Cancer for the Long Haul
Suvivors with chronic disease can face ongoing challenges.
Lorber, Elliott and others are learning to grapple with this increasingly common reality, that the cancer experience doesn’t have to be an either/or situation — that either a person is “cured” or the illness is clearly terminal. Rather, the reality of cancer can be an ongoing circumstance — and one often marked for individuals by a weighty uncertainty about how long they can survive with the disease.
Many situations can fall under the umbrella of “chronic cancer”: for instance, patients who have no evidence of disease but require ongoing medication; patients with measurable disease that has stopped growing or is progressing very slowly; people fighting a steady battle against metastases; or even those whose cancer, while in remission, has a high probability of returning (see sidebar). What can result is a state of mind that, while reflecting much of the same anxiety as that of anyone who has faced death after a cancer diagnosis, has the potential to last much longer.
“Although most of my patients certainly prefer their chronic cancer to the alternative, it doesn’t mean it’s easy,” says Steven Passik, PhD, attending psychologist at Memorial Sloan-Kettering Cancer Center in New York City, who primarily has been treating cancer patients for some 20 years. “Knowing that you have a finite number of years to live — that can be a very difficult cross to bear.”
Also, for some drugs, patients must continue their use for years or even indefinitely.
Targeted therapies have been extraordinarily effective for some rare diseases. For instance, imatinib (Gleevec) achieves remissions in the majority of patients with chronic myelogenous leukemia and also is effective against gastrointestinal stromal tumors, or GISTs, an uncommon cancer. Patients with more common tumors have also benefited from targeted therapies. Some recent successes include bevacizumab (Avastin) for colon, lung and breast cancers; erlotinib (Tarceva) for lung cancer; cetuximab (Erbitux) for colon and head and neck cancers; and sunitinib (Sutent) and sorafenib (Nexavar) for kidney and liver cancers.