Wrestling with the "What ifs"

CURE magazine invited Charlotte Huff, a regular contributor and author of "Lung Overdue," to share her own experience about the disease. For nearly two decades, medical studies have crossed my desk, first via fax and now e-mail, dozens each week. Occasionally I see one that refuels my "what if" uncertainties, that unsettling line of thinking likely familiar to anyone who has lost a loved one to cancer. What if my mother's lung tumor had been treated differently? Or more to the point: what if doctors knew then what they know now?I've reported on medicine to some degree, sometimes exclusively, since 1991. But there's one subject I've tended to avoid, as much as feasible. Writing about lung cancer revisits my mother's journey: her surprise and (to some extent) lucky diagnosis and her sudden decline six years later. Still, it's difficult to ignore emerging research without wondering if different treatment, different timing, might have mattered.Since my mother smoked, she avoided doctors. But she was forced to seek help when a goiter erupted in her neck, seemingly overnight. The cause: an overactive thyroid. She underwent surgery to remove it. It wasn't until she was recovering that a doctor shared the other news. A chest X-ray, part of the pre-surgical workup, had identified a worrisome spot on her lungs. She was 45 years old.In 1989, surgery was pretty much the only option. One of her lobes was removed. The tumor was localized; pathologists couldn't find any sign that the adenocarcinoma had spread. It was the summer after my junior year in college. I came home to help my mother recover, to change her dressing, to keep her from becoming too winded as she regained her strength. She sought a second opinion at an academic medical center in nearby Washington, D.C. Nothing else could be done, she was told. Nothing. With localized lung cancer, chemotherapy was not recommended. She could only recover and wait.It's hard not to think about my mother, as various studies about non-small cell lung cancer cross my computer screen. And I thought about her again, and about how much treatment has changed, when I wrote an article for CURE last fall about multi-disciplinary care ("Meeting of the Minds"). One of the patients I'd interviewed had been diagnosed with stage 3 non-small cell. He soldiered through a battery of treatment, including pre-surgical chemotherapy to shrink the tumor, followed by weeks of chemotherapy and radiation afterward. My mother was relieved to be given a pass on chemotherapy. But could it have saved her life? In the last several years, the studies I read also identify a shift in the treatment of non-small cell malignancies diagnosed at the earliest stages, more similar to my mother's. Several studies, including an influential New England Journal of Medicine study published in 2005, determined that chemotherapy can significantly extend survival time in early-stage lung cancer beyond surgery alone. At five years, the survival rate was 69 percent compared with 54 percent in those who only had surgery.I suggested to my CURE editors that I write an update on lung cancer, in part to lay my own uncertainties to rest. As occurs often in medicine, though, no such easy salve was available. Yes, if my mother were diagnosed today, chemotherapy might be suggested. But a 15 percent survival difference doesn't answer the question of whether it would have mattered for her, or whether she would have lived more than five years.As I said, my mother was in some senses lucky. Her freak diagnosis bought my family six years. She quit smoking. My sister and I graduated from college. Through the years, she returned to the academic medical center for regular scans, more imaging tests than she could count. Cancer started to fade from our immediate consciousness. (But likely it never vanished from hers.) Until one day in 1995, she called her family doctor. By then, the cancer was scattered, so diffuse that the autopsy report, sent after her death, couldn't conclusively say it was a recurrence. After the funeral, I flew back to South Texas and my daily newspaper job, reporting on medical news.As someone who makes my living absorbing and translating information, I well know that medical knowledge can present that proverbial double-edged sword. It can illuminate, but it also can tease. If the timing were different, my mother might have lived long enough to meet my husband and my son. Or perhaps that belief is less based on science and more on wishful thinking. Charlotte Huff, who lives in Fort Worth, Texas, frequently writes for CURE. Check out her work at www.charlottehuff.com.