Graphing the Treatment
The very best way to get a sense of the progress of treatment is to make a graph. Keeping a graph of the changes in the cancer "Blood Marker" will give an instant visual map of how the treatment is working. Just looking at raw numbers is not necessarily the best way to visualize things, unless you are someone who "thinks" using algebra (many mathematicians do think this way ---Cecily was an Algebra Tutor in high school!) In Cecily's case, the most useful marker of the acceleration or de-acceleration of the metastisis was the CA-125 level in her blood. Although the lab may send the Oncologist a small computer printout of a graph with each blood test result, these tiny printouts are not a great reference (in my personal opinion, having seen them). I maintained a huge hand-made graph the size of a desk. With this graph it was easy to see that even though the CA-125 level was still rising, the metastisis was actually rapidly DE-accelerating during the two cycles with the introduction of Molecular Targeted drugs and the new Chemo regimen. Because of this large graph that I was keeping, I became less concerned about the actual spread of the cancer at that point in time, and was worried most about the ongoing fluid complication that seemed to pose the greatest danger.
Some Oncologists will not take cancer blood-marker tests in the case of late stage cancer, citing the tests as not accurate. This is actually most likely to avoid creating a record on which to later be sued, since the prognosis for late stage cancer has the lowest odds compared with other stages.
No single blood test result can say much of anything, but it is generally agreed that if a Chemo regimen is not working after 2 cycles, then it should be changed. A failing Chemo regimen is actually DANGEROUS --- it will mutate the cancer and cause it to spread FASTER. (That's why a bio-assey makes good sense as a tool in helping to decide on the correct Chemo regimen --- see BIO-ASSAY). And over time, the blood marker results can paint a picture of how the treatment is going. Even if raw numbers are going up, this may make perfect sense as long as the amount by which these numbers go up (the acceleration) is steadily decreasing from cycle to cycle, (this would then be a negative acceleration, also called a de-acceleration). In the graph below it is easy to see that the treatment in BLACK (at Cedars), was failing. Yet the Oncologist at Cedars, who out-and-out refused to take Blood Markers, (we had them privately taken), wanted to stay with this failing regimen for a 4th cycle! Cec found a new Oncologist. It is equally clear that the new treatment, shown in GREEN, was slowing down the spread. And assuming that the new treatment were to continue working at the same rate in the short run, it is then possible to take a stab at predicting where things may be in the near future (shown in BLUE) --- bearing in mind that it is just a guide and that nature is not bound to follow the curve predicted by a graph. Any tool is only as useful as the proper judgment of the user. There is no such thing as "too much information" as long as the information is applied in the right way. Beware of a doctor who doesn't want to test the blood marker levels, or run a bio-assay on the tumor.
Keeping and Interpreting a Graph
In the graph below of Cecily's treatment, her first 3 cycles at Cedars Sinai is shown in Black arrows, (there was technically a drop in the CA-125 at the end of cycle 1 due to radiation treatment, which gives a false reading of how the acceleration of cancer in tissue is actually progressing. Because of this, the net result of cycles 1 + 2 is graphed.).
The broken Red arrow is a "projection" of what likely would have occurred (at the very least) had Cecily stayed on this failing treatment as her Oncologist at Cedars had wanted (he refused to take a CA-125 test; the CA-125 results for Cycles 2 and 3 were obtained from another doctor).
The Green arrow plots the results of Cecily new cutting-edge treatment during cycles 4 and 5. The acceleration declines in each cycle, and begins the formation of a Parabola shape --- the is the same shape that a baseball makes when it is thrown into the air, peaks, and descends. THIS SHAPE IS A SIGN OF TREATMENT THAT IS HEADED IN THE CORRECT DIRECTION, even if the numbers may still be projected to increase a little before peaking. A baseball, after all, will not stop suddenly in mid-air and just drop. ( the x indicates a week in which chemotherapy was delayed to await the results of a lab biopsy test against various drugs).
The Blue broken line is a projection of the parabola's future shape, if the treatment were to continue working in exactly the same manner in the cycles ahead. It gives an approximation of what might be anticipated.
Had a fluid complication not tragically cut short Cecily's battle, in the coming months the CA-125 might have come down to safer levels. There is no way to know anything with certainty.
CUTTING-EDGE CANCER INFO
Finding
a 'true' Cutting Edge Oncologist
The
Early Formula for "Cecily's Oil"
The
Need For New Drug Approval Laws
60
Minutes Story: The FDA and Politics
AP:
FDA Silences Internal Critics
Quality
of the Best Rated Hospitals