Survivor Story #16 Low Dosage Chemotherapy

READ THE ARTICLE AT THE ORIGINAL WEB PAGE:  http://www.bastyr.edu/news/general-news/2011/10/stage-4-cancer-free-patient-thanks-bastyr-role-holistic-care

Stage 4 to Cancer-Free: Patient Thanks Bastyr for Role in Holistic Care

Sharon Hanson credits her stunning recovery from pancreatic cancer to integrative care, a supportive care center and a controversial form of chemotherapy.

Sharon Hanson

Sharon Hanson was given three months to live. She had pancreatic cancer, which carries one of the lowest survival rates of all cancers. It was discovered too late for any treatment except a last-ditch blast of chemotherapy. Get your affairs in order, the oncologist said. Write a letter to your grandkids.

The mention of grandchildren lit a spark in her. Her husband died just two months after her diagnosis, and Hanson said to herself: "My kids and grandkids are not going to lose two of us so close. That's not going to happen."

She wanted a second opinion from an integrative oncologist — someone who could advise cancer patients on both conventional medicine and naturopathic therapies. She went to Leanna Standish, PhD, ND, LAc, FABNO, one of Bastyr University's leading cancer care researchers, practitioners and teachers.

As a research professor, Dr. Standish reviewed results from all of the cancer treatment centers around the area. She'd been tracking impressive results from Ben Chue, an oncologist who ran an unconventional center in Seattle. Go see Ben Chue, Dr. Standish said.

That was five years ago. This fall, tests show that Hanson is cancer-free, a remarkable victory against one of the deadliest forms of cancer. It's all the more unlikely considering Hanson's cancer was diagnosed as stage 4 and had spread to her lungs, liver and lymph nodes. She credits her turnaround to the pioneering approach of Dr. Chue and the Bastyr graduates on his staff. They did several important things, she says.

The Party Room

First, they gave her hope. "Dr. Chue said, 'There's no limit to your time,'" Hanson, 68, recalls. "'Nobody knows. We'll try something, and if it doesn't work, we can try something else.' That's when I felt like I'd make it."

Second, Dr. Chue and his staff offered a welcoming environment that recognized the connection between mental and physical health. His practice at the time on Seattle's Capitol Hill greeted patients with bamboo, warm colors and designs informed by feng shui (last spring Chue opened a new clinic, Lifespring Cancer Treatment Center, in the Eastlake neighborhood). Treatments were given in a light-filled a space known as "The Party Room," where patients gathered to share stories and notes and frequently laugh. The relaxing, supportive circle made Hanson's weekly appointments there her favorite days of the week, she says.

The naturopathic physicians on Dr. Chue's staff also provided botanical therapies to help Hanson deal with side effects and boost her immunity. She took glutamine to protect against nerve damage. She took cold-pressed sesame oil to raise her platelet counts. Hanson didn't feel the need for acupuncture or yoga to deal with pain, but many patients found them helpful.

Low-Dosage Chemotherapy

Finally, and most controversially, Dr. Chue administered chemotherapy in much lower doses than most cancer doctors use. "Traditional chemotherapy uses the highest dosage a person can stand," he says. "But you have to wait for a person to recover or you'll kill them."

Chemotherapies were first developed for chemical warfare, after all. They attack healthy cells along with dividing tumor cells, leaving patients with significant side effects such as nausea, vomiting, diarrhea, hair loss, reduced immunity to disease and even heart complications. So patients typically receive treatments no more than every three weeks.

By contrast, Dr. Chue gives patients like Hanson doses every week, but at one-half or one-third the usual dose. He's found that patients experience much milder side effects and are able to receive more treatment in total.

"Because we're not destroying the immune system with high-dose chemotherapy, it can continue to function to help fight the cancer," he says. "It also lets us give doses more frequently. That frequency turns out to be terribly important."

Dr. Chue began using the approach 14 years ago, before clinical trials had studied it. Other oncologists were intensely skeptical. Since then, Dr. Chue's method has found widespread acceptance at cancer centers, says Dr. Standish.

"In the past, he was ridiculed for it," says Dr. Standish. "But it's what many of us now believe is the best way to do chemo. It's become a common method."

The Value of Hope

Hanson credits the low-dosage chemo, combined with Dr. Chue's integrative care, with saving her life. Today she enjoys living in Shoreline near her two children and two grandchildren. She helps run the family's longtime hair salon in Bellevue. She knows that not all cancer patients are as fortunate as her, but she believes they can benefit from the approach that served her so well.

