Question on Chemo: How often? At Mayo or locally administered?

Posted by mikewdby @mikewdby, Jun 20, 2022

I know I am putting the proverbial cart in front of the horse here, but I have a question regarding Cemo treatment,… Are most treatments given daily, weekly, etc? Would they all be given at the Mayo Clinic (which would mean traveling an hour each way) or can the treatments be sent to a local clinic?

Interested in more discussions like this? Go to the Pancreatic Cancer Support Group.

A treatment cycle can vary based on the chemo regimen being used. Folfirinox is a two week cycle where on day one you get three components and go home with a portable pump for infusion of 5-FU over 46 hours. Cycle 2 begins on the 15th after the prior cycle.

Gemzar + Abraxane may be a where you receive the drug every 7th day for three weeks and the fourth week is a rest period before it repeats.

Speak with your oncologist about doing the treatment at a local facility. One word of caution- make sure the clinic you have in mind has experience in treating pancreatic cancer patients. Someone I was mentoring insisted on being treated locally. She was not tolerating the chemo well, the clinic administering the chemo did not do any dose reductions and issues arose. Upon investigation it was learned that with pancreatic cancer being rare compared to the others, no one had experience treating with Folfirinox. The patient eventually went back to the original medical center where the surgery was performed for all future treatments.

During my treatments that started with Gemzar and then was switched to Folfirinox, I chose to be treated at the medical center where I had my Whipple surgery. It had a pancreas program and treated a higher volume of pancreas patients so I was more comfortable knowing there was a higher level of expertise. It required a round trip train/subway commute of 4.5 hours but I didn’t mind it. I was used to doing that commute daily as I worked across the street from where the hospital clinic was located.

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@stageivsurvivor

A treatment cycle can vary based on the chemo regimen being used. Folfirinox is a two week cycle where on day one you get three components and go home with a portable pump for infusion of 5-FU over 46 hours. Cycle 2 begins on the 15th after the prior cycle.

Gemzar + Abraxane may be a where you receive the drug every 7th day for three weeks and the fourth week is a rest period before it repeats.

Speak with your oncologist about doing the treatment at a local facility. One word of caution- make sure the clinic you have in mind has experience in treating pancreatic cancer patients. Someone I was mentoring insisted on being treated locally. She was not tolerating the chemo well, the clinic administering the chemo did not do any dose reductions and issues arose. Upon investigation it was learned that with pancreatic cancer being rare compared to the others, no one had experience treating with Folfirinox. The patient eventually went back to the original medical center where the surgery was performed for all future treatments.

During my treatments that started with Gemzar and then was switched to Folfirinox, I chose to be treated at the medical center where I had my Whipple surgery. It had a pancreas program and treated a higher volume of pancreas patients so I was more comfortable knowing there was a higher level of expertise. It required a round trip train/subway commute of 4.5 hours but I didn’t mind it. I was used to doing that commute daily as I worked across the street from where the hospital clinic was located.

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My wife's gemcitibine/abraxane was 2 weekly treatments then the 3rd week off. Within the first line treatment regimens, the oncologist has some discretion on cycle and dosing

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Welcome @mikewdby. While you may be putting the cart before the horse, I admire your getting informed and asking questions.

@stageivsurvivor is right. How often you get chemo depends on different factors like your cancer type and which chemo regimen or combination you may receive. And as @beachdog points out, even the schedule for 2 patients with the same cancer getting the same drug combination may differ depending on the individual medical history and status of the specific patient.

As for where your chemo is administered, you may have options available to you. As a Mayo Clinic patient, you can choose to get treatment at Mayo Clinic. Or you may prefer to return to your home state and get chemo at a hospital more local to you. Your Mayo Clinic team will work with your local oncologist.

Do you have far to travel to Mayo Clinic?

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Thank you very sincerely for responding.

We live here in Woodbury, MN for the summer / fall; returning to Ft. Myers, FL sometime late October / early November. Although the drive is only an hour to Rochester from Woodbury, of course my concern would be once we would get to Florida (Jacksonville is a 5 and 1/2 drive).

Here is hoping my EUS scheduled for Thursday, June 22 just defines a cyst that was discovered during a CT and subsequent MRI for diverticulitis. My CA-19 was a ‘16’. But I am a worrywart. It even must have shown on my face when one of the GI Doctors said – “…don’t worry you’re at Mayo…”

Thanks again.

