Dr Zhou Xulong analyses a patient's tumour cells before an intervention [Simina Mistreanu/Al Jazeera]
Beijing, China - As she waited to see her oncologist, Raluca Pietroiu felt nervous but hopeful.
For four years, the 34-year-old Romanian marketing executive had been fighting breast cancer. She knew she was a fighter - she'd grown up watching Jackie Chan movies and had fought hard for her professional success. But in the battle for her life, she was starting to feel like she might be losing.
At first, treatments made her cancer disappear, but after two years it returned. Now it was spreading to her bones. Doctors told her that they were running out of options. But Pietroiu had a new reason to hope: She'd heard about a hospital in China that was treating advanced-stage cancer patients like her with immunotherapy and other new procedures.
Immunotherapy, a treatment that uses the body's own immune system to attack cancer cells, has proven highly effective in certain cancers, such as melanoma. But forms of immunotherapy are still labelled experimental in many places, including the United States and Western Europe, and the treatment isn't available in Romania.
Pietroiu knew her doctor would be sceptical. After all, she'd already pursued treatments in Austria, France and Turkey. But this time, it was different.
Her stage 4 cancer was unresponsive to chemotherapy and radiation. She thought she was playing her last card in the game against death.
"If it's immunotherapy and you can afford it, by all means, go ahead," her doctor told her.
Hope and science
According to the hospital's website, it uses a combination of immunotherapy, minimally invasive treatments and traditional Chinese medicine to make advanced-stage cancer patients comfortable and to possibly extend their lives.
And while the hospital's model has attracted awards from the Chinese government and praise from other doctors in the region, some Western health professionals have questioned the treatment's grounding in science, as well as the hospital's lack of randomised clinical trials.
The treatments cost in the range of tens of thousands of dollars. But about a dozen patients and family members interviewed expressed gratitude at what they perceived as a second chance at life or, at least, an opportunity to extend it by a matter of months or years.
"I think you should never take hope away from the patient," said Gurli Gregersen, a Fuda patient who has been living with stage-4 pancreatic cancer for eight years. Doctors in Denmark initially told her she had just a few months left to live.
"You shouldn't be unrealistic, but it's very important that you keep up the spirit that you can do it, and you can fight it. They are very skilled when it comes to giving you a realistic view, but they also support you to be happy for your life and to endure everything you can to live with it."
Pietroiu put it more bluntly: "You go there because you still have hope."
"Here [in Romania], they close the door in your face, and they tell you, 'There's nothing more we can do,' or 'Why don't you continue with the same therapy?'. The treatment protocols are fixed. And in Vienna, even though they treat you very nicely, and they take your money gracefully, they do the same things," she said.
The doctors don't promise to cure very advanced cancer, explained Abdalla Gurashi, who is from Sudan and at the hospital with an Egyptian friend who has stage-4 stomach cancer. "There's no cure. There's only maintaining."
Immunotherapies
The discussion around care for the terminally ill is growing more urgent as cancer affects more of us, and in many places, that involves debates around the best practices for palliative and hospice care.
But at the other end of the spectrum of care, new immunotherapies and targeted therapies are yielding results.
While the concept of immunotherapy isn't new, the breakthrough over the past several years has been the development of medicines that are more tolerable and produce better responses, particularly in melanoma patients, explained Leonard Lichtenfeld, the deputy chief medical officer for the American Cancer Society.
"What we're seeing is that with a disease like melanoma, where we had nothing much to offer, we now have 35 to 40 percent of the patients with the most advanced disease responding in a meaningful way to immunotherapy," Lichtenfeld said. "And some of those patients are now going on several years with the positive responses. We don't even know how long those responses are going to last."
Scientists are also seeing results for immunotherapy applied to other types of cancer, such as lung, head, neck, colon and kidney cancer, Lichtenfeld said. They are studying combinations of immunotherapy, as well as immunotherapy combined with targeted drugs, which focus on a particular genetic change.
Not losing hope
At Fuda, Pietroiu received immunotherapy as well as an injection with strontium-89, a radioactive substance used to reduce pain in patients with metastatic bone cancer. She didn't have any serious side-effects and after three weeks, returned home, full of hope.
Her years battling cancer had been some of the most important of her life. When she was in remission, she met Bogdan. They clicked instantly. She told him she was a cancer survivor. A few weeks later, in the spring of 2013, Pietroiu learned during one of her regular checkups that the cancer had reappeared in her spine. Bogdan joined her on some of her visits to hospitals abroad, and every time they tried to make a trip of it.
After the immunotherapy, she felt better, but tests showed that her liver had been invaded by thousands of tiny metastatic cancer cells. She returned to Fuda with Bogdan in May, two months after her first visit. This time the doctors took several days to suggest a treatment - transarterial chemoembolisation to her liver.
Pietroiu wrote an article for her friends and for people who had started supporting her with donations.
"It won't be an overnight miracle," she wrote. "It's not a one-time intervention, after which I can go back home, and it's over. The road ahead is longer. I will continue to come here once every two or three months, upon these wonderful doctors' recommendations, to stabilise my situation if the results are good. If not, I will look for something else, but I won't stop."
| Xu Kecheng talks to PhD students who work as researchers in Fuda Cancer Hospital's laboratories [Simina Mistreanu/Al Jazeera] |
Weapons and knives against cancer'
Care for the terminally ill is changing, and being debated, across the globe. In the case of cancer, doctors at first treat to cure, but they also treat for comfort.
"It's very much part of our tradition in cancer care to treat patients with chemotherapy or other cancer treatments to improve their comfort, although we won't provide a cure," said Lichtenfeld. "If we were only treating for cure, for many patients we would stop at surgery."
For patients and their families, it's often hard to decide when to stop so-called "active treatments" - those which are meant to cure.
Erik Fromme, a palliative care doctor who specialises in cancer at Oregon Health and Science University in the US, said he discusses with his patients their understanding of their disease, their priorities, their fears, their hopes, and helps them make the decision that will best suit them.
"I think people continue to do treatments as long as the benefits outweigh the burdens as they understand it," Fromme explained. "But there are people who find benefit to just being in treatment, whether the treatment is working or not."
People want another shot at life, and they will travel the world to get it. Part of it has to do with the tendency to describe cancer as a "fight". This comes naturally, Fromme said, when the "weapons" we use against it resemble poison and knives.
The flip side of that interpretation is that stopping treatment is likened to being defeated.
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