurance' as it was not
> always certain that cancer cells remained. However, when during the
> re-section operation the surgeon discovers cancer cell spread to the lymph
> nodes, then to abandon cancer treatment in the knowledge that there are
> active cancer cells in the lymph, would be negligent, would it not?
>
> &lt;a

The patient had perfectly sound treatment. There is no evidence at all that
xeloda or anything else would have improved the outcome. So no, it wasn't
negligent.

Other side of story - yes I see your point, however I am of the view that
prevention is better than cure. I base my view on the fact that the patient
had chemo during metastasis for about a year without major after effects,
but the chemo was ineffective on the tumour in its grown stage wheres it
might have been more effective in its 'unclustered' state. One reason Xeloda
may not have been repeatedly prescribed after the resection operation is the
budgetary consideration. In Australia where the patient lives, drugs are
heavily subsidised by the Government, but I am not sure when Xeloda went on
the government's pharmaceutical benefits scheme. It's only recently that I
hear of the 'insurance' option put forward my an oncologist at the Royal
North Shore Hospital and I am guessing that could be because Xeloda has only
been recently approved as a follow on option. But in any case I do feel that
in any case treatment should be continued where evidence of cancer cell
spread in the lymph system exists. Treatment could be with Xeloda and or
dietary etc. I think the weakest option is to do nothing. The nothing option
to me would be more appropriate if the cancer was diagnosed early and did
not go through the bowel to the lymph. Osos.
"J" <nexsw@nvalid,anon> wrote in message
news:462DC306.8759306D@execulink.com...
> Other Side of Story wrote:
>
>> I know a bowel cancer patient who went through the conventional treatment
>> for primary cancer i.e. chemo, radio followed by lower bowel resection
>> and a
>> little more chemo. After the operation the patient was informed by the
>> surgeon that cancer cells were found in the lymph glands nearby. However,
>> after the operation for 4 years appx, the patient received no cancer
>> treatment whatsoever (excepting a few weeks chemo immediately after the
>> op),
>> then during a gap of 4 years or so no treatment at all and then the bowel
>> cancer came back as metastatic bowel cancer.
>>
>> I now read articles that Xeloda is very beneficial in continuing the
>> cancer
>> treatment immediately after the bowel resection. One article I read said
>> that it could bring about a 'cancer free outcome'. The doctor was
>> reported
>> as saying that Xeloda was used as an 'insurance' as it was not always
>> certain that cancer cells remained. However, when during the re-section
>> operation the surgeon discovers cancer cell spread to the lymph nodes,
>> then
>> to abandon cancer treatment in the knowledge that there are active cancer
>> cells in the lymph, would be negligent, would it not?
>
> The (cancerous) lymph nodes were probably removed.
> In theory, the adjuvant chemo mops up the stray cancer cells, so he had
> the appropriate treatment.
>
> There's no point in (being on chemo long term) and toxifying the body and
> getting chemo-resistant.
> Don't believe everything you read in the news.
> Xeloda is basically the same as the long established chemotherapy drug
> 5FU, but in a form which can be taken orally and gets converted to 5FU in
> the body.
> A survival benefit over 5-FU/LV has not been demonstrated with XELODA
> monotherapy.
>
> So longterm chemo, when lymph nodes are involved, is one of those "darned
> if you do" and "darned if you don't" situations. Except you can get
> mighty sick on long-term chemo trying to mop up cancer cells that are no
> longer there. See my point?
> J
>

But Steph, obviously the medical profession believes that there is danger in
not giving any treatment af all after resection and thats why they give some
very short term chemo. And the short termness could be the actual problem as
lots of cancers seem to come back as metastatic when they are virtually
effectively untreatable. Surely it would be logical to take long term
treatment after evidence of spread in the system as it is very likely that
the cells will migrate and form tumours. To me that is basic reasoning so I
agree with the doctor at the Royal North Shore Hospital. I wonder, how did
they establish that giving the patient a little more treatment for about a
week or two only after the operation is the optimal time to stop. Surely its
a shot in the dark?
"Steph" <steph@vancouvers.island> wrote in message
news:nxoXh.121952$DE1.78674@pd7urf2no...
>
> "Other Side of Story" <replytogrouponly@notthis.com> wrote in message
> news:462dbcb1$0$13365$afc38c87@news.optusnet.com.a u...
>>I know a bowel cancer patient who went through the conventional treatment
>>for primary cancer i.e. chemo, radio followed by lower bowel resection and
>>a little more chemo. After the operation the patient was informed by the
>>surgeon that cancer cells were found in the lymph glands nearby. However,
>>after the operation for 4 years appx, the patient received no cancer
>>treatment whatsoever (excepting a few weeks chemo immediately after the
>>op), then during a gap of 4 years or so no treatment at all and then the
>>bowel cancer came back as metastatic bowel cancer.
>>
>> I now read articles that Xeloda is very beneficial in continuing the
>> cancer treatment immediately after the bowel resection. One article I
>> read said that it could bring about a 'cancer free outcome'. The doctor
>> was reported as saying that Xeloda was used as an 'insurance' as it was
>> not always certain that cancer cells remained. However, when during the
>> re-section operation the surgeon discovers cancer cell spread to the
>> lymph nodes, then to abandon cancer treatment in the knowledge that there
>> are active cancer cells in the lymph, would be negligent, would it not?
>>
>> &lt;a
>
> The patient had perfectly sound treatment. There is no evidence at all
> that xeloda or anything else would have improved the outcome. So no, it
> wasn't negligent.
>

