Patient A with cancer goes to a chemotherapy appointment, where a nurse gets an IV running with drugs that will kill cancer cells but also make the patient feel sick for awhile.
Patient B with cancer goes to the kitchen at home, takes a pill with some water, and goes about the business of the day.
What makes their treatment routines so different from each other?
Patient A has an acute and likely curable kind of cancer. Patient B has a cancer determined to be incurable yet manageable with medication for an extended period of time—a chronic cancer.
“Some cancers can kill quickly, and others grow so slowly that an elderly patient may very well die of old age and not from the cancer,” says Dr. Bharat Barai, medical director of Methodist Hospital Oncology Institute in Merrillville. “We always try to cure; in cases where we can’t cure, the next best thing is to try to convert it into a chronic disease.”
Barai likens treating a chronic cancer to treating diabetes or high blood pressure: The condition exists but is controlled as much as possible with medication.
Quality of life is an important factor in choosing treatment, says Dr. Erwin Robin, on staff at Community Hospital in Munster and St. Mary Medical Center in Hobart. “If the disease is curable, like testicular cancer, we use aggressive treatments. We probably won’t take short-term quality of life into consideration because we don’t want to compromise the curability of the disease.
“But there are many types of malignancies that we know from day one they won’t be cured; we hope for remission. If you know the patient will be around, for example eight years with a chronic malignancy, we want that to be a good quality of life time.”
Traditional treatments include chemotherapy, radiation, bone marrow transplants, and surgery, says Barai. But for a chronic cancer, treatment can be as simple as taking a pill every day, or radiation followed by medication.
Both Robin and Barai emphasize there are many cancers today that can be cured, including certain kinds of leukemias, breast cancer, colon cancer, and lung cancer. “Cancers that without treatment can kill in months, we have turned into chronic cancers,” says Barai. “Turning a cancer into a chronic cancer is not possible in every case, but more and more people are alive through treating as a chronic disease.”
For patients with a chronic, non-curable disease, says Robin, “We try to keep them in remission for as long as possible, and while they’re in remission there is always the hope that a new thing will be discovered to turn it into a curable disease. I always like to tell patients that hopefully they’ll discover a cure. “In a research project at Community Hospitals I witnessed a breakthrough … using Receptin along with chemotherapy for Stage I and Stage II breast cancers. With Receptin there was an increase in cures by twenty percent.” In a patient with leukemia, pills were prescribed and “within a month or two I sent him to a research facility. He was there a month and came back to me with a normal blood count. Several months later he was in complete remission” and survived for several years after that..
Barai agrees there have been significant advances, with “much better survival for colon cancer and lung cancer, and now 85 percent of women diagnosed with breast cancer in 2013 should be living 5 years from now and beyond.”
That’s a beacon of hope for patients with chronic cancers as well. And the patient’s outlook can affect the how well treatments work in the meantime.
“A patient who is going to fight for life and keep a cheerful outlook; in most cases the quality of life will be 95 percent of normal,” says Barai. “But if the patient thinks about that other 5 percent, it can affect how they (take care of themselves).”
“The attitude of the patient most definitely has an effect,” says Robin, who adds that patients with a positive outlook are more likely to be doing things that help overall health, such as making sure they have proper dietary intake. Definitely, a patient with a positive attitude is more likely to respond to treatment better.