Cancer and hope

By Ruth Laugesen In Commentary

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No one knows better than investment banker Rob Cameron how quickly a life can flip. Last October, Cameron, 61, began the day apparently fit and healthy apart from a very sore thumb.

But the routine medical appointment at 10.00am to look at his thumb had by day’s end escalated into an x-ray, then another x-ray, then a full body CAT scan. By 4.00pm, Cameron was staring at a scan showing a lesion on his left lung. The inference was clear: cancer had travelled from his lungs to the bone in his thumb, and was now circulating throughout his body.

Five days later at Auckland’s Mercy­Ascot Hospital, Cameron went through a full PET scan, which produces a grey and black image of the body, with active tumours glowing in yellow and red. “It lit up like a Christmas tree,” says his oncologist, Dr Richard Sullivan. “He had spots of tumours all through his bones like lights. They were everywhere. More than you could probably count.” Without treatment, he could expect to live perhaps five months. He had metastatic lung cancer, despite never smoking, or living in a smoky environment.

By late March, Cameron had won an important battle in what may well be a long campaign. Not only had he survived to enjoy his daughter Emma’s wedding, but he was in complete remission with no detectable cancer in his body. The results, says Sullivan, are “unusual … He has done remarkably well.” But, Sullivan says, Cameron knows “that sometime in the future, hopefully a long, long way away, the lights will come back on again”.

Cameron is attributing his remission not just to three rounds of chemotherapy and Sullivan’s care in the private health system, but to an intensive regime of diet, meditation, visualisation and exercise to help his healing. The support of family and friends has also been crucial. When we meet at his home in Wellington’s Wadestown, Cameron, fresh from a meditation session, is drinking green tea. It’s no exaggeration to say he looks radiant. Cameron says his new regime left him feeling profoundly well – even before he got news he was in remission.

“It wasn’t until I got my CAT scan that I could say what I really wanted to say, which is I feel the best that I’ve felt in 30 years. I was feeling fantastic, as well as I could ever remember.”
Is Cameron on to something? Could cancer patients boost their chances by a regime that emphasises healthy eating, a calm mind and a fighting spirit? How much of it is about the healing power of hope? Or is cancer just an awful, mysterious lottery in which only the doctors can improve the odds?

Cameron was never going to take a diagnosis of metastatic cancer lying down. He is one of the country’s top tier of business leaders, the founder of investment banking firm Cameron Partners who was tapped by Labour and later National to take part in powerful working groups. He headed the Capital Market Development Taskforce, which reported in December 2009, and was a member of the Tax Working Group, which reported a month later.

For all the accolades that came Cameron’s way after the work, the load was part of an approach to life he thinks gave him cancer. “In the two or three years up to my diagnosis I put myself through a lot of pressure. Frankly, I knew I was fatigued. The Capital Market Taskforce was a huge commitment, and I did it because I thought it would make a difference. But it isn’t just one event or two events – it was the way I was living my life.”

He loved his work, but he habitually “pushed through” fatigue, and lived on adrenalin. Working in a highly competitive industry, Cameron had learnt pressured habits that kept his nervous system on continual alert. He used to feel tense even when he went to the supermarket. Exercise was another way to test himself – he would exercise “to the point of pain”. “My idea was you could be bulletproof as long as you exercise like a madman.”

Cameron ignored the warning signs of his cancer, like the tingles in his bones that he mistook for the aches and pains of ageing, but which were in fact metastases at work in the bones of his spine, ribs and shoulder.

Even though Cameron comes from the orthodox world of business and banking, the grim prognosis for his disease meant that after diagnosis he began looking outside the medical establishment for extra help in battling cancer. In addition to conventional medical treatment consisting of chemotherapy, Cameron and wife Maureen headed across the Tasman to a leading centre for complementary therapies for cancer, the Gawler Foundation. The foundation stresses a healthy diet, high in fruit and vegetables and wholegrains, relaxation and mediation, and well-being for “the body, emotions, mind and spirit”.

For the first time in his life, Cameron discovered what it was to relax. “No longer do I spend most of my time tense here,” he says, pointing to his stomach, “tense, ready to act.”

Cameron’s diet had already been healthy, but under his new regime he eats no refined foods (such as white flour, white rice or white sugar), no salt, plenty of fresh fruit, vegetables and wholegrains, a little fish for omega-3, very little red meat, no processed meats, some dairy products (such as probiotic yoghurt), and plenty of soy products such as soy milk and tofu. Most nights he has a glass of red wine.

Breakfast might be rolled oats, fresh fruit and yoghurt. He makes two or three vegetable juices a day, which always include fresh garlic, a teaspoon of turmeric and pepper. Cameron’s particular food regime reflects a growing interest in the role of inflammation in cancer, and foods like green tea and turmeric show promise for their anti-inflammatory properties.