And as Bastyr works to reshape cancer care through its Integrative Oncology Research Center(BIORC), it is looking to learn from patients like Hanson. BIORC combines chemotherapy with naturopathic therapies such as botanical medicine and acupuncture, and it's in the midst of a $3.1 million clinical study with the Fred Hutchinson Cancer Research Center to compare integrative cancer treatment with conventional care. Another new study of medicinal mushrooms is expanding BIORC's scope to include prostate cancer along with its current focus on breast cancer. In all of this, Hanson's story illustrates an important point about health and hope, says Dr. Standish, BIORC's medical director.

"The last two generations of conventional doctors were taught to give statistics and timeframes," she says. "They're taught not to instill hope. The whole idea is to consider advanced-stage cancer a doomsday diagnosis and avoid giving patients false hope."

But what if there's no such thing as "false hope"?

"Hope is hope," says Dr. Standish. Whether rational or not, it can give patients the will-power necessary to return to health.

Healers have a responsibility to tell patients when they are dying and help them prepare for death, she says. But an integrated mind/body perspective, she adds, allows a doctor to recognize that Hanson's determination to survive for her grandkids matters, no matter how sick she is.

Emotional Reunion

In August 2011, Standish and Hanson met for the first time since their life-altering visit five years ago. On a balmy summer morning, they embrace with a hug and sit in Dr. Standish's office at Bastyr's campus in Kenmore to catch up. Sharon's son Matt, who accompanies her to all her doctor's appointments, joins them.

"I think you realize what an extraordinary case you are," Dr. Standish says.

Hanson nods, her face beaming. She wants everyone to know about the potential of integrative therapies. She encourages anyone diagnosed with cancer to see an integrative medicine specialist before committing to a treatment plan.

"We need to seek out every patient that has been diagnosed," he says. "There are more integrative ways of treating this disease rather than big doses of chemo alone. We want to get that word out."

Matt Hanson has become a volunteer regional leader of the Pancreatic Cancer Action Network to help reach other pancreatic cancer victims.

After the conversation, Hanson toured BIORC's facility on campus. She learned about the approach similar to Dr. Chue's, which understands that patients require support for their spirit and mind along with their body.

As she met the staff, she eagerly recounted her story. Three months to live. It had spread to my liver and lungs. That was five years ago. Now I'm cancer-free.

READ THE ARTICLE AT THE ORIGINAL WEB PAGE:  http://www.bastyr.edu/news/general-news/2011/10/stage-4-cancer-free-patient-thanks-bastyr-role-holistic-care

A Really Amazing Article on Confronting Dismal Statistics

Do yourself a favor, if you have been devastated by seemingly impossible survival statistics, take the time to get through this article by Stephen Jay Gould.  The language is a bit scientific, but the message is truly inspirational!   The link to the original website is:  http://cancerguide.org/median_not_msg.html

The Median Isn't the Message

Prefatory Note by Steve Dunn

Stephen Jay Gould was an influential evolutionary biologist who taught at Harvard University. He was the author of at least ten popular books on evolution, and science, including, among others, The Flamingo's Smile, The Mismeasure of Man, Wonderful Life, and Full House.
As far as I'm concerned, Gould's The Median Isn't the Message is the wisest, most humane thing ever written about cancer and statistics. It is the antidote both to those who say that, "the statistics don't matter," and to those who have the unfortunate habit of pronouncing death sentences on patients who face a difficult prognosis. Anyone who researches the medical literature will confront the statistics for their disease. Anyone who reads this will be armed with reason and with hope. The Median Isn't the Message is reproduced here by permission of the author.

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The Median Isn't the Message by Stephen Jay Gould

My life has recently intersected, in a most personal way, two of Mark Twain's famous quips. One I shall defer to the end of this essay. The other (sometimes attributed to Disraeli), identifies three species of mendacity, each worse than the one before - lies, damned lies, and statistics.
Consider the standard example of stretching the truth with numbers - a case quite relevant to my story. Statistics recognizes different measures of an "average," or central tendency. The mean is our usual concept of an overall average - add up the items and divide them by the number of sharers (100 candy bars collected for five kids next Halloween will yield 20 for each in a just world). The median, a different measure of central tendency, is the half-way point. If I line up five kids by height, the median child is shorter than two and taller than the other two (who might have trouble getting their mean share of the candy). A politician in power might say with pride, "The mean income of our citizens is $15,000 per year." The leader of the opposition might retort, "But half our citizens make less than $10,000 per year." Both are right, but neither cites a statistic with impassive objectivity. The first invokes a mean, the second a median. (Means are higher than medians in such cases because one millionaire may outweigh hundreds of poor people in setting a mean; but he can balance only one mendicant in calculating a median).

