Wednesday 16 September 2015

Tail Blazing

A lot has happened since my last post. I have taken early retirement at 44 yrs, moved up to East Lancashire and started third line chemotherapy. At the moment I am on a treatment break so that I can indulge in a bit of Parkrun tourism more about that here:


Friday 4 April 2014

The Rest Of The World Has Gone Home




I have had the above song running through my head this week and on today's run. It is about some bloke who gets abandoned in a club by his girlfriend when she supposedly goes to the cash machine.

I once abandoned my boyfriend but not in a club. It was when I was living and working in Plymouth. He used to come down for the weekend and I was out on an after work do so he met us down the pub. Some of us were going for a curry whilst others were going to go on to another pub and we would meet up later on. I was hungry so I went for the curry but the boyfriend wasn't so he went to the pub with some of my work colleagues. I knew he would be ok he was fairly easy going.

After the meal I was feeling tired and I didn't fancy going to the pub I had been drinking all afternoon I had drunk enough so I decided to go straight home, did not pass go and did not collect £200. 

I abandoned my boyfriend and left him with a group of people he didn't really know. He eventually came home drunk and asked 'What happened to you?'. I got told off by a girl I worked with and told it was a really mean thing to do so looking back now I am sorry I did that and would hate it if someone treated me that way - you deserved better.

It has been difficult motivating myself to go out for a run this week. I have had some important stuff to think about and I am trying to see if I can get early retirement on ill health grounds so I can draw down some of the money in my pension funds. 

There has been a bit of a debate on the Macmillan forums regarding 'special rules' and Personal Independence Plans, which are the replacement for Disability Living Allowance. Under special rules if you have an incurable and progressive illness you can be fast tracked through the application process. You do not need to wait for 3 months and you do not need an assessment interview but you do need a medical form called the DS1500.

The issue with special rules is that you need to be considered terminal and the DWP definition of terminal is a life expectancy of 6 months or less. Of course it can be very difficult to predict this and the consultant or the GP filling out the form doesn't actually have to state this. Many people have been awarded benefits under special rules and have gone on to live longer than 6 months. Generally cases are reassessed after 3 yrs to see if the prognosis has improved.

Some consultants follow the guidance to the letter with regards to terminal cases whilst some take the view that if their patient has an incurable and progressive illness like advanced cancer then they are going to need all the financial support they can get and are much more flexible. I am not sure if my consultant would feel entirely comfortable.

Anyway back to todays run as I said earlier I have been finding it difficult to get out for some training I have been feeling very tired all the time recently. I am not sure if it is the depression or something more sinister but I will be due another scan soon and my CA-125 is still going down even if it was only by 4 this time.

Today's walk/run felt hard my ankles were sore to start with and I was finding I was getting a bit more breathless. My average heat rate was 153 bpm which is zone 2 so should have been fairly easy. I stopped off at the bank to drop something off and then carried on with my training run. I covered 2.34 miles in 42 mins:











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Sunday 30 March 2014

The Controversy of Avastin

Background
http://www.thetimes.co.uk/tto/multimedia/archive/00082/78615791_Avastin_82783c.jpg
Avastin is the commercial name for a drug called Bevacizumab (pronounced bev-a-siz-you-mab). It was first given approval in 2004 to be used alongside chemotherapy treatments for Colon (Bowel) Cancer. It has also been used in the treatment of certain lung, kidney, brain and breast cancers.

Roche, the company that make Avastin, received approval from the EU for treating ovarian cancers. The approval was for its use in combination with chemotherapy for first line treatment (December 2011) and first recurrence (October 2012).

The FDA, which is the approving body in the USA, have not been asked to approve Avastin for use with ovarian cancers because of a lack of evidence that it extends life, even though it can extend progression free periods by a few months, and also over concerns of some of the side effects. The FDA also withdrew approval for the use of Avastin in breast cancers in 2011.

The purpose of this post is to explain what Avastin is, how it works and how it is funded. However not everyone in the UK has equal access to this drug.

How does Avastin Work?
Unlike traditional chemotherapy drugs that prevent cell division Avastin is a biological therapy that interferes with processes in the cell. 

It works by stopping the growth of new blood vessels that are needed by the cancer cells for food and oxygen. 
http://www.avastin.com/patient/assets/gbm/figures/2_tumors_gbm.jpg

Therefore the tumours starve and start to shrink as the cells die off. Doctors call treatments that interfere with the development of a blood supply anti angiogenesis treatments.




