Living Beyond Reality

Monday, October 4

Okay – he said it.  He told the truth. 

My oncologist was asked in the television interview, “What are the chances of recurrence with Inflammatory Breast Cancer.”

His answer:  “Quite high.”

I’m sitting there with him in the room.  And I knew that this was probably the answer, but I had just never asked.  And, of course, Dr. Makhoul had to tell the truth or he would have jeopardized his credibility, looked less than brilliant to other cancer colleagues. 

“How high,” I wanted to ask.  But I didn’t. 

Tuesday, October 5

I think I’ll just keep myself very busy, try to pretend I didn’t hear that yesterday. Maybe if I forget about it, the reality will go away, disappear like a quick bolt of lightening.  As Katie Scarlet once said, “I can't think about that right now. If I do, I'll go crazy. I'll think about that tomorrow.”

Wednesday, October 6

Damn the Internet!  It’s far too easy to find out just about anything you want to know.  Remember when you had to go to a public or medical library to read about disease? 

Today I went online, navigated straight to Google, entered “recurrence inflammatory breast cancer.”  Lots of articles about IBC with mentions of a “high chance of recurrence.”  Again, how high?

And then I came across this clinical research data from M.D. Anderson Cancer Center in Houston.

Abstract

BACKGROUND: Inflammatory breast cancer (IBC) is the most aggressive manifestation of primary breast cancer. The authors compared the prognostic features of IBC and non-IBC locally advanced breast cancer (LABC) to gain insight into the biology of this disease entity.

METHODS: This retrospective analysis consisted of 1071 patients, comprising 240 patients with IBC and 831 patients with non-IBC LABC who were enrolled in 10 consecutive clinical trials (5 from each disease group). All patients received similar multidisciplinary treatment. The authors measured time to disease recurrence for each individual site from the start of treatment to the date of disease recurrence or last follow-up (recurrence-free survival) and overall survival rates to the date of last follow-up or death.

RESULTS: The median follow-up period was 69 months (range, 1-367 months). Pathologically complete response rates were 13.9% and 11.7% in the IBC and non-IBC LABC groups, respectively (P = .42). The 5-year estimates of cumulative incidence of recurrence were 64.8 % and 43.4% (P < .0001), respectively, for IBC and non-IBC LABC. IBC had significantly higher cumulative incidence of locoregional recurrence and distant soft-tissue and bone disease. The 5-year overall survival (OS) rate was 40.5% for the IBC group (95% CI, 34.5%-47.4%) and 63.2% for the non-IBC LABC group (95% CI, 60.0%-66.6%; P < .0001).

CONCLUSIONS: IBC was associated with a worse prognosis and a distinctive pattern of early recurrence compared with LABC. These data suggested that investigating factors affecting "homing" of cancer cells may provide novel treatment strategies for IBC.

Sixty-five percent recurrence rate??  Seriously?  Okay, not such good news.  But this is the reality, even if it creates fear, uncertainty and heartache.  But living in reality is much better than living in fantasy. 

But hey, I’ve beat the odds once, and I certainly plan on doing it again.  Now, for a game plan.  I’m going to have to take some time to figure this one out.  But the goal must certainly be living BEYOND reality.