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Thứ Ba, 25 tháng 8, 2015

Carter's Cancer Is Melanoma

Former President Jimmy Carter will undergo treatment with pembrolizumab

  • by Tom Watkins
    Contributing Writer

Former President Jimmy Carter announced Thursday he is being treated for melanoma.
After doctors at Emory University removed a melanoma tumor from his liver on August 3, they discovered four small melanoma tumors in his brain, he told reporters at the Carter Center in Atlanta.
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“They had a very high suspicion – then and now – that the melanoma started somewhere else in my body and it spread to the liver,” said the 90-year-old Georgia native, who appeared at ease in blue jeans, a sport coat and tie.
Carter underwent radiation therapy on Thursday afternoon and will undergo four treatments with pembrolizumab at 3-week intervals, the Carter Center said in a statement.
Though three of his siblings and his mother had pancreatic cancer, doctors had not found that to have been the cause, he said.
In May, Carter returned to Atlanta from Guyana, where he had been helping monitor an election, because of what he felt was a “very bad cold."
During a physical late that month, doctors at Emory University gave him an MRI that showed a suspicious mass on his liver, he said.
But he delayed sharing those suspicions with his wife of 69 years, Rosalynn. “I think I put in my diary that I didn’t tell Rosalynn until about the 15th of June, and then when I found out that I definitely had cancer, key members of my family came into the Carter Center and I gave them a briefing.”
Once the diagnosis was confirmed, Carter did not immediately undergo surgery, opting instead to go forward with a long-planned book tour while his surgeon vacationed in Spain. “Doctors said it was a very slow-growing cancer,” he said.
It was not until August 3 that the tumor and margins were removed in an operation that excised a mass measuring about 85 cubic centimeters, or a tenth of his liver, he said.
But his initial relief that doctors appeared to have removed all of the cancer soon vanished. “That same afternoon, we had an MRI of my head and neck, and it showed up it was already in four places in my brain,” he said.
That night and the next day, he said, “I thought, just thought I had a few weeks left.”
Still, he said, “I was surprisingly at ease. I’ve had a wonderful life, I have thousands of friends, and I’ve had an exciting, adventurous, gratifying existence.”
Each of the spots measured about 2 mm, he said. In addition to undergoing radiation treatments, Carter said he will receive treatment intended to enhance the immune system.
“He’s a helluva lot better off with this than he would have been with pancreatic cancer,” said Peter Bourne, MD, who served as special assistant to Carter on health issues during his administration and remains a friend.
“It used to be that melanoma was just a death sentence; in recent years, they have been able to save people’s lives to an extraordinary degree, and things could go very well for him for a long time,” Bourne said in an interview.
He described as “pretty spectacular” Carter’s openness during the news conference. “He’s really setting an outstanding example.”
Carter said he will cut back “fairly dramatically” on his obligations at the Carter Center, and that his grandson, Jason, will take over as chairman of the board of trustees, but that he would continue to raise funds for the organization, whose endowment exceeds $600 million.
“If he wants me to give him advice, I’ll be delighted to do it,” said Carter, whose attention to detail is legend.
Carter said his diagnosis had resulted in calls from well-wishers, including President Barack Obama, former Presidents George H.W. Bush, George W. Bush, and Bill Clinton, Democratic presidential hopeful Hillary Clinton, and Secretary of State John Kerry. “First time they’ve called me in a long time,” said the former politician, who is not shy about speaking his mind.
Asked what would give him the most satisfaction in life, the architect of the Camp David Accords cited peace for Israel and its neighbors. He then launched into a critique of the Middle East peace process.
“Right now, I think the prospects are more dismal than any time I remember in the past 50 years,” he said. “The whole process is dormant. The government of Israel has no desire for a two-state solution, which is the policy of all the other states in the world, and the United States has practically no influence compared to past years in either Israel or Palestine.”
Though Carter said his single term as a president was the pinnacle of his political career, he added that it just laid the foundation for his work at the Carter Center, which he described as “more personally gratifying to me.”
Since its founding in 1982, the center has set up programs in 80 countries that have helped some of the world’s poorest and most destitute peoples. Meeting their needs, he said, “has been one of the best things that happened to me.”
He cited his center’s efforts to eradicate Guinea-worm disease as among his greatest achievements, a comment that Bourne said he found gratifying, since it was he who suggested 30 years ago that Carter lead the effort.
“I think he will outlive the final guinea worm,” said Bourne, who is a senior research fellow at Green Templeton College at Oxford University. “There are only 11 cases so far this year, which means it’s almost finished.”
Bourne said he admired Carter’s ability to focus on matters he can do something about, and to let go of anything over which he has no control.
“Even if it’s giving a bad speech at a political rally or anything else that doesn’t go quite the way he wants it to go, he is able to completely put it behind him — entirely and immediately.”
Bourne, who wrote “Jimmy Carter: A Comprehensive Biography from Plains to Post-Presidency” (Prentice Hall & IBD, 1997), recalled accompanying Carter after appearances at rallies that had gone poorly. “I’d say, ‘Well, I’d give that a 70 percent.’ He’d say, ‘I don’t want to talk about it.’
”He always was looking at what was in the future, never wanting to look back at things in the past. It’s something I’ve tried to adopt myself, because it’s always easy to dwell on failures or shortcomings and things, but he never did that.”
For example, during the Iranian hostage crisis, in which 52 Americans were held in Tehran for 444 days before their release, Bourne said he remarked to the president that he must be having trouble sleeping. “He said, ‘I never lose sleep over anything.’”
But Carter allowed on Thursday that his failure to free the hostages still weighed on him. “I wish I had sent one more helicopter to get the hostages,” he said about the ill-fated attempt, in which the effort was aborted after several helicopters malfunctioned and one crashed, killing eight servicemen. “We would have rescued them and I would have gotten reelected,” Carter said.
In a rare example of looking back, he said, “If I had to choose between four more years and the Carter Center, I would choose the Carter Center —- could have been both.”
Carter has always acted as though he was aware that life is finite, Bourne said. “I do think there was always a feeling throughout his life that he couldn’t waste a minute because we’re only given so much time on earth to do good things and he always was preoccupied with using every minute to achieve that goal.”
Despite Carter’s efforts to accomplish all he could – efforts that still include scheduling his days down to the minute – his failure to reorganize the nation’s health system during his administration “was a great disappointment to me,” Bourne said.
“I think he saw his reelection being tied more to having the economy in good shape than to whether he delivered national health insurance,” Bourne said.
“He saw health insurance as something for his second term.”
Bourne said he last saw his former boss in Washington at a memorial service for Robert Pastor, who had served Carter as his expert on Latin America.
“He looked fine,” Bourne recalled. “I said to him, ‘You know, I just can’t believe how you’re able to maintain the energy level that you do.’ This was two months after his 90th birthday.
“He just sort of dismissed it and said, ‘Well, tomorrow I’m going to South Sudan.’ As though it was just nothing; anybody who was worth their salt would be doing what he was doing.”
That attitude may be changing. Carter acknowledged on Thursday that he may put off a planned visit to Nepal with Habitat for Humanity, saying that he will adjust his schedule to accommodate the requests of his doctors.
But he was adamant that he has no plans to end his long-held practice of teaching at the Maranatha Baptist Church in his hometown of Plains, Ga., and to continue living his life.
“I plan to teach Sunday School this Sunday and every Sunday, as long as I’m physically and mentally able,” he said. “I’m ready for anything; I’m looking forward to a new adventure.”
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