BY KATHY LATOUR | SEPTEMBER 17, 2013
I wasn't even finished with chemotherapy when I had my first panic attack brought on by the fear that my cancer had returned.
I had one round of chemo to go when I made a phone call to an acquaintance about the use of the fellowship hall at our church. It was one of those calls where we were trying to organize two events that were supposed to occur on the same day in the same place. In the middle of the discussion she yawned, just as I suppressed my own, and we both laughed. She said something to the effect that she didn't know why I was tired but she was going through chemotherapy for breast cancer and was exhausted all the time.
"Me, too," I gasped, as we forgot all about the meeting and began comparing stories. Seems she was dealing with a bit more of an issue than I was because her cancer was in her spine; she was metastatic, she explained, and yada, yada, yada. I didn't hear anything else after the word metastatic.
Within 24 hours my back was in spasms of pain – real pain. I was sure I was dying from metastatic breast cancer. Even though I could intellectually connect my pain with our conversation, the connection was soon lost. My pain was my recurrence that had nothing to do with having just talked to someone who had metastatic disease. I had pain in my spine; that meant my breast cancer had metastasized. I was dying.
As I write this today, 27 years since my diagnosis, I can almost feel the pain. It was so vivid.
I called my nurse, Becky, and told her about the pain in my back and asked that she schedule a bone scan. She did.
Two days later my husband and I went in for the results of the scan and what I was sure would be confirmation that my cancer was back in my spine.
We arrived at the doctor's office and Becky put us in a room. A few minutes later she must have remembered why we were there because she popped back in the room and said, "By the way, the scan was fine."
At that instant the room erupted. My poor husband hissed at me to never do that again. I hissed back that he should spend some time in my body. And Becky said, in the ultimate understatement, "You guys were really worried, weren't you?"
Worried, no; sure I was dying, yes.
A bit of explanation about what this fear does to a relationship such as ours. I was the information processor in the family. My role was the researcher. I knew the details on where to go and what to do, and when I said something, it was true. So my husband counted on me for information, and when I told him information about my cancer, he believed me. So, if I said I was dying, he believed me. This was a new world for both of us.
We went home, and I noticed somewhere between the doctor's office and home that the pain was gone. No one will ever tell me the mind and body are not connected.
I continued to deal with fear of recurrence almost weekly for the first year. My triggers were the usual: a strange ache or pain (ANY ache or pain), a celebrity was diagnosed, a friend was diagnosed or learned her cancer had metastasized. Actually, any mention of cancer by anyone usually sent me into hours of "what ifs."
Remember that part of what makes fear of recurrence so difficult is that pain is the symptom of a real recurrence. I also had strong anniversary reactions that resulted in panic attacks. Holidays would often bring on depression – would this be the last one I would spend with my child?
My worst fear was around Easter, and I have no reason why except it was spring and new life was all around, reminding me once again that mine could be shortened at any moment.
My fear of recurrence persisted for years. I decided I would do a Thelma and Louise before I ever allowed my family to see me wither and die should my cancer recur. Then I had a friend who died of breast cancer and, while not beautiful, it was a healthy death, and it made me reassess my decision about my own life and death.
Then about three years after my treatment ended, I finally couldn't bear the fear any longer. In my support group, we called it crash and burn. I cried all summer. I talked to the therapist who facilitated our support group about how to stop being so afraid.
Then she asked me a logical question: What was I afraid of? I knew it was all about my daughter Kirtley and her life. I didn't want to leave her without a mother. I knew my husband would be a good father, but I wanted to be there. I wasn't afraid of dying, I was afraid of leaving my daughter.
My therapist suggested I think of ways to resolve that. So, I enlisted friends who would take my place in the event of my death. My friend Terry would be there for her education, assisting with school choices and any education difficulties Kirtley might have. She would be hands on to help Kirtley with her school work and to talk to her about learning and keep the joy of learning alive. Terry ran a Montessori school, and she loved learning.
Terry, knew what I meant when I called, and, through my sobs, asked her if she would be Kirtley's education mom. She said she would, of course.
Next came household skills, cooking, sewing - all the things I have never been able to do, but wanted Kirtley to do. I called her Godmother Diana who could cook on all four burners at the same time. Diana can knit and sew and make all kinds of things. She too said, "Of course."
