I have had two life-threatening cancers over the past 3 decades and can say without equivocation that there is never a good time to get cancer. My first cancer diagnosis happened in 1992, just weeks after I had accepted the position of Chief Executive Officer of Hughes Electronics. The job meant a cross-country move, and I was excited about the new challenges ahead. I just never expected one of those challenges to be life or death.
In my second week on the job, I received a call from the director of the medical center where I had my annual physicals prior to my move to California, apologizing for a mistake the hospital had made in my blood tests 2 years in a row. “For the past 2 years, your blood cell counts have been declining, and we missed it,” he explained. When I asked what having low blood cell counts meant, he responded, “We believe you have leukemia.”
Clinical Trial of Pentostatin
It’s hard to put into words what it is like to be told you might have cancer. In that moment, I knew my life was on the line, and it was terrifying. The physician urged me to immediately make an appointment with a specialist he was recommending. Soon my worst fears were realized. The exact diagnosis was hairy cell leukemia, a rare, slow-growing blood cancer. Although this cancer is not usually aggressive, explained the oncologist, because mine had gone undetected for so long, it was now a serious problem.
Living with such uncertainty for so many years taught me the value of living a more purposeful life.— Mike Armstrong
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In 1992, there were several U.S. Food and Drug Administration–approved therapies for my type of leukemia, but my oncologist suggested I enroll instead in a clinical trial investigating pentostatin, a purine analog and antineoplastic agent, as first-line therapy for hairy cell leukemia. The treatment was intense. For 30 days, I had a chemotherapy pack strapped around my waist, pumping continuous pentostatin throughout my body, hopefully killing the cancer cells. At the end of the 30 days, my lab test results showed that the treatment worked. Just as suddenly as cancer had come into my life, it was gone, although it was soon replaced with another life-threatening illness. The chemotherapy had caused my blood cell count to drop so low, I had contracted a serious bloodstream infection; it landed me in the intensive care unit and left me, once again, fighting for my life.
Fortunately, a strong antibiotic killed the infection, and I was soon able to resume my life and career. However, having two serious illnesses over a matter of months taught me how fragile and precious life is and left in their wake a renewed sense of an appreciation for life. I knew how lucky I was to have a treatable, and I hoped curable, type of leukemia, and I was vigilant about maintaining my health checkups, including regular prostate-specific antigen (PSA) exams. Over the years, the leukemia had remained in remission. However, in 2003, my PSA levels started creeping up from a normal range for a man of my age to 4 ng/mL, which indicated prostate cancer might be present.
To my great relief, a tissue biopsy of my prostate was negative for cancer. A second PSA test a year later again caused alarm when it showed my levels had jumped from 4 ng/mL to 8 ng/mL, an even stronger indicator that I may have prostate cancer. Despite the rapid increase in PSA readings, another tissue biopsy of my prostate failed to turn up any signs of cancer. However, the following year, 2005, my PSA level had reached an alarming 17 ng/mL, a very strong indicator of cancer. This time, a more thorough examination of my prostate tissue found that I did, in fact, have prostate cancer.
My oncologist recommended a prostatectomy. Disappointed that I had to deal once again with cancer—and a second missed diagnosis—I nevertheless went into the surgery optimistic of a successful outcome. Instead, the operation revealed the cancer had spread outside of the prostate into the pelvic area. I tried to console myself with the thought that at least the cancer was contained to this one area and had not spread to distant organs, but the news was still shocking. The planned adjuvant treatment was aggressive external-beam radiation therapy 5 days a week for 9 weeks and hormonal therapy for 3 years. But another serious health problem interrupted my treatment. While undergoing radiation therapy, I had developed an extremely rare autoimmune disease called Parsonage-Turner syndrome, which attacks the brachial plexus; in my case, the disease was affecting my phrenic nerve, making it difficult for me to breathe.
Now I was fighting two illnesses, either one of which could kill me.
Beating the Odds
Against the odds—I had been given only a 50% chance of surviving prostate cancer for 5 years—slowly, treatments for the prostate cancer and Parsonage-Turner syndrome were effective in halting the progression of both diseases. Today, 16 years later, I remain cancer-free, and my lung capacity is back to normal. However, living with such uncertainty for so many years taught me the value of living a more purposeful life. If I only had 5 years or less to live, how would I make the most of that time, I wondered.
For years, through my C. Michael Armstrong Family Foundation, I had been making financial contributions to help support biomedical research at Johns Hopkins Medicine in Baltimore and programs to assist the disadvantaged. Now, my wife, Anne, and I have decided to give most of our wealth away to fund these worthy causes. Through our foundation, we have endowed a chair to support the cancer research of Gregg L. Semenza, MD, PhD, Director of the Vascular Program, Institute for Cell Engineering and Professor of Genetic Medicine at Johns Hopkins Medicine.
Dr. Semenza’s groundbreaking discovery of the hypoxia-inducible factor 1 protein, which controls changes in gene expression in response to changes in oxygen availability and has far-reaching implications for treating cancer and ischemic cardiovascular disease, earned him the 2019 Nobel Prize in Physiology or Medicine with William G. Kaelin, Jr, MD, Sidney Farber Professor of Medicine at Harvard Medical School.
Our foundation also funded the creation of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine, which has become a global leader in patient safety.
Making the World a Better Place
Throughout my life and career, I have always tried to contribute to making the world a better place, but cancer gave me a sense of urgency to live a more purposeful life that I didn’t have before my diagnoses. Cancer changed my perception of life and my role in it. Although I can’t say I’m glad I got cancer, it has taken me to new levels of awareness I might never have experienced. For that, I am thankful.
Mr. Armstrong lives in Naples, Florida, with his wife, Anne. He is coauthor with Eric A. Vohr of Cancer With Hope: Facing Illness, Embracing Life, and Finding Purpose (Johns Hopkins University Press, 2021).
Editor’s Note: Columns in the Patient’s Corner are based solely on information The ASCO Post received from patients and should be considered anecdotal.