I rarely tell this story but it informs nearly every conversation I have with my cancer patients.
When I was a resident in oncology, my mother was diagnosed with pancreatic cancer, a disease that rarely responds to treatment. Her doctors told her she probably would not live more than 6 months. That was in December. My youngest brother was a senior in high school that year and my mother desperately wanted to see him graduate. So she set herself a goal. She would beat the cancer – at least until June.
June came. My brother graduated and our mother sat on the lawn with the other mothers filled with pride. When August came, and it was time for her youngest to go away to college, Mom was strong enough to take him. Another goal met. She died that November.
Setting Goals
I am a radiation oncologist at Wake Forest Baptist Medical Center’s Comprehensive Cancer Center specializing in brain tumors. Most of my patients come to me with breast cancer, lung cancer or some other cancer that’s spread to their brain. In almost all cases their disease is terminal. I work in the high-tech, computer-assisted world of targeted radiation, a treatment that can prolong their life without the debilitating side effects of traditional radiation. But before I talk with my patients about cancer treatment and technology, we talk about life and death and setting goals – the lessons my mother taught me during the last year of her life.
My patients have goals similar to my mother’s. They want to celebrate another Christmas with their families. They want to take that trip abroad that they’ve always put off. They want a last vacation with their husband. They want to dance at their wedding anniversary.
Treatment Options
With reasonable goals in mind, it’s time to talk about cancer treatment options.
In the old days, radiation treatment meant a daily routine that exposed the entire brain to radiation and often left patients feeling nauseated and exhausted. Here at Wake Forest Baptist we target radiation directly to the tumor with technology known as the Leksell® Gamma Knife. There’s no “knife” involved. Rather we focus multiple beams of radiation – or gamma rays – so that they intersect at a point aimed directly at the tumor. The point is sharp, like a knife, so we call it Gamma Knife.
Each gamma ray is too weak on its own to do any harm as it passes though the brain. But when hundreds of gamma rays meet at a single point, the dose is strong enough to stop or slow a tumor’s growth.
The patient arrives just before 7 in the morning. We take an MRI for an up-to-date image of the tumor. The computer uses the image as a map. The patient lies on a table, with a metal halo screwed to their head so that it remains perfectly still and the radiation hits its target. Treatment generally lasts no more than an hour. There’s no pain or discomfort, though some patients take a tranquilizer to calm their nerves. And most patients experience no side effects.
About 185,000 patients a year are diagnosed with brain cancer. Brain cancer strikes in 2 ways. Some malignant tumors originate in the brain. Known as primary brain cancers, these often have tentacles that run deep into the tissue surrounding the tumor. Targeted radiation is not as effective with these tumors. It works best with compact tumors more typical of metastatic cancer that’s spread to the brain. About 150,000 patients a year are diagnosed with such metastatic brain cancers.
Improvements in Medicine
Twenty years ago, patients with metastatic brain cancer were expected to live between 3 and 6 months. Today the average life expectancy is about a year, but I have patients with metastatic brain cancer who have lived as long as 10 years. The longer life expectancy makes it more important than ever to reduce side effects of treatment and improve quality of life.
It’s rare in our practice that we get the chance to save lives. But we do help many patients live out the rest of their lives with a sense of accomplishment. They celebrate that last Christmas with their family. They send their child off to college. They take that long- postponed vacation with their husband. In our office, we believe in helping patients meet these goals. We coordinate treatment and follow-up appointments around patients’ schedules. And we celebrate their milestones.
One patient regretted that he’d never danced with his wife at their wedding. He was young and awkward then and didn’t know how. Their 50th anniversary was coming up. He took dance lessons, determined to dance with his bride. In the end, he didn’t live long enough to celebrate his anniversary. But we saw him here at the cancer center with his wife, practicing his dance moves. I’d say he met his goal.