Nancy Currey was working for the Peace Corps in Albania in September 1995 when a doctor noticed a lump on her neck
Time on Their Side
Four survivors who passed the five-year milestone tell how a diagnosis of cancer does not necessarily mean that time has run out.
by Monika Guttman
For many patients, a cancer diagnosis initially gives them the feeling their time is up. Indeed, the first question many patients ask is, "How much time do I have left?" For more and more patients, the answer these days is that time is on their side.
Thanks to improvements in detection, many cancers are being caught in their earliest, most treatable stages. At cancer centers like USC/Norris Comprehensive Cancer Center, researchers are focused on bringing their discoveries in the lab directly to the patient bedside, resulting in better outcomes.
All this means the number of cancer survivors is growing. According to the American Cancer Society, there are a remarkable 8,900,000 cancer survivors living in the United States today. That is more than twice the number of people with Alzheimer's. Deaths from breast, prostate, lung and colon cancers declined during the 1990s, according to the National Cancer Institute.
So just what is a cancer survivor? The most common benchmark, according to the National Cancer Institute, is five years-if a patient has had no recurrence for five years, they are considered a survivor. Here are a few former cancer patients who have found time is on their side.
Nancy Currey was working for the Peace Corps in Albania in September 1995 when a doctor noticed a lump on her neck. Just 27, she was certain she was OK, even as the Peace Corps rushed her back to Washington, D.C. for further tests. "I was in a lot of denial," she recalls. "I told everyone in Albania that I'd be back soon."
A biopsy confirmed that Currey had Hodgkin's disease(a cancer of the lymph system that is diagnosed in approximately 8,000 people each year. "I was very depressed," she says. "I went to the library in D.C. and found a magazine article called 'Why Treat It Anyway?' - because [the cancer] tends to recur so much." In fact, Currey says she was so afraid of recurrence that "I was sure I didn't want to treat it; I just wanted to let the cancer run its course."
When she returned to her family in California, however, a friend recommended she see Alexandra Levine, M.D., chief of hematology at USC/Norris Comprehensive Cancer Center. Further tests showed the Hodgkin's had spread throughout the body and she was staged at a level three out of four. "It was pretty scary," she says. After discussions with Levine, however, Currey agreed to begin chemotherapy in November.
The chemotherapy treatments were very difficult, she concedes. "It was supposed to be every two weeks, but it ended up being every three weeks because my white blood count would drop too low," she says. It was also debilitating-she would be in bed for a week after each treatment, then up a bit for the second week. "I was depressed as well," she admits. "One week I'd be miserable and the next week I'd be optimistic."
Despite setbacks, such as being hospitalized for bacterial pneumonia, Currey continued the chemotherapy. "Dr. Levine was thrilled, because the Hodgkin's was going into quick remission. She'd show me my blood count and convince me that I was healing." By June the disease had gone into remission.
Currey had checkups every few months for the first two years, then semi-annually and now annually. Since her treatment, she has returned to school, earned a master's degree and now teaches English as a second language at a community college. The 33-year-old enjoys sculpting and going to movies with her boyfriend.
I would encourage anyone who finds they have cancer to get treated," she says now. "Chemotherapy isn't the end of the world." When she was first cured, "I felt on a real high, because I had almost died and I now had a second chance." Five years later, some of that initial euphoria is gone, but "I still feel life is very special, because there was a chance I might not have seen today."
Death rates from Hodgkin's lymphoma have fallen 60 percent since the early 1970s due to improved treatment. The five-year survival rate is approximately 82 percent.
As the head of thoracic surgery at Cedars Sinai Medical Center, Arnold Epstein, M.D., knew all about patients who had survived against all odds. He had even treated some of them. Still, when the then-63-year-old stood looking at the MRI (magnetic resonance image) film of his own bladder tumor four and a half years ago, "I didn't think it was operable." The radiologist, who had worked with Epstein for years, pointed out that the tumor had extensively penetrated the bladder wall and was partially blocking the left ureter. "My whole life changed that evening. I quit my practice immediately." Epstein recalls clues that something was wrong-three years of nighttime urges to urinate-but was never tested for bladder cancer. After the telltale MRI, his urologist performed a biopsy-and perforated Epstein's bladder. "It was devastating. I had a catheter for weeks, and I was sure I was now inoperable." In addition, the pathology report found that Epstein had an aggressive type of cancer. &q
That is when Epstein was referred to Donald Skinner, M.D., the Hanson-White Chair in Medical Research and chair of the Aresty Department of Urology at the Keck School of Medicine of USC. "He told me the tumor was operable, which made me feel the first rays of hope," says Epstein. Still, after the surgery "I didn't expect to be alive for long. Dr. Skinner was pretty upbeat but he told me I had only a 25 percent chance of surviving five years."
When he was told chemotherapy improved his chances another five percent, Epstein reluctantly agreed. "The regimen was really tough-it doesn't get much worse." He suffered high fevers and " after three month-long cycles, I had enough. I was pretty debilitated and sick. I thought I was going out from the chemotherapy. They wanted me to do a fourth, and I didn't think I could handle it. My oncologist, colleagues and family prodded me into it, but it was very difficult."
Three weeks after he finished chemotherapy, Epstein went back to Virginia to recuperate with his family. "I couldn't walk 15 yards, but I knew I had to get my immune system working again," he says. He continued to walk - "mothers with baby strollers were passing me," he recalls - and slowly worked up to four miles a day, which he has kept up, currently walking five to six times a week. He also began to study other ways to improve his immune system.
This September Epstein, now 68, will visit Skinner for his five-year checkup. "If I hadn't gotten sick, I'd still be practicing medicine, no question about it," he says. "I used to see patients who would defy all the odds. Now I'm one of them."
