Spoiler alert: If you're behind on your "Mad Men" episodes, stop reading now.
Spoiler alert: If you're behind on your Mad Men episodes, stop reading now. But if you caught this week's episode, all we can say is poor Betty Draper Francis. Over the years we've seen Don Draper's first wife endure philandering, divorce, massive weight gain, a thyroid cancer scare, and advances from creepy neighbor-kid Glenn, but this episode creator Matthew Weiner really let the chilly chain-smoking suburban mom have it: She has metastatic lung cancer, with at the very most 9 months to a year left.
While her ever-patient husband, Henry Francis, urges her to try the surgery or radiation that would still have her dead in a year, she decides to opt out of treatment altogether. At one point, Henry presses her, asking what would happen if his connected boss, Nelson Rockefeller, were in her shoes. "He would die," Betty replies.
Her stoicism in the face of a devastating diagnosis is gut-wrenching, as is the callousness with which a male oncologist delivers the dismal prognosis to her husband—rather than Betty—as if she weren't even in the room. So does Mad Men—which has been praised for its historical accuracy—nail what it was like to get a cancer diagnosis in 1970? How much different is it to have lung cancer today? To find out, we emailed Jorge Gomez, MD, assistant professor of medicine, hematology and medical oncology at Icahn School of Medicine at Mount Sinai in New York City, and Hossein Borghaei, MD, chief of thoracic oncology and director of Lung Cancer Risk Assessment at the Fox Chase Cancer Center in Philadelphia, Pennsylvania.
If Betty chose to fight her cancer, would she likely last a year?
Dr. Borghaei: "I believe the median survival in the 1970s was more in the order of 6-7 months."
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Would Betty fare much better now?
Dr. Gomez: "Unfortunately, the median survival today is approximately 12 months depending on the type of lung cancer. Patients with the standard lung cancer have approximately a 12-month survival. Patients with special types of lung cancers (20-25%) have a median survival of two or more years. Most patients have exactly the same options as they did in 1970 except for a few new chemotherapy drugs. Approximately 20-25% of patients are able to receive oral targeted therapies because they have a special type of lung cancer with genetic mutations that make their cancer sensitive to these drugs."
Betty likes her cigarettes. What percentage of lung cancer cases are smokers vs non-smokers?
Dr. Gomez: "Approximately 80% of patients with lung cancer are smokers. Non-smokers have a higher chance of having a special type of lung cancer that gives them a better prognosis."
What do we know about lung cancer now that we didn't know then?
Dr Borghaei: "Lung cancer is no longer considered a single disease, but many different diseases with [their] own specific molecular subtypes and in some cases very specific targeted treatment option[s]. Once the disease has spread from the lung to other parts of the body [Betty's was in her bones and liver] we no longer offer a surgical option as this approach does not improve survival and is associated with complications. The mainstay of treatment [today] is chemotherapy with radiation used for palliation of pain or other symptoms. A lot has changed, but we still have a long way to go."
Any exciting breakthroughs?
Dr. Borghaei: "Immunotherapy is now the most potentially promising treatment option we have for patients with lung cancer and it appears that patients with a heavy smoking history might potentially benefit more than non-smokers from this form of treatment. New agents, such as immunotherapy, are moving to front-line settings and the hope is they will have a bigger impact on survival."
Almost unbelievably, Betty tries to light up in the car right after she learns she has cancer. Do smokers often keep at it?
Dr. Gomez: "Many patients quit after diagnosis. More so in patients who can be cured of their cancer."
In the episode's most infuriating scene, Betty's doctor speaks directly to her husband about her grim fate without addressing her. It reminds us of a scene in the 1970 movie Love Story where Ali MacGraw's doctor tells Ryan O'Neal, not Ali herself, that she is dying of cancer. Was that standard practice in medicine back then?
Dr. Gomez: "This was a common scenario in and outside of medicine. It changed in medicine at the same time that it changed in the rest of the world."