How to Live with Cancer

Although the disease still has high mortality rates, more patients are living longer thanks to new therapies

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Lisa DeJong / The Plain Dealer

Susan Hershman, left, connects with Elizabeth Edwards about her battle with breast cancer while Edwards signs copies of her book Saving Graces at the City Club of Cleveland, Ohio, on March 26, 2007.

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Oncologists are also excited about a new generation of tests that enable doctors to do a better job of matching the treatment to the tumor. Oncotype Dx, introduced in 2004, looks at 21 genes in biopsied tissue to determine whether or not chemotherapy will be helpful for early breast cancer patients with recent diagnoses. At Duke University, molecular geneticist Joseph Nevins is testing a similar gene-based test for lung cancer. Researchers are aiming for tools that will tell them not only whether chemo is needed but also which specific drugs to use. Such a screen already exists for Herceptin, and many others are in development. Meantime, at the M.D. Anderson Cancer Center in Houston, Dr. Roy Herbst, chief of thoracic medical oncology, is looking for protein markers on lung tumors that will enable doctors to make the best choice among four different drug combinations.

None of these advances mean that living with cancer is easy, or even possible. A certain percentage of patients, as Snow and Edwards surely know, do not respond to any current treatments. And some types of cancer — particularly pancreatic, ovarian and stomach — continue to have high mortality rates, one reason cancer still kills 560,000 Americans every year. Side effects remain an issue as well, though antinausea medications are now so good that some doctors say it's rare for their patients to vomit. And drugs that prevent anemia and a drop in white blood cells mean patients can carry on with life's activities without the constant dread of contracting infections. Still, anxiety remains a steady companion for people living with cancer. "Dealing with the worry around tests and how well the drugs are working for recurrent cancer is one of the most emotionally challenging things that my patients experience," says Russell. "All medical oncologists must help patients manage this emotional roller coaster."

Edwards suspects she's better prepared than most, because she's already faced down death, not only with her first bout of cancer but also with the loss of her 16-year-old son Wade 11 years ago in a car accident. "When you lose a child through an accident," she says, "you discover that you only have an illusion of control over your own fate. I've already let go of that myth, and that makes this process a lot easier."

For now, Edwards is happy to be the public face of living with cancer and has enjoyed seeing fellow travelers at campaign stops, greeting her in headscarves or with thinly thatched noggins. She expects to begin a new round of treatment in mid-April, after a bit more campaigning and some time off to spend spring break with her kids. She's thinking less about how much time she may have and more about how she spends it. "I was cleaning my bathroom, and thinking, I really don't want to spend too much time doing this," she says. "Another thing I did was plant some lilacs and other flowers — something I hope to enjoy and I know my family will enjoy. That's work I'm happy to fill my days with."

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