The puzzle of cancer recovery.

DOI: 10.1200/JCO.2014.57.5233 Recovery from cancer, or the chemotherapy used to treat the disease, can take longer than the time necessary for your hair to grow to a length that it can be styled again. I first met my patient when she was diagnosed with acute leukemia and initiated chemotherapy as an inpatient. She was wearing a shirt with The Clash on it, and we quickly bonded over similar musical tastes. Like me, she was in her forties. She had also recently remarried, and she and her husband had each brought children from previous relationships to create what she called a Brady Bunch family. During the first few days of the new reality of her cancer, she asked me how long she would be hospitalized and when she could work again. There were a lot of mouths to feed, extracurricular activities to support, and substantial medical expenses to address. Her vacation days were limited, and the Family and Medical Leave Act regulations provided no income. “All told, it’ll probably be six months of treatment for your leukemia before you can return to work full-time.” I said to her. I sat in a chair across from the hospital bed she was sharing with her husband. They held hands, and I noticed that their wedding rings still had that pristine, just out of the box look of the newly wed. She shook her head. “I don’t see how we’re going to swing this.” “We’ll work it out. Just focus on getting better,” Her husband reassured her, although he didn’t quite meet her eye. It was the right thing to say, but like her, he was dubious about how they would cope with their rising expenses. She survived her initial 4-week treatment course and was discharged home. As additional tests came back, we learned that she actually had a goodrisk leukemia, as ironic as those words seem next to each other. Although fevers and their requisite hospitalizations interrupted her postremission therapy, she almost willed her blood counts to recover on schedule. I admired her focus on getting through these treatments, although I worried that she viewed her treatments and her diagnosis as inconveniences and wasn’t getting through the Kubler-Ross stages to make it to acceptance. Because she showed little emotion and was the type of person you might describe with the phrase “still waters run deep,” I learned to probe her feelings cautiously, lest she close off entirely. Her husband came to many of her appointments, but when he wasn’t there, she talked about how her lack of income was affecting their relationship. “He didn’t sign on for this,” she told me more than once, shaking her head in disappointment. “Stupid leukemia.” I hated to see her attack herself, as if she somehow could have stopped her cancer from occurring. I tried to catch her eye, to connect with her on a level that went beyond the medical details. “What are you worried about?” She adjusted the scarf on her head and then focused on her Skechers as she talked. “I know in wedding vows you say ‘in sickness and health,’ right?” She said. I nodded. “It’s just not supposed to happen this soon. Things were starting to get better for me and the kids finally. We’re all settled. We have a new house. And then ... this.” “There’s nothing you could have done to prevent the leukemia,” I tried to reassure her. I had the sense she blamed herself for a lot of the wrong turns her life had taken, including her illness. “And you two seem really strong. You’re lucky to have each other. You can make it through the treatment, and then it’ll be a distant memory.” I didn’t know all the details, but I had heard she had been in a rough relationship before. In truth, I was concerned and had started to see fissures in how she and her husband treated each other. He had come to fewer and fewer appointments and now often sat across the examination room from her. They had started to argue openly. She didn’t answer but finally gave me a look as if to say, “If only you knew.” “How much longer before I can get back to work?” She asked again. She was sitting in one of our clinic’s teal infusion chairs, getting a blood transfusion after her final cycle of chemotherapy. “As soon as your blood counts recover and you feel up to it,” I answered. “You may want to start out part-time though. We’ve put you through a lot, and you might be more debilitated than you think.” JOURNAL OF CLINICAL ONCOLOGY A R T O F O N C O L O G Y VOLUME 32 NUMBER 27 SEPTEMBER 2