Next came my friend Dianne who was already raising two girls, one of them my god daughter Allison. Oh, the shopping trips they took and the fun they had. I had a miserable adolescence in a family where my mom wanted to make my clothes, and she loved bright colors and stripes. There was no money for the beautiful fashionable dresses, but I was determined that my daughter would dress in the latest fashion.
Dianne said yes, she would be sure Kirtley was dressed like all the other girls when she hit adolescence.
My friend SueAnn was to be her spiritual advisor, the one to answer the questions about our mission in life and spirit's plan for us. A Methodist minister, she assured me, she would be present for Kirtley should I not be here.
When I called these friends, none of them tried to reassure me or tell me I was going to live to be 100; they just agreed to take that part of Kirtley's parenting if I died. It was amazing what it did for me. I felt free and almost buoyant about death. I talked to my support group and the therapist. What did it mean? Was it a sign that I was going to die?
No, she explained, it just meant that I had resolved my own death. She had heard the same thing from others who had crossed the invisible line from fear of death to acceptance of death. Did I want to die? No. Was I more prepared to die? Yes.
Kirtley will be 28 this month, and she can't cook or knit, and she hates to shop, but we have had a few good discussions about the spiritual parts of life, and she made it through college.
And I am still here. No longer afraid of what the future may hold.RELATED POSTS
BY GUEST BLOGGER | SEPTEMBER 11, 2013
About six months ago, I received a call at my house from a family friend who was in distress. As a community oncologist, it is not uncommon for me to receive cancer crisis calls from family, friends or someone I may not even know. This call concerned the grandfather, whom I will call John, of a friend of one of my boys; the caller was the boy's mother, whom I will call Donna, daughter of the patient.
I had actually known about the situation for some time. Donna and I had briefly talked about it at little league games or at places where parents run into each other. John had been battling liver cancer for over four years. He was being treated at a large, well-known cancer hospital and the doctors there had done an excellent job of keeping the cancer at bay. Over the years, parts of his liver had been surgically removed, others boiled with hot probes and many blood vessels had been choked off to deprive the cancer of oxygen. When these local measures no longer worked, he took chemotherapy and like a good soldier, even enrolled in clinical trials testing experimental ways to treat the cancer.
But John felt that the oncologist taking care of him now was mainly interested in enrolling him in study after study and that none of the chemotherapy or research treatments had done any good. The doctor did not answer his questions, talk to him about prognosis, or treat his ever-increasing pain. By the time his daughter reached out to me, the cancer was growing widespread in his liver and lungs, and John was told to enroll in a hospice program close to home. The center could not do anything more for him. They made him an appointment to return in three months, if he was still alive. Needless to say, the patient and his family were distraught.
Although I did not relish caring for a friend's dying parent, I agreed to see John in my office. I was thinking that I could at least make him feel cared for and supervise his end-of-life care. As John walked into my office and forced a smile, he appeared to be a man in the middle of the ocean holding onto a sinking boat. His wife and children filed in somberly. We started out by getting acquainted, talking about his life a bit and what he wanted most for the remainder of it; we even laughed some. John said he accepted that he was dying, that he could barely get out of bed and had no appetite, but that he just wanted to feel better if possible. He wanted to be hungry again, eat his favorite pasta meal, and be able to move without severe pain.
I first addressed his pain by prescribing a steady, more potent pain regimen. I had to assure him that taking narcotics would not make him an addict, something he feared and which greatly frustrated his family. Next, I was concerned about his shortness of breath, so I ordered a lung scan which revealed blood clots in his lungs (pulmonary emboli) in addition to the tumor deposits; I prescribed an injectable blood thinner, called enoxaparin (Lovenox). He seemed to immediately improved with these changes but he soon developed severe pain in his hip and I diagnosed new bone metastases. I convinced him to undergo a course of radiation therapy (he did not think it was worth the trouble), which fortunately did greatly diminished his pain.
I was relieved that John's pain and breathing improved though his appetite still remained poor. I was not sure how much time he had left. Without us noticing, the days led to weeks which somehow led to months as John's condition gradually improved. He was getting out of bed easily now, going shopping with his wife, even mowing the lawn again. And he was finally eating more; his gaunt appearance began to fill out toward normal. His mood was much less depressed. It was as if the grip of death had given him a respite and left his body.