He adds "But I think, paradoxically, my life has become much fuller without medicine." Epstein fills his days with his piano playing, adult courses in music and literature, and living a healthy lifestyle. He enjoys riding his motorcycle up the coast and in the mountains. "An acquaintance commented that riding a motorcycle was dangerous and fool-hardy. I told him, 'You only live twice.'"
During a person's lifetime, the probability of developing bladder cancer-which affects more men than women and is most common after age 50-is greater than 3 percent. However, the probability of dying from bladder cancer is small-less than 1 percent depending on the stage, according to the American Cancer Society.
Barbara Koch was 67, working part-time as a nurse in a pediatrician's office, and travelling extensively with her husband. She had been going for her annual mammograms and, while several fluid-filled cysts had been found, there had been nothing to worry about.
But when Koch began experiencing some discomfort - her left breast had become sore - she scheduled another mammogram. This time the radiologist looked at the film and "saw something that she said was definitely not a fluid-filled cyst," according to Koch.
Koch's doctors followed up with a sonogram and then a needle biopsy, which confirmed she had intraductal cancer. She made an appointment with Howard Silberman, M.D., professor of surgery at the Keck School of Medicine of USC. "I was a healthy person, and this was the first time in my life that I faced a catastrophic illness," she says. "I was depressed during the diagnosing period."
When she worked in the health care field, Koch said she saw "many seniors who have cancer simply have surgery and then don't follow it up aggressively and it comes back within a year." After consulting with Silberman, Koch opted for mastectomy. She then requested Christy Russell, M.D., associate professor of clinical medicine, to be her oncologist.
There was more bad news to come: Russell, who characterized the cancer as aggressive, found during the mastectomy that Koch's cancer had spread to three lymph nodes. But after the surgery, "Dr. Russell told me my chances of survival were about 75 percent, which I took to be good news," says Koch.
Koch wanted to follow the mastectomy with the most aggressive chemotherapy regimen possible. She went through 12 cycles-one week of chemotherapy, followed by two weeks off. She lost her hair, her appetite and a lot of weight. "The worst part was the fatigue," she says. "But I was very optimistic. And I had a lot of support from my family."
In fact, Koch says, "I definitely believed I could be cured. I think that is very important to the recovery process." Although she attended a support group for a little while, "it really was those around me who helped the most. A diagnosis like this does different things to different people. But mostly it makes you realize what is important, to get your life in order."
After chemotherapy, Koch went on tamoxifen-a drug that reduces the effects of estrogen on tissues like those in the breast-for five years. She followed up with Russell at first every three months, but now-some eight years later-just annually.
At 75, she says, "I have no physical limitations. I still travel. I see my nine grandkids and four great-grandkids often." But, she notes, "My life has changed because of the cancer. I don't take my life for granted. I appreciate my family more and all the little things I used to ignore." She adds, "My thanks to Drs. Russell and Silberman and Norris Cancer Center for excellent care."
Breast cancer ranks as second among cancer deaths in women. According to the most recent data from the American Cancer Society, mortality rates declined significantly during 1990-1997 with the largest decrease in younger women. These decreases are probably the result of both earlier detection and improved treatment.
Steve Kampff had been treated by his family practitioner for about six years for rectal bleeding, but he had always been diagnosed with hemorrhoids and given a topical cream. When the bleeding became more severe, he met with a gastroenterologist, who performed a sigmoidoscopy (a small camera is inserted into the lowest part of the colon through the rectum).
Recalls Kampff, now 51:"The doctor said the procedure was routine for my symptoms and that at my age I had nothing to be worried about."
Unfortunately, the results of the test and subsequent biopsy were conclusive: colon cancer.
The gastroenterologist scheduled an immediate appointment for Kampff with Robert Beart, Jr., M.D., the Charles W. and Carolyn Costello Chair in Colorectal Diseases at the Keck School of Medicine of USC.
"My wife and I met with Dr. Beart and his assistant Yoli Casagrande. They assured me that there was nothing I had done to cause the cancer and that it could be surgically removed without complication."
After the surgery Kampff was told his cancer had spread to his lymph nodes and doctors recommended he have both radiation and chemotherapy. "You face so many serious decisions," he recalls. "No one will ever know if I really needed both. My attitude going in was this: do everything you can and leave the results in God's hands. I didn't want to look back and say 'I wish I had done more.'"
During almost a year of post-surgical therapy, Kampff had a shunt implanted in his chest to deliver the chemotherapy from a pump he wore belted to his waist. "It wasn't easy," he admits. "I learned there are many, many trials along the way." He developed an infection and was hospitalized for several weeks. The doctors suspected an infection in the heart. "They put me on an aggressive antibiotic that, when delivered intravenously, burned up the blood vessels in my arms." Ultimately, the pump was removed and Kampff completed his chemotherapy by coming to USC/Norris from his home in Orange County.
Kampff credits his faith and the faithfulness of his wife, family, and longtime friends for his ongoing strength and recovery. "My wife was a huge part of my ongoing therapy," he says. "She was optimistic and confident. Knowing we were with the best in the field gave us the confidence that we were doing things right, and that plays well into keeping the stress under control and letting yourself heal."
Kampff continues to monitor his health with follow-up checkups, but this February he passed the five-year milestone. With a baby on the way and a new home, Kampff couldn't be happier.
Colon and rectum cancer incidence rates declined during 1985-1997. Research suggests that these declines may be due to increased screening and polyp removal. According to the American Cancer Society, in 2001, colon and rectal cancers accounted for about 10 percent of cancer deaths.