"Other Side of Story" <replytogrouponly@notthis.com> wrote in message
news:462e9e36$0$16555$afc38c87@news.optusnet.com.a u...
> Other side of story - yes I see your point, however I am of the view that
> prevention is better than cure. I base my view on the fact that the
> patient had chemo during metastasis for about a year without major after
> effects, but the chemo was ineffective on the tumour in its grown stage
> wheres it might have been more effective in its 'unclustered' state. One
> reason Xeloda may not have been repeatedly prescribed after the resection
> operation is the budgetary consideration. In Australia where the patient
> lives, drugs are heavily subsidised by the Government, but I am not sure
> when Xeloda went on the government's pharmaceutical benefits scheme. It's
> only recently that I hear of the 'insurance' option put forward my an
> oncologist at the Royal North Shore Hospital and I am guessing that could
> be because Xeloda has only been recently approved as a follow on option.
> But in any case I do feel that in any case treatment should be continued
> where evidence of cancer cell spread in the lymph system exists. Treatment
> could be with Xeloda and or dietary etc. I think the weakest option is to
> do nothing. The nothing option to me would be more appropriate if the
> cancer was diagnosed early and did not go through the bowel to the lymph.
> Osos.


But whatever your "view", there is no evidence to support it.

"Other Side of Story" <replytogrouponly@notthis.com> wrote in message
news:462ea16f$0$25225$afc38c87@news.optusnet.com.a u...
> But Steph, obviously the medical profession believes that there is danger
> in not giving any treatment af all after resection and thats why they give
> some very short term chemo. And the short termness could be the actual
> problem as lots of cancers seem to come back as metastatic when they are
> virtually effectively untreatable. Surely it would be logical to take long
> term treatment after evidence of spread in the system as it is very likely
> that the cells will migrate and form tumours. To me that is basic
> reasoning so I agree with the doctor at the Royal North Shore Hospital. I
> wonder, how did they establish that giving the patient a little more
> treatment for about a week or two only after the operation is the optimal
> time to stop. Surely its a shot in the dark?


Standard adjuvant chemo after bowel surgery is 6 months - hardly a "little
more"

six months seems to be more logical, but the patient I spoke to whose bowel
cancer came back as metastatic, told me they only had about one week's
treatment with chemo after they had the bowel resection. If what the patient
told me is found to be correct and what you r saying is found to be correct
e.g. 1week vs 6 months then there would be a good case for negligence would
there not?
"Steph" <steph@vancouvers.island> wrote in message
news:t8zXh.125081$aG1.108713@pd7urf3no...
>
> "Other Side of Story" <replytogrouponly@notthis.com> wrote in message
> news:462ea16f$0$25225$afc38c87@news.optusnet.com.a u...
>> But Steph, obviously the medical profession believes that there is danger
>> in not giving any treatment af all after resection and thats why they
>> give some very short term chemo. And the short termness could be the
>> actual problem as lots of cancers seem to come back as metastatic when
>> they are virtually effectively untreatable. Surely it would be logical to
>> take long term treatment after evidence of spread in the system as it is
>> very likely that the cells will migrate and form tumours. To me that is
>> basic reasoning so I agree with the doctor at the Royal North Shore
>> Hospital. I wonder, how did they establish that giving the patient a
>> little more treatment for about a week or two only after the operation is
>> the optimal time to stop. Surely its a shot in the dark?
>
>
> Standard adjuvant chemo after bowel surgery is 6 months - hardly a "little
> more"
>

"Other Side of Story" <replytogrouponly@notthis.com> wrote
> six months seems to be more logical, but the patient I spoke to whose
> bowel cancer came back as metastatic, told me they only had about one
> week's treatment with chemo after they had the bowel resection. If what
> the patient told me is found to be correct and what you r saying is found
> to be correct e.g. 1week vs 6 months then there would be a good case for
> negligence would there not?