It took us all by surprise. The family asked, "So, what's going on with his cancer?" I said frankly that I did not know but that we weren't treating it so I couldn't conceive that it was being controlled. But it is not usually the case that a cancer progresses and a patient's condition improves so I was indeed perplexed. Furthermore, I did drawn a tumor marker of liver cancer, called AFP, measurable from the blood. When I first met John it was over 7,000 (normal less than 5). Now two months later, it had inexplicably dropped to 300. I told John and his family that I needed confirmation and another measurement before I believed that huge drop. Sure enough, two weeks later the AFP was 220. In order to see what was happening with the cancer, and to answer their question more accurately, I sent John for a CAT scan. The result was also inexplicable but wonderful: the tumors in his liver and lungs had stopped growing and were actually a little smaller! I was incredulous.
"How could John's cancer be shrinking?" I asked myself this question over and over again as I tried to provide the family with some answers. Could it be the Lovenox? There have been no reports of cancer improving with this blood thinner, though there has been some talk of this possibility in the medical literature. Could it have been the radiation therapy? There have been rare reports of radiation therapy to a focal cancer deposit leading to regression of metastatic cancer in the rest of the body due to activation of an immune response (called an "abscopal effect"). Could it be John's change in attitude, from depression and hopelessness to a feeling of lightness and the joy of living? There certainly has been alot written about a person's "attitude" toward cancer and how important it is to maintain hope. Could it be my role as a trusted physician? I only thought of this after Donna gave me this passage from the book Anatomy Of An Illness As Perceived By The Patient (1979, W.W. Norton & Company) by Norman Cousins:
A prominent physician recalled of his physician father: "The instant he entered the sick room, the patient felt better. The art of healing seemed to surround his physical body like an aura; it was often not his treatment but his presence that cured." Francis Peabody's famous remark, "The secret of caring for the patient is in caring for the patient," is another way of stating that there is a miraculous moment when the very presence of the doctor is the most effective part of the treatment."
I was certainly flattered by that sentiment but could not claim the credit here. No, John's improvement is strictly in the realm of the unexplainable. Regardless, we all shared a joyous moment when the results came in. In contrast, John experienced a different reception when he returned three months later to his original hospital, to which he had considerable loyalty. John and his family were looking forward to seeing the pleased look on his doctor's face but were rendered speechless when he did not comment at all on John's miraculous improvement. "He told me their CAT scans were much better and that I should go for more chemotherapy there." "
Chemotherapy! Can you believe that?" John released a rare expletive as he relayed the encounter. We were all disappointed and surprised by this response.
It is now six months since I first met John, and he continues to thrive. I do not know how much longer he has or why he is enjoying more time than expected. But when you are dealing with cancer and the unexplainable happens, in a good way, I say go with it.
Richard C. Frank is a medical oncologist at Norwalk Hospital in Norwalk, Conn., and is the author of Fighting Cancer with Knowledge and Hope (Yale University Press 2013, 2nd edition).RELATED POSTS
BY GUEST BLOGGER | JULY 17, 2013
We've all seen cancer slogans on t-shirts, buttons and baseball caps. If you've received a cancer diagnosis, odds are good you've also heard them from your family and friends.
My first go-round with breast cancer, I wore my hot pink Cancer Sucks t-shirt with pride to my chemo treatments. A few years later, life is more challenging with my metastatic diagnosis and trying to live One Day at a Time.
Two weeks ago, I attended my uncle's funeral; after the service, we were traveling to MD Anderson for a PET scan and doctor's visit. During the service, I was looking at Uncle Bill's children, grandchildren and great-grandson.
"Hmmm.....let's see....if I was 31 when Henry (my son) was born, I'll be 36 when he starts kindergarten. If I'm 49 when he graduates high school, how many years until I could be a grandma?"
There I was, sitting second pew, when a familiar dark cloud slithered into my thoughts. "Will I live long enough to meet my grandchildren?"
My mom will tell you no one knows how much time they have; she could get hit by a bus tomorrow. While that may be true, some of us are standing in the middle of the road, making us more likely to get hit by a bus than the average person. Most people assume they'll live a long and healthy life, but when you're in my boat, it takes concerted effort to make that assumption.
