Focus turns to quality of life, not cure

Jane Weaver Health editor • Profile • E-mail

Presidential candidate John Edwards said Thursday that his wife Elizabeth's cancer has returned. Elizabeth Edwards, whose breast cancer was first diagnosed in 2004, was given a clean bill of health last year, but now says that the disease has spread to her bone. MSNBC.com spoke with NBC chief medical editor Dr. Nancy Snyderman about Edwards' condition, her treatment and the chances of her being able to continue campaigning for her husband.

Q. Last year Elizabeth Edwards said her cancer was in remission, but it's returned. What is her condition?
A. She has bone metastasis. The cancer has now spread to her bone and, questionably, to a spot on her lung. They’re doing other scans. John Edwards used the term that it’s not curable and they’re talking treatment and quality of life and other treatment options.

[When she was first diagnosed] we know that she got chemotherapy upfront and then surgery and radiation and chemotherapy again. That was done because, at the time of diagnosis, she had Stage 3 cancer, which is a rather advanced stage. It had spread to the surrounding lymph nodes. Today’s announcement changes it to a Stage 4 cancer.

That means that her original breast cancer tumor has spread and doctors are going to have to figure out how to treat her to prolong her life and give her the best quality of life. But it means that her breast cancer, as we think about being cured, is incurable.

If it were bone alone, it’s easier to manage. If it ends up being bone and lung — and we haven’t confirmed that yet — it changes the prognosis. Anytime you add brain, lung or liver it makes the prognosis more guarded. Bone alone would be easier to treat. She definitely has a spot on her rib and a few other bones.

Q. The Edwards are saying she’ll be treated for the rest of her life. What treatments will she get?
A. The question is, what do they mean for the rest of her life? Is the rest of her life three years or 30 years? That’s what no one is going to come out and say. But she'll go to her grave on these treatments.

As a doctor, I can tell you, only stupid doctors start to give you life expectancies, because we’ve all been snookered by [the disease]. All we can do is tell you the best medicines and what science shows us and treat it as aggressively as possible.

Certainly, she will be treated with some kind of hormonal therapy or maybe biological therapy [a type of treatment that works with the immune system], but the whole goal will be to control this tumor that’s already escaped.

We know she has an estrogen receptor-positive tumor, so she’s lucky in that certain kinds of hormone treatment can keep this tumor from growing rapidly.

Q. What happens in the next few days?
A. She’ll have more scans to make sure it's not anywhere else in her body. They’ll have to sit down and talk about how aggressive to be with the treatment and its side effects. Then, they’ll talk prognosis. I would be very shocked if they talk to the American public about prognosis. The whole thing now will be quality of life and what drugs can they give her that will keep it under control.

You have to start thinking about cancer now like diabetes. Just like we don’t cure diabetes but we treat it very aggressively, that’s exactly how she’s being treated.

Q. Edwards says he's continuing his presidential campaign. Will she be able to continue alongside him?
A. Probably so. The hormonal treatment is much easier than traditional chemotherapy.

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