Cancer & Me
Most people know Bernadine Healy, U.S. News health editor, as the former head of the National Institutes of Health and the American Red Cross. They might not recall that she was diagnosed with a brain tumor eight years ago. In a new book, Healy uses her unique perspective and personal struggle with the disease to explore the state of cancer research, care, and treatment today—and tomorrow.
There's another, even subtler goal. If we can read the signs of future malignancy early enough, it should be possible to intervene in the life of misbehaving cells, reforming and redirecting them before they commit to the dark side. To be sure, we are in the early phase of this new model. In my own predicament, I was lucky to find myself, in a small way, on the initial crest.
The standard treatment for most brain tumors is surgery followed by radiation. In the past, chemotherapy has been considered a bust because of a natural protective wall, called the blood-brain barrier. Specialized cells that line the brain's blood vessels create tight junctions impermeable to all but the brain's essential shopping list of small molecules such as glucose and oxygen. This barrier, so important to isolating the brain from blood-borne disease, also shields brain malignancies from many commonly used chemotherapy drugs that might otherwise destroy them. Historically, chemotherapy for brain tumors was the "salvage therapy" when all other options had been exhausted. And sometimes, mysteriously, a tumor did respond.
I told my medical team that radiotherapy was not for me. Though this treatment typically makes brain tumors shrink and can lengthen life, long-term exposure to the radiation also puts patients at risk for memory and cognitive difficulties. That was one risk I chose not to take, a conviction formed more by the patient in me than from any bias I had as a physician. I wanted nothing more than just to be me for as long as possible—with my kids, with my husband, at home, at work. Plus as a lifelong geek, I could not bear to threaten this brain of mine that had done me so well over the years.
Unknowns. The decision was not made without a lot of thought. Each doctor on the brain tumor team-which I dubbed my "brain trust"—brought his own perspective. We all knew of studies showing that at least some patients with my tumor seemed to do well with chemo alone. But that was nonetheless not accepted therapy, as the clinic's radiation oncologist stressed to us.
Barnett acknowledged how little we knew about the unusual properties of my tumor. From his perspective, there was no real evidence to guide us to a certain path, and good old-fashioned clinical judgment and patient choice had to weigh in heavily. The neuro-oncologist who would be providing the treatment, David Peereboom, was comfortable delaying radiation if the tumor proved sensitive to drugs.
Another oncologist in my brain trust, Brian Bolwell, came at this from his experience with tumors of the blood and bone marrow. He supported Fred's and my decision all the way, reminding us that so much of cancer treatment is trial and error. It's common to change the script midway, substituting therapies based on an individual's choice, unexpected complications, and tumor response. And my tumor was not a garden-variety one with a lot of strong science behind it, anyway. So with my docs behind me, we had our plan: surgery, chemo, then patience.
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