It's been almost a year and a half since I was first deemed incurable. Henry was only a few weeks old and completely dependent on us, but I was the one that needed him. Even when the dark thoughts felt all consuming, I had to Put One Foot in Front of the Other and go fix him a bottle! He continues to give me purpose daily, making it impossible for me to hide under the covers.
My goal is to Enjoy Life in the Now, which is much easier said than done. Most days I choose to keep busy with being a wife and mom – balancing trips to the grocery store and play dates, with oncologist appointments and medicine side effects. I am still responding to my current medication, giving me 12 weeks until the next trip to Houston. Until then, we'll be enjoying summertime in the backyard and trying to stay cool in the Texas heat, just like a "normal" family would.
From now on, when the black cloud sneaks into my thoughts, I am going to follow Henry's lead. At 18 months old, my son doesn't look at the big picture or know what he'll be doing next year or even this afternoon. Every morning, Henry wakes up smiling and ready to tackle the day by running around like a wild man, terrorizing the dogs and trying to jump off the back of the couch.
I can't think of a better example of Live for Today, can you?
Carrie Corey is a wife, mom and metastatic breast cancer survivor. She will be reporting in frequently on her journey.RELATED POSTS
BY GUEST BLOGGER | JULY 11, 2013
In 2010, Lindsay and Tony Giannobile returned from a vacation in Italy, their last "hurrah" before starting a family, but the life-changing news they received wasn't what they were planning for.
At 28 years old, Lindsay received a diagnosis of stage 3 HER2-positive breast cancer. Listening to Lindsay talk about her struggles and determination to not let a cancer diagnosis stop her from becoming a mother, I was inspired. Her story could give other cancer patients and survivors hope of having or continuing to have a family.
"It was our dream to have a family," Lindsay says. Unfortunately, like many other young adults with a cancer diagnosis, Lindsay learned infertility was a risk with her treatment.
From what I've learned, not all patients are given upfront information about potential fertility risks before therapy. If I had treatment and learned, after it was too late, that I could've done something to be able to have children of my own one day, I would feel denied the right and ability to have biological children.
With chemotherapy, the possibility of infertility may depend on age, type of drug and drug dose. Ifosfamide, chlorambucil and cyclophosphamide are a few drugs that can damage eggs. High doses of radiation therapy can also lead to premature menopause by destroying eggs in the ovaries. Even radiation not aimed at the reproductive organs can still cause damage by bouncing rays inside the body. Several options are available for women who want to plan for a family after treatment, including egg or embryo freezing, using an egg donor, surrogacy and adoption, to name a few.
The couple chose to freeze embryos before Lindsay started chemotherapy in late 2010 with the hope that she might be able to carry them after her year-long treatment of chemotherapy, radiation and surgery.
"We're very blessed that I had babies on the brain," she says. "That really was our only chance at the time."
The Giannobiles' plan for Lindsay to complete therapy, be finished with cancer and have a child was derailed when, a year after starting treatment, she learned the cancer had spread to her bones. The cancer, now stage 4, ultimately means she will stay on treatment indefinitely.
"Tony kept saying, 'God will make it so that we can be parents'," Lindsay says, but at this point, the couple had very few options of starting a family. Surrogacy was their first choice. They would have tried adoption, but Lindsay was told by multiple sources that they wouldn't qualify to be adoptive parents because of her cancer diagnosis. "We wanted our biological baby, and we believed that God's plan for us was just that since we were able to freeze embryos successfully," she says.
Their first order of business: find a surrogate.
Lindsay and Tony reached out to surrogacy agencies and sent emails to friends and family, asking if they knew anyone who might be willing to carry their child.
The Giannobiles received a response from Kristen Keighley, who she met during treatment.
"She said, 'I can do this, I want to do this for you,'" Lindsay says. "We got things started from there."
Surrogacy is one of the most expensive options for women unable to conceive. It can cost anywhere from $10,000 to $100,000, which includes doctor appointments, embryo transfer, surrogate compensation and legal fees. Most costs are not covered by health insurance.
To help them finance the surrogacy, friends of the couple held fundraisers. Lindsay's friend, Matt Russo, raised $1,000 for every mile he ran in a Columbus, Ohio, marathon. The final total neared $30,000.
