The Good News About Cancer
More Hope, Less Fear
These advances are just a start. "The conversion of an acute disease to a chronic one isn't a final achievement," says Larry Norton, MD, medical director of the Evelyn H. Lauder Breast Center at Memorial Sloan-Kettering Cancer Center. "It's a step toward a cure. Testicular cancer used to be rapidly fatal, then it became a disease that could be managed for a long period. Now in the majority of cases it can be wiped out." Tour de France champion Lance Armstrong is proof. Dr. Norton believes that eventually other forms of cancer will follow the same treatment curve from lethal to chronic to cure.
All this promise and potential gives patients new hope. But until science gets closer to a cure, they have to balance gratitude with uncertainty about the future. They may have to deal with side effects of treatment, too. Garner, the competitive runner, is lucky to have minimal side effects from Gleevec. For others, discomfort and disability are the dues they pay for long-term survival.
When Noreen Fraser, a TV producer in Los Angeles at the time, was diagnosed with breast cancer in 2001, she was 47. "It was so shocking it was surreal," she recalls. "I felt numb." After a lumpectomy and radiation, her doctor told her there was just a 4 percent chance the disease would come back. So she was devastated two years later when a scan revealed cancer cells in her bones. "The second wave was a whole new thing. Now I had incurable cancer. But my doctor told me, 'We are going to make this manageable, the way diabetes is manageable.'" And for seven years, that's how it's worked. Fraser has taken several drugs -- first Femara, then Faslodex -- to keep the cancer at bay. On a bad day, when her tumor markers have risen or she's due for a scan, she says she wakes up and thinks, This sucks. I'm in trouble. But on a good day, she says, "I believe I will have a normal lifespan."
The emotional toll of living on what feels like borrowed time can be high. "The next ache or pain could be the cancer getting worse or it could be just a day-to-day ache or pain. Not making yourself crazy is the real challenge," says Ann Partridge, MD, an assistant professor of medicine at Harvard Medical School who treats breast cancer patients at Dana-Farber/Brigham and Women's Cancer Center. Mary Jane Massie, MD, an attending psychiatrist at Memorial Sloan-Kettering Cancer Center, says there's widespread anxiety about scans because they could reveal a recurrence. "Some patients need sleeping pills or anti-anxiety meds before a scan."
Over time many chronic cancer patients come to terms with continual treatment. "I don't live from scan to scan anymore," says Harpham. "These days I have to leave little sticky notes on my mirror to remember them." But it took a long time for her to reach this feeling of well-being. "I went to counseling after my second recurrence because I didn't want to be incapacitated by fear. I had to learn coping skills and understand I'm doing everything I can to be healthy. There was no breakthrough moment; it was all little steps."
Some long-term survivors have found strength through helping others. Harpham had to quit her medical practice during her treatment, but she found a new calling. Now she writes about survivorship and doctor-patient relations, working in the morning and resting in the afternoon. Her seven books include Happiness in a Storm, a guide for finding good care and adjusting to living with an illness.
After her recurrence Fraser found a new way to fight the disease: She launched a nonprofit to raise money for a cure (noreenfraserfoundation.org). Melissa Etheridge is on its board of directors. Fraser also cocreated and coproduced the 2008 telethon Stand Up to Cancer, which has raised more than $100 million for cancer research. Her newest project, Men for Women Now, encourages guys to remind their sisters, wives, and girlfriends to get mammograms and Pap smears.
New therapies are giving a growing number of cancer patients a much-brighter future. "In the past your fate was a flip of the coin," says Harpham. "You'd either be cured or you would die. Now more of us are living."