Sept. 16, 2009 -- Patrick Swayze passed away Monday at the age of 57, but his 20-month battle with pancreatic cancer showed how tough the disease is -- and how unusual it is for people to survive with it as long as he did.
When Swayze was diagnosed, he was given a few months to live.
"The median survival is probably five months," said Dr. Lucas Wong, co-director of the gastrointestinal cancer program at Scott & White Memorial Hospital & Clinic in Temple, Texas. Wong's assessment was confirmed by several other oncologists who work with pancreatic cancer patients.
Wong said that five months represents the median survival time, so half of all patients would be expected to live beyond that time. In Swayze's case, other factors would suggest he would outlive five months.
For one, Swayze really seemed to benefit from his regimen of chemotherapy, typically administered to pancreatic cancer patients in a drug called gemcitabine.
"There are people who do better than others, even those with advanced disease," said Dr. Suresh Chari, a gastroenterologist specializing in pancreatic cancer at the Mayo Clinic. "Almost all chemotherapy agents ... do benefit some subset of patients."
Athlete, Dancer -- and Smoker
It may also have helped that Swayze, a dancer, stayed in shape his whole life, and remained active even after his diagnosis. He filmed a full season of the A&E series "The Beast," often working 12-hour work days.
"I encourage my patients to do whatever their body allows them to do," said Chari, although he said many patients feel fatigue from the cancer and are therefore unable to maintain an active lifestyle, even if they would like to.
But Swayze also smoked, and continued to smoke after his diagnosis. Smoking is just one factor that may have led to the cancer.
"Smoking is definitely a risk factor for pancreatic cancer," said Chari, noting that, by some estimates, up to a quarter of the 37,000 annual pancreatic cancer cases may be due to smoking.
Could he have fought the disease longer by quitting cigarettes? Not likely, say doctors.
"Once the cancer has spread and all this happened ... continuing smoking, I don't think, mattered at that point," said Chari.
Swayze was diagnosed initially with stage four pancreatic cancer -- the most severe form -- and the disease had already spread to his liver.
Opposition to Alternative Therapy
Because of the grim prognosis, many patients turn to alternative therapies without scientific evidence behind them. Swayze did not.
"That's one thing I'm not gonna do, is chase, is chase staying alive. I'm not, you know, you'll spend so much time chasing staying alive you won't live, you know? I wanna live. If anybody had that cure out there like so many people swear to me they do, you'd be two things: you'd be very rich, and you'd be very famous. Otherwise, shut up," he told Barbara Walters in an interview that aired in January of this year.
Swayze's feelings may be correct, according to a study released last month in the Journal of Clinical Oncology.
That study -- from Columbia University Medical Center -- compared standard pancreatic cancer care, including the chemotherapy drug gemcitabine, with a popular alternative therapy known as the Gonzalez regimen.
Researchers found that patients on the alternative regimen had a median survival time of a little over 4 months, while patients taking the standard of care regimen survived for a median of 14 months.
"We've never used it, but I've certainly had patients bring it up," said Dr. David Cosgrove, a medical oncologist at Johns Hopkins Kimmel Cancer Center. "I never want to close the door on an alternative strategy, but I try to counsel my patients on what that strategy involved and the standard risks."
Instead, Cosgrove said, he steers his patients toward clinical drug trials.
"We certainly would bring up clinical trials early in the conversation," he said.
So far, however, those have not led to new treatments.
"There's not really a standard second-line therapy," said Cosgrove.
Pancreatic Cancer Is One of the Hardest to Treat
"I call it 'the monster' because it's a monster disease," said Maryjane Barbaris, who lost her husband, Harry, to pancreatic cancer in February 2007. "It's something that's very difficult to fight, and difficult to win."
Swayze is one of several famous people who have contracted the disease in recent years, including Apple CEO Steve Jobs, Supreme Court Justice Ruth Bader Ginsburg and the late "Last Lecture" professor Randy Pausch.
"Unfortunately, when someone famous gets it, you get more publicity from it," said Barbaris.
Kerri Kaplan, executive director of the Lustgarten Foundation, a nonprofit group that funds pancreatic cancer research, said Swayze's death is also something that brings more resolve.
"When something tragic like this happens, it makes us feel like we need to continue the fight," she said.
Barbaris said her husband -- himself a surgeon -- also resisted alternative treatments.
"He was not open to that," she said. "As a physician and a surgeon, they're usually not open to that type of stuff. I was willing to try anything, and I could only support [him] in what he said is right."
A Brighter Future for A Dark Diagnosis?
Doctors are hopeful that coming years will bring both better diagnostic tools to detect pancreatic cancer, as well as better drugs to combat it.
"Progress is slow; we just wish it was more," said Wong. "We haven't gotten to the point where we can give really positive news; we're just in the developing stages. Some of the drugs that we use for other cancer have not been effective with pancreatic cancer."
Researchers have trouble enrolling patients for clinical trials of treatments of pancreatic cancer. Chari said that in up to half of all cases, patients don't have the opportunity to enroll, because the prognosis from the first physician they see is so grim.
"They are not referred to various centers for enrolling in clinical trials. A large number of patients never make it to these centers," said Chari. "The only way we're going to make progress is to enroll them in these centers.
"It's very important that patients are encouraged to enroll in these studies," he said. "They're not going to be deprived of standard treatment, but they may get something extra."
Patients in new drug trials are given the experimental drug in addition to whatever the standard therapy is.
For her part, Barbaris said she has designated over $100,000 of money she has raised toward biomarkers -- early detection.
"The problem with this disease is it's picked up too late," she said. "Perhaps my husband would still be alive if it was picked up way, way before."