Catherine Lucas

Embracing the imperfect: new beginnings after cancer

If you had visited the Visual Arts Centre in Singapore in late May this year, you would have found yourself surrounded by a profusion of strange and beautiful spheroid objects, ranging in size from a grapefruit to a large pumpkin, but looking more like colossal pebbles washed up on a giant’s cove. Made up of 174 unique sculptures, Beginnings represents the 174 lymph nodes removed from ceramicist Suan Ong’s neck and chest after she was diagnosed with stage IV thyroid cancer. Using the bean-shaped lymph node as her inspiration, she spent 3 years creating the works, and through the process learned a lesson in accepting fallibility in her art that would allow her to accept it in herself. Ong signed up for her first pottery class in 1995 and instantly connected with the medium. Apart from a 5-year period when she was living in the Middle East, she has continuously pursued ceramics alongside a career in communications. Returning to Singapore in 2011, she had a routine medical check-up and was shocked to receive an advanced cancer diagnosis. Her world was rocked again 7 months later with news that it had spread to her chest and neck. After three operations, including two neck dissections, and a further radioactive iodine treatment, Ong was forced to take a year off work to recover. It was while lying in her hospital bed that she resolved to memorialise in clay the parts of her body she had lost. Returning to her studio, she initially planned to decorate pots with lymph nodes, but the project developed into something more organic and free, leaving behind the functionality of the pottery tradition to embrace more primitive forms. The objects in Beginnings seem borne from the earth, and hold a kind of timeless power. In natural shades of brown, blue, and grey, each one is carved, glazed, or roughly textured, proud in its asymmetry, dignified in its simplicity. Some have gold seams, like veinlets in a leaf— evidence of rupture and repair. Having begun with a firm vision of what the final pieces should look like, Ong quickly found that the clay would sometimes dictate its own form. “Like [in] any relationship, it may not respond according to my wishes!” she explained in an email interview. Clay shrinks when it dries in a kiln, so there is always a risk of cracking as it comes under stress. During work on Beginnings, Ong would find herself repeatedly discarding one of her favourite pieces when it would emerge cracked from the kiln. Each time a piece was not to her exacting standards, she would start again, setting her back. It was then that a Japanese potter friend introduced her to the art of kintsugi. In kintsugi, broken ceramics are repaired using a lacquer mixed with powdered precious metals, creating shining seams in the stone, and sometimes enhancing the value of the object. This wabi-sabi philosophy of embracing flaws, and incorporating breakage into the visible life of an object is central to Japanese aesthetic principles. Ong recognised a strong resonance with her own experience of cancer, which forced her to rebuild and accept imperfection in herself. “I am choosing to quieten my mind, and accept this piece as it is. I’ve come to appreciate it even more.” She grew to treasure those objects that had imperfections, because they became a way of embracing the past, and moving forwards towards recovery. Ong has now been cancer free for 5 years, but she has had to accept changes in her life. Treatment has left her with severe damage to her salivary glands, and she suffers from xerostomia, or dry mouth, affecting her enjoyment of some foods. But with Kintsugi, she has found a way to move forward in her art and her life. At the show, next to a large oval piece, split like a giant almond, are scrawled the words of Ernest Hemingway: “the world breaks everyone, then some become strong at the broken places.”

Communicating cancer in the digital age

Part memoir, part travelogue, Danny Clinkscales’s book is not the eventfilled odyssey its subtitle suggests—it is a love story between one man and the American midwest. Clinkscale tells his reader early on that his life has always been pretty darn good. This charmed existence was interrupted by a bout of skin cancer that progressed to a tumour on the salivary glands, leaving him to juggle a full-time job alongside surgery and regular radiotherapy treatments. In Leaving Cancer for the Circus, we glimpse the dream that allowed Clinkscale to maintain his positive outlook on life: a 10-day solo roadtrip around his beloved America. Overwhelmingly positive, Leaving Cancer for the Circus documents a wholesome—if lonesome—journey across the small town midwest. Refreshingly, traditional tourist traps are actively avoided in favour of the road less travelled. The resulting calm allows for an unrushed writing style, and contrasts with the high energy of Clinkscales’s frequent sports anecdotes. Despite the relatively few memorable events or standout locations over the course of the roadtrip, and the subsequent tendency for one small town to blur into the next, lost among stories of baseball triumphs and childhood memories, Leaving Cancer for the Circus remains a fast-paced, attention-holding book. Clinkscales’s skill lies in his familiar, homespun voice, and the attractive nature of his anecdotal digressions. Unlike many traditional travel narratives, we aren’t presented with a writer discovering himself alongside the landscape. Instead, as we navigate Clinkscales’s storytelling, we find a man who has always had a strong sense of self. Alone on his travels, Clinkscale is able to reflect on his passions in life, and expound upon his deep love of radio, baseball, and golf. Readers seeking an adventure fit for Odysseus, or a tale of an escape from the drudgery of daily life to the glamour of the circus, should look elsewhere. But Clinkscale has written a touchingly heartfelt portrayal of the country he loves, and reminds the reader on every page that we should stop and be grateful for the people and places around us—in the smallest of towns, one can find the hope to overcome whatever life throws your way.