The drug is given through a drip into the vein and for ovarian cancer it is given every 3 weeks. 

Initially Avastin is given over 90 minutes, which is gradually reduced to 30 minutes if you do not have any problems with it.

Common Side Effects
More than 10 in every 100 people have one or more of these.

  • High blood pressure occurs during treatment in about 1 in 4 people (25%) – this is monitored before every treatment and can be controlled with blood pressure tablets
  • Feeling sick happens in about 2 out of 3 people (67%) but most people aren’t actually sick
  • Diarrhoea and abdominal pain – this can be severe in up to 1 in 3 people treated (32%)
  • Tiredness (fatigue) and weakness during and after treatment – most people find their energy levels start to improve when treatment ends
  • Pain and weakness affecting your joints, muscles, chest and abdomen
  • A drop in white blood cell count causing an increased risk of bacterial infection – infection may cause headaches, aching muscles, a cough, a sore throat, pain when passing urine, or may make you feel cold and shivery. Infections can sometimes be life threatening.
  • Numbness or tingling in fingers and toes occurs in more than 1 in 10 people (10%) – this can cause difficulty with fiddly things such as doing up buttons. It may start within a few days or weeks and usually goes within a few months of finishing treatment
  • Slow wound healing –  Avastin will not be started until at least 28 days after surgery or after any wounds have healed
  • Poor appetite
  • Constipation
  • Watery eyes
  • Difficulty speaking
  • Nosebleeds
There are other side effects but these are less common and in some cases rare.
 
Avastin Trials for Ovarian Cancer (Source: Cancer Research UK)
The American GOG218 trial reported in June 2010 that Avastin with chemotherapy controlled advanced ovarian cancer for longer than chemotherapy alone. All the women in the trial had standard chemotherapy. Half of the women also had Avastin during the chemotherapy and then on its own once the chemotherapy had ended. Another large American trial reported in December 2011 and confirmed that adding Avastin to standard chemotherapy seems to control advanced ovarian cancer for about 4 months longer than chemotherapy alone.

In the UK a large, phase 3 trial called ICON 7 looked into whether adding bevacizumab to standard chemotherapy could lower the risk of ovarian cancer coming back after surgery. Between December 2006 and February 2009, 1528 women from Europe, Canada, Australia and New Zealand joined the trial. They all had ovarian cancer removed with surgery. Half the women had standard chemotherapy with carboplatin (Paraplatin) and paclitaxel (Taxol) every 3 weeks for 6 cycles of treatment and then no treatment until their cancer started to grow again. The other women had Avastin as well as the standard chemotherapy. When their chemotherapy finished they had 12 more doses of the Avastin every 3 weeks. 


 

The research team found that combining Avastin with standard chemotherapy lengthened the time before the cancer came back for some women. But it didn't help the women live longer. Overall, women who had Avastin and chemotherapy had an average of 2 months of extra time without the cancer coming back or growing. Women who had a more advanced stage cancer to start with had the most benefit. Women in both treatment groups had some side effects. The most common side effect of Avastin was high blood pressure but this was easily treated. 

The video above shows Dr Timothy Perren, from Leeds Teaching Hospitals NHS Trust being interviewed at European Society for Medical Oncology (ESMO) in 2010. At that time data for the overall survival (OS) figures from the ICON 7 trial were not available but were anticipated in 2012. The final results were presented at the European Society of Gynaecological Oncology (ESGO) meeting in 2013 . The data showed that women at highest risk of their cancer recurring lived on average 9.4 months longer than those who received chemotherapy alone.

Results of the ICON7, phase III clinical trial. Results of the ICON7, phase III clinical trial. ecancer.tv - Essential viewing for oncologists
The mEOC trial is comparing 2 different chemotherapy combinations with or without Avastin for a rare sub type of ovarian cancer called mucinous ovarian cancer. The doctors in this trial want to find out which chemotherapy combination works better to control cancer growth. And they want to find out whether adding Avastin to chemotherapy is a useful treatment for this group of women. Recruitment for the trial closed in August 2013 but the results have not yet been made public.

NICE Guidelines
NICE stands for The National Institute for Health and Care Excellence and it decides which drugs and treatments are available on the NHS in England and Wales and produces guidelines for medical professionals. 

