Simone, Joseph V. MD
We can expect that more and more cancer patients will be older and will be cancer survivors. The entire population is aging, particularly in Western countries. As I have been considering the aging of family members, friends, and patients, as well as my own, I decided to start where I often do when taking on weighty issues; I listen to the poets.
We begin with an excerpt from Shakespeare's poem containing the famous seven ages of man. He writes as an observer of the inevitable decline of each man (and woman).
The sixth age shifts
Into the lean and slipper'd pantaloon,
With spectacles on nose, and pouch on side,
His youthful hose well sav'd, a world too wide,
For his shrunk shank, and his big manly voice,
Turning again towards childish treble, pipes
And whistles in his sound. Last scene of all,
That ends this strange eventful history,
Is second childishness and mere oblivion,
Sans teeth, sans eyes, sans taste, sans everything.
The following are two excerpts with decidedly different views of old men. The first is from the Canterbury Tales written by Geoffrey Chaucer in the 14th century. The narrator describes the old and cold (and maybe weary) Greek god Saturn. Faced with a looming destructive conflict between Venus and Mars, he seems to have mellowed in old age.:
The Knight's Tale
As truth is said, old age has great advantage,
In age is both wisdom and experience;
Men may the old outrun yet not outwit them.
Saturn anon, to stop strife and dread,
Albeit that it was against his nature,
Of all this strife he began a remedy to find.
In the Four Quartets, poems largely expressing pessimism about the world before and during World War II, T. S. Eliot has a different take on old men (he was not old when he wrote this).
And the wisdom of the age? Had they deceived us
Or deceived themselves, the quiet–voiced elders,
Bequeathing us merely a receipt for deceit?
The serenity only a deliberate hebetude [mental lethargy],
The wisdom only the knowledge of dead secrets
Useless in the darkness into which they peered
Or from which they turned their eyes…
Do not let me hear of the wisdom of old men,
But rather their folly,
Their fear of fear and frenzy, their fear of possession,
Of belonging to another, or to others, or to God.
The rest of the poems were written by old men. The Nobel Laureate Czeslaw Milosz lived into his 90s and wrote often about aging. Here are two of his poems, both expressing a more personal and optimistic view of aging, his continuing need to write, and the greater clarity of his poetic vision in old age.
My body doesn't want to take my orders.
On a straight path it stumbles,
It has a hard time getting up the stairs.
My attitude toward it is satirical. I laugh
At the flaccidity of my muscles, my dragging feet, my blindness,
All the parameters of deep old age.
Fortunately, I continue to compose verses at night.
Though for what, when what I write down in the morning
I cannot make out later in the day.
I am helped by the large font of a computer
Which I have lived long enough to see,
And which is an advantage.
Not soon, as I approach my 90th year,
I felt a door opening in me and I entered
the clarity of early morning.
One after another my former lives were departing,
Like ships, together with their sorrow.
And the countries, cities, gardens, the bays of the seas
assigned to my brush came closer,
ready to be described better than before.
I was not separated from people, grief and pity joined us.
We forget—as I kept saying—that we are all children of the King.
For where we come from there is no division
into Yes and No, into is, was, and will be.
We were miserable, we used no more than a hundredth part
of the gift we received for our long journey…
I knew, always, that I would be a worker in the vineyard,
as are all men and women living in the same time,
whether they are aware of it or not.
Stanley Kunitz is another of my favorite poets. The poem is from his book, Next-to-Last Things: New Poems and Essays. (The essays and a long interview in the book provide the best concise exposition of poetry that I have read; it is very accessible to us novices and I recommend it with enthusiasm.) The following excerpt is from a poem addressed to his wife on the occasion of his 79th birthday.
Sometimes, you say, I wear
an abstracted look that drives you
up the wall, as though it signified
distress or disaffection.
Don't take it so to heart.
Maybe I enjoy not-being as much
as being who I am. Maybe
it's time for me to practice
growing old. The way I look
at it, I'm passing through a phase:
gradually I'm changing to a word.
Whatever you choose to claim
of me is always yours;
nothing is truly mine
except my name. I only
borrowed this dust.
It is not surprising that these poets tell us that aging is inevitable. We can slow or mitigate its effects, but not stop it. We can become bitter old men and women living in the past and refusing to face change, refusing to get out of the way. Or we can accept aging as an evolving new adventure and work around the limitations it imposes on us.
We can take advantage of the wisdom and experience that the years have given us and share them with others (only if they ask). And if we are fortunate to have largely retained our mental faculties, we may find, as did Milosz, new eyes to see with, a new clarity about life and death.
And like Kunitz, we can be grateful for whatever time we have because we have “only borrowed this dust.”
Treanda Approved as CLL Treatment
The FDA has approved the use of bendamustine (Treanda for Injection, made by Cephalon) for the treatment of patients with chronic lymphocytic leukemia (CLL). The drug, which had received priority review about six months earlier, is the first new agent approved for patients with CLL since 2001, a news release from the company notes.
In a randomized, international, multicenter, open-label study of 301 treatment-naïve patients with CLL, patients receiving bendamustine had better clinical outcomes than those receiving chlorambucil.
The overall response rate and complete response rate for patients receiving the drug were higher at 59% and 8%, respectively compared with patients receiving chlorambucil, at 26% and less than 1%, respectively.
Progression-free survival was also significantly longer in patients treated with Treanda (18 vs 6 months) and response to the drug lasted longer in these patients as well (19 vs 7 months).
The most common adverse events observed were myelosuppression, fever, nausea, and vomiting.
“Patients with CLL can often live normal lives for many years because of treatments that control the disease over the long-term. Treanda is an effective new option that offers a delay in disease progression, an important goal for patients with chronic lymphocytic leukemia,” Bruce Cheson, MD, Professor of Medicine at Georgetown University Hospital, said in the news release.
Cephalon has also submitted a new drug application requesting approval of Treanda for the treatment of patients with indolent non-Hodgkin's lymphoma who have disease progression during or following treatment with rituximab or a rituximab-containing regimen.
© 2008 Lippincott Williams & Wilkins, Inc.