Are you looking for someone to blame, someone to sue, someone to collect
damages from, or just possible answers to "how did this happen"?
bj

Other Side of Story wrote:

> six months seems to be more logical, but the patient I spoke to whose bowel
> cancer came back as metastatic, told me they only had about one week's
> treatment with chemo after they had the bowel resection. If what the patient
> told me is found to be correct and what you r saying is found to be correct
> e.g. 1week vs 6 months then there would be a good case for negligence would
> there not?

You said the patient had chemo/radiation before the lower bowel resection.
Then a few weeks of chemo.
How long did the patient have chemo (before the resection)?
J

Xeloda carries risks.
<http://www.bccancer.bc.ca/NR/rdonlyres/2BB030DB-8731-496F-BF22-94EA2BBD631F/21333/Capecitabinehandout_20Feb08.pdf>

Xeloda is called Capecitabine

This is dated June, 2005 and says 24 weeks.
http://content.nejm.org/cgi/content/...ct/352/26/2696

Methods We randomly assigned a total of 1987 patients with resected stage III
colon cancer to receive either oral capecitabine (1004 patients) or bolus
fluorouracil plus leucovorin (Mayo Clinic regimen; 983 patients) over a period
of 24 weeks. The primary efficacy end point was at least equivalence in
disease-free survival; the primary safety end point was the incidence of grade 3
or 4 toxic effects due to fluoropyrimidines.

Results Disease-free survival in the capecitabine group was at least equivalent
to that in the fluorouracil-plus-leucovorin group (in the intention-to-treat
analysis, P<0.001 for the comparison of the upper limit of the hazard ratio with
the noninferiority margin of 1.20). Capecitabine improved relapse-free survival
(hazard ratio, 0.86; 95 percent confidence interval, 0.74 to 0.99; P=0.04) and
was associated with significantly fewer adverse events than fluorouracil plus
leucovorin (P<0.001).

Conclusions Oral capecitabine is an effective alternative to intravenous
fluorouracil plus leucovorin in the adjuvant treatment of colon cancer.

bj wrote:

> "Other Side of Story" <replytogrouponly@notthis.com> wrote
> > six months seems to be more logical, but the patient I spoke to whose
> > bowel cancer came back as metastatic, told me they only had about one
> > week's treatment with chemo after they had the bowel resection. If what
> > the patient told me is found to be correct and what you r saying is found
> > to be correct e.g. 1week vs 6 months then there would be a good case for
> > negligence would there not?
>
> Are you looking for someone to blame, someone to sue, someone to collect
> damages from, or just possible answers to "how did this happen"?
> bj

Apparently. On an Aussie board, he's a QC
J

"J" <nexsw@nvalid,anon> wrote in message
news:462F68F6.5EC02F79@execulink.com...
> bj wrote:
>
>> "Other Side of Story" <replytogrouponly@notthis.com> wrote
>> > six months seems to be more logical, but the patient I spoke to whose
>> > bowel cancer came back as metastatic, told me they only had about one
>> > week's treatment with chemo after they had the bowel resection. If what
>> > the patient told me is found to be correct and what you r saying is
>> > found
>> > to be correct e.g. 1week vs 6 months then there would be a good case
>> > for
>> > negligence would there not?
>>
>> Are you looking for someone to blame, someone to sue, someone to collect
>> damages from, or just possible answers to "how did this happen"?
>> bj
>
> Apparently. On an Aussie board, he's a QC
> J
>

In that case, I'll send him a bill for my opinion

"Other Side of Story" <replytogrouponly@notthis.com> wrote in message
news:462f47fb$0$13365$afc38c87@news.optusnet.com.a u...
> six months seems to be more logical, but the patient I spoke to whose
> bowel cancer came back as metastatic, told me they only had about one
> week's treatment with chemo after they had the bowel resection. If what
> the patient told me is found to be correct and what you r saying is found
> to be correct e.g. 1week vs 6 months then there would be a good case for
> negligence would there not?
>

It's much more likely you have the story wrong somewhere.

