20 August 2018 - Cancer Centre, Old QE Hospital

Deb in her wheelchair on Brighton seafront

Visit to Cancer Centre for a meeting with Dr Sanghera. Also present Dr Allos (registrar) and Fred Berki (CNS).

Dr Sanghera explained that the latest scan results indicate that the chemotherapy is not proving very effective in stopping tumour growth. In addition the chemo was affecting Deb's blood cell production and in particular her platelet count was very low (normal range is 150 to 400. Deb's count today was 47. Below 30 action has to be taken to improve the count, usually by a blood transfusion.). Dr Sanghera therefore recommended that chemotherapy was stopped. 

He said we had various options: 

1) Do nothing and have another scan in one month's time. 

2) Have a second course of radiotherapy. This would be 20 sessions over 4 weeks at lower dose than  Deb's original radiotherapy. The first course of radiotherapy was given at the maximum dose it is thought the brain can tolerate and it is not common to give a second treatment. Dr S is recommending the treatment because it is 10 years since Deb was first treated, he thought she could tolerate the treatment and she would benefit from it.

The side effects from radiation to the head could include: hair loss in the area of the head that is being treated. tiredness, worsening of the brain tumour symptoms before they improve, sickness. There is also a risk of cognitive impairment. With a second treatment the risk of side effects is increased.

3) He could go back to Mr Kay and discuss surgery again.

He gave Deb a few days to go away and think about what she wanted to do and we are due to return to the hospital on Thursday 23 August. At that time Deb will also have a further blood test to see if the platelet count has improved. 

Deb was prescribed steroids (dexamethazone) at the last visit. In the time she has been taking them she has markedly improved. Her movement and posture has been better, her mental capacity and alertness has improved, she has slept less and ate more. Dr Sanghera explained this was a short term 'bounce' in improvement and as the tumour progressed higher doses of steroid would be required to keep the swelling around the tumour in check. In the mean time Deb will continue with the steroids although at a reduced dose (2mg a day instead of 4mg).

Deb has already decided she will proceed with the radiotherapy.