Cameron also favours garlic, leeks, onions and vegetables from the cruciform family (cabbage, brussels sprouts, broccoli and cauliflower) for their potential role as anti-cancer agents. There are a host of others favourites, too – including darker-coloured berries, such as raspberries and blackberries. Cameron says his extensive reading suggests variety is ­crucial.

Cameron’s oncologist has encouraged his search for more answers outside conventional medicine. As well as maintaining a rigorous diet, Cameron meditates daily, using mindfulness techniques that focus on intense awareness of the body.

He has a daily walk or gym session. But now his workouts are kinder. And after exercise he spends time visualising his body healing, “telling my body that my immune system is going to work better”.
A man used to a sense of control over his life, Cameron is seeking to find that sense of control with cancer. He remembers seeing other patients, receiving their chemotherapy who “were victims, lying on their backs … You could see they were hoping desperately it would work. Whereas to me it was an engagement process.”

He decided to look forward to chemotherapy, seeing the toxic brews as his friend, and would sit in a chair. Each visit, he would spend more than an hour visualising the drugs making his body inhospitable to cancer.

We know, though, that cancer is a powerful foe. Is there a danger of hubris, of pretending greater control than he really has? Cameron pauses. “Yeah, there is. My oncologist was concerned about that when I got the result, and he’s very concerned that there’s a danger here that people can feel bulletproof again, and then they’ll fall off the bus. I’ve got to stay in control. I know absolutely that if I’m not disciplined around the things I do, whatever good outcomes I’m achieving will be worse.

“I haven’t beaten lung cancer. I know it’s there, I know it’s likely to show again. I’m not being unrealistic about that. But I know I’ve got a lot more options to manage it, and I’ve learnt something about myself and I’ve learnt a lot about my choices for managing it. That’s the insight I’ve got to stick with, not that I’ve developed a killer app.”

He speaks of having put fear and anxiety to one side. He certainly looks robustly confident, like a man who’s dodged a bullet. But when his wife comes in, she looks drawn and anxious. “It’s hard to stop worrying. It’s easier being the patient,” Maureen says. She must keep the fridges stocked with the bags of vegetables for the ever-hungry juicer, and work out appetising things to do with brown rice

As most of us know, there is now a mountain of evidence that a Mediterranean-style diet heavy in fruit, vegetables and grains and low in saturated fats lowers the risk of getting cancer, as does regular exercise. But is there any evidence that diet, exercise and other non-medical measures can improve the odds of recovery from cancer?

Professor Lynnette Ferguson, head of nutrition at the University of Auckland’s medical school and an expert on cancer and nutrition, says good diet is “absolutely vital” in recovery from cancer, both to boost the immune system and help wound healing.

“There is evidence that certain foods may have benefits, but the strong evidence is that you want a mixture of things. So I do worry about these superfoods and people who are convinced that if broccoli is good for them they ought to be eating it morning, noon and night. And displacing other items of the diet.”

Although population studies have shown a Mediterrean-style diet lowers the risk of cancer and heart disease, the exact mechanisms are not known. Whereas vitamins and minerals were once thought to be the key to health, now a host of other food elements are being recognised as working together, including plant pigments, antioxidants, anti-inflammatory agents and omega-3.

Ferguson recommends those recovering from cancer rigorously follow a conventional healthy diet. But she says the evidence that this will change the course of the disease “is slightly less direct than I would like” at this point. “The evidence is indirect at the moment that it may be beneficial in some types of cancer, [that] it may be helping slow things down.” The most promising research so far is in prostate cancer, where a range of studies suggest a very healthy diet slows progression of the cancer.

“And in terms of meditation, if you can clear your mind of panicking – stress is certainly a factor in the development and progression of cancer.”

With food, increasingly researchers are realising that extracting individual elements from a healthy diet and taking them as supplements doesn’t prevent cancer or help recovery from it, and may even be harmful. Another expert on cancer and nutrition, University of Otago head of nutrition Professor Murray Skeaff, says a decade ago excitement was high about the potential for antioxidants to fight cancer. It was thought perhaps antioxidants were the active ingredient in fruit and vegetables that produced lower cancer rates for those with healthy diets.

Rob Cameron in 2006 before his diagnosis, photo/APN

Research money gushed into a huge number of trials using high-dose anti­oxidant supplements. But once the results from all the trials had been number-crunched, the overall picture was worse than disappointing. The results suggested high doses of antioxidant supplements can actually increase the risk of some cancers. Unsurprisingly, antioxidants are no longer “hot” as an area of research.

“It’s really caused people to rethink, that maybe it’s not the antioxidants, maybe it’s the fruit and vegetables themselves,” says Skeaff. “They contain a range of compounds and bioactive ingredients. There are a range of compounds that help the body to detoxify carcinogens, get rid of carcinogens.”

The failed promises of supplements aren’t limited to antioxidants. High doses of beta-carotene have been proven to increase the risk of lung cancer in smokers.

