Radical Remissions: Cancer Patients Who Defy the Odds

Medscape Medical News > Oncology
Radical Remissions: Cancer Patients Who Defy the Odds

Roxanne Nelson
July 08, 2014


According to statistics, Lola Baltzell should have died 3 years ago. Instead, she celebrated the fifth anniversary of her diagnosis of metastatic breast cancer by biking 110 miles to raise money for the Dana-Farber Cancer Institute in the Pan-Mass Challenge.

Not only is Baltzell still alive after 6 years when median survival is 3 years, her scans have been clear of cancer for more than 5 and a half years.

"You will never be in remission, you are a chronic patient, you will never be cured — that's what the doctors keep telling me," she said. "But every scan done after November 2008 has been negative."

Baltzell, a 53-year-old social worker and artist who lives in the Boston area, is constantly on the move. She bikes to work year round, no matter what the weather, curates art shows, has showings of her own work, and is an avid practitioner of yoga and meditation. She sees herself as strong and healthy, and is hopeful that she will continue to defy the statistics.

Baltzell's experience is not unique. Although it is neither typical nor common, it is not all that rare. There are thousands of cancer patients just like her, who have extended their survival way beyond the upper limits of the median or who are seemingly cured after a terminal prognosis.

These individuals, sometimes called exceptional patients, have begun to attract the attention of researchers who are interested in what, if anything, they are doing to heal themselves of incurable diseases or to improve their chances of being cured.


Spontaneous remission, as it is often referred to, caught the attention of Kelly Turner, PhD, when she was an undergraduate at Harvard University in Boston. "I was surprised how little research was being done by the medical community on these patients who had healed from cancer," she said in an interview. "Many of the patients had healed without undergoing Western medical treatment or, following its failure, they used other therapies to extend their survival."

It became the focus of her PhD thesis at the University of California, Berkeley. Dr. Turner's research involved a year-long trip to 10 countries to interview 50 holistic healers and scores of cancer survivors about healing techniques. Since that time, she has analyzed more than 1000 cases of spontaneous remission and written a book: Radical Remission: Surviving Cancer Against All Odds. Dr. Turner prefers the term "radical remission" because typically there is nothing spontaneous about these unusual cures. Most patients were actively doing something to facilitate healing.

In the course of her research, Dr. Turner identified more than 75 different healing factors that patients used to help heal themselves. Of these, 9 stood out and were used by almost all of the survivors. These key healing factors involved body, mind, and spirit interventions. Dr. Turner noted that she is just presenting research, not prescribing cancer cures.

"Some of the popular media outlets were trying to present this as a '9 steps to curing cancer' sort of thing, and I said no, you can't do that," she told Medscape Medical News. "This is not a 9-step program for getting well. These are just 9 factors that most of the survivors had in common."

"I am a researcher who is simply trying to get a conversation started about this important subject," she said.

Dr. Turner emphasized that this is preliminary, exploratory research. "My biggest hope is that we can bring radical remissions to the discussion table. I have put out the hypotheses and now they need to be tested in prospective trials."


Navigating False Hope

She came across her first case of radical remission about 10 years ago when she was working as a counselor at a major cancer center. Intrigued, she conducted a quick search of the medical literature and was surprised to find there were more 1000 cases reported in medical journals. "I wondered why none of the physicians I worked with had ever mentioned these," she said.

These were primarily case studies, but there was no information about how the patient managed to survive, she noted. "No one had asked the patients what they had done to heal," Dr. Turner explained.

Most of the cancer survivors she interviewed reported that their doctors never asked what, if anything, they were doing that might be helping them. They also said that no one was keeping track of them.

She specifically studied 3 categories of cancer patients: those who healed from their disease without the use of any standard/conventional medicine; those who were treated with standard therapy and, when it failed to work, tried other treatments that did help; and those who used conventional and alternative medicine at the same time to overcome a very serious prognosis (i.e., any cancer that has a 5-year survival rate below 25%, such as advanced lung or pancreatic cancer).

"Everyone has seen cases like this in their practice," Dr. Turner said, "yet few have ever investigated them."

One reason for that, she believes, is that physicians simply don't have the time and can't explain it. Another is that oncologists might not want to instill false hope in patients with advanced disease. Still, those are not good reasons to ignore these cases. "It is not only scientifically irresponsible, it is also foolish, since there is the potential to learn so much about how the body heals," she said.

Of the cases that she reviewed, about 85% have no evidence of disease on their medical charts. About 15% still have cancer, but their tumors have shrunk and have remained stable for years.