On May 15, Lindsay and Tony's son, Rocco, was born via caesarean section. Lindsay says words can't describe the experience of watching Rocco come into the world. It is something she and Tony will always "vividly remember."
"To think our baby was frozen for about two years, then developed in someone else's body is just an absolute miracle," she says.
Lindsay describes their surrogate as a "selfless, selfless person." Kristen, a single mom, works and attends school full-time. "And to add one more thing to her plate, she carried our child."
Lindsay isn't ashamed of her decision to use a surrogate and feels surrogacy isn't talked about enough.
"I think our generation has gotten better with talking about cancer, but surrogacy is a different story."
Lindsay encourages others to not give up on the dreams they had before cancer. "Look at the things that you thought your life would consist of before cancer" she says. "I think that is so important."
For more information on requirements, costs and support for surrogacy, here are a few resources:
You can read more about family planning with cancer in CURE's Summer issue article, "Managing Expectations."RELATED POSTS
BY ELIZABETH WHITTINGTON | JULY 8, 2013
Cost is one of those "difficult conversations" between a patient and a physician, right up there with end-of-life discussions. Does that surprise you?
An article posted online from the Journal of the American Medical Association addresses the issue of medical cost in "First, Do No (Financial) Harm."
"... seemingly simple decisions that physicians make about testing could directly lead to thousands of dollars in out-of-pocket costs," the authors write, noting that physicians shouldn't assume that high medical costs are a known and unavoidable fact of life for all patients. The article encourages physicians to optimize care for individual patients in regards to cost, a strategy used commonly to treat cancer. The article is geared toward a general medical audience, not specifically cancer, so the examples it provides may not apply. However, the overall theme is that physicians should have a financial conversation with their patients, including if patients are worried about cost and are understanding the financial ramifications of screening and treatment.
"Too often physicians choose less than ideal options for their particular patients not due to a lack of caring, but rather a lack of knowing. This includes not prescribing generic or other insurance-covered drugs when appropriate. Lack of awareness about the opportunities to provide higher-value care should no longer be an allowable excuse."
While the article is geared toward physicians having that financial conversation with their patients, this should also encourage patients to initiate the discussion. Asking for lower cost treatment alternatives, generics or making sure their doctor works within their insurance plan are conversations that patients shouldn't be ashamed to have with their physicians.
At the annual meeting of the American Society of Clinical Oncology this year, a study examined how likely insured patients were to talk to their physician about treatment cost. Nearly half of the 119 patients surveyed expressed a desire to discuss the issue, but only 21 percent had actually done so. Of that 21 percent, half felt the discussion helped lower their treatment costs.
In another study of women with breast cancer, 94 percent believed cost should be discussed between patient and physician, but only 14 percent reported ever having the discussion.
"To provide truly patient-centered care, physicians can live up to the mantra of 'First, do no harm' by not only caring for their patients' health, but also for their financial well-being," the authors conclude.
Do you discuss cost with your physician? And does cost affect your treatment decisions?
Stay tuned for more on this subject. CURE is producing a supplement on the cost of cancer care later this year, which will include tips and resources to help manage the financial burden of cancer.RELATED POSTS
BY GUEST BLOGGER | APRIL 8, 2013
Ever heard anyone say it was a great time in their life to get cancer? No! You'll usually hear people talk about their diagnosis in reference to some other major life event. Either "My daughter was getting married," or "I had just started a new job when I found my lump."
The first time I was diagnosed with breast cancer, it was a few months after I married the love of my life. We married on Valentine's Day, 2009, and honeymooned in March. I turned 29 in April, and I was diagnosed in May. After a bilateral mastectomy and 18 weeks of chemotherapy, the year was coming to a close. After a particularly rough day, I looked at my husband and joked, "Well, 2009 kind of sucked. 2010 has GOT to be better!"
Chris responded very matter-of-factly, "I for one refuse to think of 2009 as bad - it's the year we got married." He was right then, and now he is even more right.
How many years can be defined as cancer years? 2012 can't be known as the year of my recurrence. It's the year we adopted Henry.
I refuse to let cancer define my life or the way I think about it.
