Sometimes it takes a stricken celebrity or two to bring home a new truth about a disease. In the course of a few days, both Elizabeth Edwards, wife of Presidential candidate John Edwards, and White House spokesman Tony Snow revealed that they are not just battling recurrences of cancer but also contending with malignancies that have spread and are no longer curable. Many Americans were stunned to hear that the Edwardses will continue their quest for the White House, with Elizabeth campaigning despite metastatic breast cancer. Snow, who was treated for colon cancer two years ago and now has tumor cells on his liver, will take time off but expects to return to his post.
Fellow cancer patients and their doctors are less surprised by such decisions to "push forward with the things you were doing yesterday," as Edwards put it in a 60 Minutes interview. Reason: in recent years the treatment of what used to be dismissed as terminal cancer has shifted from a win-or-lose battle against acute illness to something more akin to managing a chronic disease in many cases with extended periods of feeling just fine, thanks.
"To us it's a great sea change in the way people look at cancer," says Dr. Daniel F. Hayes, clinical director of the breast oncology program at the University of Michigan Comprehensive Cancer Center. Hayes says that he and fellow oncologists are enthusiastic about the example Edwards is setting. "From our standpoint, we spend a lot of time trying to make it clear that while cancer especially metastatic breast cancer won't just go away, you can still live a long and productive life with it."
The change in managing cancer reflects a series of hard-won improvements in treatment not, alas, for every form of cancer, but particularly for breast, colon, prostate and even lung. The gains include an explosion of new drugs that are more targeted and less toxic than old-school chemotherapeutic agents. In addition, new tests are beginning to help doctors match drugs more precisely to the genetic and molecular makeup of an individual tumor. Finally, there are remarkable advances in managing the side effects of treatment, which, in the past, could be as debilitating as cancer itself.
The payoff is being seen in longer and better-quality survival. According to the American Cancer Society, the percentage of people living five years after a diagnosis of any type of cancer barely budged from 50% in the mid-1970s to 52% in the mid-'80s, but it shot to 66% for patients with a diagnosis after 1995 and is continuing to rise. For breast cancer patients the five-year survival numbers leaped, from 75% in the '70s to nearly 90% by 2002. Receiving a diagnosis of cancer and seeing that cancer return is always a terrible blow. But in fact, there is no better time to be living with the disease.
The idea that we might one day find a cure for cancer seems axiomatic to anyone trying to understand the disease. That was the goal, after all, of the War on Cancer promoted by President Richard Nixon in 1971. But given the enormous complexity and variety of malignancies and the ways they can evolve and migrate in the body, an all-embracing cure is a naive hope. Instead, cancer doctors now appreciate that wayward cells may not necessarily have to be destroyed, just corralled and contained in a safe and tolerable way, often with drugs that are taken for the rest of the patient's life. "There was a mind shift that happened in the 1980s," says Dr. John Glaspy, professor of medicine at UCLA's Jonsson Comprehensive Cancer Center. "We realized that there is a power in the chronic-disease model where you can focus on a high quality of living with a disease instead of necessarily curing it. If we can have people alive, productive and happy, that's now viewed as a very wonderful outcome."
That new perspective provided fertile ground for the growth of new classes of cancer therapies. While older drugs were like heavy artillery obliterating cancer cells but causing lots of collateral damage newer drugs are more like smart bombs. Some of them target communication signals within malignant cells, some cut off supply lines by interfering with the growth of blood vessels around a tumor, and others block the chemical agents that enable tumors to expand into new territory. These more targeted therapies tend to focus on frantically proliferating cancer cells while leaving healthy cells intact.