18A. The Exceptional Patient in Cancer Care

Focus Area: Mental Health The topic of the exceptional patient with cancer has been a puzzling mystery, and the phenomenon has not been formally investigated. The rare and spectacular occurrence of remarkable recovery, against all odds, that is totally inexplicable but real is something that most physicians have seen within their practice. From time to time, patients turn up with advanced cancer, beyond the possibility of cure, and without clear explanation they become free of disease or have survival that cannot be explained with the nature of their disease or treatment. Exceptional disease course and at times spontaneous regression of cancer is exceptional but a well-documented biological event. Further understanding of this phenomenon and of the possible mechanisms involved may have significant preventative and therapeutic implications. To date, the research that has examined these success stories is limited and there is no clear explanation for the phenomenon. Multiple speculations as to the mechanism of exceptional disease course have focused on physiological factors including immunological, elimination of carcinogen or antigen, anti-angiogenesis and tumor necrosis, apoptosis, and genetic and epigenetic mechanisms and possibly psychological mechanisms. Others note that a certain percentage of patients have undergone some kind of spiritual awakening before the remission took place, suggesting that the patients themselves had an important role in the healing process. Much of the literature is based on individual case reports. In this presentation, we will discuss current research findings and additional research being implemented on this topic.