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  • Im being denied Neulasta

    Hey everybody im going to be starting chemo on Monday. Looking forward to starting this once and for all.

    Anyway i asked my doctor if i could have Neulasta while i was on BEP and he goes it aint necessary. He was going how its only really necassary while on high dose/VIP.

    I then pushed him a bit more and told him 'im requesting it' but damn he didnt budge.

    Ive got a feeling this is a money thing and he doesnt want to cash out the bill for the hospital on something which aint THAT necessary. I know its not something i really need but id feel better having a WBC booster after every round.

    Shall i forget about asking him again? What do you think i should do

  • #2
    Hi Aaron. I did radiation, so I don't know much about your situation, but it doesn't sound unusual to not use Neulasta for lower dose chemo.

    It's my understanding, and it might be faulty, that Neulasta is used to boost WBC count so that chemo does not have to be interrupted due to low counts.

    With a lower dose of chemo could it be that this situation is much less likely? All drugs have side effects (i've read about bone pain from WBC boosters, for instance), and it might be best to hold off on Neulasta unless your WBC count does become low. Is your count low already, or did you want to take this as a way to prevent low WBC?

    I think you can still confidently say that you are throwing everything you can at the cancer. The neulasta doesn't affect a cure unless it enables more frequent chemo that would otherwise be prevented by a low white blood cell count.

    All the best! You'll recover 100% from this (aside from the nut, which -- alas -- does not grow back. )
    ---------------
    Left IO 4/21/05 | Seminoma Stage I |Blood markers normal before surgery | CT scan and xray normal.
    Final day of radiation was June 2, 2005 (15 days, 2500 cGy total). Anti-nausea drug of choice: Zofran.

    Comment


    • #3
      Neulasta

      Aaron,

      I had neulasta during 4xBEP when my WBC counts went below a certain threshold, and I also had aranesp when my RBC counts were too low. My oncology nurses told me that insurance policies only pay for neulasta and aranesp if WBC and RBC counts drop below a certain level. I guess mine did, because I had shots after each round.

      I would say your doctor is being a bit premature about dismissing neulasta even before you start chemo. I think the fact that the injections are very expensive may be a factor, I don't know. I would check with your insurance carrier to determine the WBC and RBC levels at which they will approve neulasta and aranesp. If your levels drop below the applicable thresholds and your doctor still won't approve neulasta, I'd get a second opinion.

      Just FYI, both the neulasta and aranesp injections are exquisitely painful, at least they were for me. Fortunately, I didn't have any bone pain. Anyway, they sure helped me keep on schedule with my chemo last year.
      Last edited by mrb1980; 05-06-06, 04:29 PM. Reason: Spelling correction
      Left I/O 6/24/05
      100% Embryonal Cell Carcinoma, Stage III
      4xBEP August - October 2005
      Surveillance since Nov. 2005

      Comment


      • #4
        How quickly does the neulasta kick in? It doesn't sound like his doctor's decision would affect the ability to treat effectively, or does it?

        I have no idea how much the drug costs (I know these drugs are not cheap, to say the least), but if cost was not a factor and if you were willing to pay out of pocket, would that affect the doctor's decision? If the latter is true, then clearly insurance coverage is one of the doctor's concerns.

        My radio onc didn't want to give me Zofran because he assumed it wouldn't be covered. Turns out it was (we pay through the nose for our health insurance, so I was more than happy to let them pay).

        Then again, I was in for surgery at 7:30am and home by 2pm, so I guess insurance still wins the game in the end.
        ---------------
        Left IO 4/21/05 | Seminoma Stage I |Blood markers normal before surgery | CT scan and xray normal.
        Final day of radiation was June 2, 2005 (15 days, 2500 cGy total). Anti-nausea drug of choice: Zofran.

        Comment


        • #5
          They gave my son Neupogen which is less expensive than Neulasta. I believe he needed at least one shot. Maybe that is another alternative. If you need it you should get it. Good luck going through chemo. The first day is the hardest. Dianne
          Spouse: I/O 8/80; embryonal, seminoma, teratoma; RPLND 9/80 - no reoccurrence - HRT 8/80; bladder cancer 11/97; reoccurrence: 4X
          Son: I/O 11/04; embryonal, teratoma; VI; 3XBEP; relapse 5/08; RPLND 6/18/08 - path: mature teratoma

          Comment


          • #6
            Neulasta

            Folks,

            According to my insurance statements, the neulasta injections cost $3,000 each. That's right, three grand. Thank goodness they were covered, otherwise I'd be sleeping in my car.

