CANCER THERAPIES KEEP MORE ALIVE.

Byline: CONNIE LLANOS Staff Writer

NEWHALL -- Black pills, yellow pills, pink, blue and gray.

Thirty total, Colleen Shaffer said as she looked at all the little spheres spread over the dining table in her Newhall home.

The statuesque crimson-haired Shaffer doesn't mind the numbers. They're all part of the cocktail that keeps her alive.

She is among a growing number of breast cancer patients who are living with the disease in its most aggressive state, defying what used to be a death sentence.

Shaffer was diagnosed with breast cancer in March 1999. She had a lumpectomy, followed by a double mastectomy, six aggressive rounds of chemotherapy treatment and radiation. She thought her cancer was gone for good.

Then, three years later, routine lab work revealed that Shaffer's liver was peppered with tiny cancer tumors, too small to remove, as well as large lesions. The cancer had spread to her spine and down into her hip bone, too.

It was stage IV, or metastatic cancer.

``I knew once it was in my liver, if treatment didn't work, I had six to 12 months to live,'' Shaffer said, unfazed by the painful memory.

``The doctor told me I didn't have to be so up about this, but somewhere I always knew I would be OK.''

A recent survey, released by the American Cancer Society, revealed a decline in cancer deaths in the United States for the second year in a row. A decline in smoking, better and earlier detection, and better treatments all have been cited as reasons for the downward trend.

Shaffer is part of a special group of pioneers, as she says, surviving metastatic cancer. Her case is among those marking the transition from cancer as a terminal disease to a chronic one.

Metastatic cancer is a returning cancer that spreads primarily into four areas: the brain, lungs, bones and liver.

In the past, this diagnosis would have given someone months, maybe a year, to live. But new medications and combinations of treatments are changing those statistics.

``Survival has doubled for these people,'' said oncologist John Barstis, medical director of the UCLA Jonsson Cancer Center in Santa Clarita.

Barstis has been treating Shaffer for the past couple of years and has followed, and lectured about, the increase in advanced breast cancer patients living with their disease.

``There are a lot of new medications which are making cancer just another chronic disease,'' Barstis said, explaining that these medicines are keeping the disease at a controllable state, without curing it.

Traditional cancer therapies are nonspecific, designed to kill the cancer cells -- and everything else in its path. New therapies, called targeted therapies, affect just the cancer cells, Barstis said, by reducing them ``to seeds.''

``The seeds could start growing if you stop the treatment, but while on the medicines, the cancer or cancer symptoms are not enough to bother the patient.''

These medicines deprive the cancer cells of various things they need, such as blood supply or hormones, or unbalance them to the point they kill themselves.

``They can get rid of up to 99percent of the cells sometimes, but they won't get it all,'' he added.

``Ten or 15 years ago, women diagnosed with this type of breast cancer would have been given two years survival. Now, it's four years, and in that statistic many of them are living longer.''

It was statistics that drove Carol Silverander to fight for her life.

A former documentary photojournalist and business owner, Silverander was first diagnosed with breast cancer in 1997. It was stageI cancer. A tumor and eight lymph nodes were promptly removed, and chemo and radiation treatments followed.

Two years later, her cancer came back, this time in her liver.

``My doctor gave me the news over the phone,'' Silverander said. ``She told me I had a 3percent chance of beating the cancer; she just hoped I would live for another two years.''

Silverander had traveled the world documenting the struggles of people and societies and knew what it was like to watch people struggle against disparate odds.

``The first thing I thought was people make up those statistics so let's see what it is I need to do to beat those odds.''

Now, in her eighth year of survival, Silverander has written a book about living with advanced breast cancer and is finishing a second.

Mimicking other advocates for the stabilization of cancer, Silverander says she looks at the disease as chronic, like diabetes or heart disease.

But her life with advanced breast cancer has not been steady.

``It is a rollercoaster ride.''

Meds stop working

After remaining on one medication for too long, the body can grow tolerant and the medicine can stop working.

Stress, diet and fatigue can wake up the cancer cells, sometimes causing the cells to grow back, many times stronger and faster than ever.

A few years ago, the deaths of several loved ones put Silverander in a state of stress.

Her chemo pills stopped working, and even a few intravenous chemo treatments failed to scale down her cancerous tumors, which were doubling in amount and size.

A combination of plant-derived medicines, a new chemo treatment, and an incessant desire to live stabilized Silverander again.

``It is key for people to know they have to become the managers of their own disease.''

A cancer group facilitator for more than 15 years, Tara Shores knows first-hand how therapeutic talking can be for patients battling a chronic disease.

Shores holds several WeSpark metastatic cancer groups in Santa Clarita and Sherman Oaks, and she says for most survivors of this advanced stage of the disease, emotions are ever- changing.

``There is incredible fear, stress, anxiety and depression.''

Shores admits that while survival has increased, deaths in her metastatic groups are not uncommon.

``We had a woman die in one of our groups recently, and it brings up all the issues they are constantly battling, this hope they have for a cure and the fear they will not live long enough to see it.

``But this fear can be motivating. They gain a new perspective on life and look for that silver lining,'' Shores continued.

``We are all going to die sometime, but they savor every day and begin to realize the value of life.''

Among this emerging group of breast cancer patients lies a second generation whose reactions to targeted therapies include a reduction in cancer cell size that, it appears to doctors, cures the patient.

Canyon Country resident Pam Coch was in remission for 16 years before she discovered in April 2004 her metastasized cancer had spread to her collarbone and lungs.

Targeted hormone therapies seem to have reduced Coch's cancer to invisibility.

``I am confused myself, but I believe the term is remission for me,'' Coch said.

``This is our new challenge,'' said Barstis, who also treats Coch at Santa Clarita's UCLA Cancer Center.

As he explained it, it is a real possibility that Coch's cancer could be completely gone, a medical accomplishment that only a few years ago would have been deemed almost impossible.

But the minute size of cancer cells can make tests deceiving.

``There are 1,000 cancer cells on the head of a pin,'' he said. ``I can do all the tests in the world and not see them, but at the same time, the cancer cells are so suppressed they appear to be gone.''

Always facing death

Life for this new breed of cancer patients can be very uncertain.

Last year, after four years of living with stable cancerous tumor counts, Shaffer had a string of deaths that shook her emotionally.

Her cancer cells seemed to be reactivated in her stressful state.

``You think you are all right, and then all of a sudden something else hits you,'' Shaffer said.

For most, the constant brushes with death would be too much to handle, but as Shaffer sipped her black coffee and talked about her life she said she isn't afraid of death. Living can sometimes be harder.

``Surviving cancer is not cheap,'' Shaffer said. ``My husband is eight years my senior. If he retires in three years, how will I pay for my $3,400 in medications or high-cost insurance premiums with Cobra?''

Side effects from her daily dose of pills include a skin irritation that feels like burning blisters.

A few more medications and Shaffer goes about her days -- never forgetting that each for her is a blessing.

``I am not going to lie, I have asked the Lord to please give me 25 years,'' Shaffer said. ``I have lived for five, I have 20 more to go.''

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CAPTION(S):

2 photos

Photo:

(1 -- color) Breast cancer survivor Colleen Shaffer of Newhall is one of a growing number of patients who have survived aggressive forms of cancer, as the terminal disease shifts to become a chronic one.

(2) ``I am not going to lie, I have asked the Lord to please give me 25 years,'' says Colleen Shaffer, a survivor of an aggressive stageIV breast cancer who lives in Newhall. ``I have lived for five, I have 20 more to go.''

David Crane/Staff Photographer