When you have metastatic disease, you have to shift your way of thinking. I will always be in some form of treatment. We are not marching toward the light at the end of the tunnel like I did with the first go 'round. This is not a temporary situation or something I am going through. It's not the path I would have picked, but it is the hand that I have been dealt. And so, THIS IS MY LIFE. I can't think of it in terms of weeks between scans or times in or out of the chemo chair.
Right now, I'm not sure if I am responding or progressing on my new medication (anastrazole) since my last scan had mixed results. But I have a little guy who is learning how to walk, and we just bought and moved into a new house. Cancer is just going to have to take a backseat. I'm too busy to stress about it today. I need to buy a new shower curtain and pick out paint colors for Henry's room ... I'll worry about cancer in a few weeks when I check into the PET scan waiting room.
Carrie Corey is a wife, mom and metastatic breast cancer survivor. She will be reporting in frequently on her journey.
BY GUEST BLOGGER | APRIL 3, 2013
"What is this lump on his neck?" asked our family physician. Just past six and a half months old, our baby, Jasan, had a few nights of intense crying followed by nausea and diarrhea. That prompted a visit to the family doctor, Richard L. Huffer. He was an amazingly thorough doctor and as he was examining Jasan, he kept going back to Jasan's left neck over and over again. He found a lima bean-sized lump on Jasan's left neck. I told him that I had given him a bath just before leaving home and didn't notice anything out of the ordinary. He guided my right index finger over the left neck and sure enough there was a lump. He told me it might be a gland that was infected and that a course of ampicillin would probably do the trick.
The next week was somewhat normal for an almost seven-month-old baby; he ate, played, got changed, slept and fought me every inch of the way when it came to taking the ampicillin! The lump didn't really shrink; in fact I thought it was getting bigger, so we were back in the doctor's office before our next appointment. Dr. Huffer had spoken to a surgeon at Loma Linda University Medical Center and knew that it was time to refer us to him. I asked him if it was serious, "like cancer serious?" He handed Jasan to the receptionist and did his very best to calm me. He told me to let the Loma Linda guys check him out; told me to call him as soon as I knew a diagnosis, gave me a hug and sent us home. I packed a couple of small bags for the two of us and then with Jasan on the floor grabbing at the dog's tail, I just sat on our bed and bawled. I just felt so helpless.
I made the necessary phone calls to family and friends and then enlisted the help of my sister-in-law, Mary, to make the trip with us the next morning. She was great at tending to her little nephew as we drove and kept my mind off the challenge of the day. My husband, Jim, would join us the next afternoon.
After the initial examination by the pediatrician, we waited to see the pediatric surgery team. By this time Jasan had a mass the size of a small egg on his left neck and was extremely agitated. Jim joined us late in the afternoon with the news that he was staying with us for a few days until we knew a little more about what we were facing.
Jasan was admitted to the hospital that evening and surgery to excise the lump was scheduled for the next morning. Paperwork had to be signed that evening and we wanted to hear any news from the surgical team when they made rounds. They told us the surgery would be about four hours. It was closer to six. They also told us that when he came out of surgery he would be hooked up to tubes, monitors, lots of bandaging on the neck and most likely would still be groggy from the anesthesia. After surgery, his crib was pushed out of the surgical elevator, he saw his daddy and all we heard was a very loud "dada dada dada" and saw no tubes, no monitors and only a small bandage on his neck. We were elated.
A frozen section during the surgery gave us a preliminary diagnosis of neuroblastoma, a sympathetic nerve cell cancer. The formal diagnosis came about a 10 days after surgery when reports were returned from various labs across the country.
Neuroblastoma. Tumor. Malignant. Radiation. The fight was just beginning!
The following days were filled with more blood tests , 24-hour urine collections, tomograms, esophagogram, radiology studies, bone marrow test (this was the worst so far...no anesthesia ... just blood-curdling screams from Jasan as we waited for him just outside the procedure room). The oncology and medical teams wanted to discuss treatment with Jim and me. We listened to the information they presented. Our decision would ultimately determine our baby's future health. We both felt so helpless. What should we do?
After two weeks we were released to go home. We had to return three days later to see the radiation therapy team. At that appointment Jasan was fitted with a clear Plexiglas mask that could be strapped to the table in the radiation chamber so that he couldn't move his head during the treatments. This was worse than hearing those blood-curdling screams during the bone marrow test.