The All Wales Medicines Strategy Group also makes some decisions for the NHS in Wales. Generally they follow NICE decisions. 

Scotland and Northern Ireland have separate organisations to make decisions.

The government developed NICE in 1999 to get rid of the post code lottery, which meant that some drugs and treatments were available in some parts of the country, but not in others. However with regards to access to Avastin this aim only appears to have been achieved to a certain extent in England.


Avastin has not been approved by NICE or the Scottish Medicines Consortium (SMC) as a first treatment or for first recurrence within the NHS on the grounds that it is not cost effective and does not increase overall survival. Although th latest data from the ICON 7 trial demonstrated that on average 9.4 months was added to the overall survival of patients most at risk. It is likely that this figure may increase as time goes by and is anticipated to reach the 12 months additional survival required by NICE.

In England only, doctors may be able to access this drug through the cancer drugs fund. 

The Cancer Drugs Fund (CDF)
The Cancer Drugs Fund is money the Government has set aside to pay for cancer drugs that haven’t been approved by NICE and aren’t available within the NHS in England. This may be because the drugs haven’t been looked at yet or because NICE have said that they don’t work well enough or are not cost effective. The aim of the fund is to make it easier for people to get as much treatment as possible. 
The Cancer Drugs Fund has been in operation since October 2010 and in April 2013 the management of the fund was taken over by NHS England. Now there is one national list of approved fast-track drugs which the Cancer Drugs Fund will routinely fund, giving uniform access to treatments across England.

Originally the Cancer Drugs Fund was only set to run until the end of March 2014 but this has now been extended until 2016. However the long term future of the fund is at present uncertain.

Avastin is approved for funding by the Cancer Drugs Fund in the following circumstances:

First-line treatment: Women with a new diagnosis of ovarian cancer can apply for funding for Avastin if they meet the following criteria:

  • This is their first treatment for ovarian cancer
  • They have stage III ovarian cancer, have undergone a debulking surgery but still have 1cm or more of cancer remaining. Or, they have stage IV ovarian cancer.

Second-line treatment: Women who have been told they have recurrent ovarian cancer for the first-time can access Avastin if they meet the following criteria:

  • This is their first recurrence
  • They have not previously been treated with Avastin
  • They are platinum sensitive i.e. they finished carboplatin + taxol chemotherapy 6 months ago or more
Avastin is to be given in combination with two drugs, carboplatin and gemcitabine

Situation in Wales, Scotland and Northern Ireland
The governments of Scotland, Wales and Northern Ireland decide on how they spend money on health and so far have decided not to have a Cancer Drugs Fund or similar programme.

Therefore it is down to individual health authorities as to whether the drug is funded or not so where you live can determine what cancer treatments are available. 

This has become such an issue in Wales that women with ovarian cancer are crossing over the borders to register an address in England so that they can legally access the Cancer Drugs Fund. A recent article published by the Sunday Express explains the issues faced by patients:

 The good fight: A drug that can add years to lives of ovarian cancer patients

My own experiences of Avastin

As I was diagnosed and treated for first line before Avastin was given EU approval I was unable to access Avastin until my recent first recurrence.

I met with my oncologist in November 2013 following a CT scan that showed my cancer had spread to discuss my treatment options. The options included chemotherapy and hormonal treatments and I was told that this would be the last time that I would be allowed to have Avastin.

My consultant explained that whilst the chemotherapy may or may not work because of my low grade cancer that low grade cancers have responded to Avastin and this has been suggested by a retrospective review undertaken at Memorial Sloan-Kettering Cancer Center, New York by Dr. Aghajanian and her colleagues. I was also advised to start treatment straight away because of the cancer on my bowel. 

Getting the Avastin was a lot easier than I thought it would be and I started treatment the following week. The first treatment of Avastin was given over 90 mins and initially it made me feel sick and I also had a banging headache for which I was given some paracetamol. 

I was warned that I might get nose bleeds and whilst there may have been some spotting of blood the main impact of my nose seemed to be blocked sinuses and a runny nose. The inside of my nose also felt really irritated and this would happen every time I had the Avastin. Many of these symptoms have now settled down.


At first my blood pressure and urine samples were fine but gradually my blood pressure began to increase as did the protein in my urine. I am now on tablets to manage my blood pressure and my medication is reviewed on a regular basis by my GP.