J wrote:
>
> Apparently. On an Aussie board, he's a QC
> J
>
For the uninitiated, what is a "QC?"
Curious,
Belle

"Belle Gin" <""no$pam\"@no$pam.net"> wrote in message
news:5d642$462f789c$48317ac9$4034@FUSE.NET...
>J wrote:
>>
>> Apparently. On an Aussie board, he's a QC
>> J
>>
> For the uninitiated, what is a "QC?"
> Curious,
> Belle

Queen's Counsel. In the USA, a lawyer. The legal system is a
complex animal over there. There are solicitors who advise
clients and do basic legal tasks like drawing up wills, simple
business agreements and so forth. For litigation and court cases
one's solicitor works with a Queen's Counsel, who tries the case.
There are hierarchies and so forth but I don't pretend to
understand any of them.

Pam S.

Well, it is a known historical fact. The medical profession does stuff up,
like others. Now the fact is we pay insurance so that when there is a stuff
up, some compensation can help the patient and/or their families. Also, the
compensation could make unsound dicisions/systems more correct and efficient
and this would help future and other patients. So really I am looking for
all these things which flow from a claim of compensation. I dont think its a
personal dishoner if a doctor faces a claim. Its probably similar to a
driver facing a claim in an automobile incident/accident.
"bj" <bjones44@bellatlantic.net> wrote in message
news:PKJXh.10307$Fs6.8199@trnddc03...
> "Other Side of Story" <replytogrouponly@notthis.com> wrote
>> six months seems to be more logical, but the patient I spoke to whose
>> bowel cancer came back as metastatic, told me they only had about one
>> week's treatment with chemo after they had the bowel resection. If what
>> the patient told me is found to be correct and what you r saying is found
>> to be correct e.g. 1week vs 6 months then there would be a good case for
>> negligence would there not?
>
> Are you looking for someone to blame, someone to sue, someone to collect
> damages from, or just possible answers to "how did this happen"?
> bj
>
>

I dont rember exactly ( I think it was 4 weeks of chemo and 4 weeks radio. I
ll check and post back) but I do know it was much longer than the period
after the op. After the op was about one week. Pre the op patient had
extensive radiotherapy also. The surgeon commented that the patient had done
well as the tumour was considerably shrunk to avoid an abdominal perinial
op. The patient changed surgeons in the last day before op because the
original surgeon wanted to do the larger op (perinnial) but the patient got
nervous in the last day or so and asked around and found a specialist
colorectal surgeon who was able to avoid a permanent 'stoma'. The surgeion
who proposed a permanent stoma was a general and vascular surgeon.
"J" <nexsw@nvalid,anon> wrote in message
news:462F685B.B0E8FDFE@execulink.com...
> Other Side of Story wrote:
>
>> six months seems to be more logical, but the patient I spoke to whose
>> bowel
>> cancer came back as metastatic, told me they only had about one week's
>> treatment with chemo after they had the bowel resection. If what the
>> patient
>> told me is found to be correct and what you r saying is found to be
>> correct
>> e.g. 1week vs 6 months then there would be a good case for negligence
>> would
>> there not?
>
> You said the patient had chemo/radiation before the lower bowel resection.
> Then a few weeks of chemo.
> How long did the patient have chemo (before the resection)?
> J
>
> Xeloda carries risks.
> <http://www.bccancer.bc.ca/NR/rdonlyres/2BB030DB-8731-496F-BF22-94EA2BBD631F/21333/Capecitabinehandout_20Feb08.pdf>
>
> Xeloda is called Capecitabine
>
> This is dated June, 2005 and says 24 weeks.
> http://content.nejm.org/cgi/content/...ct/352/26/2696
>
> Methods We randomly assigned a total of 1987 patients with resected stage
> III
> colon cancer to receive either oral capecitabine (1004 patients) or bolus
> fluorouracil plus leucovorin (Mayo Clinic regimen; 983 patients) over a
> period
> of 24 weeks. The primary efficacy end point was at least equivalence in
> disease-free survival; the primary safety end point was the incidence of
> grade 3
> or 4 toxic effects due to fluoropyrimidines.
>
> Results Disease-free survival in the capecitabine group was at least
> equivalent
> to that in the fluorouracil-plus-leucovorin group (in the
> intention-to-treat
> analysis, P<0.001 for the comparison of the upper limit of the hazard
> ratio with
> the noninferiority margin of 1.20). Capecitabine improved relapse-free
> survival
> (hazard ratio, 0.86; 95 percent confidence interval, 0.74 to 0.99; P=0.04)
> and
> was associated with significantly fewer adverse events than fluorouracil
> plus
> leucovorin (P<0.001).
>
> Conclusions Oral capecitabine is an effective alternative to intravenous
> fluorouracil plus leucovorin in the adjuvant treatment of colon cancer.
>

