Treatment Schedule
Quite a few of you have asked about the dates for my treatments. At this point, I only have the dates for my chemo days as my surgery dates and radiation dates are yet to be defined. Additionally, the dates for chemo are subject to change depending on how I'm reacting and/or if there are any concerns about my ability to sustain a round. For the sake of consolidating information in one place, I wanted to provide the dates I do know here, along with a brief overview of what a "typical" chemo day encompasses. The information below doesn't cover side effects or anything like that, but just gives you a sense of what a cancer patient goes through when receiving chemo.
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Radiation Dates:
Radiation will take place for 4.5 weeks, starting 7/30/2018 until 8/28/2018. I will receive radiation twice daily, five days a week. Radiation is still not scheduled yet, however, I've been told that if all goes well, I will begin radiation four weeks after the date of my surgery. Dates for radiation are completely dependent upon when I finish surgery and recovery time as well. For now, I know that radiation will begin 4-6 weeks after my surgery and will last for 6 weeks, with radiation sessions occurring twice per day. I, again, will update this space once I have more information.
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Chemo Dates:
The first three months, I will be having chemo on a weekly basis on Wednesdays. Each "cycle" of chemo starts on the third week during the days when I receive an infusion of three drugs. The two weeks in between when I receive two out of the three drugs belong to the cycle that was kicked off in the week(s) prior. After the first 13 infusions, I will be switching to two new drugs which I will receive every 21 days. The two new drugs are more spaced out in part due to the aggressive nature of the two drugs (e.g., one of them carries the risk of being cardiotoxic and is nicknamed "red devil" for a reason). The schedule looks like:
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First three months:
11/29/2017: Infusion of Panitumumab only
12/06/2017 (Cycle 1): Infusion of Panitumumab, Paclitaxel (Taxol), and Carboplatin
12/13/2017: Infusion of Panitumumab and Paclitaxel (Taxol)
12/20/2017: Infusion of Panitumumab and Paclitaxel (Taxol)
12/27/2017 (Cycle 2): Infusion of Panitumumab, Paclitaxel (Taxol), and Carboplatin
01/03/2018: Infusion of Panitumumab and Paclitaxel (Taxol)
01/10/2018: Infusion of Panitumumab and Paclitaxel (Taxol)
01/17/2018 (Cycle 3): Infusion of Panitumumab, Paclitaxel (Taxol), and Carboplatin
01/24/2018: Infusion of Panitumumab and Paclitaxel (Taxol)
01/31/2018: Infusion of Panitumumab and Paclitaxel (Taxol)
02/07/2018 (Cycle 4): Infusion of Panitumumab, Paclitaxel (Taxol), and Carboplatin
02/14/2018: Infusion of Panitumumab and Paclitaxel (Taxol)
02/21/2018: Infusion of Paclitaxel (Taxol)
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Next three months:
03/14/2018: Infusion of AC (Adriamycin and Cyclophosphamide)
04/04/2018: Infusion of AC (Adriamycin and Cyclophosphamide)
04/25/2018: Infusion of AC (Adriamycin and Cyclophosphamide)
05/16/2018: Infusion of AC (Adriamycin and Cyclophosphamide)
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Surgery Dates:
My unilateral modified radical mastectomy is scheduled for Wednesday, 6/13/2018. Surgery dates are still TBD as I've previously mentioned. I've been told that surgery will be scheduled 4-6 weeks after the date of my last chemo infusion depending on my counts and recovery time from chemo. I will update this space once I have more information.
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Typical "chemo" day
On the day of infusion, my schedule depends on whether I am starting a new cycle (e.g,. receiving three drugs) or if I'm in the middle of an ongoing cycle (e.g., only receiving two drugs). Regardless of the start of a new cycle or not, though, my day always starts with my blood being drawn a minimum of one hour before any other appointments. This weekly blood draw is required for them to check my "counts", including my red blood cell counts, my white blood cell counts, platelets, kidney function, liver function, and more.
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When I'm starting a new cycle, I first have my blood drawn and then must meet with my Medical Oncologist. She, along with the Research Coordinator in charge of the clinical trial I am a part of, discuss my side effects, the results of my blood work, any concerns they may have and any new drugs that they need to prescribe to help me manage side effects. Assuming that everything is at an acceptable level, my Medical Oncologist will sign-off on the orders for my chemo.
When I'm in the middle of a cycle, I don't have to meet with anyone as long as my counts are ok. If my counts are off or unacceptable, then I will have to meet with my Medical Oncologist or one of the Nurse Practitioners to determine the best course of action, which may include a delay in chemo (which I'm definitely trying to avoid!).
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In either case, after meeting with my Medical Oncologist or after having my blood drawn, I then proceed to what is called the "ATC" or Ambulatory Treatment Center where I sign in and then wait to be called back. While I usually have an appointment time on the calendar for when chemo is scheduled to start, the timing is rarely (if ever) accurate. Once I'm called back into the ATC, my vitals are checked and then I'm told which room I'll be in for the duration of my chemo treatment. A qualified nurse then comes in to set everything up and to also access my port, which is actually a whole process because it requires a sterile environment since it connects directly into some pretty important blood vessels!
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Once all of this is done, it's a waiting game for the drugs to arrive from the pharmacy. Due to my inclusion in the clinical trial, the nurses are pretty strict about sticking to the order of drugs that they see in my file. Unfortunately, Panitumumab is the first drug I must receive and due to its short shelf life, it is only "made" (or mixed) once a signed order from the doctor is received, my blood work is clear and I've checked into the ATC. This means that even if all the other drugs are ready to go, the nurses cannot begin my infusion until the Panitumumab arrives.
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For days when I'm receiving only Panitumumab and Paclitaxel (Taxol), the infusion goes something like:
- Access port and wait for Panitumumab to arrive (has taken up to 2 hours before to arrive)
- Panitumumab is dripped in over a 60 minute period
- Line is flushed with saline
- Infusion of steroids to help manage side effects from Paclitaxel (Taxol)
- Wait 30 minutes for steroids to go into effect
- Infusion of Paclitaxel (Taxol) over a 60 minute period
- Line is flushed with saline
- Port is de-accessed and flushed
...from the point that Panitumumab is started, I can usually estimate that it will take me 3-3.5 hours before I'll be done
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For days when I'm receiving Panitumumab, Paclitaxel (Taxol), and Carboplatin, the infusion goes something like, all the steps above and then:
- after the Paclitaxel (Taxol) infusion, my line will be flushed with saline
- Infusion of anti-nausea medications
- Wait 30 minutes for anti-nausea medications to go into effect
- Infusion of Carboplatin over a 30 minute period
- Line is flushed with saline
- Port is de-accessed and flushed
...from the point that Panitumumab is started, I can usually estimate that it will take me 4.5-5 hours before I'll be done