            As I recall, I'd have a BEP round one week, a CBC the next week, then a neulasta injection the following Tuesday. Then, I'd start the cycle over again the next Monday. I don't know how long the injections take before they work.
            Last edited by mrb1980; 05-06-06, 05:42 PM. Reason: Spelling
            Left I/O 6/24/05
            100% Embryonal Cell Carcinoma, Stage III
            4xBEP August - October 2005
            Surveillance since Nov. 2005

            Comment


            • #7
              Holy crap. That IS expensive.

              But is this ordinarily taken to prevent the white blood cells from getting too low, or once they appear to be at risk of going too low? I mean, are there situations where it may not be needed and the doctor is actually being prudent?

              Originally posted by mrb1980
              Folks,

              According to my insurance statements, the neulasta injections cost $3,000 each. That's right, three grand. Thank goodness they were covered, otherwise I'd be sleeping in my car.

              As I recall, I'd have a BEP round one week, a CBC the next week, then a neulasta injection the following Tuesday. Then, I'd start the cycle over again the next Monday. I don't know how long the injections take before they work.
              ---------------
              Left IO 4/21/05 | Seminoma Stage I |Blood markers normal before surgery | CT scan and xray normal.
              Final day of radiation was June 2, 2005 (15 days, 2500 cGy total). Anti-nausea drug of choice: Zofran.

              Comment


              • #8
                Here's another data point for you to consider with the Neulasta. I got a Neulasta shot on the sixth day of the first two 21-day cycles of BEP, as a preventative measure so that my schedule needn't be interrupted due to low WBC counts. I am not getting it on the sixth day of my third and final cycle of BEP, since I am near the end of my chemo schedule and there is little risk that I won't be able to keep on track.

                I did get some severe bone pain, mostly as migraine headaches and neck pain, usually 5-7 days after the Neulasta was given. The Neulasta did its thing, as a drug this expensive should - my WBC count two days after the first shot was about 18,700; while my WBC count two days after the second shot was 23,100. To put these numbers into perspective, the "normal range" given on my test result sheets is 4,800-10,800. Before starting 3xBEP, my WBC count was measured at 6,300. At the end of each week of treatment (so far), it was (1) 18,700 (2) 7,400 (3) 7,000 (4) 23,100 (5) 10,600 (6) 6,200

                There are a couple of ramifications of having very high white blood cell counts. This is a condition known as leukocytosis, and according to my family medical book (by Johns Hopkins) it may cause (1) abscesses in random locations, and (2) fibrous growth around the heart that can lead to heart disease. I ended up getting something like an abscess in my arm, in conjunction with thrombophlebitis (inflamed vein) from the chemo IV. This may have been exacerbated by the high WBC count since it happened right around the time my count was 23,000.

                Here is another piece of information for you to ponder. At the beginning of my treatment, I had a wonderful chemo nurse who explained how many of the drugs worked. In speaking of the Neulasta, she said it was very important that it be given no sooner than 24 hours after the chemo is administered on the fifth day of each cycle (the EP days). She said that although it is made to stimulate WBC's, it can also stimulate active cancer cells through the same mechanism. She said that 24 hours after the EP is administered, pretty much all the cancer cells that are in the stage of development that would be most likely to be "supercharged" by the Neulasta have been killed by the chemo. I have not searched for any independent confirmation on what she's told me, but if it is true, it sounds like you definitely want to get the timing right on administration of Neulasta to avoid accelerating the growth of cancer.

                I believe I also recall reading somewhere that there is a small risk (< 1%) of developing Leukemia as a side effect of Neulasta. In case you are wondering, if I had it to do over again, I'd skip the Neulasta shots.

                -TSX
                Last edited by TSX; 05-07-06, 12:35 AM.

                Comment


                • #9
                  For information, at the beginning of the last week of my 1st and 2nd BEP cycles, my white count dropped to low values. My doctor prescribed me antibiotics (cyprofloxacin) as a precautionary measure to minimise the potential developing an illness that would disrupt my chemotherapy.

                  My white count then naturally picked up by the start of the next chemotherapy cycle.

                  Davie
                  Diagnosed March 2006, Stage IIB, 3cm RP mass
                  10% Seminoma, 90% Non-Seminoma (Embryonal, and a tiny amount of choriocarcinoma and teratoma)
                  Prechemo bHCG-2648, AFP-582
                  3xBEP March-June, markers normalised
                  3 months postchemo - 1.2cm residual RP mass
                  RPLND September 2006 - mostly necrotic tissue plus tiny amount of well differentiated teratoma
                  June 2009 - TRT commenced to help out my lefty
                  May 2011 - check-up, all clear

                  Comment


                  • #10
                    AaronK,
                    Good luck with the chemo!!!!! Keep us posted on how you're feeling!
                    Retired moderator. Husband, left I/O 16Dec2005, stage I seminoma with elevated b-HCG, no LVI, RTx15 (25Gy). All clear ever since.

