Cure May Never be the Right Word
Is anyone ever truly cured of cancer? This remains an unanswered question although plenty of people believe, or would like to believe, that they have been. I even hear stories suggesting that some doctors have used the word, but I have never witnessed such a moment.
For some cancers, like leukemia or lymphoma, the five year mark usually is a moment of relief. For other kinds of cancer, e.g. breast cancer, the five year mark means very little. When we read or hear statistics, the time markers are five or ten years. This does not mean that those moments have particular import; it is merely a way to organize the data.
With the reminder that everyone and every situation is different, here is what we do know. For many cancers, the longer you stay well, the more likely it is that you will continue to stay well. However, cancers sometimes recur after long periods of silence, and no one understands what stimulated those dormant cells to become active. What we can hope to hear when we see our doctors is something like: "You are doing fine." or "Everything looks good." or even "I think you are NED." NED=No Evidence of Disease, and that is as good as it gets. There is an old joke in oncology circles that we only know for sure that someone has been cured of cancer when s/he dies of something else.
This is an essay about the elusive cure by an leukemia specialist at the Cleveland Clinic, published in the New York Times online. Here is the start and a link to read more:
Cured From Cancer, Almost
By Mikkael A. Sekeres, M.D.
I had to admit I was more than a little excited to see my next patient. This was a big day, for both of us.
Five years earlier, when he was 68, he had come to the emergency room, feeling terrible. His white blood
cell count was higher than his age, and he was profoundly anemic — really, to a degree that was almost
incompatible with life. He was transferred to our hospital, where we performed a bone marrow biopsy that
clinched the diagnosis of acute leukemia.
“You sat on my bed,” he said to me, “and you gave it to me straight. You laid out my options.” He stared
up toward the fluorescent lights in the clinic room, thinking back to this seminal moment. His wife sat next
to him, focusing on his face, her smile frozen as she probably thought about that same moment from her own
For people approaching their eighth decade, the decision of whether or not to take chemotherapy for
leukemia is anything but straightforward. The treatment can be brutal, confining a person to his or her
hospital room for a month, and it can accelerate a death that might have taken months if the leukemia were
left to its own devices. People go through with it to try to win the golden ticket — the chance to be cured of
leukemia. In someone my patient’s age, that occurs only 5 percent of the time.
Two handfuls of people of the hundreds I have treated over the past decade.