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As you probably heard, sports anchor Stuart Scott died of cancer over the weekend. The immensity of Scott's love for his daughters is palpable in this ESPY award speech. He calls his girls his "heartbeat." Like almost every parent, I can relate. And watching this (just fair warning), I cried big, ugly tears. A reminder that even though cancer research has come so far, we still have miles to go before we sleep.

 

Here is some of the research I've seen over the past few weeks. If I've missed anything over the holidays that you think should be included, please send me an email and I'll add it next week. Now that I'm done stuffing myself with gingerbread and dark chocolate candy cane bark, I have time again for sifting through articles online. Because, ahem, THAT CANDY CANE BARK WASN'T GOING TO EAT ITSELF.

Zinc Test for Early Breast Cancer Looks Promising

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"For the first time, a study shows that breast cancer cells process zinc isotopes differently to normal cells - leading researchers to suggest this might be a way to detect the cancer early."

No Surprise: Herceptin Improves Long-Term Survival for Her-2+ Patients

"The results show that the 10-year survival for HER2-positive breast cancer patients who received chemotherapy without Herceptin was 75%, whereas for those who also had Herceptin, it was 84%."

Two Pre-Surgical Drugs Improve Survival for Triple-Negative Breast Cancer Patients

"We found that adding either carboplatin or bevacizumab to standard preoperative chemotherapy increased pathologic complete response rates for women with basal-like cancers -- that is, it increased the proportion of women who had no residual cancer detected at surgery."

Disease Progression Delayed by a New Drug Combination in Some Advanced Patients

"A new combination of cancer drugs delayed disease progression for patients with hormone-receptor-positive metastatic breast cancer, according to a multi-center phase II trial.

'Because the study showed a statistically significant benefit among patients whose disease progressed on an aromatase inhibitor, a larger phase III study comparing this combination to other approved therapies used after initial therapies fail, like exemestane and everolimus, should be done.'"

Updated Results of MARIANNE Study for Advanced Her-2+ Patients

"The study assessed the feasibility of three different regimens targetting HER2 in people with previously untreated (first-line) advanced HER2-positive breast cancer. Patients enrolled in the study received one of the three composites: Kadcyla (ado-trastuzumab emtansine) plus Perjeta (pertuzumab), Kadcyla alone, and Herceptin (trastuzumab) plus either docetaxel or paclitaxel chemotherapy.

Results from MARIANNE trial showed that all the three regimens were feasible in progression-free survival (PFS) for a similar amount of time."

Development of Most Cancers Is Beyond Our Control, Study Finds

Notably, breast and prostate cancer were NOT included in this particular study. So the jury's still out as to whether those might be controlled by environmental factors.

"In a groundbreaking paper published in Science, the duo describe a new factor, a tissue’s stem cells, that may explain as much as two-thirds of the difference in cancer risk among different tissues."

What's Blowing Up the Breast Cancer Blogosphere This Week

In case it's not obvious, I'm in total agreement with Ms. Schattner on this one. No amount of whisky could ease the pain I would feel if treatment wasn't an option for me. There were other great articles countering Mr. Smith's blog post -- if you're interested, here are a couple that resonated with me.

"The image of a person retching or in pain, afraid to ask questions of his doctor and not being offered palliative care is outdated by several decades.

Today, cancer surgery and medicines can extend and improve the lives of people who live for years and decades after treatment. Malignancies that were notoriously hard-to-treat just a few years ago, like some forms of lung cancer, melanoma, T-cell lymphomas, Her2+ breast cancer and other conditions have become, in many cases, manageable." (emphasis mine)

Miracles Do Happen (What I Was Thinking About Over the Holidays)

We know very little about spontaneous remission except that it's extremely rare. Most doctors refrain from mentioning it to avoid giving false hope to patients. But the allure is undeniable.

Enough Brave to Go Around

I suspect by now you've heard of Brittany Maynard. The 29-year-old newlywed recently made the very public decision to end her life before incurable brain cancer could make that decision for her. If you hadn't followed her story, you can read more about it here.