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Hi Mike – I take chemo once a week for three weeks. Off for the fourth week, then repeat infusion 3 off 1. I'm being treated at my local UCLA Health Clinic, an extension of the facility in Los Angeles. Chemo consists of Gem/Abrax;
dexamethasone an Aloxi. I have a mild allergy to the Gem. It was reduced 20% and with the added chemicals I am able to tolerate it. Hope this answers your question. I have been in treatment since September 1st. Sammie

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Hello~
My husband was diagnosed July 3 2022 with Stage 1B Pancreatic cancer, and had his tumor removed Aug. 1, 2022. He started chemotherapy last Monday Oct 3 (3 days on 11 days off, and repeat for 4 mos). We are seeing our local Oncologist and have been asked repeatedly by friends/family “Why aren’t you going to a big University/Medical Center?). We feel like our Oncoligist is doing right by us but how do we know? It feels like it would insult his expertise to seek a second opinion. What do you think?

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@tomswife

Hello~
My husband was diagnosed July 3 2022 with Stage 1B Pancreatic cancer, and had his tumor removed Aug. 1, 2022. He started chemotherapy last Monday Oct 3 (3 days on 11 days off, and repeat for 4 mos). We are seeing our local Oncologist and have been asked repeatedly by friends/family “Why aren’t you going to a big University/Medical Center?). We feel like our Oncoligist is doing right by us but how do we know? It feels like it would insult his expertise to seek a second opinion. What do you think?

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Hi @tomswife, a second opinion is not always necessary, especially if the medical condition is not complex and the treatment is standard. However, if you wish to get a second opinion, you should. Most physicians are not insulted when a patient asks for a referral for a second opinion. It affords them the benefit of consulting with an expanded team of experts. The goal is the patient and treatment outcomes.

@annebauer19 @chemobile @colorafo19 @terryabk @marvinjsturing may have persaonl experiences with getting second opinions to share with you.

You may be interested in these related discussions:
– How do I get a Second Opinion (cancer)? https://connect.mayoclinic.org/discussion/second-opinion-8/
– Getting a second opinion on treatment (for pancreatic cancer) from Mayo https://connect.mayoclinic.org/discussion/getting-a-second-opinion-on-treatment-from-mayo/

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@colleenyoung

Hi @tomswife, a second opinion is not always necessary, especially if the medical condition is not complex and the treatment is standard. However, if you wish to get a second opinion, you should. Most physicians are not insulted when a patient asks for a referral for a second opinion. It affords them the benefit of consulting with an expanded team of experts. The goal is the patient and treatment outcomes.

@annebauer19 @chemobile @colorafo19 @terryabk @marvinjsturing may have persaonl experiences with getting second opinions to share with you.

You may be interested in these related discussions:
– How do I get a Second Opinion (cancer)? https://connect.mayoclinic.org/discussion/second-opinion-8/
– Getting a second opinion on treatment (for pancreatic cancer) from Mayo https://connect.mayoclinic.org/discussion/getting-a-second-opinion-on-treatment-from-mayo/

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Thank you for the rapid response. I will check out the resources you recommend, much appreciated

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@tomswife

Hello~
My husband was diagnosed July 3 2022 with Stage 1B Pancreatic cancer, and had his tumor removed Aug. 1, 2022. He started chemotherapy last Monday Oct 3 (3 days on 11 days off, and repeat for 4 mos). We are seeing our local Oncologist and have been asked repeatedly by friends/family “Why aren’t you going to a big University/Medical Center?). We feel like our Oncoligist is doing right by us but how do we know? It feels like it would insult his expertise to seek a second opinion. What do you think?

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Hi, I also was diagnosed with Stage 1b pancreatic cancer, following a distal pancreatectomy on July 29. I am on a modified Folferinox treatment every 2 weeks for 6 months. I have had 2 out of 12 treatments so far. My oncologist told me that, for my situation, the treatment plan was standard. I hope this is a little helpful.

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@tomswife

Hello~
My husband was diagnosed July 3 2022 with Stage 1B Pancreatic cancer, and had his tumor removed Aug. 1, 2022. He started chemotherapy last Monday Oct 3 (3 days on 11 days off, and repeat for 4 mos). We are seeing our local Oncologist and have been asked repeatedly by friends/family “Why aren’t you going to a big University/Medical Center?). We feel like our Oncoligist is doing right by us but how do we know? It feels like it would insult his expertise to seek a second opinion. What do you think?

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I think you owe it to yourself to get a second opinion and the Dr should never be insulted. This is a horrible disease. Maybe the more advanced center will find something they missed – or not- but at least you would know.

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