Through the battle with breast cancer that she and her mother endured,
the ‘Sex and the City’ star defines what being a cancer survivor means.
By Allan Richter
Cynthia Nixon had given plenty of speeches about breast cancer before. Each time, she unflinchingly declared herself a breast cancer survivor and the daughter of one. But Nixon, known for her role as attorney Miranda Hobbes on “Sex and the City,” was less certain about her choice of words when she appeared before a group of more than 400 breast cancer survivors and health advocates last year.
What was different this time was that earlier in the year Nixon’s mother Anne had succumbed to her third bout of breast cancer. Could she still call herself the daughter of a breast cancer survivor, she wondered? “This very natural, almost rote description of myself is no longer accurate,” she told the breast cancer group on New York’s Long Island. “This—like the loss of my mother herself—seems at times quite unfathomable and I haven’t yet quite caught up with the new order of the universe.”
The impasse over the term “survivor” that Nixon faced after her mother’s death is one that cancer support groups and healthcare advocates have wrestled with for decades. Being tagged a survivor has been shown to instill hope among cancer patients and their loved ones. But some contend that the term is too vague and dilutes its meaning in this and other contexts.
“This remains a controversial issue to this day. There is not always consensus about when a person can be considered a survivor,” says Kevin Stein, PhD, managing director of the Behavioral Research Center of the American Cancer Society.
“At first there was no concept of survivorship or survival because the disease up until the 1950s was basically a death sentence,” Stein says. “You didn’t say the word out loud because most of the people who got the diagnosis died. For many years, a person was not considered a survivor until they were five years disease-free after they had completed their treatment. Then years later, it moved from this five-year survival period to two years.”
Today, some cancer advocacy organizations define a survivor of the disease as anyone living with a cancer history, from diagnosis through the remainder of life. The embrace of that definition by those organizations, the American Cancer Society among them, takes into account post-treatment support that extends to families of people who have been diagnosed with the disease.
That broader definition of who is a survivor jibes with demographic trends. In parallel with a general population that is both growing and aging, the number of people who have had cancer is increasing—and they are living longer. “You combine all of that with more advances in cancer treatment and also in early diagnoses,” Stein says, “so we’re better at catching cancers early, when they’re more treatable and more survivable.”
Cynthia Nixon’s mother was first diagnosed with breast cancer in 1979, when she was 49 and when more than 75% of people who had been diagnosed with the disease were living five years or more, according to American Cancer Society statistics on relative survival rates. (Relative survival adjusts for normal life expectancy by comparing survival among cancer patients with that of the general population, controlling for age, race and sex.)
By the time her mother was diagnosed with breast cancer for the third time, four years ago, more than 90% of people who had been diagnosed with the disease were living at least five years. Cynthia Nixon’s own diagnosis with breast cancer came in 2006, when the five-year relative survival rate was 90%.
“My mother said when she was diagnosed in 1979 that she didn’t think she was going to die from this cancer, and I felt very much the same way in 2006,” Nixon told the Long Island breast cancer group.
“It was something I was going to take seriously and do everything I thought would help. But for whatever reason, it didn’t feel like a death sentence, just a diagnosis you would prefer the doctor had been mistaken about. And while I call myself a cancer survivor, it makes me feel funny to. I feel like some people got four tours of duty in Iraq, and I just went through basic training and they never shipped me out anywhere.”
Phases of Survival
Cancer care advocates point to Fitzhugh Mullan, MD, as the first to use the term “survivor” in the context of cancer when he described his experiences as both a physician and a cancer patient himself in a 1985 New England Journal of Medicine article. In that piece, Mullan dismissed the prevailing two classifications of someone who has endured cancer: those who have been cured and those who have not.
Instead, Mullan proposed that the “survivor” tag be applied to all people who had been diagnosed with cancer. He segmented survival into three distinct phases: acute survival, when patients focus their efforts on surviving treatment; extended survival, when people complete treatment and cope with its physical and mental effects; and permanent survival, when the survivor is dealing with the long-term effects of treatment, and when recurrence seems increasingly unlikely.
