What the Oncology Field Can Learn From Jimmy Carter
Expert Perspectives · Rahul Banerjee, MD, FACP · 2024-10-31
More than any other year, 2024 has come with many questions in the media about the age of various US presidential candidates (a topic well outside the scope of this humble oncology-focused column). I want to draw attention, however, to the age of a former US presidential candidate as something even more newsworthy. Former US President Jimmy Carter turned 100 years old earlier this month just in time to cast his absentee ballot for the upcoming election. Beyond becoming the longest-lived US President in history, this story is even more remarkable because he had been placed on hospice in February 2023.
Jimmy Carter’s Melanoma Journey
President Carter’s journey with living with melanoma is impressive in its own right—he was one of the first public personalities to receive pembrolizumab in 2015, barely one year after its first approval as a checkpoint inhibitor. But how likely is it for someone placed on hospice for metastatic cancer in February 2023 to be casting an absentee ballot 18 months later—and what does this tell us about our own field?
Hospice: Underused in Oncology?
Many studies have noted that we underuse hospice for our patients living with cancer when no good treatment options are left: in one analysis, 42% of patients received hospice services for less than one week while only 7% were on hospice for over six months. This skewed distribution is in part due to regulatory wording around a six-month life expectancy (which, of course, is only an educated guess and not an inflexible cap) but more likely due to our inclination as oncology professionals not to “give up hope” on systemic cancer treatments until the very end.
To be clear, novel oncology drugs are continuing to improve life expectancies across the board, even for heavily pretreated patients. And as I’ve reflected on before, hospice is not a panacea and should not be offered as a solution to all that ails a patient living with cancer. But with those caveats in mind, Jimmy Carter’s resilience is a good reminder to us to consider hospice referrals earlier for our patients. The former President had long spoken about his desire to be able to vote in the 2024 election, and I have no doubt that being on hospice rather than intensive therapy as a frail centenarian made this goal possible for him.
The Second-Generation Jimmy Carter Effect
When he was first placed on pembrolizumab almost a decade ago, the “Jimmy Carter effect” was coined for the intense interest in immunotherapy that his subsequent remission engendered. Now, seeing how well he has done on hospice, we can hopefully use this update to better counsel patients about hospice and perhaps usher in the “second-generation Jimmy Carter effect” in the process!