May 15, 2009 -- Actress Farrah Fawcett's fight against anal cancer has included treatments in Germany that aren't approved in the U.S., sparking debate about cancer patients' options when they want more than what's approved by the FDA.
Fawcett, 62, was diagnosed with anal cancer in 2006.
Fawcett is "doing very well right now," Fawcett's doctor, Lawrence Piro, MD, told NBC's Today show. "She's obviously having a lot of side effects that come with cancer and come with cancer chemotherapy. And she's weak and she's spending a lot of time in bed and resting. But overall, she's in good spirits and she certainly still has her characteristic sense of humor, which is helping her get through all of this," said Piro, who is the president and CEO of The Angeles Clinic and Research Institute in Los Angeles.
Apart from her U.S. treatment, Fawcett has traveled to Germany six times seeking cancer treatment, actor Ryan O'Neal -- Fawcett's partner and the father of her son, Redmond -- recently told People.
Treatments in Germany
Ursula Jacob of Germany's Alpenpark Clinic has treated Fawcett. In an interview with Access Hollywood, Jacob says that, in Germany, Fawcett was given "natural supplements and also immune treatments" that were tailored to her specific case.
Those treatments improved Fawcett's quality of life and "the tumor shrank in size and also the mass of the tumor shrank," Jacob said. "For a long time, two-and-a-half years, she was in really good shape."
Jacob recently flew to California to see Fawcett, but says she can't give Fawcett the care she got in Germany while Fawcett is in the U.S., because those treatments aren't FDA approved. The treatments, which Jacob didn't describe in detail, are "normal" in Europe, Jacob says.
Fawcett's friend, Alana Stewart, told the Access Hollywood reporter that Jacob was there "more to be a friend and a support to Farrah than to give treatments. She's under treatment by her American doctors."
Laurence R. Sands, MD, is associate professor of surgery and chief of colorectal surgery at the University of Miami Sylvester Comprehensive Cancer Center. He treats many anal cancer patients but isn't one of Fawcett's doctors.
Sands says some of his anal cancer patients have expressed interest in going to Europe to get mistletoe and other herbal treatments touted as boosting the immune system.
The theory, Sands says, is "if you bolster the immune system and make it vibrant, then you can kill off cancer cells." But Sands says that approach doesn't have solid scientific proof. "It's really based mostly in theory more than in science."
Sands says he tells his patients that such treatments shouldn't be used instead of standard medical treatments -- in the case of anal cancer, that's chemotherapy and radiation, and surgery if chemotherapy and radiation aren't enough.
Sands says he isn't against other treatments being used in addition to standard medical therapy, and he urges patients to talk it over with their mainstream doctors.
Some of his patients have shown him the herbal treatments they've been given to check if there might be a conflict with their standard treatment. Sands says he generally hasn't seen troublesome ingredients but says some ingredients could make bleeding more likely, and he would discourage the use of those ingredients.
Overall, Sands says his patients haven't shown him products "that should be particularly detrimental; I just don't know how helpful it really is."
Suggestions for Patients
Michael Fisch, MD, MPH, directs the general oncology program at the University of Texas M.D. Anderson Cancer Center. He isn't one of Fawcett's doctors, but he sees many patients with advanced cancer.
Here are Fisch's suggestions for patients with advanced cancer who are disappointed with their treatment options:
- Define and prioritize your goals. "What is it that you really want?" asks Fisch, noting that many patients have more than one goal -- like having hope for a new treatment, having less pain and better quality of life, and also not wiping out their family's financial resources. "If they just pick one goal and go after it, they might find that the other goals that weren't explicit get lost [by] the wayside."
- Talk about your goals with your doctor. "It doesn't mean you have to ask permission from your doctor to go to some other country," Fisch says. But do listen to their perspective, ask what else you need to consider, and, if you do go forward, you'll need a copy of your health records.
- Don't take good care for granted. The U.S. health care system has a lot of safety checks in place for patients, and not all countries match that. "We're not the only country that does research and can do good patient care. It's not an arrogant statement," says Fisch. " It's just [that] you have to ask the question, 'What are all the ingredients that make this go well and are those ingredients there" in the overseas facility you're considering. "It's more than just the doctor or the drug," Fisch says. There's a whole bunch of other things that make excellent care and hopeful care for the kind of goals you might have.
- Consider your own backyard. Fisch points out that M.D. Anderson Cancer Center and other academic centers in the U.S. conduct clinical trials of new drugs and have mind-body and other programs. "Going far, far away and trying something unproven is not the only angle towards a hopeful result," Fisch says.
- Recognize your vulnerability. "If you have advanced cancer, and people don't think they can shrink or cure it with existing treatments, you're vulnerable" to possible exploitation, Fisch says. That doesn't mean that every potential therapy is bogus. "Your hope for a miracle or hope for a cure might lead people to ask you to take treatments that are very expensive or very inconvenient or have a very, very improbable chance of helping you." His advice: Share your thoughts with other people, including health care professionals, who can help you weigh your choices.
Cancer Care Options
Every country sets its own standards for medical care. In the U.S., the FDA is the authority that approves drugs and other medical treatments.
Clinical trials of experimental drugs may be another option for cancer patients. The National Cancer Institute has a searchable database of more than 8,000 clinical trials.
Many cancer patients are also interested in complementary or alternative treatments. Complementary medicine is used with conventional medicine; alternative medicine is used in place of conventional medicine, according to the National Center for Complementary and Alternative Medicine (NCCAM).
The NCCAM recommends that anyone considering complementary or alternative medicine should first talk with their doctors and carefully research the therapy and its practitioners. Resources include:
- For basic information on therapies, visit the National Center for Complementary and Alternative Medicine's web site and click on "health information."
- For information on dietary supplements, visit the web site of the National Institute of Health's Office of Dietary Supplements.
- For tips on spotting cancer treatment scams, visit the Federal Trade Commission's web site.