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Column: A Victim of My Own Circumstances

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Kenneth B. Lourie

— Outliving one’s prognosis leads to all sorts of twists and turns and treatment conundrums: the longer one lives, the fewer the treatment options. Over the course of time and in consideration of the miscellaneous drugs which are infused (or ingested if you’re lucky enough for oral chemotherapy), success in fending off the cancer (tumors remaining stable at a minimum; shrinkage would be better, but one can live with “stable,” duh!) breeds a familiarity (biochemically) which is contemptible: eventually, the drugs which have been effective stop being effective. Either the cancer cells become resistant to them, or your body becomes weakened and/or damaged by its prolonged infusion (too much of a good thing becomes a bad/harmful thing) by them. Not only is it important – as I’ve learned, to treat the underlying problem (in my case, stage IV lung cancer: “NSCLC”), preventing collateral damage to the patient is of equal consideration and significance (the patient needs to live, and have the operation be successful; to turn an old saying around). Ergo, treatment is an ongoing, ever-changing process of elimination based on the diagnostic results from lab work and scans; a delicate balance of stopping and starting drugs before they harm the patient more than they harm the cancer. And when you’ve survived for as long as I have, whatever protocols may have been relevant at the beginning of treatment are much less so now, 40 months later.

In essence, if one is lucky enough (like me), to tolerate all the various treatment options, and live beyond your original prognosis (because of it?, in spite of it?), it is possible that one might run out of treatment options. It’s sort of like out-kicking your punt coverage (to use a football analogy): the punter kicks the ball beyond the distance that his punt coverage team is timed/expected to cover and as a result, the receiving team gets time and opportunity for a successful return. The whole process is based on averages. When you’re not average, the system can break down. As my treatment has continued, it has become apparent that I’m not average. The longer I live, the fewer documented cases and/or clinical studies exist to support a protocol for my treatment. Common sense begins to play as much a role as efficacy. Oddly enough, for those who live beyond expectations, the choices are not nearly as clear as for the newly diagnosed.

Since I’ve been there and done that: received drugs when they were hoped/thought to be most effective, I’ve sort of become a successful victim – of my own longevity. The longer the drugs/chemotherapy/targeted treatment work, the shorter the time that they will continue to work and/or your body will tolerate having them work. Given the toxicity of the drugs, generally speaking, it’s just a matter of time. You’re sort of damned if you do, and probably really damned if you don’t (although there are many nontraditional pursuits which don’t involve chemotherapy). However, as a long-surviving cancer patient, I am happy for any conundrum which presents itself.

The way I figure it, the longer I am alive to deal with any of it, the greater the chance at overcoming it. My goal is to try and stay in the game for as long as possible; as my oncologist says: “Have another swing at it.” The only problem is, this isn’t a game; this is life – and death, and it doesn’t get any more real – and serious than that. Forty months post-diagnosis and still being treated. I don’t see any reason to stop now. Unless of course, I run out of choices.