In Cancer Battle, Do Appearances Deceive?

Patrick Swayze looks well despite his pancreatic cancer. Is it a good sign?

January 8, 2009, 12:22 AM

July 23, 2008— -- As Patrick Swayze walked through Los Angeles International Airport on Sunday, evidence of the pancreatic cancer diagnosis he received earlier this year was conspicuously absent.

He greeted reporters with a smile, and when asked about his health, he gave a thumbs-up and replied, "I'm a miracle, dude, I don't know why."

As the media single out Swayze for his healthy looks despite his disease, another public figure's appearance has also been the subject of speculation -- but on the opposite end of the spectrum.

Apple CEO Steve Jobs was diagnosed with the same disease in October 2003 and had surgery the following year to remove a pancreatic tumor.

Though his condition was thought to have been cured by the surgery, last month when he spoke at the company's annual developers conference Jobs seemed to have lost a significant amount of weight, leaving investors questioning the state of his health.

On average, patients diagnosed with pancreatic cancer have only a one-in-20 chance of being alive five years after the cancer is found, according to the National Cancer Institute.

The average life expectancy is grim as well. The patient-advocacy group Pancreatic Cancer Action Network reports that 75 percent of pancreatic cancer patients die within a year of their diagnosis.

While Wall Street-watchers might search for slight indications of trouble ahead, medical experts say that you simply can't judge cancer patients by their appearance.

"Looks can be deceiving, and it can happen in either direction," says Dr. Michael Fisch, director of the general oncology program at the University of Texas M.D. Anderson Cancer Center.

For one, a person's seemingly ill outward appearance could actually indicate that they are undergoing treatment and not that they are in the stages of advanced disease.

"Some people can really look terrible right after a dose of chemotherapy, and then they look better," says Dr. Steven Greer, CEO of The Healthcare Channel. "That's not indicative of them being on their deathbed."

A person with cancer typically recuperates from the hair loss, weight loss and skin changes that accompany treatment within a few months, Greer says.

Fisch agrees that the side effects of treatment could be transient. "If you catch [a patient] on a difficult day ... they might not look good, but it might not tell you how they are doing in general," he says.

The only people who can accurately gauge a person's internal health status based on looks are the healthcare professionals treating the patient, Fisch says. They understand the circumstances surrounding treatment, and they can use this information to estimate the "realistic ideal" for the patient's appearance.

"The truth is that knowledgeable health care providers do put great weight on the way someone looks at a glance ... but it takes knowledge and skills to get it correct," Fisch says.

Appearances aside, Dr. John Chabot, director of the Pancreas Center at Columbia University Medical Center, says he is careful to tell patients that in terms of cancer survival, "averages don't predict the outcome for any one individual."

Some may die just a few months after diagnosis and some may respond well to chemo. He says he has seen several patients who outlived the average lifespan by several years.

Doctors don't completely understand why some people respond better to treatment than others, but overall health, emotional wellbeing and fitness levels may play a roll, Chabot says.

"It's pretty clear to me that patients who are in better health when they began treatment generally do better," he says.

But looking healthy can also be misleading.

"It's very common for patients to look awfully good, even in the face of advanced cancer," Fisch says. "This can happen because sometimes those folks are incredibly vulnerable, and they try especially hard to look good."

They may pay special attention to their appearance in order to preserve their dignity in the face of illness. When they walk into his office, Fisch says his patients may look healthy and shake his hand, but when he asks them how they are feeling, their words may tell a different story.

So as for Swayze's looking good in the airport earlier this week, Chabot says, "It's better than looking bad in the airport."

But he adds: "That's not a solid piece of information to base anything on."

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