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While chemo works, the patient can, too

New drugs to fight cancer and the nausea that the treatment can cause are helping people live more normally through the fight.

By LISA GREENE
Published July 24, 2005

	[Times photo: Bob Croslin]
	Debbie Gardner puts the finishing touches on cake at the Kash n' Karry in Kenneth City on Friday, a day after her chemotherapy treatment.

KENNETH CITY - On Wednesday, Debbie Gardner baked French bread and sub rolls at the Pinellas County Kash n' Karry where she is the bakery manager.

On Thursday, she went to chemotherapy for her breast cancer.

On Friday, she was back at work, slicing trays of chocolate fudge into neat squares and pulling meringue pies from the oven.

Gardner, 44, is part of a new generation of cancer patients - a group that often is able to work not just after surviving cancer, but during treatment.

"I honestly didn't think I'd be able to go to work," Gardner said. "But I was praying real hard I could."

She had good reason for her doubts. Gardner's cancer, found in April, is her second bout with the disease. During her first treatment in 2001, she was too exhausted and sick to work during chemotherapy. The difference for her: a better drug designed to fight her cancer with fewer side effects, plus an antinausea drug that calms her queasiness.

Such changes are making it possible for more and more patients to work through the disease. In two recent studies of breast and prostate cancer patients, about two-thirds were working six months after diagnosis, when many would still be undergoing treatment. These days, the American Cancer Society even tells patients that most people are able to work.

Public figures who get cancer and stay visible, from Chief Justice William H. Rehnquist to rocker Melissa Etheridge, are changing the public view of what it means to have cancer.

Still, that perception has a way to go. Many people still expect that chemotherapy will be a devastating experience. When most people are diagnosed, said social worker Page Tolbert, their first thought is that they're going to die.

"Their second thought is: "How am I going to get through this treatment?' " she said. "Most people have a lot of preconceived ideas - the movie-of-the-week treatment, where you're hanging over the toilet bowl, and wasting away, and barely able to sit up.

"Not that that never happens, and not that people with very advanced cancers aren't very sick, but often times, it's eminently treatable," said Tolbert, of the Post-Treatment Resource Program at Memorial Sloan-Kettering Cancer Center in New York.

In Tampa, a 10-year database at H. Lee Moffitt Cancer Center & Research Institute of 1,350 of the sickest patients - bone marrow transplant candidates - showed that 22 percent kept working.

"Even in this very sick group, 20 plus percent are working - that's pretty cool," said Margaret Booth-Jones, assistant oncology professor at Moffitt and the University of South Florida.

Among people with less advanced cancer, the numbers are higher.

"People doing well with chemo is the rule rather than the exception," Booth-Jones said.

At Kash n' Karry, Gardner hauled a cardboard box - large, but light - of plastic trays from a shelf above her head. She turned over a fudge tray and slammed it on the counter, whack, to loosen the candy. She got out a double-handled knife and leaned her weight over it to slice.

"Everybody reacts differently," she said as she sliced. "There might be somebody with the same cancer and the same medicine and they react differently and can't handle it."

Last time around, she couldn't either. This time, except for the filmy blue scarf tied over her bald head, she doesn't look sick.

She feels it sometimes. Most days, Gardner heads home from chemo and goes to bed. And while she's having less nausea, she often has little appetite.

"I wish this upon nobody," Gardner said. "I'm not going to lie. It's hard getting up to go to work every day. But I have bills. And I don't want to sit here and dwell on what's wrong."

When St. Petersburg resident Mary Jo Baras was diagnosed with breast cancer in February, she also found her job, as office manager of her husband's medical practice, an escape from cancer.

"I looked forward to going to work," she said. "It got my mind off the pain. It was a supportive cocoon to get me through the day."

Joy Fincannon remembers how it used to be. Ten or 15 years ago, chemo patients struggled so much with nausea that just the thought of getting chemo was enough to make some patients throw up on the way to the clinic, said Fincannon, a nurse and associate medical editor of the American Cancer Society.