I had a CT scan in February 2014 which showed a partial response including some minor shrinkage and no new disease. I had never had shrinkage before on carboplatin. At this stage with the recommendation from my consultant I decided to stop chemotherapy but continue with the Avastin. My CA125 has been falling gradually and we should have a better idea if the Avastin is still working when I have my next scan in May 2014.
 
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Saturday 29 March 2014

Killing Me Softly - a long & difficult day at The Christie

Thursday of this week I was due at The Christie for my next treatment of Avastin. I also had an appointment in the morning with pyschooncology then blood at midday. I was due to see the oncologist an hour later and then start treatment mid-afternoon so it was going to be a long day.

I had missed out on training on Tuesday so I did not want to skip Thursdays session so I decided the best thing to do was to include it into my journey over to The Christie. I got up early enough fed the cats, made myself some breakfast, checked my email etc. and generally faffed around getting everything together that I would need for the day. I had let the cats out so before I could go I would need to get them back in so I was 15 mins late setting off.

I jogged over through the park but Princess Parkway was very busy with traffic trying to get into the city centre so rather than risk an accident I decided to jog over to the pedestrian crossing and then Wilbraham Road. I was looking for a short cut through the housing estate but instead I turned into a dead end end requiring me to retrace my foot steps. It took me about 56 mins to walk/run the three miles over to the hospital making me a little bit late for my appointment. Here are Thursdays stats:



I checked in at reception and handed over my letter for that mornings appointment apologising for being a bit late. I was then slightly confused when she told me my appointment wasn't until this afternoon and I was too early. I referred her back to the letter and told her that I was due to have treatment this afternoon and have my bloods done and see the consultant before then. 

Of course then I was told I couldn't have my bloods done at mid-day as they would still be on morning clinics. I have had this problem before so I decided to stand my ground and very firmly pointed out that my bloods needed to be done then and all she had to do was to fill out a blood form from my details on the computer.

However we still had the issue of this mornings appointment so I asked again but thankfully one of her colleagues intervened and told her she had to phone through to let them know I was here. By this time I was half an hour late going into my appointment.

http://www.institutooncover.com/imagenes/noticias/psychooncology.jpgI was meeting with one of the team from the pyschooncology team they can help patients cope with human side of cancer. I had felt really drepressed during chemotherapy and I was also very sad about the recent losses of some friends to ovarian cancer. The hour flew by I almost talked non stop, one of the issues we discussed was talking to my oncologist about my prognosis. I felt confused about my diagnosis I didn't understand what being low grade would mean in the longer term and I felt I was putting off some important decisions because of this.

Next I went and had my bloods taken when you have cancer they like to keep an eye on your blood count, liver and kidney function and also check your tumour (CA125) markers. I had an hour before my next appointment so I decided to pop into Withington village to run a couple of errands and get a bite to eat.

Then it was back to Outpatients to see the oncology team. Today I actually got to see my consultant he is always very positive and seemed pleased that bloods were good, blood pressure was normal, urine sample only a little bit of protein and my CA125 was falling so I was OK to have my treatment that afternoon. We also discussed having a CT scan in May to see how things were going as they like to do a scan every three months whilst on Avastin.

At the end he always asks if I have any questions. This time I decided to be brave and asked a direct question about my prognosis. I asked if the cancer would kill me or if I could die of something else and I also asked if it was possible to give some sort of time-frame and explained that there some financial reasons for this. The first part of my question was relatively straight forward he confirmed that the cancer would shorten my life. However he couldn't really put any sort of time-scale on this he mentioned that he thinks I might be platinum resistant. 

 

This is significant because carboplatinum is made from platinum and is one of the best tolerated drugs used in the treatment of ovarian cancer. The last two times I have had carboplatinum I have stopped part way through treatment because although the cancer stabilises it does not completely eliminate the cancer. This means that my options for treatment are now a little bit more limited I have always known that this might be the case as low grade cancers do not always respond to chemotherapy.

There was a bit to this conversation that I felt was a bit odd, I have always assumed that when the time comes I would get a bit of advance notice but I was told I would need to keep asking the question and to ask again in a years time.

I had another hour before my next appointment so I took my notes to Oak Road Reception, made sure they had my mobile number and went to the relaxation room to use the computers. The computers are so old and slow that is it far from relaxing. However I did notice that someone had posted on my time-line that there was an article about my fund raising in the Sale & Altrincham Advertiser. 

