On ‘Men of a Certain Age,’ questions arise about colon cancer and chemo
The premise
Joe (Ray Romano) and Manfro (Jon Manfrellotti) are good friends who go to a strip club the night before Manfro is scheduled to begin chemotherapy to treat Stage 3 colon cancer. Manfro, whose tumor had spread to his lymph nodes by the time it was detected in a colonoscopy screening exam, has already had surgery to remove the bulk of his tumor. At the club, he meets a stripper whose father also has Stage 3 colon cancer and went to the same oncologist that is treating Manfro. The stripper, Carly (Tasha Ames), tells Manfro that the chemo made her father nauseated, made his hair fall out and caused him to lose weight. At the end of the night, Manfro tells Joe that he’s decided not to go through with the chemo and will consider alternative treatments. His talk with Carly has made him see life from a different perspective, he says, plus he wants to keep his hair. It is clear Joe isn’t in favor of the idea, though he never says so directly. Manfro starts spending time with Carly, and the next time we see him, he is having the chemo — with Carly there to provide emotional support. Her own father is still alive after his treatment, and that appears to have influenced her decision to help Manfro.
The medical questions
How effective is colon cancer screening, and does it reduce the death rate from this cancer? What is the prognosis for Stage 3 colon cancer, and does chemotherapy improve long-term survivability for patients who have already had surgery? What alternative treatments are available? How crucial is it to have a positive outlook and emotional support, and can it come from an unlikely source?
The reality
Colon cancer is almost completely preventable with routine screening, says Dr. Heinz-Josef Lenz, co-leader of the Gastrointestinal Cancers Program at the USC Norris Comprehensive Cancer Center. The U.S. Preventive Services Task Force recommends a screening colonoscopy every 10 years beginning at age 50. The procedure involves inserting a colonoscope — a thin, flexible tube with a camera on the end — through the rectum and up into the colon to look for and remove polyps that may turn into cancer.
Stage 3 colon cancer has spread beyond the colon to nearby lymph nodes, and it often happens when a patient wasn’t screened early enough, Lenz says. In such cases, chemotherapy is routinely recommended because it improves overall survival, he says. The typical course of this therapy is called FOLFOX because it includes folinic acid, Fluorouracil and Oxaliplatin. Depending on the extent of the tumor and the number of lymph nodes to which it has spread, between 44% and 83% of patients survive for five years after surgery plus chemo. There are no alternative therapies that have shown any benefit in treating colon cancer, Lenz says.
Though the idea is certainly appealing, there is no direct evidence that emotional support or a positive attitude directly affects cancer survival. James C. Coyne, director of the Behavioral Oncology Program at the University of Pennsylvania School of Medicine, analyzed quality-of-life data from more than 1,000 patients with head and neck cancers and found no difference in survival rate based on the emotional state of the patient. (Overall, about two-thirds of the patients died over the eight years of the study.) “The hope that we can fight cancer by influencing emotional states appears to have been misplaced,” he says. Lenz agrees with this but adds that a good attitude is critical to helping patients cope with chemo. That makes them more likely to stick with the therapy, which in turn leads to better outcomes.
People with cancer most commonly turn to their spouse or partner, other family members and friends for emotional support, says Kathleen M. Ingram, a Virginia Commonwealth University psychologist who is an expert in social support networks. “Emotional support also can come from healthcare professionals, co-workers and religious communities, and from people who have had cancer themselves or are related to someone who does,” Ingram says. She points out that sometimes support comes from a completely unexpected source, as in Manfro’s case. Research shows that cancer patients with high levels of emotional support tend to report greater psychological well-being and less distress, Ingram says.
Siegel is an associate professor of medicine at New York University Langone Medical Center. His new book is “The Inner Pulse: Unlocking the Secret Code of Sickness and Health.”
‘Men of a Certain Age’
10 p.m. June 2, TNT
Episode: ‘The Great Escape’
