Round Two: Infusion #9

Yesterday was the ninth treatment and I did receive a reduced dose of the chemo drug, I am hopeful that my body will be stronger with a reduced dose. Today I have had the wonderful steroid high - I was wide awake at 3 this morning with flushed cheeks and lots of energy. I had a short nap this afternoon but it is evening now and the flush is disappearing and the steroid high is beginning to wear off.

I thought for this post I would share with you the details of one treatment - the procedures, drugs and financial cost.

When I am called back to the chemo room I am weighed and then told who my oncology nurse is for the day. The chemo room is very nice and rather than being one large room it has one large area and then a few smaller areas. It has one wall of windows and large comfortable recliners line the walls; you select your chair in the area where your nurse is stationed. There are a couple of large fish tanks and a separate room with a refrigerator, microwave, vending machines, a table and chairs. By each recliner there is an IV stand and throughout the room are carts with supplies. There are three or four bathrooms in the room and a few more in the hallways outside - it's important to have bathrooms close by because of the amount of fluid we receive as well as the amount of water we drink during treatment.

I select a chair within my assigned area that is the farthest from a vent because it gets cold in there. Once the medical assistant takes the vitals she brings a blanket from the warming oven and I get settled in with a pillow and the blanket. Randy pulls up a chair beside me and helps to unpack my bag: book, glasses, water bottle, ipod, etc; the recliners have a pop-up arm table on each side.

The oncology nurse brings the supply cart and then prepares to access my port: first is swabbed with betadine twice and then the betadine is removed with clean swabs; then a freeze spray is applied, I take a deep breath and the needle is popped in. The needle has tubing attached with a connection point and clamp. The port is flushed with saline and the first tube of blood is drawn and then "wasted" because the port line has saline the blood is diluted and thus not good for testing. Since I am in a clinical trial I have several tubes of blood drawn ... about six or eight tubes. I'm not sure if the lab at CBCC runs all the tests or if some of the tubes of blood are shipped off to the researchers to perform their own tests but I do know that CBCC runs the tumor marker test which takes several days and performs a quick test to check the level of red and white blood cells to insure I can receive chemotherapy.

Once the lab report is received and the nurse verifies the blood cell levels are adequate she attaches the IV bag of normal saline solution and then connects the bags of pre-meds which are two steroids and two anti-nausea drugs: methylprednisolone sodium, dolasetron mesylate, dexamethasone sodium, and tagament; the cost of the IV bag and the pre-meds is a little more than $600. I think it takes about 30 minutes to receive the pre-meds but I'm not too sure because the anti-nausea drugs make me sleepy and I often drift off to sleep.

Once I've received all of pre-meds the nurse requests from the pharmacy the clinical trial drug Pertuzumb (per-tuz-umb), by the way if I have not told you before the name of the clinical trial I am in is the Cleopatra Trial. If I remember correctly it takes one hour for this drug infusion and when it is completed vitals are taken. There is no charge for the drug since it is still a trial drug.

Then over a 30 minute period I receive Herceptin (Trastuzumab). Herceptin is the biologic drug which deals with the HER 2 issue, since my cancer returned I will receive this drug every three weeks for the rest of my life. The cost of the drug is $4,257.

The third and final drug is Taxotere (Docetaxel) - the chemo drug; it takes one hour for this infusion. The cost of the drug is $4,752.

The final procedure is to flush the port with saline and Heparin to prevent blood clots. Depending upon how long it takes the lab to run the blood test, our time at CBCC is about five hours. The total cost is $12,143 - the difference between the costs I have listed and the total cost are charges for needles, syringes, tape, wipes, micro filter, positive pressure cap, IV pole rental, hourly charge for the chemo room, IV tubes, Heparin, chemo waste charge, and etc.

I began receiving care from CBCC in November 2007 and until May 2009 the care was monthly port flushes and lab tests, and scans and check up every three months. The total cost from Nov. 07 through October 1, 2009 has been $220,128. A port flush is $194 and the monthly lab is $372. Scans are several thousands: a CT is about $4,000 and the PET is about $5,000. A Procrit injection (to promote red blood cell production) is $1,160 and a Lukine injection (to promote white blood cell production) is $780.

I am so very blessed to have an excellent insurance company with minimal co-pay; cancer is scary enough without having to worry if you can afford treatment you need.