“We have so many treatment options available to treat what you have,” said the first oncologist seeing Uzma upon diagnosis of stage 4 breast cancer, “that these days we manage it like a chronic disease.” The renowned oncologist Uzma saw for a second opinion said the same, as did the one she saw for a third opinion at an institution that is renowned globally for cancer treatment. It’s as if they are trained to read from the same script. It’s a lie.
In doctor-speak, a chronic disease usually means diseases like heart disease, high blood pressure, high cholesterol, diabetes, etc. You get the picture. Every person with high blood pressure has probably heard their doctor say, “High blood pressure cannot be cured, but it can be controlled. You will have it for the rest of your life. But if you take your medication as prescribed, you will be okay.” Some patients with chronic disease get upset at the prospect of having to take medicine for the rest of their lives. But no one with high blood pressure thinks that the rest of their life means 3-5 years.
There may be many treatment alternatives available for Stage 4 breast cancer, but it is nowhere like a chronic disease. Stage 4 breast cancer has a median survival time of 3 years. In other words, half the women who suffer from it die within 3 years of diagnosis. It has a five-year survival rate of 22%, which means that only about one-fifth of the women with this affliction are alive 5 years after diagnosis. At 10 years only about 1 in 10 are still alive. How many diabetics do we know who died within 3-10 years of diagnosis?
And what are those 3-5 years like for those four-fifths to half of Stage 4 breast cancer patients? If they are anything like Uzma’s last 3 years, they are a time of trying one chemotherapy regimen after another while cancer continues its long, unending march. And chemotherapy is nowhere like medications for diabetes, cholesterol or heart disease. It is a blunt tool, a cannon brought to a fight where we should be using snipers — only we don’t yet have the targeting mechanisms for snipers to be effective. We have the promise of immunotherapy just over the horizon, but it remains a mere promise for most individuals with Stage 4 cancer today. Uzma was rejected as a subject for an immunotherapy study at the National Cancer Institute. As I said, we don’t yet have cancer-snipers. So we use cannons. Between the guerilla army that is metastatic cancer, hiding inside one organ then the next, and the cannon that is chemotherapy, there is a lot of collateral damage. The temple that is the human body slowly crumbles before one’s very eyes.
Chemotherapy, depending upon the drug, affects the patient’s skin, her hair, her bones, her brain, her nerves, her heart, her soul. Yet, she keeps taking it because in hope that the regimen could put her in remission. Sometimes, it’s just an elusive dream of few months-long breaks in cancer’s march is what makes a person keep on standing in front of one cannon after another. Eventually, cancer takes over enough organs or enough of key organs that the physical edifice can take no more cannon fire and active treatment is discontinued.
Stage 4 breast cancer does not behave like diabetes, high blood pressure, and heart disease, and oncologists need to stop using the chronic disease metaphor. It is unfair to patients and their families because it creates unreasonable expectations. I think I understand why they use this metaphor. It is probably to provide reassurance so that the diagnosis of stage 4 cancer does not end up draining all hope right from the get-go. But the reassurance comes at a price — one that is paid ultimately by the patient. But, that’s a topic for another post.