                    Comment


                    • #11
                      Aaron, my experience was that I got 2 shots of Neulasta both on the Mondays when I was to start cycle 2 and cycle 3. I came in each Monday ready to start the next round and my WBC was too low. But, like everybody says, it is terribly expensive (my bills from United Insurance said $10,000 - I don't know if that is right) and it hurts like hell (I couldn't sleep that night since it felt like my entire skeleton was throbbing). TSX, that is interesting what your nurse told you about when to give it. I hadn't seen that. anyway, make sure your doc has a good reason. it certainly shouldn't be ruled in right now, nor out.
                      Age 33, Right I/O Mar '05, 90% embryonal, 10% teratocarcinoma, Surv until 4 mo CT (+), 3 x BEP Aug/Sep '05, CT 10/05 ok, CT 2/06 ok, CT 3/06 ok, CT 6/06 ok, X-Ray, Blood 8/06 ok, Sperm Count 09/06: Low but active, CT 10/06 ok, X-ray 12/06 ok, CT 02/07 ok, X-ray/blood 4/07 ok, CT 6/07 ok, X-ray/blood 09/07, CT 10/07 ok, CT 4/08 ok, CT 10/08 ok

                      LAST NIGHT I DREAMT 1000 LIES
                      I CAN SEE THE DAWN
                      THROUGH A DIFFERENT SET OF EYES

                      Comment


                      • #12
                        For what it's worth my son's shot was always on the tuesday following his round of chemo. I knew that Leukemia was a possibility because of the treatments but I did't know that it was related to the Neulasta. If that is indeed correct wouldn't it be better to simply give a transfusion when the counts are to low?
                        Son Jason diagnosed 4/30/04, stage III. Right I/O 4/30/04. Graduated College 5/13/04. 4XEP 6/7/04 - 8/13/04. Full open RPLND 10/13/04. All Clear since.

                        Treated by Dr. Rakowski of Midland Park, NJ. Visited Sloan Kettering for protocol advice. RPLND done at Sloan Kettering.

                        Comment


                        • #13
                          Hi Aaron,
                          My son was given Neupogen injections. Throughout his chemo he endured probably 15 or more injections. He was told to take claritan and Aleve after his shots. Believe it or not the bone pain was not too bad. The shots brought up his count which was important because you want to stay on the chemo schedule. The shots themselves were painful though.
                          Good luck to you!!!!
                          Jane
                          Mother of TC survivor.
                          Son, Josh 20, diagnosed Jan. 24, 2005. Left Orchiechtomy Jan.31, 2005. 4XBPE March 7th to May 28th 2005.

                          Comment


                          • #14
                            I just got done 3 weeks ago with chemo, 3 BEP, and after each of the first two rounds I was given a drug called Leukine, which is a white cell booster. I would start getting them the day after my last chemo during my full weeks and recieve them for 5 days after that. I asked the doctor and was told that it was more of a preventative than anything. These where $560 a peice, but you take that times 5 and it adds up. What I found to work best for me was to take a couple of aleeve about 1/2 an hour before I got the shot and then I was OK, otherwise it felt like I had two 500 lb. sumo wrestlers trying to tear me in half, no kidding it hurt that bad. I would continue taking tylenol after that when I would start to feel any pain. Good luck, and remember that this a necessary evil that will soon be a memory.

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                            • #15
                              I had neulasta 2x...the shot was painless...just under the skin...needed it after round 2 in hospital and and round 3 in the hospital....a little bone pain but nothing that bad...
                              - lump first noticed 11/20/2005
                              - I/O right Dec 8, 2005
                              - 95% embryonal / 5% seminoma
                              - normal markers PRE surgery
                              - no vascular invasion, tunica free of cancer, epididymis free of cancer, lungs free, lymph free
                              - Stage I diagnosis
                              - surveillance
                              - mid feb '06, beta hcg slightly elevated = 4.6...small enlarged lower node seen on CT scan...
                              - 3BEP began feb 20, 2006
                              - finished 3 BEP, last bleo, april 17, 2006
                              - CT scan, blood markers, chest..all clear
                              - back on surveillance

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