ok you tell me appx where u think I got the story wrong and I'll go back and
check with the patient or even the medical records. U r coming across as if
u feel that its not possible for medical negligence to exist. I'll be
interested to know in what circumstances u think it could be medical
negligence? thanks.
"Steph" <steph@vancouvers.island> wrote in message
news:G4KXh.125988$DE1.119313@pd7urf2no...
>
> "Other Side of Story" <replytogrouponly@notthis.com> wrote in message
> news:462f47fb$0$13365$afc38c87@news.optusnet.com.a u...
>> six months seems to be more logical, but the patient I spoke to whose
>> bowel cancer came back as metastatic, told me they only had about one
>> week's treatment with chemo after they had the bowel resection. If what
>> the patient told me is found to be correct and what you r saying is found
>> to be correct e.g. 1week vs 6 months then there would be a good case for
>> negligence would there not?
>>
>
> It's much more likely you have the story wrong somewhere.
>

"Other Side of Story" <replytogrouponly@notthis.com> wrote in message
news:4630b4cf$0$5743$afc38c87@news.optusnet.com.au ...
> ok you tell me appx where u think I got the story wrong and I'll go back
> and check with the patient or even the medical records. U r coming across
> as if u feel that its not possible for medical negligence to exist. I'll
> be interested to know in what circumstances u think it could be medical
> negligence? thanks.


Sure negligence exists, but claims of negligence are much more common than
negligence.
Sue away.......if your claim has merit, you may get somewhere. If it
doesn't, you won't.

That will be $100 thanks

On Apr 24, 4:31 pm, "Steph" <s...@vancouvers.island> wrote:
This is a good a place as any to ask.......is there a posibility that
Xeloda will someday be used as a preventative for mestases and as a
prophylactic? It seemed as long as Franzi was on the Xeloda he was
cancer free....or at least it was not active or progressing. And, for
him, the side effects were minimal. Taste a bit off. After the
original surgery and round of chemo with the Xeloda he was OK for 3
months. Then the beast came back. Another round of the Xeloda and
then another 4 months free. 'Then recurrence. 'Then the FOLFOX7 and
Avastin. Bowel perforation. Massive infections...etc. >I have
wondered for two years whether just continuing the Xeloda would have
been possible or made a difference in the outcome. Really, no
regrets. We do the best we can when we can with the knowledge we
have at the time. But I can't help but wonder.. Especially now when
I see that they are beginning to treat ovarian cancer as a chronic
condition.

turtletrot1 wrote:

> This is a good a place as any to ask.......is there a posibility that
> Xeloda will someday be used as a preventative for mestases and as a
> prophylactic? It seemed as long as Franzi was on the Xeloda he was
> cancer free....or at least it was not active or progressing. And, for
> him, the side effects were minimal. Taste a bit off. After the
> original surgery and round of chemo with the Xeloda he was OK for 3
> months. Then the beast came back. Another round of the Xeloda and
> then another 4 months free. 'Then recurrence. 'Then the FOLFOX7 and
> Avastin. Bowel perforation. Massive infections...etc. >I have
> wondered for two years whether just continuing the Xeloda would have
> been possible or made a difference in the outcome. Really, no
> regrets. We do the best we can when we can with the knowledge we
> have at the time. But I can't help but wonder.. Especially now when
> I see that they are beginning to treat ovarian cancer as a chronic
> condition.

Sure, go ahead and try it as a preventative, for a year.
Let us know how it goes after 3 months, 6 and 9 months, and 12 (same
dose).
Here's the side effects according to winkipedia'
http://en.wikipedia.org/wiki/Xeloda
Dose Adjustments

* For mild renal dysfunction (creatinine clearance 30-50 mL/min), it
is recommended to reduce dose by 25%.
* For severe renal dysfunction (creatinine clearance <30 mL/min),
treatment is not recommended.
* There is no recommendation for hepatic dysfunction.
* For elderly patients, lower doses may be required due to higher
incidences of serious adverse reactions.

[edit] Side effects

Potential major adverse reactions include:

* Cardiovascular: EKG changes, myocardial infarction, angina (these
may be more common in patients with pre-existing coronary artery disease)
* Dermatological: Hand-foot syndrome (numbness, tingling, pain,
redness, or blistering of the palms of the hands and soles of the feet)
* Gastrointestinal: Diarrhea (sometimes severe), nausea, stomatitis
* Hematological: Neutropenia, anemia, thrombocytopenia
* Hepatic: Hyperbilirubinemia
..