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THE UNREAL WORLD : Misguided cancer plan

November 16, 2009|Marc Siegel

'Brothers and Sisters' ABC, Sunday, Nov. 8, 10 p.m.

Episode: "The Wig Party"

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The premise

Kitty Walker (Calista Flockhart) is a 41-year-old political show host who has been diagnosed with non-Hodgkin's lymphoma (diffuse large B-cell type) on the basis of a needle biopsy of a lymph node. Her blood cancer is very aggressive, and she has completed her first round of chemotherapy. In this episode, her hair begins to fall out, and she spends sleepless nights caused by side effects from the prednisone she now is taking. She considers stopping chemotherapy and opting instead for an alternative approach (flaxseed oil and herbs), as well as stress reduction, hoping that these will cause her cancer to regress. Walker suggests that her cancer, which doesn't run in her family, is due to her "type A" personality and is using that as a justification to stop her treatment and switch to the behavioral approach. Her mother, Nora (Sally Field), and her sister Sarah (Rachel Griffiths) argue against her decision to go "alternative," and ultimately Walker decides to return to her oncologist and undergo further chemotherapy.

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The medical questions

How common is non-Hodgkin's lymphoma in a 41-year-old? Could it be diagnosed by a needle biopsy alone? How well does it respond to chemotherapy and what is the prognosis? Are the standard treatments well tolerated? How common is it for patients to drop out of treatment? Would Walker's unconventional treatment regimen help fight her cancer?

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The reality

Lymphoma is cancer of the lymph nodes. Diffuse large cell lymphoma, the type Walker has, accounts for about 35% of all lymphomas in the U.S. It is most common in people in their early 60s, but it is not unusual to see it in a 41-year-old, says Dr. Bruce D. Cheson, head of Hematology at Georgetown University Hospital's Lombardi Comprehensive Cancer Center.

It would be unlikely to diagnose the exact type of lymphoma by a needle biopsy of a lymph node in the neck, says Dr. Lauren Pinter-Brown, director of the UCLA lymphoma program. Instead, a surgical biopsy would be performed, followed by a bone marrow biopsy to see how far the disease had spread.

Since the adoption of the chemotherapy drug rituximab over the last decade, the cure rate for this type of cancer has grown to at least 60%, Pinter-Brown says. (Rituximab is an antibody specifically targeted against B lymphocytes.) Even when a patient relapses, more chemotherapy plus stem cell treatment is often successful. The treatment is generally well tolerated with the help of supportive measures including anti-nausea drugs, Pinter-Brown and Cheson say.

Side effects include hair loss, lowering of blood counts and a predisposition to infections that can be treated with growth factors. Pinter-Brown adds that some of her patients continue to work during chemotherapy.

"There are no alternative approaches that have been demonstrated to cure this type of lymphoma," Pinter-Brown adds, "and personality changes have not been shown to treat lymphoma." It's uncommon, Cheson says, for patients to drop out after starting. Both doctors agree that a trusting relationship between the patient and the treating oncologist (and his or her team) is crucial.

Finally, though some unconventional treatments are harmless, some aren't. Cheson expresses concern that some herbs might interfere with the chemotherapy.

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Siegel is an associate professor of medicine at New York University's School of Medicine.

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marc@doctorsiegel.com

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