In January, I met with Dr. M. Once again, my cancer showed signs of awakening. I feel good. I am not overtly symptomatic. Nevertheless, the myeloma stretched and yawned. After a nearly 2 1/2-year nap, my drug-free remission was about to end.
Since last October, we’ve discussed a course of action. I digested statistics from clinical trial findings. The doctor weighed in with his experience. Opinions from several other respected sources aided me in my deliberations. Finally, I assessed my own treatment history. No doubt, the chemo I received in 2008 altered the environment of my bone marrow. Those drugs subdued the disease. Over time, though, the cancer adapted and the surviving cells began to grow.
During the intervening months while thinking about what to do, MM claimed the lives of two members of my support group and an online acquaintance. That, coupled with the undeniable activity of my disease, broke the resolve to withhold treatment. I agreed to begin a maintenance therapy of 10mg of revlimid daily, three weeks on, one week off … indefinitely.
My rationale is a gut decision as much as it is about the clinical findings. Stable disease lulls one into complacency. This creates a Hamlet-like dilemma for the patient. Do you strike out at the cancer, or wait? No matter what you decide, it’s a coin toss with your life in the balance. Heads or tails; make the call.
Elsewhere, life goes on indifferent to my stewing over the choices. Winter arrived with enthusiasm. Ski resorts opened early. The season’s frigid momentum persisted through the holidays, clenching the long nights in an icy grip. Then, with New Year’s arrival, its hold loosened when the rains of El Niño drenched the western states.
At home, our modest sized Hood River, swollen to flood stage, growled with boulders tumbling downstream. Pear farmers renewed the premiums on their crop insurance as the thawing ground awakened the roots of trees accustomed to dormancy.
Dormancy, as blood cancer patients and farmers know, is a good thing. Temporary inactivity helps plants rest and rejuvenate. Nature’s balance depends on a period of suspended animation that unleashes itself in a nurturing climate. Too early, and the plant is vulnerable; too late and it may not mature.
Cancer, on the other hand, is more about co-existence with a situation that is out of balance. A patient, such as I, attempts to stay one step ahead. If eliminating the disease is unlikely, then perhaps suppressing it can moderate the ill effects. With luck, a durable remission is possible. In fact, given the dynamics of research into multiple myeloma, surviving until new treatments become available is a reasonable strategy.
Am I convinced about my decision? No. But I feel fortunate to have choices. The dirty little secret about revlimid is that a 21-day supply of this miraculous drug can cost over $10,000.00. That is not a misprint. Obviously, I don’t pay that. I have health insurance that happens to cover the drug. But for those that don’t, the choices about their cancer treatment are much more difficult than mine.