Hard choices

This is not about Hillary Rodham Clinton’s book published in 2014. I suppose it is about a much more mundane matter, but one with which I am sure many people are struggling in these challenging times.

I was scheduled to go to MSKCC for another pembrolizumab treatment on March 25^th. The original trials of pembro in bladder cancer were two years, and there has not been any published data on longer-term therapy. Since I had a very rapid response to the drug two years ago, and have had no signs of return of the cancer, Dr. Iyer felt it was time to stop the therapy.  I wrote about this back in mid-January. At the time, Barry consulted with a number of colleagues who suggested a sort of compromise, to go to six weeks cycles and “ease off” the treatment. March 25^th would have been six weeks from my last treatment (#33) on February 12^th.

But now the equation has changed. Does the potential benefit of continuing treatment at this time outweigh the risk of my spending the better part of a day at MSKCC in close proximity to individuals who may be infected with COVID-19? Barry helped me to compose an e-mail to Dr. Iyer with precisely this question, and he responded at lightning speed, writing

I was actually just about to e-mail the both of you regarding the below. As you have very nicely described, the risk of coming in for treatment and potentially being exposed to COVID-19 outweighs the risk for a recurrence of the cancer, especially as we are at a point where the treatments are being spaced out. Given the DIPNECH*, there is a higher risk for significant complications if you do contract the virus, so my recommendation at this time would be to cancel the March treatment and plan to treat again in May when, hopefully, this situation is under better control.

We are currently calling all of our patients who could have their treatment delayed to advise them as above.

I would also advise that both of you follow the CDC guidelines on frequent hand washing and social distancing for the immediate future.

*DIPNECH stands for Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia

So, the decision is made. Odd as this may sound, I in fact feel quite fortunate that this has happened after I completed the two years of therapy. It would have been a much more difficult decision had we been confronted with it a year ago.

Having said that, it is quite incredible how many people have remained in denial, and the crowds at Disney World and on the Florida beaches this weekend, on the eve of plans to close these areas, prove that.

So, I really am hunkered down here for a while. As Passover is quickly approaching, thanks to all of our friends who have offered to shop for us, with a special shout-out to our friend Lanny who picked up a few items for us in Monsey today that have not yet appeared at the local grocery store.

Our grandchildren are all out of school now through Passover. Difficult as this is, I believe that the correct decisions have been made all around.

We are hunkering down and watching some old movies. We watched the 2009 film “Julie and Julia,” based on the true story of a young woman who cooked and blogged her way through the entire 524 recipes in Julia Child’s cookbook, “Mastering the Art of French Cooking.” Amy Adams plays Julie with Meryl Streep as Julia child. We had seen this when it first came out but it is really a charming film and worth watching again as a great relief to the distressing news.

Meanwhile, stay safe and well!

Love,

Rebecca