Cancer for the Long Haul

Suvivors with chronic disease can face ongoing challenges.

David Lorber calls each day a gift. Diagnosed in 2004 with a slow-growing form of lung cancer, bronchoalveolar carcinoma, the chemotherapy pills that he takes each morning are a daily reminder that his time is likely to be limited.  When John Elliott was diagnosed with the aggressive brain cancer glioblastoma multiforme in 2004, he was told he had six to eight weeks to live. Now, almost four years later and after a lengthy regimen of medication, Elliott is defying the odds.  New cancer therapies are extending life for a growing number of patients. But the road for these cancer survivors can still be long and arduous, filled with social, emotional and physical challenges that extend well beyond treatment.

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.”

Recently approved cancer drugs, often referred to as “targeted therapies,” are contributing to increased survival rates, says George Fisher, MD, PhD, an associate professor of Medicine at Stanford University in Palo Alto, Calif. Targeted therapies refer to drugs that disrupt biochemical pathways that tumors rely on to grow. By targeting key molecules in these pathways, the drugs tend to be less toxic to noncancerous cells (although they can have other side effects). 

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.

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