Month: July 2011

News Flash

Portland Man Completes “Intense” Cancer Treatments

The Last Day of Temodar
The last day of temodar, for a while

PORTLAND — Bogart Salzberg completed a six-week course of radiation and chemotherapy treatments for his brain cancer today at Maine Medical Center. Mr. Salzberg, who was diagnosed May 5 with a typically fatal grade IV tumor, said he feels relatively healthy.

Patients often experience fatigue for a month or more after concluding radiation therapy, according to doctors at Maine Medical Center’s Radiation Oncology Department, where Mr. Salzberg was treated.

“I’m going to take it easy for a month or so and then look at going back to work,” said the software developer, 36, of Portland. “I haven’t done any programming since the surgery, so, we’ll have to see how it goes”, he said, referring to his May 6 craniotomy.

Mr. Salzberg admitted he is “not thrilled” by the prospect of returning to work. “I think having terminal cancer changes your perspective on a lot of things, especially work and family.” He had planned to build a successful software development career, but has changed course since receiving a prognosis of 15 months to live.

“You can be creative as a software developer, but to be creative and make money is hard”, said Mr. Salzberg. He is considering working part time, but will need to “weigh the pros and cons”, he said.

According to Mr. Salzberg’s employer, Portland Webworks, he would not be eligible for benefits as a part-time employee. However, he may be able to retain health insurance benefits for a limited period on an unpaid leave of absence.

Mr. Salzberg will continue to take the chemotherapy drugs Temodar (five days per month in pill form) and Avastin (every two weeks intravenously). However, he admits to having doubts about the value of ongoing treatment. “Seriously, at some point you just have to pull the plug”, he said.

He cited an Aug. 2, 2010 New Yorker article that emphasized the importance of frankly discussing palliative care options before the patient becomes too disabled to clearly communicate his wishes. ([10. Atul Gawande. Letting Go: What should medicine do when it can’t save your life?. The New Yorker, Aug. 2, 2010]) “There’s a guy in the article that was talking with his daughter about when to pull the plug. He told her that as long as he could still watch baseball and eat ice cream, he wanted to live. That’s pretty much my philosophy, too. I don’t want to be a vegetable,” he said.

In recent years some oncologists have stepped back from intensive management of advanced brain tumors. A treatment plan should “avoid useless prolongation of a burdensome situation”, according to a 2004 study of palliative care in brain tumor patients. ([20. S. Taillibert, F. Laigle-Donadey, M. Sanson. Palliative care in patients with primary brain tumors. Curr Opin Oncol, Nov. 2004, 587-92.])

Mr. Salzberg said he plans to pursue artistic endeavors and spend more time with his family, and possibly also earn income. “I’ve been spending a lot of time at the beach lately. It’s been nice,” he said.

NOTES:

Chances

Chances are, you do not have gliosarcoma. ([10. Hiroko Ohgaki, Pierre Dessen, Benjamin Jourde, et al. Population based study on the incidence, survival rates, and genetic profile of glioblastomas. Proc Amer Assoc Cancer Res, Volume 45, 2004. (This 2004 study lists the incidence of glioblastoma, of which gliosarcoma is a subset, at 27.4 per one million people).]) ([20. Kevin R. Kozak, Anand Mahadevan, and John S. Moody. Adult gliosarcoma: epidemiology, natural history, and factors associated with outcome. Neuro Oncol, April 2009, 183-191. (Gliosarcoma accounts for between one and eight percent of malignant gliomas. My chances of getting gliosarcoma were about one in a million).]) Chances are, if you do, you will be dead in a few years. ([30. Ibid. (This 2009 study was based on a national database of 353 gliosarcoma cases from 1988 to 2004. Median survival for gliosarcoma patients was nine months, but about a fifth of the 24 patients under 40 years of age were still alive at five years).])

I do have gliosarcoma. Will I be dead in a few years?

We have an idea of what to expect in life. Marriage and kids. Career and retirement. Eighty years, maybe more. ([40. Wikipedia article “Life Expectancy“])

I know some who season their talk of future plans with “God willing”. I will see my mom next month, God willing, for example. Others might see this calamitous asterisk as superstition. Why give breath to a dark and remote possibility? I see it as a humbling reminder of the limits of our control.

Now that I have cancer, calamity is the story and the asterisk is a miracle. Now the remote possibility that I might somehow live a “full” life is the focus of great fervor. Many reasonable people, including myself, believe in this miraculous asterisk. ([45. The third footnote is an example of a miraculous asterisk, though it’s technically not an asterisk.]) Superstition? I guess not. Hubris? Well, that depends.

It depends on your attitude about personal power. Compare and contrast these famous quotations:

  • Where there’s a will, there’s a way. ([50. This is listed in several collections of old sayings, without attribution to an author.])
  • God grant me the serenity to accept the things I cannot change; the courage to change the things I can; and the wisdom to know the difference. ([60. Wikipedia article “Serenity Prayer“])

I’m encouraged to adopt the former. I’m told, by people knowing little of my case, that I can (or will) “beat” my cancer. Who can disparage the “can do” spirit? In doubting the scope of my power, do I invite calamity?

The latter quote captures a more subtle calculus: calamities and miracles in the same soup; a dash of serenity and a dash of courage, stirred with wisdom. We put men on the moon, yet we remain meek, flawed mortals. Own it.

NOTES:

Avastin

Intravenous Avastin Treatment
Intravenous treatment with Avastin (bevacizumab) on July 1, 2011

I had my first treatment of Avastin yesterday at the Maine Center for Cancer Medicine in Scarborough.

Avastin (generically known as bevacizumab) is supposed to limit the growth of tumors by choking their blood supply. My oncologist claims I’m a good candidate for Avastin because my tumor was “highly vascular”. (It was so impressively vascular that it became a subject of the oncologists’ weekly case review).

Unlike Temodar, which I take in pill form, Avastin must be administered intravenously, every two weeks.

The treatment room at MCCM has more than a dozen cubicles, each with a vinyl recliner, a small table and an IV pump. I felt uneasy as I waited for the nurse. My last IV treatment (probably morphine) was at Maine Medical Center in early May, shortly after my craniotomy.

My Avastin dose was specified in detail on a sheet of paper on the table:

Bevacizumab 610 mg (at 10mg/kg) Intravenous

Avastin 10 q2wks – Cycle – 1, Day – 1

I asked myself “how many times will I have to come back and sit and watch a bag of liquid drain into my arm?” My oncologist’s answer to a similar question about Temodar was “indefinitely”. He also said “No one can tell you how long you have to live”, citing “5 or 10 years” as a particularly fortunate outcome.

Waiting for the needle was the hardest part, of course. Once it was in, I relaxed. Already the wound is almost gone.