Living with lung cancer

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Tuesday, May 10, 2005

By PATRICIA ANSTETT

KNIGHT RIDDER NEWS SERVICE

DETROIT - ABC anchorman Peter Jennings' announcement that he was diagnosed with lung cancer underscores the hopes and obstacles that surround the nation's leading cancer killer.

Lung cancer too often is found late, when it is no longer curable, as appears to be the case with Jennings, two local cancer experts say. Statements that Jennings would undergo chemotherapy instead of surgery or radiation, which typically are performed first to remove or shrink tumors, and a decline in Jennings' health and voice indicate that he most likely has metastatic lung cancer - the most advanced kind, the specialists say.

Jennings has not disclosed the extent of his cancer, and Memorial Sloan-Kettering, the leading cancer program in New York City, declined comment on whether he is seeking treatment there.

Fewer than one in five people are alive five years after a lung cancer diagnosis. Still, new chemotherapy options are extending the lives of those with the most advanced tumors. And among those whose cancer is found earlier, there are more examples of people beating the odds.

Just ask Edna Sanders, 70, of Detroit. She is approaching the 10th anniversary of living with lung cancer discovered in July 1995. It is one kind of non-small-cell lung cancer, the most common type. Jennings also has non-small-cell lung cancer.

Sanders outlived her own daughter, who died of lung cancer in 1998, just five months after her diagnosis.

"She's my superwoman, that's for sure," Dr. Antoinette Wozniak says of Sanders. Wozniak is Sanders' longtime oncologist at the Barbara Ann Karmanos Cancer Institute in Detroit.

Jennings' case

Jennings' treatment plan - no surgery or radiation - and his fatigued appearance and hoarse voice suggest he has metastatic, or stage 4, lung cancer, the most advanced kind, according to Dr. Jack Ruckdeschel, chief operating officer of the Karmanos Cancer Institute, and Dr. Gregory Kalemkerian, co-director of thoracic oncology at the University of Michigan's Comprehensive Cancer Center in Ann Arbor, Mich.

"Looking at him, he's clearly lost weight, looks tired and is hoarse," Ruckdeschel says. Lymph nodes where cancer spreads, in the middle of the chest, control vocal cords that affect the voice, he says.

"The fact that they didn't use all the euphemisms" also is telling, Ruckdeschel says. "Nobody said, 'His chances of recovery are good.'"

Not doing surgery is common, Kalemkerian says. Only 25 percent of all lung cancer patients are candidates for surgery, he says, because the tumors have advanced beyond the lungs. Thirty-five percent of lung cancer patients are diagnosed with stage 3 disease, when it has spread to lymph nodes on one or both lungs, and 40 percent have stage 4 disease, in which it has spread to another organ such as the brain.

The reason for these late diagnoses is that there's no good detection test, including X-rays. A study is under way to determine the accuracy of a new detection test: spiral CT scanning, or computerized tomography. It uses a computer to improve the accuracy of images CT scans take of internal body structures. The technology is spreading, though costs range widely (from $300 to $1,000) and insurance coverage varies.

"We are on the cusp of some fairly significant advances in detection," Ruckdeschel says. "The spiral CT and tests springing from it will be a major advance in finding this disease earlier."

Recently, George Smith, 69, of Lansing, Mich., underwent a spiral CT scan at Karmanos to help his doctors plan his cancer treatment. A 40-year smoker, Smith has stage 3B non-small-cell lung cancer and does not want to have chemotherapy. He hopes to limit the spread of his cancer with vitamins and a healthy diet, he says.

His brother died of lung cancer in November. Like many smokers, Smith started as a teen, stealing cigarettes from his mother's purse. In the Air Force, he often got free cigarettes from visiting American Red Cross and United Services Organization crews. He tried to stop smoking several times, but balked at the cost of stop-smoking treatments.

At leading cancer programs, teams specialize in lung cancer and meet regularly to discuss cases.

At Karmanos, for example, two of the five authors of the leading lung cancer textbook, "Lung Cancer, Principles and Practice" (Lippincott Williams & Wilkins, $199, www.lww.com), are part of the institute's lung cancer team. They are Dr. Harvey Pass, a thoracic surgeon specializing in lung cancer, and Dr. Andrew Turrisi, a top radiation oncologist. The team also includes Ruckdeschel and Wozniak, both lung cancer chemotherapy specialists.

U-M has a similar team that includes Kalemkerian, a nationally recognized lung cancer chemotherapy specialist and author of a chapter on cellular markers associated with non-small-cell lung cancer, in the Lippincott textbook.

"I see 300 people a year with lung cancer, and that's it," Kalemkerian says.

Leading centers have early access to cutting-edge drugs being tested in clinical studies, including several that have gained federal approval in the past two or three years. They are "the first generation of specifically targeted chemotherapy" for lung cancer, Ruckdeschel says.

Lung cancer patients have a few other drugs that work to inhibit an enzyme associated with fueling cancer growth. One is Tarceva, a pill found to extend survival several months in patients whose cancer has returned after at least one chemotherapy regimen.

Kalemkerian prescribed Tarceva for Debbie Verhines, 50. The federally approved drug costs about $2,125 a month. Insurance coverage varies.

In July, Verhines was diagnosed with metastatic lung cancer, even though she never smoked.

"I'm probably one of the most boring people you'd met," says Verhines. She survived ovarian cancer in 1998 only to be shocked to learn she had lung cancer. "These are the cards you are dealt," she says. "Every day is a gift. The biggest thing to me is my relationship with my husband, letting him know how much I care about him," and to spend more time with friends.

Sanders' advice to anchorman Jennings is to stay positive. "Don't take to your bed," she says. "The bed makes you weak. Keep moving. Don't give up. You can have a happy illness or a sad one."

Sanders, who smoked for nearly 50 years, enjoys a Karmanos support group called Tough Broads. The retired Detroit neighborhood services worker takes the bus to her medical appointments, donning one of her snazzy hats to cover hair thinned by repeated chemotherapy. She enjoys fiddling with numbers, including helping people do their taxes, and has been a DJ at local events.

"I'm a witness," she says. "You can live with this thing."

More information

For details, call the Karmanos Institute at (800) 527-6266 or visit www.karmanos.org or U-M at (800) 865-1125, www.med.umich. edu.

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[Donna G]

That was a little depressing. I still wonder if that Dr. in Michigan is guessing that he has NSCLC and what stage ,if no one is talking, how does he know? Also saying long distance his prognosis and all by guessing that he has lost weight and his voice is hoarse? I for one had lost weight ,started with chemo and radiation and I am NED now! I pray that is the case with Peter also. Donna G.

[SBeth]

Thanks for mentioning that about your father Katie. I was reading that article and felt the wind go right out of my sails as Bill's voice has been steadily getting more hoarse, yet the last PET scan did not show any lymph node involvement. I don't think that it is fair for that "person" to make assumptions about PJ's diagnosis; and if he was making an informed and factual statement, then he should have stated so. Either way, it was an interesting article and it's ALWAYS good to have a little attention in the Lung Cancer Awareness forum.

Thanks Rich for posting it!