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A pessimistic prediction of survival

Special to The Times

“Rails & Ties,” Warner Bros. Pictures, release date Oct. 26.

The Premise: Megan Stark (Marcia Gay Harden) is suffering from stage 4 (metastatic) breast cancer that, though being “cured twice,” has spread to her bones. She has not responded to the latest chemotherapy and she asks her oncologist, Dr. Peter Offenberger (John Nielsen), exactly how long she has to live. The answer, based on his negative look and her dismayed response, seems to be: “Not very long.” She has tried alternative treatments, such as cupping, electromagnetic therapy and relaxation techniques, to no avail. As she becomes sicker, her marriage to train engineer Tom Stark (Kevin Bacon) unravels. She becomes more depressed and considers leaving him -- until the day his train hits a car, purposely parked on the tracks, with a mother and son inside. The boy survives, entering their lives and adding meaning.

The medical questions: Is stage 4 metastatic breast cancer curable? Can a physician predict how long a patient will live when the cancer does not respond to treatment? How effective are alternative treatments? How painful and disabling are bony metastases? Do terminal cancer patients become severely depressed? Are they more likely to divorce?

The reality: A complete cure for metastatic (stage 4) breast cancer is unusual, but the five-year survival rate with appropriate treatment (surgery, radiation, chemotherapy or a combination) is 20%, according to the American Cancer Society. And the survival rate for recurrent breast cancer of all kinds is improving because of new treatments. A study at MD Anderson Cancer Center, published in 2004, found that, in the 1990s, 40% of women with recurrent breast cancer survived at least five years; in the 1970s, only 10% of such patients survived more than 15 months. So it is somewhat unrealistic for Megan’s doctor to suggest that death is imminent, even though the cancer has spread to the bone.

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Alternative treatments for breast cancer, such as nutritional supplements and relaxation techniques, have been successful in relieving symptoms in some cases but are not clinically proven to prolong life.

Multiple metastases would probably make the patient more incapacitated than the film portrays, but pain treatments can be fairly effective. In 85% of cases, external beam radiation can provide significant pain relief for the area most affected, and bisphosphonates can treat pain by slowing the abnormal bone destruction caused by metastases.

Opiates are commonly used for treating pain from diffuse bony metastases, and Megan is clearly receiving them, though they are less effective as the cancer spreads.

Finally, a 2001 University of Massachusetts study showed a much higher rate of divorce among patients with terminal tumors, especially when the patients are women. And at least 25% of terminal cancer patients suffer from clinical depression. A study published in the Journal of Clinical Oncology in 2003 showed significant improvement with antidepressant treatment. Engaging in meaningful activity can also be helpful.

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Marcia Gay Harden, who lost a niece and nephew in a devastating fire, said in an interview: “Getting back on track when your life is being derailed by cancer and death requires an act of great humanity. The goal is to leave something of yourself behind.”

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Dr. Marc Siegel is an internist and an associate professor of medicine at New York University’s School of Medicine. He is also the author of “False Alarm: The Truth About the Epidemic of Fear.” In The Unreal World, he explains the medical facts behind the media fiction. He can be reached at marc@doctorsiegel.com.


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