When a current or former President of the United States has
a major health problem, it is international news. And when a former president
has cancer, we all take in a collective gasp. Especially when that former
President is 90 years old. On August 12, 2015, Jimmy Carter announced that he
had cancer.
As an oncologist, I read such announcements with particular
interest. I look for certain words or phrases that carry a lot of meaning.
According to the New York Times coverage that day, Mr. Carter has a diagnosis
of “a spreading cancer that was detected by recent liver surgery.” Already, my
antennae went up. No cancer in a 90 year old is good news, but a few are
potentially more benign acting – not likely to be fatal – than others. For
example, prostate cancer in the elderly may not even need to be treated. But
just about any cancer in the liver is extremely serious, no matter what one’s
age. The New York Times goes on to say that “a small mass” was removed, as if “small”
is any more comforting.
But the next statement attributed to the former president’s
office blew me away: “(T)he prognosis is excellent for a full recovery.” Full
recovery, in my mind, means cure. What sort of propaganda is this, I wondered.
The Times noted that Mr. Carter has a strong family history
of pancreatic cancer; his father and three siblings all died of pancreatic
cancer, and his mother had it as well. If he had pancreatic cancer that spread
to his liver, prognosis is likely months, with a chance for “full recovery”
being zero. Most other metastatic cancers also have a poor prognosis, although
time frames can vary. How could I reconcile what I presume medically to be a near
zero chance of “full recovery” to a press release predicting an excellent
prognosis?
What bothered me in the early discussion was not so much
that the news media refused to speculate; that is understandable. But Mr.
Carter’s team did a disservice to those who have cancer – and to those of us who
treat cancer – by overly reassuring and misleading the public about his
condition rather than owning up to it.
Thankfully, that misdirection did not last long. It was
announced on August 20, 2015 that Mr. Carter, in fact, had metastatic melanoma.
Surely that was known on August 12 (the liver surgery was August 3, after all).
At a videotaped news conference on August 20, Mr. Carter explained that the
melanoma in his liver had been completely removed, but that four small tumors
were found in his brain. He started radiation treatment that afternoon and
famously taught his Sunday School class three days later.
To Mr. Carter’s credit, he admitted on August 20 that his
cancer is “likely to show up other places” in the future. And being the man of faith
that he is, he is quoted as saying that his life was in God’s hands and that he
was perfectly at ease with whatever comes. It was reported that when he first
learned that the cancer was in his brain, he believed he “had just a few weeks
left.” After radiation, he will pursue several courses of a brand new drug pembrolizumab
– also known as Keytruda – over a period of several months, depending on how he
is doing.
Regardless of how Mr. Carter responds to treatment or how
long he lives, what started as obfuscation on the part of a press machine ultimately
turned into an amazingly vulnerable self-revelation by a man of deep faith. I
hope and pray President Carter responds well to treatment. I also hope that as
he confronts treatment and end of life decisions he will spark an honest and
open discussion of the role of palliative (comfort) care and hospice care. That
would be as great a humanitarian legacy as any he has yet left behind.
