Stage IV cancer? More like a Chronic ailment

When Nurani Poerbonegoro arrived in Singapore, she was thin and in a wheelchair. She had fourth stage breast cancer and had declined treatment for months.

“Finally, I could not stand it because the disease was taking over my life. I could not walk, I could not eat, I was in pain. I went to the hospital by ambulance from the airport,” she said.

That was in 2001. At the time, she had already known for some time that she had a tumour. An operation was suggested, but she was too afraid to take the plunge. “I just read and read about chemotherapy, all the other treatments, and I got scared,” she said.

But by 2001, she had no choice. “I was dying,” she said simply.

Nurani had stage IV breast cancer, which cannot be cured. However, it can often be treated and controlled.

She first saw Dr Ng Eng Hen, a surgeon who said she was not operable because the cancer had spread too far. He referred her to Dr Ang Peng Tiam.

Dr Ang said: “As high as 70 to 80 per cent of patients with breast cancer can have the disease treated and controlled. For Nurani, I tend to favour chemotherapy programmes which are effective but do not have significant side effects. As this is an incurable condition, it is important to preserve the patient’s quality of life while she’s undergoing treatment.

“After all, it would be meaningless to “successfully” control the cancer but render the patient very sick and bed-ridden.”

Nurani recalled that she had chemotherapy in “baby doses” because her body was very weak. By the third day, she was delighted when she was asked to leave the hospital.

She rented a flat, and started walking slowly from one room to another. Gradually, she got stronger and the medication was increased. After three months, she started walking, went back to Indonesia and began walking to neighbours’ homes. After four months, she was strong enough to travel by herself to Singapore for treatment.

Her doctor, Dr Ang, said: “It is not uncommon for me to see breast cancer patients who have widespread metastases. I hate to admit it. While I feel sorry that in this day and age, there are women who end up with such advanced disease at presentation, I relish the challenge of helping these women get better.

“The tougher the case, the more challenging it is and the greater the satisfaction of beating the disease. Nurani has been one such example. She was breathless and in severe pain from her lung and bone metastases. Now she is doing so well. Each time I see her, I share in her joy of living!”

Nurani has been well since she started treatment, despite her late stage cancer. Is she one of a very few?

Dr Ang replies: “Breast cancer is not a homogenous disease. There are those where the disease is very aggressive and despite our best efforts, the disease roars away with a vengeance. There are others where the disease tends to be somewhat more indolent and sensitive to therapy. Thankfully, there are many patients like Nurani where the cancer is more like a chronic ailment that requires regular treatment.”

Today, Nurani sports a full head of shoulder-length black hair, and sparkling eyes. She does almost everything she had done before she had cancer, except work. The former management consultant, now 50, gave up her job when she found out she had cancer.

Now she spends her time with her family and counselling other cancer patients.

“For me, the most important thing now is to have the spirit of life. If say, I have a pain in my hand, I can either give in to it and say “Oh, this is really killing me.” Or I can say “This is part of the process, it is therapy and I am getting better.”

“I love having people around me, my friends, my neighbours, they give me support, they fill me with the joy of living.”