Jimmy Carter's Cancer Revelation

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.

Living Between the Dates

As a cancer physician, reading obituaries is, unfortunately, part of my job description. I don't mean to be morbid about it. Not everyone who gets cancer dies from it - far from it. We cure two-thirds of cancer today. But we still have a long way to go.

I recently read my father's obituary. Oh, he hasn't died yet. My mother, you see, is nothing if not organized. So both of my parents' obituaries have pretty much been written for some time now.

Obituaries are fairly emotionless documents. They also don't often convey the true sense of who a person is. Usually, an obituary is a simple compendium of facts - dates - such as when a person was born and when they died. Others before me have said that what is important is not the date of birth or death, but the "dash" in between. That dash is what symbolizes who a person is, how they lived, what they accomplished.

My father just had his 81st birthday on Sunday. He has been working full time as a financial consultant at the same firm in Midland, Texas (RBC Wealth Management) for more than 48 years. That is a remarkable accomplishment in a field where jumping between firms is not uncommon. But loyalty was important to my dad, and to his clients. They knew they could trust him. His honesty and integrity were natural, unspoken expressions of his Christian faith. But that won't be in his obituary.

My parents love to travel, and they have taken quite a few overseas trips since he reached retirement age, even though he didn't retire! In September, my wife and I were able to go with them to Ireland on a fantastic trip. At 80, their vigor and stamina was amazing. Those two weeks together were so precious, even more so now in retrospect.

Just weeks after we got home, my father was diagnosed with pancreatic cancer. He had the usual tests and meetings with specialists to determine what, if anything to do. His liver is involved and his prognosis is quite poor.

I consult often with patients who are bombarded by well-meaning friends and relatives who think they know what is best and are, frankly, a bit too vocal with their opinions. Thus, seeing my father have to deal with the "You ARE going to MD Anderson, aren't you?" pretentiousness was particularly difficult. Those of you who want to comfort someone dealing with a cancer diagnosis need to learn simply to listen. Don't give advice, because 1) your story or experience is almost always irrelevant, and 2) you unknowingly aggravate the situation by making the patient feel guilty or second guess their decision. Please remember: It's not about you!

Ultimately, after much deliberation, my father opted for comfort care only. I am incredibly proud of the strength it took to make that brave decision. His cancer is not curable and his prognosis is less than six months under the best of circumstances. He chose instead to share quality time with friends and colleagues, with each of his three sons' families, and with his wife of nearly 60 years. What a blessing that time has been!

The apostle Paul wrote that he has fought the good fight and finished the race well. Thank you, Dad, for finishing strong. For demonstrating integrity and commitment in your work for more than 50 years. For your quiet faith, service, and generosity. For your love of family. For filling that "dash" between birth and death with a life well lived and memories we will cherish. Maybe we can insert that into your obituary!