Dr.Xu: How To Live With Cancer For Advanced Cancer Patients

'Living with cancer'

The capital of Guangdong province, in south China, sprawls across the Pearl River Delta and around Baiyun Mountain. The tropical city boasts a tradition of medical expertise. Sun Yat-sen, the celebrated father of Chinese democracy, and a doctor, founded one of the city's major universities, which carries his name.

Fuda Cancer Hospital was established here as a private facility in 2003. Its founder, Xu Kecheng, had previously led a hepatic disease research centre in the nearby city of Shenzhen, where he was also a chief physician.

From his office inside the hospital, 76-year-old Xu explained that he wanted to open a cancer hospital to explore new methods of treatment. 

With a ready smile, he listens intently, giving the impression that he has all the time in the world, although his phone rarely stops buzzing.

He had been disillusioned with the global "war on cancer", ignited in 1971 by then US President Richard Nixon, he explained. In 2004, he read a story in Fortune magazine that resonated with him. The article, titled Why We're Losing the War on Cancer, centred on how efforts to fight advanced forms of cancer were largely unfruitful.

Xu decided he wanted to explore ways to "live with cancer".

"Cancer originates in a gene mutation, so it's actually not an enemy from the outside," the doctor explained. "It's not like a bacteria or a virus that invades our body from the outside to produce a disease; it's a changing of our own cells."

If the cancer is identified early, then it has high chances of being eradicated from the body. But for many patients, the cancer has recurred or has already spread before its detection. In those cases, fighting it aggressively with chemotherapy and radiation is purposeless, Xu believes.

"It's like the Americans invading Iraq - you do a lot of damage, but you're fighting a war you can't win," he said.

So Xu decided he would build the hospital around offering palliative treatments to advanced-stage cancer patients, with the aim of making them comfortable and prolonging their lives.

He wanted to use new, minimally invasive procedures, such as cryoablation, which destroys tumours by repeated cycles of freezing and thawing produced by probes inserted into the body; and the NanoKnife, which uses high-voltage current to puncture the membrane of cancer cells. 

He paired the minimally invasive treatments with immunotherapy to boost the body's immune response to cancer, and with transarterial chemoembolisation, where microspheres containing chemo drugs are directed through an artery straight into the tumour, thus increasing the drug concentration that reaches the tumour and reducing the overall side-effects. 

A common area in Fuda Cancer Hospital's patient ward is decorated with paintings sent by former patients [Simina Mistreanu/Al Jazeera]

The standard treatment at Fuda Cancer Hospital was called "3C P" - which stands for cryosurgical ablation, cancer microsphere intervention, and combined immunotherapy for cancer, as well as a personalised approach. But the specific treatments for each patient are decided by a board of doctors based on their individual case, explained Niu, who is also the hospital's chief surgeon for minimally invasive surgery.

"My thinking is problem-based medicine," said Niu. "I first solve the patient's problem.

"If the patient feels pain, I'll solve the pain. If the patient cannot eat, I'll help him to eat. If the patient has a psychological problem, we call in a psychologist. If he has a nutrition problem, we call in the nutritionist. After all these problems have been solved, then the second aim is to prolong the life."

 The hospital has thrived: From a 20-bed capacity when it opened in 2003, it has now grown to include 400 beds and a second, 11,000-square-metre facility that opened in 2011. Xu has won a slew of awards from the Chinese government and other institutions, including the Bethune Medal, which is considered China's highest medical award.

Yet scepticism about the hospital has lingered through the years. In 2008, a Danish newspaper covered the case of a patient from Copenhagen who sought treatment for her stage-4 pancreatic cancer at Fuda. Ulrik Lassen, the chief physician at Copenhagen University Hospital Unit for Experimental Cancer Treatment, was quoted as saying Fuda's treatments were "unethical" for offering patients false hope.

And in 2014, when Xu gave a presentation in Perth, Australia, together with an Australian patient, the vice president of a regional chapter of the Australian Medical Association, Andrew Miller, accused Fuda of quackery. Both Lassen and Miller haven't responded to requests to expand on their concerns.

Gurli Gregersen, the Danish patient profiled in the 2008 story, is still alive today. The 68-year-old retired teacher was diagnosed with stage-4 pancreatic cancer in 2007. She underwent a few rounds of chemotherapy, after which her Danish doctors told her to go home and enjoy the last months of her life with her family.

But Gregersen's daughter wouldn't hear about her giving up. She had read a story about Fuda and suggested Gregersen give it a try. The retiree sold her apartment to pay for the treatment and flew to Guangzhou in the spring of 2008. She received cryosurgery, immunotherapy and other treatments, and then flew back home.

"I was just expecting to live a little longer, maybe half a year. I would have been happy," Gregersen said. "But then I could see I was not tired, I was not getting skinny, and I didn't have pain. You know, it got better and better." 

Since then, Gregersen has taken annual trips to Fuda for immunotherapy and other minimally invasive procedures. The doctors and nurses there have become her second family, she said. 

She now lives an idyllic retiree life – she has a small house in the country outside Copenhagen, where she gardens, knits, takes long walks on the beach, looks after her grandchildren and spends time with her friends visiting museums and art galleries. She even started attending an evening class on Chinese history.

She said her Danish doctors prefer not to discuss her treatments in China, and request that new tests be done even when she brings recent scans from Guangzhou. 

Xu is proud to talk about Gregersen's case. He calls her a "miracle patient". The doctor takes pride in taking on cases other doctors have deemed untreatable and his office is decorated with gifts from patients and pictures they've taken with him.

He opens a book that catalogues some of Fuda's most famous cases, including patients with visible external tumours: "Before, after; before, after," he says as he thumbs through the pages.

In January 2006, Xu was himself diagnosed with liver cancer - a disease that also affected his mother and sister. He received surgery and immunotherapy then, but is unaware of his current status. He said he feels great, and he still comes to the office every day.

"Most doctors like to treat early-stage cancer," Xu said. "But there are larger and larger groups of people who suffer from advanced cancer. Early-stage cancer can't always be discovered on time. We have no choice but to deal with this matter. These things are very difficult for doctors to do, but I'm willing to try."

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.

In February 2015, they married.

Raluca and Bogdan Pietroiu met during Raluca's remission [Photo Courtesy of Bogdan Pietroiu]

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."