Dressed in a sport jacket and blue jeans, the 90-year-old man walked with slow but determined steps into the crowded room. He had recently undergone surgery to remove a tumor from his liver. Former President Jimmy Carter announced to the world that his doctors have also found cancers in his brain.
A diagnosis of cancer is big deal, but having it go to the brain can be even more terrifying. Too many things can go awry: debilitating headaches, nausea and vomiting, blindness, seizures, and a slew of other issues. But some of the cancers can be treated. In addition, with help from the right professionals such as palliative care specialists, many of the symptoms can be controlled.
Carter plans on receiving a special kind of radiation to his brain, called stereotactic radiotherapy. Luckily, Carter’s cancer, melanoma, is one that responds well to radiation. Stereotactic radiotherapy involves applying pinpoints of beams to the individual spots of cancer, rather than radiating the whole brain.
“This type of treatment is good for brain cancers that are quite small and are very few in number,” said Dr. Virgilio Matheus, a specialist in brain and spine surgery at Southeastern Health in Lumberton.
But there can also be side effects, such as bleeding and damage to sensitive nearby vital structures. For some brain cancers, surgery may be the better option, said Matheus.
Carter will also receive chemotherapy. Again, he seems to be lucky in that regard.
“The latest big progress in treating cancers is with melanomas,” said Dr. Maleka Ahmed, a specialist in the care of cancers and blood disorders at the Gibson Cancer Center in Lumberton, an affiliate of Southeastern Health which partners with Duke Medicine for medical oncology services.
But there is little likelihood that Carter’s cancer will be completely cured. Hopefully, treatment can add months or even a few years to his life. During that remaining life, in addition to his cancer doctors, he could be well served by other professionals.
“When cancer has spread to the brain and liver like Jimmy Carter’s, it’s hard to expect total cure — he will also need palliative care,” said Ahmed, who is also board certified in hospice and palliative care.
Palliative care takes into account the whole person with critical illness, such as metastatic cancers and advanced heart, lung and other conditions. The former president will need support to control his physical symptoms, such as headaches, pain and nausea. He was an active man, so his social situation must be considered as well. Carter will also require emotional and spiritual support.
These are what the team of palliative care doctors, nurses, chaplains, and social workers are especially trained to do — look at the total person, not just their disease. And those under palliative care can still pursue many treatments to manage their conditions.
Carter has not made public if he has formally seen palliative care specialists, but I am certain these professionals will in one way or another be part of his overall care. His doctors may even guide him towards hospice-like care when the time is right.
Born and raised in a small town, a former farmer and deeply spiritual person, the former commander-in-chief seems ready for the biggest and final fight of his life.
“I’m ready for anything,” Carter said. And “my message is one of hope and acceptance — hope for the best and acceptance of whatever is coming.”
Dr. Godfrey Onime is the medical director of Southeastern Hospice and Palliative Care programs.