Neulasta: is it really necessary to take?

ditto marejo

I had chemo last summer, C&T, 4 treatments, every 3 weeks.  No side effects from the chemo to complain about, tired on the 4th day and hair loss were the biggies. My blood was monitored and was always good, I never had a neulasta shot.

Hello All,

My first chemo treatment, after my WBC were 0, nunca, nada - NOTHING they gave me Neuprogen for 2 days. After that 2nd dose, my WBC was 8.  My 2nd chemo treatment, they gave me Neulasta the day after. My WBCs were 17 count when checked a week later. My 3rd chemo treatment will be on 7/29/09 and want to take Claritin since these hard narcotic pain killers keep me as immobile as the bone pain.  As my Hema Onc indicated, the bone pain is a result of the WBCs increasing. I want to convince my Onc. not to give me the Neulasta shot on my 3rd Treatment. I have one more after this - 3wks apart.  From this shot, I get plenty of rest, water and blankets.

Also, I was told NOT to eat raw fruits and vegetables and only cooked/well done foods during chemo treatements. This could comprise my health with bacteria and infection.  I so craved my micro salads. Therefore, most foods purchased were "No Sugar Added" and home cooked. (I learned to make home made applesauce). This helped with the thrush, mouth sores and hormonal hot/cold flashes.

Lot's O Love!

I had chemo in 2007 and did what my onco called TAC. I did every three weeks w/neulasta the day after each treatment, 6 treatments in all. Each time my WBC went to dangerous lows and I was neutropenic the entire time. After the first round of chemo I was hospitalized with a major infection and was there for three days. I wouldn't want to know what would have happened without the Neulasta. The bone pain from it was awful, but it did seem to keep me fairly stable after that first round. Maybe I still would have struggled with my WBC, but I think you have to do what the onco suggest for the most part, but if she is nervous maybe she should ask more about it. We really do have to be our own advocates when it comes to treatment.

leigh,

I don't know about other areas of the country or other drs; I only know here Neulasta is not "automatically" given.     I guess it's partly a matter of your dr. and the area you live in.  Most recently, my mother and my SIL, who have been battling ovarian cancer for 3 and 4 years respectively, have never had Neulasta.  My mother and I see the same oncologist and have had some of the same chemo.  At least with my oncol. the decision is based on the patient.  My SIL is in another part of the country, in a large city.

I would suggest, as I did before, that your friend take her questions to her oncol team.  It helps to have questions prepared and written down so they're clear to her and to her team.  Her team is there to help address exactly these kinds of things.  They will not force her to do anything that she's uncomfortable with.

I can't address why someone else has had different treatment than I can have; I can't begin to know their situation, physical details, etc., that all impact every treatment   I only share my own experience.  I was comfortable with my need for Neulasta and with my ability to deal with the side effects without additional pain meds -- only an OTC allergy med that I tend to take a lot of the year anyway.  I don't see not using something just because of SE's, but for some that's reason enough, and there are good reasons to use or not use anything.  For me, it was worth it; for others, it won't be.

I am surprised that some people think drugs are used primarily because of the push by drug companies. I don't disagree there is a push, I just disagree with the impact it has on a good physician.  Public ads are aimed at the consumer, not the dr., so I don't give them credit with anything except causing patients to run (often unnecessarily) to their drs. with new drug requests.  A good dr. knows when these requests are appropriate and when they aren't.  I know drugs are also promoted to drs.by drug companies, but I have a high level of trust in my dr and his team to evaluate the claims of any drug company, and not just accept it on the company's say-so.  I had a recent conversation with my oncol. about a drug recently, and he actually goes against the drug company's rec. based on his own comfort level and experience with the drug.  If I didn't trust my dr. to make independent evaluations, I'd find another.  

That doesn't mean I don't do my own research or ask questions (that's why I had the recent conversation!)..  I've gotten some of my protocol changed because of it (and it's also why I pointed out that every decision is ultimately the patient's.  Don't blame the dr. if you go along with something you don't agree with!). 

It's a sad but real truth that the patient, although often too worn out emotionally and physically to be so, is usally their own primary advocate.  You have to keep track of your own body, meds, reactions, etc. -- no one else will do it to the same degree or know you the way you know yourself.  Anecdotal information is just that -- anecdotal.  It may or may not be of value.  Being able to do your own research, evaluate that research, come up with questions, talk openly with your oncol. team, and ultimately decide what is right for you -- all part of the picture. I had one friend who chose to treat her cancer only with nutrition.  Her outcome didn't change, but she made her own decision based on what was right for her.  That's all anyone can do.

No one here has the ultimate answer for your friend, including me.  Best of luck as she searches for her own answers!

Not a lot to add, except that it is amazing the variation of treatments and reactions! I'm on TCH, and did not have Neulasta prophylactically or automatically. However, on day 8 of cycle 1, came down with neutropenic fever and spent 4 days in the hospital. Have had a Neulasta shot after each treatment since AND -- have had NO bone pain or ANY other noticeable side effects! Those days in the hosiptal were not fun, and were very expensive in terms of direct costs and loss of income, so I'm very grateful to have had the Neulasta keeping me on my feet. I've followed all the neutropenic precautions (no raw fresh fruits/veg, no unfiltered or unbottled water or ice, no pepper, no digging in the dirt or exposure to blown soil, no crowds, no handling flowers, etc. etc.) during "nadir" anyway -- until this last cycle when I had to help out my husband with a major art sale during which I broke almost every rule and spent two whole days glad-handing strangers. But, I'm delighted to say, suffered no ill effects! So count me among the Neulasta cheerleaders!

I had TCH and my Dr. wanted to give me Neulasta as a standard. We discussed it and I chose to see how I made it through the first round.  My counts did dip (obviously) and I had to take neupogen to be able to have the next treatment.  

I did not tolerate the Neulasta well, and I had Neupogen for the  balance of treatments.  For some reason the Neupogen didn't bother me as much as the Neulasta. I did take left over pain med from my surgeries to sleep at night. I had a chronically low WBC even after completion of chemo.

Also - it greatly lowers your chance of having to delay treatments due to your WBC - and delayed treatment can mean less effectiveness of the chemo - yikes! I was so nervous about having delays, and so grateful after my final treatment that I could stay on the regimen as planned.  If we're going to go thru this, we want the best chance possible in the end!

i had horrible bone pain with neulasta too...could count on it starting like clockwork. When the changed from the FEC to the taxotere, the combo of taxotere and neulasta proved to be much too much for me...I was in so much pain i could hardly walk. We changed over to neupogen. While it is aggravating to take more shots it is sooo worth not having the bone pain. I had hardly any pain with neupogen. Onco says neulasta ups the counts quicker so that is why they use it first. My WBC's took a severe beating on the first chemo and the last few. I was taking chemo in the winter during cold and flue season so that was a big concern. I stayed in more that i would have if it was another time of year. Tell her to ask about changing to neupogen or trying to go without it to see how the WBCs do. We all know that pain..it is predictable in it's arrival and leaves as quickly as it comes but while it is there it is AWFUL

I just ended up in the hospital five days after my first chemo. Around Day 8-9 I started getting a severe fever - got to the emergency and had 1 WBC and ZERO neutophills (what fights infection in the white blood cells)

I wish I was given nuelasta previously - It's been awful. My chemo is Taxotere and Cytoxin, and I had bad pains following my  chemo, so I'm shocked to hear people don't regularly get bone/joint/muscle pains from their dose... Why me? Just kidding.

 Anyways, just thought to share that.