Weighing up all the claims is not easy. Internationally, the World Cancer Research Fund provides the most rigorous assessment of the evidence on healthy food and lifestyle and their effect on cancer. In its most recent report, it concludes that for cancer survivors, the research is still sketchy on what difference diet might make. “It is of variable quality; it is difficult to interpret; and it has not yet produced impressive results.” However, the fund does say there is “growing evidence” that physical activity and other measures that control weight may help to prevent cancer recurrence, particularly breast cancer.

The research fund recommends that cancer survivors follow the same healthy diet and lifestyle recommended for cancer prevention. That is: be lean; be physically active; limit consumption of energy-dense foods and sugary drinks; eat mostly foods of plant origin; limit intake of red meat and processed meats; limit alcoholic drinks; limit consumption of salt; don’t take dietary supplements; and mothers should breastfeed.

In the arena of support groups and psychological treatment, Dr Elizabeth Broadbent, senior lecturer in psycho­logical medicine at the University of Auckland, says “the jury is out”. Although such interventions improve the quality of life, “there’s not a lot of evidence that they can improve outcomes from cancer, like survival”. Hopes were raised in 1989 when the Lancet published a study by American psychiatrist David Spiegel that showed women with metastatic breast cancer who took part in support groups lived 18 months longer than those who did not take part in the groups. However, says Broadbent, subsequent studies have failed to reproduce his results.

But despite the patchy findings on complementary approaches, Cancer Society medical director Dr Chris Atkinson, says patients are not helpless in all this. “There’s a huge body of evidence to suggest the things you do for yourself help you cope with the cancer journey. They improve your quality of life and, if you do survive your cancer, probably prevent you getting other chronic illnesses.”

Visualisation, meditation, exercise “is all good stuff … People who are able to visualise and meditate often do get rid of a huge amount of stress, they feel better for it, they’re able to exercise more and they’re able to better accept the changes in their nutrition, so they often live better.”

However, the unfortunate reality, says Atkinson, is that cancer cannot always be vanquished. “The sad thing is you can have many patients who do everything right – they are positive, they accept all the orthodox therapies, they do things for themselves, complementary therapies – and they still die of a rotten cancer.” And too often, in these days where people are expected to not just endure cancer, but have the “right” attitude to it, those who succumb are quietly blamed for not ­fighting hard enough.

What patients do have control over, says Atkinson, is the maintenance of hope and meaning on their journey. How? “I think you mainly maintain hope by honesty. I think you can maintain hope until almost your last breath if you talk about the fact that you’re still making a difference to your community and your family. You maintain hope and meaning until you die.”

University of Otago associate professor David Perez is an oncologist known for his understanding of quality of life issues in cancer care. He says research suggests hope and a positive attitude improve the quality of life and psychological well-being, but do not actually, on average, extend life expectancy. “However, a sense of helplessness appears to be capable of shortening life.”

Rob Cameron’s oncologist, Richard Sullivan, says he believes it is critical for cancer sufferers to build their hope for the future.

“It’s a bit like building a wheel. The person is the hub, and they’re collecting spokes to make sure their wheel is strong to take them on their journey, wherever it’s going to take them to. Some of those spokes are obviously their chemotherapy, and their clinician, but other spokes are their family, their whanau, their diet, whatever else it may be.” Sullivan specialises in lung cancer, one of the most deadly forms, with only 10% surviving five years.

Does having a fighting attitude help? “I think it helps a lot. I feel very lucky to do what I do. I get to see people as they work out what matters to them and how they want to fight. But you don’t see that many miracles, sadly.”
Of the patients who do particularly well, is there anything they have in common? Biology comes into play, but so do attitude and determination. “This is just a personal view, but when people come and see you and are determined to maintain well-being, they still might live for only six months, but they may have only lived for two. The ones who come along and say, ‘I’m going to die from this, aren’t I, Doc’, then generally speaking they do.”

What about those who are not fortunate enough to be optimists? “My role is to stop you from giving up. One of the roles of the oncology team I believe is to try and find value for that individual on why you don’t give up. But if you’re giving up because that’s the right and rational thing to do, then support that and make that work.”

Rob Cameron in April 2011, photo/David White

Cameron says he doesn’t have the luxury of waiting for the evidence to come in, for the double-blind randomised control trials to tell him whether his morning vegetable smoothies with turmeric and garlic really will work. He has read widely the research there is, and feels well under his new regime.

“I live in a world where people make judgments in capital markets, where they get information from all over, and then they back themselves on it. Give me information and I’ll make judgments on it.”

But he is under no illusions. “This is a serious disease. A lot of things have gone my way. But all you can do is influence it at the margins, with a very big influence on the quality of life. But this disease can be cruel.”
Cameron’s words turned out to be all too true. As the Listener was going to print, Cameron told us the latest scan showed his cancer had returned, “mildly”. He is taking the next step in his treatment. He is among the 10-15% of lung cancer patients with a mutation that responds to a new chemotherapy drug called Tarceva, funded by Pharmac, which blocks the cancer for a year or longer.
The expectation, says his doctor, is Tarceva “will turn the lights off again”.

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