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The Truth About Cancer
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Watching: The Truth About Cancer

Chapter 3: Hope for the Best [5:59]

The latest news about Jamie's pancreatic cancer isn't good. Her doctor imagines what he would do in her situation.

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Transcript: Chapter 3 - Hope for the Best

JAMIE KLAYMAN: Hello.

ABBYE WARREN: Hello, how are you?

DAVID RYAN: Hey, crowded today, huh?

JAMIE KLAYMAN: Yes.

DAVID RYAN: Let me bring this in.

ABBYE WARREN: Do you need me to get up so you can sit down?

DAVID RYAN: No, I'll--let me grab another chair. Oh, I can grab this chair.

ABBYE WARREN: I'll move.

DAVID RYAN: We'll just switch around a little bit. Here, you can sit right there. That's fine.

JAMIE KLAYMAN: How's everything going with you?

DAVID RYAN: Good. So you're taking the Atavan as needed?

JAMIE KLAYMAN: I kind of take it, um, not every night, but sometimes if I feel like I need something just to kind of--if I'm too awake, and I'm not, you know, too wired at night, I'll take it to go, you know, try and go to sleep.

DAVID RYAN: Okay.

JAMIE KLAYMAN: But I have, yeah, plenty of that.

DAVID RYAN: Alright.

JAMIE KLAYMAN: How did the, um--how'd the scans look?

DAVID RYAN: The scans--overall, it's not great.

JAMIE KLAYMAN: Right.

DAVID RYAN: The, the CT scans--it's, it seems like the cancer is growing through the chemotherapy, which is unfortunate. We're kind of at the point now with the standard chemotherapy...

JAMIE KLAYMAN: That there's not...

DAVID RYAN: ...that, really, the reports of any of the other drugs working is mostly anecdotal; they rarely have a good effect on pancreatic cancer. I brought the, the scans in...

JAMIE KLAYMAN: Okay...Right.

DAVID RYAN: ...if you wanted to see them.

JAMIE KLAYMAN: Yeah, sure.

ABBYE WARREN: Oh, yeah.

JAMIE KLAYMAN: I don't, I mean, yeah, I'd like to look at them.

DAVID RYAN: We're seeing you this, straight up, your feet are out here, your head's in the computer, this is your right side, that's your left side, and as we come down, the first thing you'll see is the liver, right here, this big grey area.

JAMIE KLAYMAN: Right, yeah.

DAVID RYAN: And these dark spots...

JAMIE KLAYMAN: The dark spots...

DAVID RYAN: ...in the liver...

JAMIE KLAYMAN: Are the -- are the tumor.

DAVID RYAN: ...are the tumor, right?

ABBYE WARREN: Is that what--and it was there before. It's just gotten bigger?

JAMIE KLAYMAN: Yeah, these are all the same. They just get...

DAVID RYAN: They've all gotten a little bit bigger, and we can actually compare--makes it a little bit smaller, but--the bulk of the cancer that we can see is in the liver.

JAMIE KLAYMAN: Right.

DAVID RYAN: That's a pretty good sign that what you're doing isn't working.

JAMIE KLAYMAN: ...isn't working. Okay.

ABBYE WARREN: So, but there's--is there something else that you can do in its place?

JAMIE KLAYMAN: I was gonna say, so what's our next step?

DAVID RYAN: So (sighs)...

JAMIE KLAYMAN: Seeing more at the same spot we were before?

DAVID RYAN: We come back to that same spot, so let's go--so we've--let's go back to the beginning.

JAMIE KLAYMAN: Right.

DAVID RYAN: So, you were, when you were first diagnosed, we had three options:

JAMIE KLAYMAN: Yep.

DAVID RYAN: We said you could either do the standard chemotherapy;

JAMIE KLAYMAN: Right.

DAVID RYAN: ...you could do a clinical trial;

JAMIE KLAYMAN: Clinical trial.

DAVID RYAN: ...or supportive care, alone.

JAMIE KLAYMAN: Right.

DAVID RYAN: There's no right answer here. Um, ah, my bias -- you know, I'm in an academic center, um -

JAMIE KLAYMAN: Right, right, right. You're looking at, you know, I mean, the research element, and that's what...