I've been debating writing about her life, her choice, her death here because I wasn't sure whether I agreed with what she did -- even if I 100% support her RIGHT to choose. After all, who am I to judge? Who are any of us, if we haven't been in the same situation? As my dad liked to tell me when I was young (and very often I had no inkling what on earth he meant): judge not lest ye be judged.

And yet, I couldn't help thinking of all of us who are fighting so hard to stay alive, or participating in clinical trials to further advance research for the next incurable patient who comes along. People lauded Maynard's choice as "brave," which left me wondering what that made the rest of us, those of us who dig our heals in until the bitter, ugly end. Those of us suffering through treatment after treatment in the hopes that one might work. Were we not brave?

Then I realized -- had an epiphany of sorts -- one has absolutely no bearing on the other. 

We can all be brave (or not; a diagnosis of cancer does not automatically turn one into a superhero, and some days, brave has nothing to do with the decision to get up and keep fighting. No--some days, that decision is pure stubbornness, or a deep-rooted responsibility to those who most depend on you to get your ass out of bed, or a little seed of hope that today might be the day they announce a cure). However you look at it, there is enough brave to go around. There is no brave shortage for which we need to conserve.

Putting on our bravest faces

Brittany's bravery was in her voice. Her bravery was in speaking up for the right to choose how you leave this world when you are told you will be checking out very soon. Tick-tock, tick-tock, tick-tock.

I was also diagnosed with incurable cancer, but I have not exhausted my treatment options. I do not have tumors in my brain threatening to take away my ability to make independent decisions. I am not having seizures that leave me unable to express myself. 

I repeat: I am one of the lucky ones. 

***

On Tuesday this week, a dear friend was admitted to hospice care, somewhat unexpectedly, as her cancer has taken a rather rapid turn for the worse. Radiation to treat her inoperable brain tumors (from metastatic breast cancer, not brain cancer) isn't having the desired affect. Someday soon, she will leave her two little girls, aged two and four.  

I cried until I couldn't cry anymore that night, and it had nothing to do with the elections.

This friend of mine told me she's at peace with whatever lies ahead for her. I can't quite wrap my brain around that idea -- of peace in the face of death. For me, it's an idea that no longer fits, like a sweater I accidentally put in the dryer. While I don't understand my friend's acceptance of her fate, I can find a form of bravery there, too. She has come to the end and -- still, she is bravely forging ahead to whatever might be next. My friend is a Christian, and I'm certain she would not choose the path Brittany Maynard did, even if it were an option in Arizona. 

Instead, hospice (from what I understand) provides comfort in the form of spiritual counseling to the extent one needs/requests it, social services for the family being left behind, and palliative care to keep the patient as comfortable as possible for however long it takes. In hospice, treatment for the disease itself is over. This process of dying can take weeks, or it can take days. With Medicare, hospice is available to any patient whose physician certifies that they have six months or less to live.

My friend will spend this time -- however much of it she's got -- with her little ones and her husband standing by. She'll be in and out of consciousness, in and out of pain, in and out of breath, until there is no more and she is just out. 

***

I have a scan on Monday. I expect good results (hope for them with every breath I take if I'm being honest), but I still filled my prescription for Xanax. I'm still jumpy with every weird pain -- the pinching where I probably pulled something under my arm in yoga, the place where my sternum cracks like knuckles when I stretch a certain way, and the headaches that are most certainly from stress and grinding my teeth at night but a little seed in my brain wonders what if anyway.

And all of this has me thinking: I don't know what choice I would make, if my options had run out and my possibilities were between a slow expiration and a quick end to suffering -- mine and my family's.

As my friend Nancy Stordahl wrote this week: "I remember when my mother was extremely ill, lying in a bed at a care facility and unable to do much of anything at all anymore. She was dying from metastatic breast cancer and it was a slow, painful and agonizing experience for her and for my family to witness. I remember there were moments when I wished the end would just come for her because she was suffering so much. I also remember immediately feeling guilty for thinking such things. I bargained with God for more time. I wanted more time; just one more day or one more night. I wanted it both ways."

I am a LONG way from that fork in the road. If and when it gets to that point, though, I really hope nobody will judge me if I move to Oregon, where I could at least get rid of my Xanax prescription.