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NYT – New Cancer Threat Lurks Long After Cure

NYT – New Cancer Threat Lurks Long After Cure


Watching Robin Roberts tear up in front of millions of viewers on “Good Morning America” last month,

I cried, too.

With equal measures of courage and fear, Ms. Roberts, an anchor of the show and a breast cancer survivor, explained that the life-saving treatment she received five years ago was responsible for a new diagnosis, this time myelodysplastic syndrome (MDS), a rare blood and bone marrow disease once called preleukemia.

MDS is a potentially fatal condition that can be caused by radiation and chemotherapy, both of which Ms. Roberts had in her initial cancer treatment. In medical-speak, it’s a “secondary cancer.” As a cancer and chemo survivor, I know that I, too, have a higher likelihood of developing these cancers.

When I was given a diagnosis of testicular cancer in 1984, secondary cancers were primarily a threat for pediatric cancer survivors. Their young bodies are most vulnerable to radiation and chemo, and they have more years in which to develop new malignancies. Also at risk were those beating some of the more “curable” adult cancers because of the highly toxic treatment regimens.

Secondary cancers now make up the sixth-most-common group of malignancies, in part because more survivors are living longer. Physicians are better at limiting toxicity from radiation and chemotherapy, so fewer people die from the effects of treatments. The bad news: More people are surviving their original cancers only to be haunted by the prospect of new diagnoses later.

Cancer survivors generally fall into one of two groups when it comes to our psychological health. First are those plagued by anxiety, depression, even post-traumatic stress disorder, which may afflict up to 58 percent of us, according to a recent American Cancer Society study. Then there are those who experience heightened self-esteem, a greater appreciation of life and its meaning, and sometimes a new or deeper spirituality.

Which bucket do you fall into? More important, can you choose where you land?

One of my heroes, Senator Frank Church, Democrat of Idaho and an ardent environmentalist and survivor of testicular cancer, died of a second cancer two weeks before I joined the cancer club. After his first diagnosis, Mr. Church wrote that survival had inspired him to live life to its fullest: “Life itself is such a chancy proposition that the only way to live is by taking great chances.” For Mr. Church, his original diagnosis became a metaphoric kick in the pants, resulting in a lifetime of good works.

I had read his advice a few years before my own diagnosis … and ignored it. But after I started chemo, I revisited those words, and in the years that followed I took some decided risks of my own. Some of them worked out beyond my imagining. I left a Ph.D. program to compile an oral history of the AIDS epidemic, and found a life as a writer. I lost other gambles, notably a relationship that crashed and burned, as so many do.

Along the way, I became aware that you couldn’t really take big risks without, well, taking big risks. Though cancer liberated me from what had seemed like a small life, for me, and for many survivors, freedom does not last forever.

Back when I was treated, there were no data showing testicular cancer survivors living more than 20 years. If you survived, you got a reprieve, but a limited one.

At 26, that seemed like a lifetime. As I approached the 15-year survival mark, not so much.

As time moved on, the fear of a secondary cancer engulfed me — I began to hear what I feared was the tick-tock of the death clock. And then entering my 40s, the alarm bell rang.

My doctors discovered a new tumor on a grainy ultrasound. Two months and three opinions later, the mass turned out to be a phantom. But the damage was done. I took a desk job with a matching 401(k) and a Cadillac health insurance plan. I paid off my student loans and credit card debt. I said goodbye to great chances.

My life shrank again as I toiled in an office the sun never even winked at. And I was single again. As my 20th year of survival approached, I started to have panic attacks, my heart seemingly exploding out of my chest. Eventually a therapist helped me understand that while I was morphing, so, too, was medicine. Testicular cancer survivors now live beyond 20 years; I was part of that data set.

That was eight years ago.

For the nearly 14 million cancer survivors, including Ms. Roberts and me, life is a roller coaster of a ride knowing that the treatments administered to us may one day exact a heavy price. Neither the reprieve nor the freedom it brings is permanent — but with more awareness of these mental health issues and new therapeutic interventions, doctors and patients are much better equipped than ever before to fight these demons.

After I found the bottom of the bucket of fear, I looked again to Mr. Church. Again, I am trying to seek out his notion of great chances, but it is more challenging in my 50s, with a mortgage and aging parents.

I now understand that the senator’s credo was not meant solely for those with life-threatening conditions. Are you happy in your relationship? Does your work satisfy you? If not, take your own great chance. You don’t need to have had cancer to benefit from this life lesson.