DAVID RYAN: That's been my, it's -

JAMIE KLAYMAN: It's...

DAVID RYAN: ...it's basically what I've done, as -- in my academic career, is Phase I studies...

JAMIE KLAYMAN: Right.

DAVID RYAN: ...for the most part, and so my bias is -- has been that.

DAVID RYAN: But I've been doing this long enough to know that it's not the right thing for everybody.

JAMIE KLAYMAN: Mmhmm.

DAVID RYAN: And you have to decide where you want to go with this, at this point,...

JAMIE KLAYMAN: Right, yup.

DAVID RYAN: ...and it's more a philosophical decision. But we're at that point now where, um, I think that the available -- the existing drugs that we have to fight pancreatic cancer are, um -- are just not working.

JAMIE KLAYMAN: Right.

DAVID RYAN: I'm sorry.

JAMIE KLAYMAN: Me too.

DAVID RYAN: It's... it's a little awkward, in this case.

JAMIE KLAYMAN: (laughs) Yeah.

ALLIE HUMENUK: Do you want us to leave?

DAVID RYAN: Why don't you give us, uh...

JAMIE KLAYMAN: ...a couple minutes. Yep.

DAVID RYAN: Yeah, give us a couple of minutes. Thanks.

DAVID RYAN: I actually drive home at night thinking, "What would I do in that patient's situation?" So, I actually don't know what I would do, because some nights I drive home and I say, "You know, if I have pancreatic cancer, and it's metastatic, I might try a treatment or two to get me some more time with my kids." The problem with these Phase I trials is that we absolutely have no idea whether each individual patient will benefit from that particular drug.

JAMIE KLAYMAN: There's no crystal ball as far as what we're talking, time-wise? I mean, there's no, you know, that you're gonna say six months, a year, three years, two years, as far as what we're looking at, time-wise? Is a...

DAVID RYAN: So that's the hardest - the... that's the hardest question that people ask is how much time do I have if...? And the truth is, with pancreatic cancer, people can get very sick, very quickly, and they can...

JAMIE KLAYMAN: Right, it just sorta depends on when and how the tumors grow and how it...

DAVID RYAN: Correct. And when I -- the best case scenario is that, um, the cancer slows down and just gets stable for whatever reason, and -- you know, three months goes by and you're fine, and another three months goes by and you're fine, and you build up these blocks -- these three month blocks -- where a year goes by and everything's fine.

JAMIE KLAYMAN: Right... fine.

DAVID RYAN: And have I taken care of enough people with pancreatic cancer where that's happened, and I've been surprised where, for whatever reason, the cancer stopped growing and people just got way more time than I ever thought that it --

JAMIE KLAYMAN: Right.

DAVID RYAN: ...they were gonna get? Absolutely, it happens, and I can't explain it.

JAMIE KLAYMAN: Right.

DAVID RYAN: But there's also the flipside of that, where people get sick very quickly, and they can wind up dying very quickly, even over the course of several months.

JAMIE KLAYMAN: Right.

DAVID RYAN: And so there's this somewhat trite saying, but it's something that seems to work out well, which is: you have to, on some level, hope for the best case scenario, but on another level, prepare for the worst.

JAMIE KLAYMAN: Right, plan for the worst.

DAVID RYAN: It's very American to think that you can control your destiny, and in the business world, and in the sports world, there's something to that, um, you can control your destiny; but when it comes to having metastatic lung cancer, or pancreatic cancer, it's all biology. Lance Armstrong's associated with, "If I'm strong enough, and if I fight hard enough, and I'm smart enough, I'm gonna beat it." And so when you tell people that they have metastatic pancreatic cancer, their first reaction is, "Let's beat it; you're just gonna point me in the right direction, or give me the right drugs, and we'll beat it," and they don't understand that Lance Armstrong had, you know, won the lottery, essentially. He had the world's most sensitive cancer to chemotherapy that we know - testicular cancer - and his melted like butter; it had nothing to do with, ah, the fact that he was a Olympic athlete.

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