About 3 pm my phone rings and its the chemotherapy unit to advise that my treatment wasn't taken off hold until 2:30 pm so it won't be there until the last delivery at 5:30 pm. I am not best pleased but there is not much I can do about this except try and take my frustration out on the PCs that do not seem to want to co-operate with my frantic button pressing.
http://th02.deviantart.net/fs70/200H/f/2011/214/8/2/compute_this_by_fluidgirl82-d42pcdp.png

Eventually I was called upstairs at about 5:00 pm feeling absolutely shattered I was upstairs until about 8:00 pm and on the way home I popped into the supermarket for a bottle of wine - it had been a long and difficult day.

Sunday 23 March 2014

Not Nineteen Forever

From the title of this post some of your may be able to work that I am a big fan of The Courteeners. The Courteeners are a Manchester band from Middleton and formed in 2006. I can't quite remember how I discovered them but I remember going to see them in Preston @ 53 Degrees in 2008. Their tracks are always on my playlist when I am running and 'Not Nineteen Forever' is perhaps one of their better known songs entering the charts at number 19 on 31 March 2008 from their début album St Jude:




I was looking forward to today's run and went out in the sunshine this afternoon. I headed over to my local park, which is currently being regenerated due to a successful lottery bid. The regeneration works have caused some controversy because it involves removing some of the trees so parts of the park are currently fenced off making it a bit more challenging to run round but it is used for a monthly women's 5k.

Today's run was the longest so far 45 mins that included a 5 min warm up walk and 8 sets of run 2 mins walk 3 mins, this is probably what I will do on race day but without the warm up walk. It felt a bit hard at first probably I was going a bit too quickly but as the run progressed I settled into a rhythm and finished strong. These are today's stats:


 
I have also had some good news about my press release - the Manchester Evening News are sending a photographer round on Tuesday to photograph me running. Fingers crossed it will get published and help to raise awareness and money for Target Ovarian Cancer.

Please don't forget to sponsor me if you haven't already.

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Friday 21 March 2014

Running is a social activity

I missed a training run earlier in the week due to some complicated admin that took longer than I expected. I was trying to sort out a mail merge to send out a press release to the local press but it took me three attempts to get it right.

I did manage to get out for a walk/run yesterday evening and I had a bit of company as well. I was joined by a friend who I know through local running club Chorlton Runners. She has had a bit of time away from running as well due to family commitments and was struggling with motivation to get out. Sometimes the most difficult part of a run can be just getting out the door.

I certainly knew that feeling yesterday as it had been a bit wet earlier in the day. Often when I feel like that I will put on my running kit and tell myself I will get changed and see how I feel knowing that by the time I have that I will think well I might as well go out now. It also helped that knowing that someone else would be joining me.

We talked a bit about my cancer diagnosis and also some of the barriers that women can feel that often stop them running or even joining a club. I know I have had some issues in the past because I am a slower runner.

When I lived over in Chorley between 2007 and 2009 I used to belong to a women's running group that had evolved out of the now disbanded women's running network. It was a completely different atmosphere to a mixed group club. Women run for different reasons to men often it is more about weight management, becoming fit and healthy, feeling good about yourself and to enjoy the company of other women. I loved being part of this club no one ever got left behind and whilst I wasn't the fastest I also wasn't the slowest either.

Our local running club is also very good and very inclusive catering for all ranges and abilities and since I first went a couple of years ago it has really grown into quite a big club. I haven't been for a while as I was finding with the cancer becoming active I became increasingly fatigued and struggled to keep up with the beginners group.

Here are yesterday's stats:


However it was good to have some company on the run last night as it encourages you both to push a little bit harder. The minutes certainly flew by and some how we managed to switch from running 2 mins and walking 3 mins to running 3 mins and walking 2 mins. No wonder I was starting to struggle a lot towards the end. So thanks to my fellow clubmate for her company and making me work harder.

I also have some other news my sister-in-law Lynn Broadhurst has also decided to enter the Bupa Great Manchester Run and will also be raising money for Target Ovarian Cancer this will be her first run and I am very proud of her. Please show your support by sponsoring her:

Lynn Broadhurst is fundraising on JustGiving for Target Ovarian Cancer  

 
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