What Causes Decrease In Hemoglobin After Every Cycle Of Chemotherapy?

Question: Hello Doctor,

Mother completed her 3rd cycle last week. She is currently having fingernail pains and calves pain continues but somewhat manageable with Tramadol. My specific question is about her HB, her HB drops after every cycle. Till now in 3 months, we did blood transfusion 3 times. At the start of 3rd cycle her HB was 11.5 and now it is 9.1. Is it very common to have such a frequent HB drop on paclitaxel or is it the sign of aggressive disease? She will have PET scan next week and I will update you more on that.



Please advise on HB issue.

Thanks,
XXXXXX
Asked by Me , 2 days ago     
In addition to above- I would like to learn if the survival period of Stage 4 patient can be predicted. I understand even if my mother achieves remission or NED status she is going to have recurrence sooner or later. But, is there a clinical number which will say recurrence will occur after 2 months or 2 years? We have been hearing from people who say relapse will happen in 6 months but there are few who say it can be much longer than that. I will appreciate your comments. I am sure you must be coming across to this question many times.
Asked by Me , 3 hours ago
Regards,

XXXXX

Thank you Doctor.

This is my mother's 3rd relapse which has shown progression to her liver. She was diagnosed at stage 4 in 2006 with mets to her bones, lymph nodes and right breast. She then had 6 months taxotere, 12 rounds of radiotherapy, double mastectomy which completely removed her cancer. She was on hormonal therapy for one and half year, on arimedix but could not continue as she felt side effects were too much, especially bone pain and hot flashes.

Until XXXXXXX 2013 she did not show any clinical signs of cancer. XXXXXXX 2013 she her progression was with extensive bone mets her spine, shoulder, hip, and couple of spots on skull. She then continued with tamoxifen and zolendronic acid. But since May 2013 she had many problems including frequent infections, acute renal failure and then recently in Feb 2014 pathological fracture to right hip joint. In May she diagnosed with progression to liver. That is when we started NAB paclitaxel chemo, she showed significant improvement right after first cycle, tumor markers dropped more than 60%, after 2nd cycle liver mets were not detectable on USG. Now after 3rd cycle she is suffering with server leg pain, especially calves and thighs to some extent. She has been diabetic but never had leg pain like this before. She is also vitamin D deficient which we have started additionally. But, is there anything we can do to give her relief from calves pain? I suppose that is because of paclitaxel. Please advise. Pain killer like ultracet is not helping her much.

Regards,
XXXXXX

Thank you so much doctor. Your suggestions have been very helpful. The calf pain is somewhat manageable but once in while she feels stabbing pain the Calf and which takes some time to subside. She is now experiencing tingling and numbness in lower body, throughout her legs and feet. It subsides after a while, I am guessing that this along with in between lower abdomen pain are side effects of chemotherapy. And, this should go away as she finishes her treatment. Please let me know if you have any advice to manage these side effects. Thanks again for your help.

Hello Doctor,

With the recent USG, the liver mets were not detectable so we discussed with the Oncologist about possible chemo break to recover. And, he agreed- so we are not completing 4th cycle right away. However he suggested that she should complete 6 cycles and next 3 cycles would be 3 weekly dose. Oncologist is suggesting to start with 175 mg/m2 dose than the standard 260mg/m2, which will then give 3 weeks recovery time before she starts 5th cycle. Do you think this is reasonable? One of the reasons her doctor mentioned was her nails being badly damaged which he feels are the side effects of weekly dose and she may not have that side effect on 3weekly dose.

My other question is the two worrisome side effect she is currently having
One is burning sensation on buttocks and the area under thighs.
Second is the constant pain she has after the bowel movement. This pain persists for a very long time, sometimes for a few hours. She did have constipation earlier but even with loose stools she is having the pain.

Are these side effect of neuropathy due to Paclitaxel? If yes, are these side effect reversible once the chemotherapy is completed or how long the side effects lasts?

Appreciate your suggestions.

Thank you doctor. The neurologist suggested a tablet which helped with her burning sensation. We also took opinion of Gastroenterologist who did some investigation and suggested that her mucosa doesn't have any problem. Could the bowl movement pain be paclitaxel induced neuropathy? She did have similar pain after very first cycle but it went off on its own in 7-10 days. This time pain is lasting for quite long time.