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A new definition of cancer survival

November 06, 2007

I have been doing an informal survey on what image comes to mind when we hear the words "cancer survivor." Lance Armstrong, who was triumphant over widespread testicular cancer and subsequently won five more Tour de France competitions, is the hands down choice. He has become not only the poster boy for survivorship, but has taken survivorship to the covers of Newsweek and Sports Illustrated, and the halls of Congress.

Second place falls to Elizabeth Edwards, a very different kind of survivor who won't be cured, but is living her life very much determined that cancer won't keep her from living life on her terms. She continues to stump for her husband's presidential aspirations, home school her young children and fight her cancer, surviving one day at a time and publicly acknowledging that there is a greater than 75 percent risk that she may die during her husband's first term if he is elected president.

But there is a new kind of cancer survivor that defies the expectation that, when you get cancer, you must either be cured or die. More often than ever before, patients are living much, much longer with their cancer. The idea of cancer as a chronic disease, akin to diabetes or rheumatoid arthritis, runs counter to popular notion and historical fact, but it is an exciting fact that an increasing number of my patients live every day.

Cancer comes with a lot of emotional baggage. That just happens when the expectation of patient, family, friends, employer, media, and society at large is that cancer is an enormous life or death struggle. If a survivor and their support system can conclude that death is not just around the corner, they are able to jettison some of that old baggage and focus on living.

The treatments that are making this paradigm shift in our thinking possible are a category of medications loosely lumped together as biologicals. We've had a few of these around for a long time. The earliest biological therapies were surgical and they are still used sometimes. Orchiectomy, the removal of the testicles, and oophorectomy, the removal of the ovaries, take testosterone and estrogen, respectively  the hormones that prostate and breast cancers depend on for growth  out of circulation and stop the growth. Generally, biological therapy targets biochemical pathways that are necessary for cancer proliferation and growth.

The beauty of biologicals is that, by and large, they are significantly less toxic and dangerous than the "take no prisoners" approach of chemotherapy. It is not uncommon when giving chemotherapy that the patient is too sick to continue with treatment even though the cancer is continuing to respond. Biologicals, conversely can often be given for many years with limited and tolerable side effects.

To me, the most amazing thing is not the changing of the course of the disease, but the change in the vision of the patient and those who love them. Slowly at first, they eventually come to the realization that they are not dying. Their focus shifts from surviving one day at a time to "what am I going to do with the rest of my life?" They take their lives and loves back from the cancer. They may have some side effects, but they are merely the bitter tastes of life that remind them of how sweet the rest of it is. Sometimes the near-death experience of surviving cancer has created a metamorphosis and it is a new and different life than the one they had &mdasha life shaded by cancer  but not c ontrolled by it.

Currently there is a movement within the oncology community, led by cancer survivors more than oncologists, to recognize the unique care and emotional needs of cancer survivors. Current efforts are designed around roughly 10 million cancer survivors who have completed treatments and need customized follow-up care to monitor for recurrence and deal with any long-term treatment complications.

The day is not far away when the numbers of chronic cancer survivors may well eclipse the cured cancer survivors  a day when the Lance Armstrongs don't seem quite so unique and brave, the Elizabeth Edwardses are the anomaly, and cancer is just another disease.

Dr. Jeffery Ward is a medical oncologist at Puget Sound Cancer Centers. He currently serves as Cancer Committee chair at Stevens Hospital and has been medical director of Hospice of Snohomish County since 1994. For more information, call (425) 775-1677 (Edmonds), 206-365-8252 (North Seattle) or go to www.pscc.cc on the Web.

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