"We had a doctor who one of our patients saw in the airport, and she threw up when she saw him," Fincannon said.

Better drugs to control nausea have changed that. Newer chemo drugs, such as Gleevec, Tarceva and Avastin, are more targeted to attack cancer cells alone, rather than also attacking healthy cells, so they cause fewer side effects. And drugs to boost the red and white blood cells that are sapped by chemotherapy have lowered infection rates and eased fatigue.

Dr. Richard Knipe of Gulfcoast Oncology in Pinellas County used to visit three to five patients hospitalized every week for infections. Now he sees three to five a year.

"It's just completely changed the practice of oncology," Knipe said.

Still, doctors stress that the picture hasn't changed for everyone. Many cancer patients still face harsh drugs with sickening side effects. For others, the tumor itself causes severe pain. And cancer is now the leading killer of Americans under 85.

Even patients with less severe cancer still battle side effects. The worst one for doctors is treating the fatigue that often accompanies cancer.

"The profound fatigue is something we haven't been able to make huge strides in," Fincannon said. "It's not just being tired. It's bone-weary - literally, you can't put one foot in front of the other."

What especially irks Knipe are the rosy TV ads that make it sound as if newer drugs, such as Procrit, can deliver the strength to get up and dance.

"The commercials make it seem like one shot and you're going to feel normal," he said. "It definitely helps, but it doesn't completely eliminate fatigue."

Many of Knipe's patients see such TV ads and ask him about the drug. Knipe finds that at least half of them don't realize they're already taking it.

If changing medicine makes it easier to work, changing times makes it necessary, said Cathy Bradley, health administration professor in the Massey Cancer Center at Virginia Commonwealth University.

In a study of nearly 300 prostate cancer patients published this month in the Journal of the National Cancer Institute, Bradley found that most of the men were working six months after they were diagnosed.

But about two-thirds of them said they were doing so because they were afraid of losing insurance.

"As long as we continue to link health insurance and employment, people will continue to work through fairly intensive treatment," Bradley said.

The increase in screening tests, from mammograms to PSA tests, also makes it more likely that patients work, Bradley said, because the screenings find cancer in younger people who haven't retired.

When patients do work, many still need time off to recover from chemotherapy or go to medical appointments. Some have to change their work duties.

Doctors for Gardner, the bakery manager, have told her not to lift anything heavy. Her co-workers have been so supportive, Gardner said, that they offer to carry things for her, or scold her if they think she's doing too much.

When Port Richey resident Sandy Coniglione, now 55, got cancer nine years ago, she scheduled her chemotherapy treatments for Fridays, so that she would have the weekend to rest.

Baras also did her treatments at the end of the week and got her daughter to fill in for her each Monday, while she stayed home.

Tolbert sees another sign of the changing landscape: Some patients now come in expecting to work, and work hard, all through their treatment.

"We're starting to see this kind of "cancer macho' syndrome," she said. "People will tell us tearfully, "Another woman in my office had cancer and didn't miss a day of work.' "

As more people come in contact with cancer survivors, Tolbert said, their expectations are rising.

"It's chemo as a competitive sport," she joked.

Patients also find a wide range of responses from co-workers and employers. Tolbert has heard from patients whose co-workers wrongly believe cancer is contagious, and don't want to sit near a patient or use the same phone. Or there are employers who suddenly eliminate a patient's job, or refuse to promote them - actions that can break disability laws.

The flip side: employers who are almost too nice.

"Sometimes it's out-and-out discrimination, and sometimes it's misguided empathy," she said. "Their boss says, "I'm not going to give you that account because you need to rest.' "

Gardner said she hasn't suffered any such problems. The support from her husband and co-workers has made working possible, and that, in turn, has made coping with cancer easier.

"If I hadn't been able to put my mind somewhere else, I probably would have gone stir-crazy," she said. "How many times can you clean the house? How many times can you lie on the sofa and watch the same thing? I've always been an active person. I can't do that."

[Last modified July 24, 2005, 01:14:28]