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BY KATHY LATOUR | NOVEMBER 28, 2011
If you or anyone you love has had cancer, you must read The Emperor of All Maladies by Siddhartha Mukherjee, MD, PhD, an oncologist and assistant professor at Columbia University. What sounds like it could be the most boring book this year by its title is actually a page turner and has won a Pulitzer Prize. It also gives those of us who have tangled with this vicious disease just a glimpse of its history and the men and women who have made an impact.
I had a chance to meet Dr. Mukherjee at a company event last month, and he was every bit as interesting as his book, which captures the imagination as it looks at where cancer fits in a 20th century timetable of those who have tangled with the crab.
Of course,I may be a bit biased because when I introduced myself he immediately reminded me that he had used a piece of reporting I did on Larry Einhorn,MD, and the first patient Einhorn treated with the chemo combination that eventually cured Lance Armstrong.
Mukherjee takes us into the lives of the researchers - men and women who were often idiosyncratic and often driven by ego, but who solved a piece of the cancer puzzle. He introduces heroes of cancer research such as Sidney Farber, MD, who took on leukemia when it had been "abandoned by internists, who had no drugs to offer for it, and by surgeons, who could not possibly operate on blood," Mukherjee writes. Farber's first efforts to treat leukemia were met with "skepticism, disbelief, and outrage," but his determination led Farber to partner with philanthropist Mary Lasker who taught him how to use the media and the power of advertising to draw public attention to the disease. Lasker is credited with shaking up the ACS and turning it into a powerhouse for cancer.
Mukherjee also adds moments of high drama, including the day when patients gathered for the first study of Herceptin (trastuzumab). All 15 of the trial's initial women had exhausted their efforts for treatment for metastatic breast cancer. Metastatic cancer patient Barbara Bradfield's cancer had metastasized to the lymph nodes near her collarbone and was clearly palpable. As Mukherjee writes:
"On the morning of the first intravenous infusion of Her-2 antibody, all the women came up to feel the lump, one by one, running their hands across Bradfield's collarbone. It was a peculiarly intimate ritual that would be repeated every week. Two weeks after the first dose of the antibody, when the group filed past Bradfield, touching the node again, the change was incontrovertible. Bradfield's tumor had softened and visibly shrunk."
I think this vision is haunting for me because I know of so many women whose tumors who could be felt, and I could almost feel the joy as those women understood from touching Bradfield's tumor what must be happening to their own.
Most haunting in terms of today's needs is Mukerjee's discussion of the pressure brought to bear on the government after the first man walked on the moon. Cancer activists wanted a "programmatic" effort to cure cancer, just as there had been a concentrated effort to build the atomic bomb in Los Alamos and to put a man on the moon in Houston. It's an intriguing thought. What if all the cancer researchers moved to a remote location and worked in collaboration on the cure for cancer?
And this is one place where the book stops short. When activists demanded action from President Richard Nixon in a full page advertisement in the Washington Post in December 1969, they used the number of Americans dying each year from cancer as their proof that that the nation had to declare war on the disease. The figure then: 318,000.
Today, it's more than 500,000 -- an estimate of 1,500 Americans a day. More people are being cured, but more are dying. Is that progress? Where are we failing? What needs to be done to speed the process?
My other issue with the book is that nurses aren't present or even mentioned. Oncology nurses have become a critical part of the healing of cancer patients in this country and it didn't happen overnight. It's time they are brought out of the shadows of patient care and their professionalism, research and commitment to cancer is recognized and applauded. Perhaps that will be Mukherjee's next book.
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BY KATHY LATOUR | AUGUST 3, 2010
The hype for Showtime's new "dramady" about cancer has started, and I was intrigued by this weekend's story in The New York Times Magazine on Laura Linney, the show's star. I have always liked her and was more curious than ever about the show. The premise of the series for those who don't know: a rather uptight high school teacher is diagnosed with metastatic melanoma and given two years to live.
When I learned the first episode was available on the Web, I tuned in (You can watch it here). The hype had described the show as not about cancer, really, but about a woman going through the stages of grief as she recognizes the end of her life is near. For the regular viewing audience, this should work, but for those of us who have been there, I was reminded of my dad watching WWII movies with me in the '60s. Every time the director would interject actual footage from the war, dad would say, "real." Then we would be back to the action of the movie and he would say, "fake." You see, he had been there, and to enjoy it, he had to separate out what was real and what wasn't. Cancer survivors watching The Big Cwill also have to separate out fact from fantasy.
For example, only minutes into the episode, Linney's character Kathy tells her husband that she can't argue because she has a dermatology appointment. We then see her in the exam room with a cute, young doctor who has clearly told her that she has advanced cancer. You get the idea that chemotherapy has been mentioned because Kathy talks about wanting to keep her hair.
If you can suspend reality to believe she is getting this information from a dermatologist, your reaction could be like mine. "Wait, you have to get a second opinion. The guy is a dermatologist for heaven's sake, and he doesn't know that at ASCO this year there was new treatment introduced for metastatic melanoma. Call M.D. Anderson. Don't give up." Then it was over.
Whew, OK, that was fast: A diagnosis in five minutes. I reminded myself that they needed to get the premise out there in a hurry so Kathy could start reacting. And react she does, ordering the swimming pool for the back yard that she always wanted and saying all the things she has wanted to say to her students but was too "nice."
Nice is gone. And Kathy begins her metamorphosis alone, trying, but not succeeding, to tell her husband or brother that she is dying. Everything she does is with confrontational energy, from running across the street to tell off a nasty neighbor to doing cartwheels down the empty hall of the high school.
And here was the biggest rub for me. I could swallow the reaction to start living in overdrive. We all know someone who left the oncologist's office and went directly to the car dealer to buy a red Mustang convertible off the show room floor, or the woman who turned to her husband and said, "Out. If I am going to die, I am not spending the last five years with you."
But come on. Cancer is a physical disease first and an emotional disease second. I kept wanting details during the episode that would explain why she didn't have any symptoms of metastatic cancer. No apparent pain, no problems running and jumping. That became a bit of outrage in the final scenes when we are looking at her scans on a light box and there are multiple black tumors in her lungs.
The reality is that living with cancer is both physical and emotional, and the process through which we learn the details of our cancer put us in shock long before we begin grieving. To watch The Big C you have to suspend reality about the physical. Something survivors probably will have trouble with.
But I am guessing that, just as the WW II movies of the '60s were for entertainment more than education, so is The Big C. It makes me wonder what the HBO series will look like in 50 years when the next Tom Hanks and Steven Spielberg decide to tell the real story of the men and women who lived and died in the war on cancer -- just as they did in the recent miniseries The Pacific. I don't know if my dad could have stood the reality of The Pacific had he lived long enough to see it, but it certainly helped me understand the man I grew up with who left his soul somewhere in those tiny islands so many years ago.
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