Diabetes – an apt metaphor?
For some women, metastatic breast cancer can be managed like a chronic disease.
Stories of survival like Shafner's have been in the spotlight since Elizabeth Edwards revealed in March 2007 that her breast cancer, originally diagnosed in 2004, had returned and spread to her bones. The bad news, she vowed, wasn't going to stop her from leading a full life and working in the campaign of her husband, Democratic presidential hopeful Sen. John Edwards.
"The bottom line is, the cancer is back," John Edwards told a press conference. "Her cancer will not be cured now. Elizabeth will have this as long as she's alive."
But quoting his wife's oncologists, he added an upbeat note that grabbed attention throughout the breast cancer community: "It's like a patient having diabetes. The disease never goes away, but you treat it."
Is it an apt comparison? Some cancer specialists were skeptical, pointing out that many diabetic patients survive for decades, while until recently, only about 20 percent of women with metastatic breast cancer could expect to survive beyond five years. Still, some women may live eight, 10, or more years after diagnosis.
Georgia Litsas, MSN, RN, NPC, a nurse practitioner in Dana-Farber's Breast Oncology Center, is inclined toward the positive. "I have to agree with the 'chronic disease' metaphor to some extent because so many of our women with metastatic breast cancer function at such a high level," she says.
Even if the diabetes comparison is a bit of a reach today, DFCI researchers are confident that the tide is slowly shifting. Eric Winer, MD, director of the Breast Oncology Center, says, "There have been a number of studies of newer 'targeted' drugs and hormonal therapies that show very clear survival benefits, though I am the first to say that these drugs do not help everyone. Women are living longer, and we are helping women live better lives in spite of their cancer."
Ian Krop, MD, PhD, also of the Breast Oncology Center, adds, "We are optimistic that things are changing and that metastatic breast cancer will be routinely considered a chronic and very manageable condition, not a debilitating disease that ultimately threatens a woman's life."
Jennifer Riley works on her laptop while receiving treatment for advanced breast cancer.
Jennifer Riley of Providence, R.I., an office manager at Johnson and Johnson Consumer Products, has been battling metastatic breast cancer for four years. She finds the diabetes metaphor comforting. "What a great way to think about it!" she says. "As long as they can keep it contained and I can continue to participate in clinical trials, I'm fine with it."
Riley was only 29 when originally diagnosed and treated for breast cancer in 2000. Three years later, the disease showed up in her lungs. Aggressive treatment with chemotherapy held the tumors in check for a while, but when they returned she came to Dana-Farber and is now in her second clinical trial of experimental therapy – while continuing to work full time.
"I don't feel the illness and treatment have affected my life too much," says Riley. "My team has been good about scheduling my chemotherapy sessions toward the end of the day (she drives up from Providence, R.I., every week or two). Now that they have free wireless Internet access in the clinic, I bring my laptop and do work while I'm there."
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