Jasan cried and screamed and yelled "mama," "dada," and "no, no, no" through a series of 25 radiation treatments. Subsequently, he fought thyroid cancer at age 15 and at age 21 had a recurrence of thyroid cancer. Three cancers would seem more than enough for one child, yet in between were numerous scares, hospitalizations, more surgeries, illnesses, regular testing; all due to the side effects of radiation.
Did we make the best decision? We think that we did. The oncology team told us we could do nothing and take our chances of Jasan living a few more months or we could choose radiation and that would give him at least 18 more months on this earth and possibly side effects through the years.
Jasan has surpassed those 18 months by three decades plus and now serves as a cancer advocate helping others meet their own challenges. We know it hasn't been easy for him or for us, but we were always by his side and that will never change.
Note: Jasan's neuroblastoma was diagnosed in 1976. We lived in a small town of about 25,000 people. There were no support groups, no major medical centers and we didn't know anyone that had a child with cancer. We traveled an hour and 15 minutes each way from Indio, Calif. to Loma Linda University Medical Center in Loma Linda, Calif. for each appointment, treatment and hospitalization. Jasan's case was the 26th neuroblastoma in the U.S. It was the first tumor recorded on the neck, most are found in the stomach. Thank you, Dr. Huffer and LLUMC for saving Jasan's life!
Carolyn Zimmerman is the mom/caregiver of a three-time cancer survivor. Her experience covers caring for a six-month-old baby diagnosed with neuroblastoma, a 15 year old diagnosed with mixed papillary and follicular thyroid cancer, and a 21 year old diagnosed with recurrence of the thyroid cancer. She says the treatments, surgeries, scares, support and dealing with the medical world have been a major part of her son's life and directly affected her role as mom/caregiver.RELATED POSTS
BY KATHY LATOUR | FEBRUARY 28, 2013
I loved it when breast surgeon and breast cancer advocate Susan Love said she would rather talk about death than sex. I think it puts in perspective how very difficult it is to discuss something that has always been seen as mystical, and yet, as we all know, people who can talk about it have the best sex lives.
I say "people" because single people get cancer too. So, whether single or married or divorced or whatever, cancer changes our perspective on sex. When I wrote my book "The Breast Cancer Companion," I wanted to include sex because it had been an issue in my marriage and I knew it would be for other women.
What surprised me was the wide variation of responses that women and men gave me when I asked about sex. One woman said she and her husband had become so close during the cancer experience that she was having trouble relating to him sexually, and another said she refused to talk about sex because they never had. It had been the one thing in their marriage that worked without words or communication of any kind and now the deal had changed and she was angry.
For men who get cancer the issues can be the same or different. Some men see it as their place to take charge in the bedroom, and if they feel diminished physically because they don't feel well or they have had to let their wives take care of them, they may have trouble finding their role again.
The bottom line is that cancer changes us, mentally, physically, emotionally, spiritually and if you look at that list, each of those facets is part of sex. It also changes our partners who will, perhaps, see us differently than they ever have. How these changes play out in sex will depend on the two people who have gone through the experience and their commitment to the relationship and each other.
For single people it's a whole different ball game as they try to find a life partner with the added chapters of their life that cancer brings. Fertility may be affected by cancer, and there is always the question, "So when do I tell him or her that I have had cancer."
Talk to people who have been there, get help to find your way, every piece of advice comes from a core message: communicate. Communicate with your partner, your potential partners, yourself.
We have done a number of stories about sex in CURE. Go to www.curetoday.com and put sex in the search field and have fun.RELATED POSTS
BY DEBU TRIPATHY | FEBRUARY 18, 2013
Personalized cancer medicine has become a major buzzword as of late, but what does it really mean?
Everyone defines it differently, so the bird's eye view of this term would be as encompassing as possible. On one level, it means that every patient is an individual and that their course through the diagnosis and treatment of cancer should reflect their values and preferences within the boundaries of medical evidence that is works. The way information is communicated, the way different choices are presented, and even how treatment choices are balanced against side effects (sometimes permanent), all need to be customized.
A mother of two young children and a professional violinist might make very different treatment decisions about using a chemotherapy agent that causes neuropathy even if the benefit (improvement in cure rate) is identical. Similarly, the medical care team needs to formulate tailored strategies to keep patients satisfied with treatment, compliant with medications and educated about when to call with side effects. Using a one-size-fits-all approach will probably lead to much lower performance in all these departments.
