WASHINGTON -- From the start of his candidacy last April, when Paul E. Tsongas announced his intention to pursue "the obligation of my survival" and seek the presidency, the most important health care issue for the former Massachusetts senator has been his own health.
The Democratic hopeful has made exceedingly public a show of his fitness, working out with weights, entering swim meets and launching his ad campaign last fall with images of him racing through a pool with a vigorous, showy butterfly stroke. His doctor, who supports his candidacy and performs exhaustive examinations twice a year, the last one in December, has pronounced him in "superb shape" and free from cancer.
The candidate himself, having been free of the disease for more than five years, has said he now considers himself "cured" of the form of lymph node cancer that curtailed his Senate career in the early '80s.
But some doctors, although they see no reason why a past
cancer should prevent Mr. Tsongas from running for, or assuming, the presidency, are hesitant to predict the state of his future health. In particular, they note that the type of lymph node cancer, or lymphoma, that afflicted Mr. Tsongas from 1983 to 1986 has had a history among other patients of coming back.
His own doctor, although greatly optimistic about his patient's future, stops just short of using the word "cured."
"It's not a word I use. In my business, we don't know," says Dr. Tak Takvorian, a senior staff doctor at Harvard's Dana-Farber Cancer Institute. "But I'm pretty confident. . . . I'm very confident that he's fine."
Mr. Tsongas has been free of cancer since 1986, when he underwent a radical, aggressive, and at the time experimental, treatment at the Dana-Farber Institute that involved huge doses of chemotherapy and whole-body radiation followed by a bone marrow transplant using his own, cleansed bone marrow. He was one of the first approximately 100 lymphoma patients to be treated with this course of action, which has now become "fairly standard treatment," his doctor says.
Dr. Takvorian says that such transplants "do seem to cure" about 50 percent of all lymphoma patients, and those who are not cured usually relapse within the first year. Those, like Mr. Tsongas, who have been clear for more than five years, Dr. Takvorian says, have a 90 percent to 95 percent chance of remaining cancer-free.
But those figures are based largely, although not exclusively, on patients with large-cell lymphoma, a more aggressive but more treatable and more curable form of the disease than the low-grade, small-cell variety that Mr. Tsongas had.
In the past, small-cell lymphoma, unlike its large-cell counterpart, has been known to recur after long periods of remission, doctors say. And since bone marrow transplant has only been used to treat lymphoma since the early '80s, they caution that it is too soon to know if this line of treatment ultimately cures the small-cell version of the disease.
"For a low-grade lymphoma, with all previous therapies, relapses occur in a steady way up to 20 years," says James Armitage, chairman of thedepartment of medicine at the University of Nebraska Medical Center and secretary of the Paris-based International Autologous Bone Marrow Transplant Registry.
"Whether that changes with bone marrow transplant requires 10, 15, 20 years of follow-up [to determine]. We just have to wait and see. I don't think there's a consensus yet about whether this is a curable disease with bone marrow transplant. We all hope that it will be."
Dr. Bruce D. Cheson, head of medicine for the National Cancer Institute's cancer therapy evaluation program, believes that Mr. Tsongas is in a "high-risk group" but adds that "the longer he is without a recurrence, the greater his chances are that he's cured."
Still, he says, "Because we know the natural history of this disease -- that even with long-standing remissions patients all eventually relapse [with prior conventional treatments] -- it's going to take years to tell whether intensive therapy [such as Mr. TC Tsongas received] is actually curing this disease."
Dr. Takvorian says that "every thing points to success" for his patient. For one thing, he says, there was "some evidence" that Mr. Tsongas' disease was evolving to the more curable version at the time of his treatment.
With this aggressive procedure, he says, the prognosis for the small-cell variety appears to be no different than for large-cell. But he adds a caveat: "We're on thinner ice [with small-cell cases] until we have more patients going through it. That will increase our confidence that the preliminary results are accurate."