by Trevor Bayliss, MD

If you live waiting to know your cancer is gone and not coming back you might miss a lot. On a more cosmic scale if you live waiting for the reassurance that you won’t die… guess what… it will never come. If we are fortunate to live a life where our basic needs are taken care of we don’t go through it thinking about death. I certainly didn’t and probably still wouldn’t.

• Death seems to be one of the only absolute certainties. Ironically it is the deep understanding of this that allows us to live our most fulfilled lives.

It was shortly after the removal of my 10 pound spleen, my diagnosis less than a month old, when I met with my oncologist to review the next course of action. “Well, your spleen is out, your blood counts are better… this is a slow moving condition, it may not causes any trouble for months or even years. We’re going to keep a close eye on it.” I was expecting an aggressive course of action to eradicate this invader in my body. MAY not cause any trouble!? Keep an eye on it!?!? This concept seemed crazy to my 19 year old brain.

Many cancers are thankfully curable and the treatment approaches and mindsets are geared toward that goal. Others, with the current treatment options, are not. There is an initial shock, grief, anger, confusion as you realize you have a condition that can’t be cured. That a cancer will sit with you, making a home in your body is a hard concept to grasp. If my physician had told me at age 19, after this understanding had settled in, “We can’t eradicate your leukemia, but we will watch it carefully, and when it progresses we have a medication that should be able to keep it in check for years, or even decades,” I would have taken that in a second. But at that time he didn’t know what we would do when it became aggressive and the chemotherapy failed.

• Some cancers require a mindset shift to one of co-existence.

As treatment options expand, symptom management improves, and cure in many settings remains elusive, the approach for many cancers is increasingly becoming one of chronic management. As an oncologist I am now recommending a similar course of action in many situations, for many different malignancies. Cancers where a surveillance approach may be best include low grade prostate cancer, chronic lymphocytic leukemia, low grade lymphomas, other low grade tumors. In many other advanced cancers, the idea of a “maintenance treatment” aimed at controlling the cancer, while maintaining quality of life is becoming increasingly recognized as a standard approach. Examples include, again, hormonal therapy in advanced prostate and breast cancer. The development of an increasing selection of oral targeted therapies for a variety of cancers, immunotherapy (drugs aimed at activating the immune system to fight cancer) in many different cancers has broadened the options for this type of approach. Of course, the goal of curing cancer should always continue to be a priority of research efforts. But what if we can control a cancer for years, decades even? And what if the controlled cancer causes no or minimal symptoms, and the treatment causes no or minimal side effects? What if in some cases the “War on Cancer” is better thought of as a “Truce with Cancer?”

• As a provider it can be challenging to explain that sometimes doing nothing might be the best course of action. But of course, there are always interventions that can help regain a sense of control and improve the odds.

In my opinion these situations of “close surveillance,” living with a low grade cancer, and decreasing the risk of a cancer recurrence are ripe to benefit from lifestyle modifications, from altering the body’s microenvironment that supports cancer cell propagation. Future blogs will delve deeper into this concept and how complementary therapies like regular physical activity, good nutrition, reducing stress, making social connections, can have a profound impact. These interventions have been shown to decrease inflammatory markers, support immune function, improve a sense of wellbeing, and in some case actually delay or possibly even reverse progression of cancer.

• Take control by incorporating evidence-based complementary therapies.

I did eventually require a “maintenance” treatment and 20 years later I continue that weekly medication. My blood counts are normal, but when my blood is smeared over a glass slide and looked at under the microscope those Large Granular Lymphocyte cells are there, just a few more than there should be. At one time they choked my liver and lungs, forced me to use supplemental oxygen. But now they float peacefully, existing harmoniously with the rest of me. I have existed the last 20 years this way and in that time lived as a ski-bum in Colorado, fell in love and got married, completed medical school, became an oncologist, celebrated remissions with patients, held the hands of patients whose disease we could not stop, ran marathons, and had children. Here is a philosophical question I sometimes think about… Is it even a disease if you are living your life like that? My reminders are the 8 pills every Monday and the blood draws every 3-4 months. They remind me that nothing is guaranteed.

• As you can see from Charlie’s face (furthest left in the picture of my boys) it can be a long trek to the top, but worth the view!

As you come out of the fog of a cancer diagnosis and rise to find a birds eye view you see more clearly that life is short and never guaranteed, but that there are paths leading through the chaos below. From that vantage point you can track backward to find your next step, and see that life with all of its beauty, pain, and imperfections is all right there in the foreground. Somewhere out there the path ends for all of us. I’ve been blessed and yes, lucky. If I have another 20 years like the last what will I do with it? Which paths will I take? For now I’ll just focus on today and my next step.