A very different definition of personalized medicine is the high tech world of genomics and proteomics that exposes unique vulnerabilities in an individual's cancer. Just in the last year, massive amounts of genomic information from the tumors of many patients has been made available through publications and databases-–analyzing this fire hose of data is starting to reveal that cancers do in fact harbor many genetic "drivers," and the next step will be to squelch these with targeted drugs. Also, deciphering inherited variations the drug metabolizing enzymes will help us predict who is more susceptible to drug side effects--further customizing treatments.
The best model of personalized medicine is one that integrates all these definitions to create an environment that revolves around the patient. This includes a rationally composed and individualized treatment plan using the best science along with supportive approaches that add up to a holistic plan that is reflective of the individual. Let's hope that health care reform will encourage and incentivize personalized medicine for cancer.RELATED POSTS
BY ELIZABETH WHITTINGTON | FEBRUARY 6, 2013
Pancreatic cancer is an aggressive, hard-to-treat disease, especially once it spreads outside the pancreas. Unfortunately, about 80 percent of pancreatic tumors are diagnosed at stage 4. Because of the nature of the disease, even small gains are cause to take notice.
At the 2013 Gastrointestinal Cancers Symposium, results of the MPACT study, a phase 3 international trial that examined Abraxane and gemcitabine extended overall survival by more than 7 weeks when compared with gemcitabine alone.
Abraxane, called nab-paclitaxel, is a form of Taxol which is encased in a protein and is given intravenously. This formulation helps reduce side effects, such as severe allergic reaction, and the protein albumin may make it easier for the active compound paclitaxel to reach cancer cells than the camphor oil used in traditional Taxol.
Daniel Von Hoff, lead investigator of the MPACT study, presented the results at the conference as a late-breaking abstract. The study included 842 patients with newly diagnosed metastatic pancreatic cancer. Researchers found that the combination increased the median overall survival by almost two months (8.5 months compared with 6.7 months), meaning that half of the patients in the Abraxane arm were alive at 8.5 months.
Von Hoff noted that the benefit of the Abraxane combination over gemcitabine alone increased over time. At the one-year mark, 35 percent of patients taking Abraxane were alive compared with 22 percent in the gemcitabine-alone arm. Although only a small percentage of patients were followed to the two-year mark, the survival benefit had then doubled (9 percent versus 4 percent). The effect also stretched across various subgroups, even those with poor prognostic factors, such as extent of metastases. The poorer the prognostic factors, the more favorable the addition of Abraxane, Von Hoff said.
Patients who went on to second-line therapy after progressing in the MPACT trial also did better if they had been treated in the Abraxane arm. Although side effects were seen with the combination, including fatigue and peripheral neuropathy, more patients in the Abraxane arm were able to complete their treatment, hinting that it was more tolerable than gemcitabine alone.
Von Hoff predicted that the combination could become a backbone in new regimens for advanced pancreatic cancer.
Philip A. Philip, an oncologist with Karmanos Cancer Institute in Detroit, led the discussion of the study and also proposed Abraxane should be considered with other combinations, as well as in earlier stages of the disease.
"The rational in developing nab-paclitaxel in pancreatic cancer was based on hypothesis largely related to targeting the stroma," Philip said.
Recent studies have shown that one reason pancreatic cancer may be resistant to standard treatment is the stroma, a matrix of cells and molecules that are tightly knit together around the cancer. If Abraxane can weaken the stroma, gemcitabine may have a better chance in getting to the tumor cells, which could explain the synergistic effect researchers are seeing.
"I strongly encourage the investigators to grab this opportunity and go back to the lab to determine the molecular basis of this clinical benefit and its association with any biomarkers, such as SPARC." Research has shown that pancreatic cancers overexpress a protein called SPARC, which may attract Abraxane molecules and subsequently may increase tumor response to the drug. Philips called it an "invaluable opportunity" in developing future trials for this disease.
Celgene, the company that produces Abraxane, is planning to submit the drug to the FDA for approval for this patient population by mid-year. Abraxane is already approved for advanced lung and breast cancers.RELATED POSTS