Cracking the cancer code: a personalised genomic approach

In a February, 2017, episode of Canada’s flagship science series The Nature of Things, presenter David Suzuki outlines “a revolutionary new approach to cracking cancer”—one that puts genomic analysis at the heart of diagnosis and treatment. In Cracking Cancer, viewers witness the inner workings of a medical trial at the BC Cancer Agency in Vancouver (BC, Canada), and follow the intimate stories of participants as they test out a new personalised approach that promises to change not only the way we treat, but also the way we think, about cancer. Cancer is categorised according to where it occurs in the body. Project co-founder Dr Janessa Laskin is working on an approach that will cut across existing divisions and re-organise cancer into “hundreds, maybe thousands of diseases,” thus presenting a new set of remedial possibilities. This is achieved with the help of a new diagnostic system called Personalised OncoGenomics (POG). Using immense computer power, each participant’s genome is mapped twice, once using their normal cells, and again with biopsied cancer cells. These DNA and RNA sequences are then compared to reveal the precise breakages and mutations driving the cancer. Interdisciplinary teams of geneticists, scientists, and doctors from across the spectrum of cancer specialties examine and discuss the genomic abnormalities found. For each participant, this culminates in a search for drugs that might block the cancer drivers so that a long-term programme of treatment can be prescribed. The documentary begins with the story of ‘super responder’ Zuri Scrivens, the 10th patient to participate in the POG trial, after her breast cancer spread to her liver and lymph nodes. Scrivens made a full recovery when POG revealed very high expression of a growth factor in her cancer cells that could be blocked with a drug commonly used for diabetes. Scrivens has become a poster child for the programme, but, as Dr Stephen Chia, a medical oncologist at the BC Cancer Agency, is at pains to stress, “POG does not provide miracles, it offers insights into what might be driving or not,” helping to indicate a path for possible treatment. Fewer than 5% of participants turn out to be ‘super responders’, and while only less than 40% experience improved outcomes, some relapse, others do not respond to treatment, and about 25% do not have any remedial approach indicated by their genomic analysis. In an unobtrusive ‘observational’ style, we are privy to the intimate medical lives of several participants at various stages of the POG programme, illustrating this diversity of outcomes, but also the day-to-day disruption, anxiety, and drama of experiencing cancer diagnosis and treatment. Trish Keating, initially classed as a ‘super responder’ when her cancer disappeared after a course of blood pressure medication, is found to be relapsing, and a second POG analysis reveals the cancer developed resistance to the drug. When we return to her story, we learn that she has responded positively to an increase in dose. When Jen Strack, diagnosed with stage 4 lung cancer, enrols in the POG trial, her analysis shows an unusual genetic fusion that produces very high levels of a protein driving her cancer, and while a drug exists to target the protein, until Strack’s case, no patient had yet been found to test its activity. The treatment programme, at least for some time, sends her cancer into remission, and, as the first genefusion case of its kind, it represents a breakthrough in oncogenomics. All of these new insights about cancer drivers feed into a POG database of information on genetic behaviour in cancer. While resource-hungry genomic analysis is unlikely to become standard procedure for individual patients with cancer, the cost has fallen majorly in the past 5 years, from CAN

“Death is an adventure”: the power of terminal diagnosis

250 000 to around CAN

Laughter is the best medicine

20 000. Programme co-leader Dr Marco Marra predicts a future where with “100 000 fully characterised genomes, complete with outcome information...[you could] have a resource that might revolutionise how we develop drugs.” 5 years and 750 enrolments into the programme, Laskin does not expect POG to provide a cure for cancer, but she does hope for a future where cancer has become “a chronic disease with tolerable treatments”. Measured against this goal, POG has been successful in buying some participants time with the help of manageable drugs. But beyond this, a genomic approach could represent an important step in a major shift from the traditional classification of cancer towards a highly individualised understanding of the disease under the banner of personalised medicine. In presenting an accessible, detailed, and balanced look at the work of the POG team, The Nature of Things is doing valuable public engagement work at the cutting edge of cancer research.

Miracle mineral or mesothelioma: cancer and asbestos in the USA

Av an ti M ed ia treatment options, and does not seem overwhelmed by medical information, which is unusual for those newly diagnosed. Some viewers might therefore not resonate with Jules’ response to the diagnosis. Although vulnerable at times, especially when Mike is on tour, she is relentlessly optimistic and rarely complains. Before her cancer diagnosis, Jules said that “if anyone had had to deal with this as a couple, we’re probably the best couple to take it”. Their determination and courage in dealing with cancer also stems from non-cancer related experiences, such as the in-vitro fertilisation treatment that Jules underwent to have their two children. However, the documentary seems to linger on this point, which feels disjointed from the rest of the story. The documentary also retraces the couple’s personal history, including how they met and their musical career, which adds context to the film, but might seem distracting to some viewers, since their recollections of the past are less compelling than their present-day activities. Mike and Jules only use their fame to boost cancer awareness through their charity, the Love Hope Strength Foundation, which promotes outreach programmes, often involving music, for patients with cancer and their families. For example, Mike hosts a bone marrow donor registration drive in Washington, DC, USA. Despite their celebrity status, the couple is down-to-earth, and their values are highly family-oriented. Jules repeatedly says that she will rely on friends and family, militating against isolation. The couple emphasise the importance of choices; not cancelling work commitments that they were looking forward to, and choosing to be treated in their local hospital, where they are familiar with the doctors. In doing so, Mike and Jules show us how they manage life with cancer. However, we get the impression that this was designed to be an uplifting documentary from the beginning, and it is difficult to tell how much the positive tone of the documentary accurately reflects their response to the situation. Mike and Jules tells the story of a couple both affected by cancer, yet summarising it as a couple’s cancer story would be incomplete and undermine its broader interest. Mike’s retrospective views on his life with cancer contrast with Jules’ prospective ones. The couple do not emanate misfortune and unhappiness, but hope and determination. Mike says “cancer makes you aware of life”. This documentary is inspiring in many ways, and will leave viewers reflecting on their happiness and values.

A family chronicle of love and death

Over the past few years, there has been a growing belief that laughter is not only good for the mind and soul, but also for the body. For example, there are many reports that laughter can actually boost a persons immune system. However, a recent review of the medical literature by Dr. Howard Bennett, at George Washington University, shows that the maxim, Laughter Is The Best Medicine, has yet to be proven