One example is a patient with stage III non-small-cell lung cancer. His tumors are still there but they have shrunk considerably and haven't caused him any trouble, Dr. Turner explained. He never received any standard treatment for his cancer; instead, turned to a form of energy work and kept asking his doctors for "6 more months" before beginning chemotherapy. Six months became a year, and now it's been 5 years.

"Every time he goes in for a scan, his doctors shake their heads and say that they don't understand it, but that whatever he is doing, to just keep on doing it," Dr. Turner noted.

The issue of false hope can be difficult to navigate. "It's tricky because you don't want to give people false expectations, but it's only false hope if it is false," she explained. "These people are true, and they have truly healed. We have to be careful how to discuss them, but it doesn't mean we shouldn't talk about them at all, just because we don't understand it."

By not studying these long-term survivors, she contended, "we are missing out on an opportunity to learn how cancer behaves and about the healing process. We can learn a lot by studying anomalies."

The 9 Factors

Although the cancer patients she analyzed used a number of strategies, there were 9 factors common to most of the patients.

The patients radically changed their diets, took control of their health, followed their intuition, used herbs and supplements, released suppressed emotions, increased positive emotions, embraced social support, deepened their spiritual connection, and had strong reasons for living.

Several of these factors applied to Baltzell; however, she didn't consciously think about how they were going to help her survive or extend her life. Baltzell had a mastectomy followed by radiation to the chest and the bone metastases in her hip. "They told me it was too late to do chemotherapy, and that they would save it until the 'end' in order to extend my life," she said.

She was a long time devotee of yoga and found the practice helped her physically and emotionally. She was on the mat every day, even right after her mastectomy. "I didn't do much that day, but I was on the mat," she explained.

Meditation, which she had started to practice 6 months before her diagnosis, also helped. "I thought I was going to die sooner rather than later," she said. "I saw the stats and they didn't look very good, but meditation really helped me get over that."

She explained that as her practice deepened in the weeks after her diagnosis and treatment, meditation helped her find peace and accept the situation. "I was okay either way and ready to go if that was going to be the case," she told Medscape Medical News. "I even told that to a friend that I was fine and I released the fear and attachment to life."

She had long wanted to get a dog but her physicians told her that it was not a good idea because caring for a dog required energy and time. "I took that to mean that my doctor was worried that I wasn't going to be around long enough to take care of my dog," she said.

After 2 years, she got a Chocolate Labrador Retriever, which has a lifespan of about 10 years. "I decided that I wasn't going to die before my dog," she explained.

Baltzell also embraced the great support she received from her husband and friends and, in 2009, dove head on into a long-term art project with her colleagues. It has since been completed and has been exhibited in several states, as well as in Russia.

Limited Research

There has been some research into the idea of spontaneous or radical remissions, although it is limited. In 1993, the Institute of Noetic Sciences published Spontaneous Remissions: An Annotated Bibliography, which catalogued the world's medical literature on the subject. It included references to cancer and a wide range of illnesses — from ulcers to injuries caused by gunshots. It is essentially the largest database of medically reported cases of spontaneous remission in the world, with more than 3500 references from more than 800 journals in 20 languages.

Some research in this area has been conducted by Moshe Frenkel, MD, from Integrative Oncology Consultants, who is a clinical associate professor at the University of Texas Medical Branch in Galveston.

"The issue of exceptional patients has been an interest of mine for over 20 years. I have met hundreds of patients that fit the criteria in the medical arena," he told Medscape Medical News.

He is currently summarizing data for a study of exceptional patients from a population registry in Israel and documenting "lessons as perceived by these patients about their unusual recovery." He plans to submit the research for publication.

In earlier work tracking exceptional patients, Dr. Frenkel found that they were not using complementary therapies to extend their survival. "That means they did not use a magic alternative medicine cure to obtain their recovery," he said. "In the current study, we have similar findings, but also additional points that were found in the previous study and were not emphasized enough."

In one study of 14 medically exceptional outcomes, Dr. Frenkel and colleagues found that the overarching theme was connections, both internal and external (Palliat Support Care. 2013:1-8). Internal connections include relationships with God or a higher power and with oneself. The external connections include relationships with friends and family, with the medical system (physician, nurses, and other staff), and with other patients.

In another study, Dr. Frenkel's team interviewed 26 exceptional patients (14 from the United States and 12 from Israel) and found that personal activism was a recurrent theme (Support Care Cancer. 2011;19:1125-1132). This involved taking charge and getting involved in the process of diagnosis and treatment and becoming more altruistic in their relationships with others. In many cases, this activism reflected a change in the patient's philosophy of life.

For Baltzell, cancer changed her life for the better. "I think the cancer introduced a sense of fearlessness in me," she explained. "I am grateful that it happened, as I would have been a completely different person — less engaged, less passionate. It really upped the ante for me."