The larger issue that creates a common distrust or contempt for statistics is more troubling. Many people make an unfortunate and invalid separation between heart and mind, or feeling and intellect. In some contemporary traditions, abetted by attitudes stereotypically centered on Southern California, feelings are exalted as more "real" and the only proper basis for action - if it feels good, do it - while intellect gets short shrift as a hang-up of outmoded elitism. Statistics, in this absurd dichotomy, often become the symbol of the enemy. As Hilaire Belloc wrote, "Statistics are the triumph of the quantitative method, and the quantitative method is the victory of sterility and death."

This is a personal story of statistics, properly interpreted, as profoundly nurturant and life-giving. It declares holy war on the downgrading of intellect by telling a small story about the utility of dry, academic knowledge about science. Heart and head are focal points of one body, one personality.

In July 1982, I learned that I was suffering from abdominal mesothelioma, a rare and serious cancer usually associated with exposure to asbestos. When I revived after surgery, I asked my first question of my doctor and chemotherapist: "What is the best technical literature about mesothelioma?" She replied, with a touch of diplomacy (the only departure she has ever made from direct frankness), that the medical literature contained nothing really worth reading.

Of course, trying to keep an intellectual away from literature works about as well as recommending chastity to Homo sapiens, the sexiest primate of all. As soon as I could walk, I made a beeline for Harvard's Countway medical library and punched mesothelioma into the computer's bibliographic search program. An hour later, surrounded by the latest literature on abdominal mesothelioma, I realized with a gulp why my doctor had offered that humane advice. The literature couldn't have been more brutally clear: mesothelioma is incurable, with a median mortality of only eight months after discovery. I sat stunned for about fifteen minutes, then smiled and said to myself: so that's why they didn't give me anything to read. Then my mind started to work again, thank goodness.

If a little learning could ever be a dangerous thing, I had encountered a classic example. Attitude clearly matters in fighting cancer. We don't know why (from my old-style materialistic perspective, I suspect that mental states feed back upon the immune system). But match people with the same cancer for age, class, health, socioeconomic status, and, in general, those with positive attitudes, with a strong will and purpose for living, with commitment to struggle, with an active response to aiding their own treatment and not just a passive acceptance of anything doctors say, tend to live longer. A few months later I asked Sir Peter Medawar, my personal scientific guru and a Nobelist in immunology, what the best prescription for success against cancer might be. "A sanguine personality," he replied. Fortunately (since one can't reconstruct oneself at short notice and for a definite purpose), I am, if anything, even-tempered and confident in just this manner.

Hence the dilemma for humane doctors: since attitude matters so critically, should such a sombre conclusion be advertised, especially since few people have sufficient understanding of statistics to evaluate what the statements really mean? From years of experience with the small-scale evolution of Bahamian land snails treated quantitatively, I have developed this technical knowledge - and I am convinced that it played a major role in saving my life. Knowledge is indeed power, in Bacon's proverb.

The problem may be briefly stated: What does "median mortality of eight months" signify in our vernacular? I suspect that most people, without training in statistics, would read such a statement as "I will probably be dead in eight months" - the very conclusion that must be avoided, since it isn't so, and since attitude matters so much.

I was not, of course, overjoyed, but I didn't read the statement in this vernacular way either. My technical training enjoined a different perspective on "eight months median mortality." The point is a subtle one, but profound - for it embodies the distinctive way of thinking in my own field of evolutionary biology and natural history.

We still carry the historical baggage of a Platonic heritage that seeks sharp essences and definite boundaries. (Thus we hope to find an unambiguous "beginning of life" or "definition of death," although nature often comes to us as irreducible continua.) This Platonic heritage, with its emphasis in clear distinctions and separated immutable entities, leads us to view statistical measures of central tendency wrongly, indeed opposite to the appropriate interpretation in our actual world of variation, shadings, and continua. In short, we view means and medians as the hard "realities," and the variation that permits their calculation as a set of transient and imperfect measurements of this hidden essence. If the median is the reality and variation around the median just a device for its calculation, the "I will probably be dead in eight months" may pass as a reasonable interpretation.

