TREATMENT
Dr. Daud recommended starting interferon immediately following 2-3 weeks of radiation, which is to start this week. He said in major clinical trials, Interferon has been known to reduce the rate of recurrence by 20-30%, which is significant with a IIIB diagnosis. The first month of Interferon is the most intense part of the treatment. It starts with one month of Interferon administered in-office — 5 days per week (M-F) about 2-1/2 to 3 hours per day, and side effects that are the most acute. This will be followed by a longer period (11 months) of sub-cutaneous injections that are self-administered at home; these are about 1/3 the dose of interferon as the first month and accordingly the side effects are considerably reduced.

For the first month, Dr. Daud offered the following advice. Because Jim is likely to feel worse after receiving Interferon, the optimal schedule would be getting treatment late in the day, so he can return home afterwards, eat something and then rest. He proposed getting to the Dr’s office around 4, allocating 1-1/2 hours for fluid intake and an additional hour for the Interferon, as well as the administration of drugs designed to reduce side effects such as Benadryl (to reduce itching), Compazine (for nausea) and Tylenol (for aches and pains).

The side effects are considerable. Of patients that receive treatment, 1/3 tolerate it fairly well, another 1/3 show moderate symptoms and the other 1/3 exhibit severe symptoms. Moderate to severe symptoms include: flu-like chills, aches and pains, nausea, fatigue. Patients can also experience depression, anxiety, panic attacks and can even be delusional. It is VERY important that Jim and his support network keep an eye on the possibility of depression. I did ask the question of how does one discern the difference between feeling crappy and “blue” because you are experiencing the usual side effects of interferon versus slipping into depression; there’s no good answer except that we need to keep watch on this possibility and talk about when Jim is feeling despairing. Dr. Daud said he would contact Jim’s psychiatrist to talk to him about this as well.

Support/Reducing Side Effects
Regarding the Interferon appts, Jim will be able to drive himself to the Interferon appointments if necessary but he should NOT drive himself home. So he will need help with this on a daily basis for the month of intensive treatment.

To help reduce side effects, Dr. Daud said Jim would be helped by doing 20-30 minutes of light exercise per day (walking, cycling, etc) and center his diet around staying hydrated with fluids of every sort: soup, Gatorade, smoothies, pudding, nutritional supplements such as Ensure – pretty much anything that contains fluids and ideally has lots of both nutrition and calories. Essentially, if Jim isn’t going to the bathroom at least every 2-3 hours, he’s not consuming enough fluids. It also would be helpful to reduce or eliminate caffeine.

When he’s getting Interferon, Jim is particularly susceptible to infections, diseases, contagious illnesses, which means it’s very important to limit his exposure to anybody who has a cough, cold or flu – adults and children alike. It is not unusual to experience a mild fever with Interferon, but Dr. Daud and his nurse Michael want to know if Jim’s fever gets above 100.5 degrees or if he gets a “productive” cough, as well as a host of other symptoms. To help minimize  the risk of getting sick, it was suggested that Jim wash his hands regularly, use antiseptic wipes/gels and make sure that those around him, especially children, wash their hands.

ONGOING
Ongoing scans throughout treatment and afterwards are aimed at monitoring for the possibility of recurrence. After 5 years, we can be “quite confident” that Jim is cancer-free, according to Dr. Daud.

MISCELLANEOUS
Clinical trials
The only trial Dr. Daud offered was one that involves the drug GMCSF, aimed at helping patients with advanced melanoma who were not doing interferon because of pre-existing conditions that are contra-indicated (e.g., depression)

Chinese medicine
No opinion on Chinese medicine and herbal supplements except to advise refraining from initiating any supplemental therapies until AFTER the month of intensive interferon is complete.

Pain management
Dr. Daud said Jim’s sensations would not return to normal for six months. He gave Jim a new prescription for Oxycodone which doesn’t present the risk of liver damage if you take too much.

Lung
The spot on Jim’s lung is not suspicious in and of itself; we are just keeping an eye on it because can’t rule it out since Jim has cancer.