She doesn't know why she has beaten the odds. She said she will continue to listen to her doctors and follow her own intuition.

Dr. Turner is continuing her research and following up with the 200 people she interviewed. She has created the Radical Remission Project Web site, where people can post their stories and share their experiences.

Longevity in Advanced Cancer Attributed to Relationships

Medscape Medical News > Oncology
Longevity in Advanced Cancer Attributed to Relationships

Roxanne Nelson
July 08, 2015



Relationships trump treatment when it comes to beating the odds in advanced cancer, at least according to one small group of patients who have far outlived their prognoses.

Fifteen patients with advanced lung or pancreatic cancer attributed their longevity to their relationships with their doctor and their family, rather than the type of treatment they received.

An article outlining their cases was published online in Future Oncology. Although most of the patients in this small cohort used some form of complementary and alternative medicine, they did not consider it to be a main cause of their survival. Rather, the main recurrent themes in most of the interviews were patient–doctor communication, family support, and the patient's proactive attitude in accounting for their remarkable survival.

"This study emphasizes two main factors in survival," said lead author Moshe Frenkel, MD, clinical associate professor at University of Texas Medical Branch, Galveston, and director of the integrative oncology service, Meir Medical Center, Kfar Saba, Israel. "First, being active and involved in the care of each patient is extremely important, and second, having a unique physician that can think out of the box can be a major factor in survival of cancer patients."

A crucial observation is that although most of the patients in this group used complementary therapies as additional options of care, they not did perceive this to be a major contributor to their survival. "This was an important point, as most people look for a magic wand that would clear the cancer and get them back to normal life, but this was not the case," Dr Frenkel told Medscape Medical News.

Cases in which patients have an exceptional disease course and experience spontaneous regression of cancer have been well-documented, but the research that has examined these stories has been limited and largely incapable of providing a satisfactorily clear explanation. "Most articles are based on anecdotes and not on systematic research, and it is very hard to make conclusions when information is coming only from anecdotes and case reports," said Dr. Frenkel.

Different Mechanisms and Common Themes

Some studies have focused on a wide array of possible physiologic factors and psychological mechanisms. Other research has observed that some patients have undergone some kind of spiritual awakening before their disease remission occurred, suggesting that the patients themselves had an important role in the healing process. In her book Radical Remission: Surviving Cancer Against All Odds, Kelly Turner, PhD, analyzed more than 1000 cases of spontaneous remission and identified more than 75 different healing factors that patients used to help heal themselves. As previously reported by Medscape Medical News, nine factors stood out and were used by almost all of the survivors. These key healing factors involved body, mind, and spirit interventions.

"Everyone has seen cases like this in their practice," Dr Turner told Medscape Medical News at the time. "Yet few have ever investigated them."

One such investigation, undertaken as a collaborative effort between the University of Texas MD Anderson Cancer Center, in Houston, and Israeli researchers, identified 26 "exceptional" patients. Interviews with this cohort revealed several common themes: activism, open communication with physicians, support from family and friends, and belief in a higher power (Support Care Cancer. 2011 Aug;19(8):1125-32).

However, one of the weaknesses of that study was that the true occurrence of these patients among the general population was not reflected in the small sample size, and another limitation was the selection bias, because the patients were identified by their treating physicians, according to the authors.

Hardship and Gratitude

In the current study, which was conducted in Israel, Dr Frenkel and colleagues identified exceptional patients through a computerized population registry system that is part of the Israeli healthcare system. This allowed them to ascertain the true occurrence of these patients with specific cancer types that are associated with a very poor prognosis. This registry accurately tracks patients' medical care, and patients cannot disappear from the system.

There was also no mistaking the diagnosis, nor were the problems involving incomplete information on the patients. "We had access to the full medical records with all conventional workup and verification of diagnosis utilizing objectives measures, all after complying with the institutional review board and local regulations," he explained.

A total of 23 patients with advanced lung or pancreatic cancer were identified through the regional computerized registry. These patients were given an expected 5-year survival rate of less than 15%. Of this group, 15 participants agreed to be interviewed (nine women and six men).

Eight of the patients had advanced lung cancer; seven had pancreatic adenocarcinoma. The mean duration of their survival since diagnosis was 8.2 years (range: 5 - 15 years). The average age was 70 years, and all patients had received conventional treatment, including surgery, chemotherapy, and radiation therapy.

The authors note that many of the patients could not see themselves as either past the disease or cured. "For many of these patients, who still suffer from symptoms of cancer and from deterioration in their functioning, the definition of survivorship can only be understood literally: that is, not having perished, but certainly not in terms of having won the battle with the disease," they write.

