Shelby has cancer. More precisely she has pre-B cell acute lymphoblastic leukemia. (Shelby's mom, Kami, and her dad, Brian, gave me permission to use their names and tell her story.)
In part, I share her diagnosis because within several days of Shelby's diagnosis, Newsweek magazine's Sharon Begley reported on the struggling or stalling American war on cancer. President Richard Nixon in 1971 signed the act committing the scientific power of the United States to the cure of cancer. Like any conflict, the battle is lasting longer than anyone thought, costing way more than anyone imagined, and has more casualties than anyone feared. The headline shouted: "We Fought Cancer ... And Cancer Won."
The 4-year-old Shelby hurt herself on a slide a couple of weeks before coming to see me. She had pains and complaints that were not like her. On a Friday, she and her mother came to the office. The precious blonde didn't appear ill but her walk was troubled. Her mother said that she was always hot; so, worried about possible infection in addition to the assumed injury, I ordered tests looking at the cells of her blood.
Because it was late on a Friday afternoon, I asked that the results be phoned to me. I was hoping the white blood cell count would not be elevated suggesting an infection. When receiving the phone call at a restaurant I asked my assistant if the numbers were low, meaning normal. They were. They were a bit too low. Reassured they were not high without asking the exact numbers, I erroneously assumed they were OK. Leukemia was the farthest thing from my mind. In fact it wasn't anywhere near my brain.
It was not until Sunday evening when Kami called me at home saying that Shelby had a true fever did I get more concerned and sent her to the Children's Hospital's Emergency Department for more tests and blood work. There the cells of her blood were further suppressed. By morning, with her continued decline everyone was thinking leukemia, just not saying it. After a bone marrow biopsy confirmed the diagnosis, Shelby officially entered the heroic ranks of kids with cancer.
When I heard of the drugs for the induction to clear Shelby's body and bone marrow, they were familiar. They were the same ones I pushed as a pediatric resident in training 30 years before. Yet the survival rate has increased so that Shelby's chances are in the 90s. The reason is that teams of care, such as Southwest Oncology Group, or SWOG, and Children's Cancer group and others, have fine-tuned the medicines and the doses and the timing and duration through various protocols.
In general practice of pediatrics, one doesn't see a lot of kids with tumors or blood malignancies. In two decades, Shelby is only the fourth child in my care diagnosed with it. For adults, they say the cancers are more diverse and more difficult to treat. However, while about 90 percent of children are enrolled in some national treatment cooperation system, Newsweek said only 1 percent of adults are given a choice by their physician or take the opportunity to be in such networks to share information and learning over thousands of patients.
In adults, the victories are fewer. It is true that colon screenings do help, Pap smears work, and mammograms identify earlier. However, part of the reason the war goes on is that there are more cancers due to us living longer. A dear 88-year-old second father has a thyroid cancer today because he didn't die two years ago yesterday.
But as the article points out, there is also no glory or money in prevention. Fewer people smoke, but cigarettes and smokeless tobacco are still poorly regulated. Besides, if broccoli decreases colon cancer it can't be patented and therefore make pharmaceutical companies billions. In addition, few want to listen about reducing tension or stress to make the human host less susceptible. Further, just as bombs often miss their targets, the funding has gone to enormous biological discoveries with a lot fewer real-life applications to halt the spread of the metastatic killers. The challenge is to transfer the millions of discoveries from the lab rat to the patient in the waiting room. So it seems the real war has just begun, with perhaps a surge needed to further slow the elusive and recalcitrant enemy. Still, "sometimes death is not optional."Shelby, I believe and hope, will not only survive but will thrive. She is now in remission with zero leukemic cells found in her latest bone marrow aspirate. That is the kind of message from the battle-front that we like. At least for some and hopefully for more the whole war is not lost.
Joseph Cramer, M.D., is a fellow of the American Academy of Pediatrics, practicing pediatrician for more than 25 years and an adjunct professor of pediatrics at the University of Utah. He can be reached at [email protected]