Ghosts
2006; Wolters Kluwer; Volume: 28; Issue: 20 Linguagem: Inglês
10.1097/01.cot.0000295287.82395.14
ISSN1548-4688
Autores ResumoDo you believe in ghosts? I do. So does Tina Marie. I'm far from home and all alone when I participate in my first clinical trial. Dropping my guard one day, I tell the research nurse, Tina Marie, about my ghosts. After that, at every visit she asks about them, even though she can never see them or talk to them. Tina Marie always refers to them individually, knowing that ghosts, like pets and boats, have given names. That she dares to veer from the science of my disease into delicate non-medical talk makes me feel understood in a way that addressing my disease doesn't. Ghosts come in all shapes and sizes. Do you remember Casper, the friendly ghost of children's television? In one episode, Casper meets Wendy, the good little witch. Together, they conquer evil. Maybe it's because my name is Wendy that most of my ghosts are like Casper. But the reality is that loitering around the cancer clinic are terrible ghosts, too.Figure: Wendy S. Harpham, MD is an internist, cancer survivor, award-winning author, and mother of three. Her books include “Diagnosis: Cancer,” “After Cancer,” “When a Parent has Cancer,” (selected as the #1 Consumer Health Book of 2005 by American Journal of Nursing), and, most recently, “Happiness in a Storm.” She lectures to professional and lay audiences on a wide range of issues centering around “Healthy Survivorship,” including recovery and late effects after cancer, raising children when a parent has cancer, clinical trials, and finding happiness in hard times. Further information about Dr. Harpham and her work is available at www.wendyharpham.com.I know you're probably going to think I've gone off the deep end when I tell you this: Ghosts are helping me and my doctors make my hardest treatment decisions. This first happens quite unexpectedly when I'm facing an agonizing choice: bone marrow transplant or a clinical trial of immunotherapy. Transplant offers an excellent chance of remission, and everyone's hoping the treatment will prove curative. But, in fact, it will take a few more years before anyone knows how long these remissions might last. It seems that soothsayers, not scientists, are needed if I want a clear-cut best decision. Suddenly good ghosts are swooping over-under-and-around to support me, as they always do when I'm struggling. I realize most ghosts know nothing about cancer treatments, and all suffer blindness when it comes to foreseeing the future. Yet a few special ghosts have the power to advise me. And I have the obligation to listen. Three little ghosts lean in close as my oncologist outlines my options. It's a faint feeling: “Not yet.” My sixth sense notes the little ones' votes: “Temporize with less toxic treatments, unless transplant gives you an excellent chance of cure or is your only hope.” With my three young children in mind, I enroll in the trial. Once treatment begins, all my ghosts zoom into high gear. Some of my ghosts—Boo!— scare me when I'm in the middle of having fun or finally settled down. Others—Whoosh!—carry me when my legs are oh-so-weary. I suspect they get a charge out of changing my world with a wink or blink. At times, my ghosts' voices sound so clear in my ear that I swear I can reach out and touch them. Usually they make their presence known only by a rising courage in my chest, like water filling a jug. I lie down for a scan or a needle or a knife, and I sense them shushing me to lie still and insisting I hold onto hope. Thirteen years later, this is what I know: Along with good care and good luck, it helps to have good ghosts. And bad ghosts get in the way. Patients come to your office, all alone. But patients are rarely alone. Each brings a lively entourage of ghosts. Can you see them? Can you hear them? Spirits. Specters. Call them what you will. If you look, you'll see how they hover around patients, especially at checkup time. Double-especially when patients are hurting or making treatment decisions. “How are you feeling?” you ask. Your patients may or may not tell you everything, as their spirits—their ghosts—move them. A stoic says, “I'm fine,” to keep from coming home with scan requisitions that would worry loved ones. A reluctant self-advocate self-consciously unfolds his list, having promised loved ones he would. A frightened patient remains silent, paralyzed by vivid memories of a loved one's miserable cancer death. You examine your patient's belly. Some patients relax, soothed by the ghosts of people who are watching the clock at work, ready for whatever news. Other patients tense up, troubled by the ghosts of loved ones who are at home, poised to fall apart (or walk away) if the news is bad. Still others wince, not from physical distress but because they have loved ones—in nearby nursing homes or with babysitters—who need them and can't understand any news. Surviving cancer is a spiritual journey. Health care professionals can help patients harness the power of the good ghosts and flush out the bad ones. Whatever you do, don't be afraid of ghosts. Head & Neck Cancer Model with Complete Penetrance Created A new mouse model for head and neck cancer is the first to demonstrate 100% penetrance, researchers reported in Genes & Development (2006;20:1331–1342). “It mimics several common molecular alterations in human head and neck cancer, so this will be a very good model or tool to screen for common therapeutic approaches or novel therapeutic approaches,” senior author Xiao-Jing Wang, MD, PhD, Professor in the Department of Otolaryngology at Oregon Health & Science University Cancer Institute, explained in an interview. Dr. Wang and colleagues reported that overexpression of K-ras or H-ras and loss of the transforming growth factor-beta type II receptor commonly occur in human head and neck squamous cell carcinoma. To create the mouse model, they activated either K-ras or H-ras and deleted the TGFBR2 from mouse head and neck epithelia to cause head and neck cancer with complete penetrance, some of which progressed to metastases. The pathology of the tumors was indistinguishable from that of human head and neck cancer. The researchers also reported that elevated endogenous TGF-beta type I in the lesions contributed to inflammation and angiogenesis, leading the team to conclude that a two-pronged approach of targeting common oncogenic pathways in tumor epithelia while blocking the effect of TGFB1 on tumor stroma could represent a novel therapeutic strategy for head and neck cancer. The study supported TGFBR2 as a prognostic indicator, Dr. Wang said. “If the tumor head and neck lesions have loss of TGF-beta type II receptor, they will have poor prognosis.”
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