But still...all were very grateful that they were still alive. Dr Moshe Frenkel


But because many of them were elderly, it was somewhat difficult to disentangle the effects of cancer and of aging on their functioning. Some of the patients found their longevity to be a burden, because they were still alive but not healthy. "Some of these patients survived the disease, but with a cost," said Dr Frenkel. "But still...all were very grateful that they were still alive."

Three Underlying Components

The most prominent theme was the patient–doctor relationship. The authors point out that the typical account emphasized the roles of the "bad" (or vilified) physician and the "good" (or idealized) physician. The "bad" physicians, according to the patients, were those who lacked the proper vision to make an accurate diagnosis or who were rude, dismissive, arrogant, or disrespectful.

Conversely, the "good" physician were portrayed as something of a savior. They were described as being omniscient, omnipotent, benevolent, engaged, sensitive, and decisive.

Family support was also one of the strongest themes among patients and was acknowledged by all but two participants. Family members boosted morale, helped financially, helped with logistics, such as driving the patient to the doctor or hospital, provided medical advice in cases in which the family member was a healthcare professional, and used personal connections to further care (knowing someone in a key or important position).

The third component was having a proactive attitude, and that manifested in many ways, according to the patient interviews. Some patients got second opinions, they asked for advice from lay people, such as friends, neighbors, and family, and they turned to the private healthcare sector (after being dissatisfied with the public services). Some went abroad for treatment, changed physicians, pressured their doctors to get more tests and further the diagnosis and, at times, openly questioned the diagnosis.

A seeming drawback to the study is the small population in Israel and thus a small patient sample. But Dr Frenkel pointed out that conducting the study in a country with a small population is actually an advantage. "It is very hard to track patients in a big country," he said. "This is where the big advantage and not the drawback of having a small country, where identification and follow-up is more accessible and easier to follow. So far, this format of study was done only in Israel."

He and his coauthors note that further research is needed to determine the true frequency of these outliers, the types of cancer these patients have, and the characteristics they might share.

The study was funded by the Reliable Cancer Therapies Fund (Verbier, Switzerland) and by Clalit Health Services (Israel). The authors report no relevant financial relationships.
Future Oncol. 2015;11:1741-1749. Abstract

ASCO: Obesity and Cancer

American Society of Clinical Oncology Position Statement on Obesity and Cancer

Jennifer A. Ligibel⇑, Catherine M. Alfano, Kerry S. Courneya, Wendy Demark-Wahnefried, Robert A. Burger, Rowan T. Chlebowski, Carol J. Fabian, Ayca Gucalp, Dawn L. Hershman, Melissa M. Hudson, Lee W. Jones, Madhuri Kakarala, Kirsten K. Ness, Janette K. Merrill, Dana S. Wollins and Clifford A. Hudis

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Author Affiliations

Jennifer A. Ligibel, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, National Cancer Institute, Bethesda, MD; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Robert A. Burger, University of Pennsylvania, Philadelphia, PA; Rowan T. Chlebowski, Harbor–University of California Los Angeles Medical Center, Torrance, CA; Carol J. Fabian, University of Kansas Medical Center, Westwood, KS; Ayca Gucalp, Lee W. Jones, and Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Melissa M. Hudson and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN; Madhuri Kakarala, Van Andel Institute, Grand Rapids, MI; and Janette K. Merrill and Dana S. Wollins, American Society of Clinical Oncology, Alexandria, VA

Corresponding author: Jennifer A. Ligibel, MD, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02155; e-mail: jligibel@partners.org.

Abstract

Rates of obesity have increased significantly over the last three decades in the United States and globally. In addition to contributing to heart disease and diabetes, obesity is a major unrecognized risk factor for cancer. Obesity is associated with worsened prognosis after cancer diagnosis and also negatively affects the delivery of systemic therapy, contributes to morbidity of cancer treatment, and may raise the risk of second malignancies and comorbidities. Research shows that the time after a cancer diagnosis can serve as a teachable moment to motivate individuals to adopt risk-reducing behaviors. For this reason, the oncology care team—the providers with whom a patient has the closest relationships in the critical period after a cancer diagnosis—is in a unique position to help patients lose weight and make other healthy lifestyle changes. The American Society of Clinical Oncology is committed to reducing the impact of obesity on cancer and has established a multipronged initiative to accomplish this goal by 1) increasing education and awareness of the evidence linking obesity and cancer; 2) providing tools and resources to help oncology providers address obesity with their patients; 3) building and fostering a robust research agenda to better understand the pathophysiology of energy balance alterations, evaluate the impact of behavior change on cancer outcomes, and determine the best methods to help cancer survivors make effective and useful changes in lifestyle behaviors; and 4) advocating for policy and systems change to address societal factors contributing to obesity and improve access to weight management services for patients with cancer.