But all evolutionary biologists know that variation itself is nature's only irreducible essence. Variation is the hard reality, not a set of imperfect measures for a central tendency. Means and medians are the abstractions. Therefore, I looked at the mesothelioma statistics quite differently - and not only because I am an optimist who tends to see the doughnut instead of the hole, but primarily because I know that variation itself is the reality. I had to place myself amidst the variation.

When I learned about the eight-month median, my first intellectual reaction was: fine, half the people will live longer; now what are my chances of being in that half. I read for a furious and nervous hour and concluded, with relief: damned good. I possessed every one of the characteristics conferring a probability of longer life: I was young; my disease had been recognized in a relatively early stage; I would receive the nation's best medical treatment; I had the world to live for; I knew how to read the data properly and not despair.

Another technical point then added even more solace. I immediately recognized that the distribution of variation about the eight-month median would almost surely be what statisticians call "right skewed." (In a symmetrical distribution, the profile of variation to the left of the central tendency is a mirror image of variation to the right. In skewed distributions, variation to one side of the central tendency is more stretched out - left skewed if extended to the left, right skewed if stretched out to the right.) The distribution of variation had to be right skewed, I reasoned. After all, the left of the distribution contains an irrevocable lower boundary of zero (since mesothelioma can only be identified at death or before). Thus, there isn't much room for the distribution's lower (or left) half - it must be scrunched up between zero and eight months. But the upper (or right) half can extend out for years and years, even if nobody ultimately survives. The distribution must be right skewed, and I needed to know how long the extended tail ran - for I had already concluded that my favorable profile made me a good candidate for that part of the curve.

The distribution was indeed, strongly right skewed, with a long tail (however small) that extended for several years above the eight month median. I saw no reason why I shouldn't be in that small tail, and I breathed a very long sigh of relief. My technical knowledge had helped. I had read the graph correctly. I had asked the right question and found the answers. I had obtained, in all probability, the most precious of all possible gifts in the circumstances - substantial time. I didn't have to stop and immediately follow Isaiah's injunction to Hezekiah - set thine house in order for thou shalt die, and not live. I would have time to think, to plan, and to fight.

One final point about statistical distributions. They apply only to a prescribed set of circumstances - in this case to survival with mesothelioma under conventional modes of treatment. If circumstances change, the distribution may alter. I was placed on an experimental protocol of treatment and, if fortune holds, will be in the first cohort of a new distribution with high median and a right tail extending to death by natural causes at advanced old age.
It has become, in my view, a bit too trendy to regard the acceptance of death as something tantamount to intrinsic dignity. Of course I agree with the preacher of Ecclesiastes that there is a time to love and a time to die - and when my skein runs out I hope to face the end calmly and in my own way. For most situations, however, I prefer the more martial view that death is the ultimate enemy - and I find nothing reproachable in those who rage mightily against the dying of the light.

The swords of battle are numerous, and none more effective than humor. My death was announced at a meeting of my colleagues in Scotland, and I almost experienced the delicious pleasure of reading my obituary penned by one of my best friends (the so-and-so got suspicious and checked; he too is a statistician, and didn't expect to find me so far out on the right tail). Still, the incident provided my first good laugh after the diagnosis. Just think, I almost got to repeat Mark Twain's most famous line of all: the reports of my death are greatly exaggerated.

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Postscript By Steve Dunn

Many people have written me to ask what became of Stephen Jay Gould. Sadly, Dr. Gould died in May of 2002 at the age of 60. Dr. Gould lived for 20 very productive years after his diagnosis, thus exceeding his 8 month median survival by a factor of thirty! Although he did die of cancer, it apparently wasn't mesothelioma, but a second and unrelated cancer.
In March 2002, Dr. Gould published his 1342 page "Magnum Opus", The Structure of Evolutionary Theory. It is fitting that Gould, one of the world's most prolific scientists and writers, was able to complete the definitive statement of his scientific work and philosophy just in time. That text is far too long and dense for almost any layman - but the works of Stephen Jay Gould will live on. Especially I hope, The Median Isn't The Message .