Nixon says her mother’s approach to dealing with her cancer was shaped by the healthy view that doctors and scientists were “not all-knowing gods and that their opinions should be taken as such. If your doctor’s advice deviated from your own opinion,” Nixon said, “it was probably best to find a doctor you saw more eye to eye with.” Anne Nixon learned that lesson from her own mother, herself a scientist.
Her line of attack against the disease was also the result of her own education. In what Cynthia Nixon called “an odd twist of fate,” her mother had been between jobs when she discovered her breast cancer and had been supporting herself by doing research for pamphlets put out by the American Cancer Society.
In her first bout with breast cancer, Nixon’s mother found the lump in her right breast herself. She had been accustomed to doing breast self-exams and assessing odd textures and bumps. And when she felt the lump, “she knew it was different,” Nixon said, “and not in a good way.”
Anne Nixon later put that sixth sense, as well as her mother’s advice, her independent spirit, and the knowledge she gleaned from preparing the American Cancer Society research, to use when she dismissed her doctor’s advice to get a full mastectomy of the right breast. “Why, she thought to herself, would he need to take the entire breast when the cancer was only a localized lump in a certain part of the breast?” Cynthia Nixon recounted in her Long Island talk. “Her breast, after all, was a part of her and an important part at that. Why throw the baby out with the bath water?”
Instead, Anne Nixon found a doctor, Louis Slattery, who was able to save much of her breast. “He was a follower of common sense, rather than of medical fashion, and it seemed nonsensical to him to take off healthy tissue for no reason,” Nixon said.
“The lumpectomy of which Dr. Slattery was a huge proponent and which my mother could hardly find anyone to perform in 1979 is, thirty some years later, the standard procedure for women whose cancer is the size and stage that my mother’s was and was what was done for me when I received my breast cancer diagnosis in 2006,” Nixon said.
In addition to being proactive about her breast cancer diagnosis and treatment, Anne Nixon helped allay the fears of others who had cancer, her daughter told the Long Island breast cancer group.
When Cynthia Nixon was 19, she was doing a play with actress Jill Eikenberry, who was about to begin filming the television series “LA Law.” But Eikenberry had just been diagnosed with breast cancer, Nixon recalled, and was despondent.
“Me and all of my nineteen-year-oldness said, ‘Oh, don’t worry. You’ll be fine. My mother had that and they simply cut the cancer out, gave her radiation and now she has a scar—that’s all. She’ll show it to you!’
“And sure enough a few days later my mother was at the theatre, and she went in the dressing room with Jill, hiked up her shirt and showed her scar. ‘You’ll be fine.’ my mother told her. ‘Just don’t let them take the whole breast’—my mother’s mantra. Later she sent Jill some cream that had been very beneficial in helping her heal,” Nixon said.
“Jill has spoken many times publicly about her cancer,” she continued, “and has said that the conversation she had with my mother was the beginning of the dawning realization that maybe she wasn’t going to die from this cancer after all.”
Anne Nixon had what her daughter described as a brief recurrence in her other breast in the mid-nineties, about 15 years after her initial diagnosis. When her third and final diagnosis came around four years ago, she had a doctor who, by Nixon’s account, did everything right.
Because her mother’s cancer, though at stage four, was very slow moving, the doctor explained that “we didn’t have to go full throttle to knock it out,” the actress recounted. The family would not have been able to pursue that approach anyhow because of Anne Nixon’s advanced age, her late seventies.
“The main thing we had to do was watch it very carefully, keep it from running amok and make sure the ‘sprinkling of chemo’ we were using to keep it down was going to be a dosage my mother could handle,” Nixon said.
“The most evocative thing he said,” Nixon recalled of the first detailed consultation with her mother’s doctor, “was that my mother’s cancer was like being at a party with an obnoxious guy you really can’t stand. The guy is leering, he’s racist, his breath is terrible, he’s constantly stepping on your toes, but you have to remember to keep your cool and keep him at bay. You’re going to get in trouble if you try to run screaming away or if you throw yourself on him and try to beat him away. You’re not going to succeed at either of those things and you’re only going to make things much worse for yourself. Just keep cool.
“And we did. And in contrast to how sick she had been from the previous chemo overload, she was able to have another really solid year with not a lot of drama really until the end.”
‘A Good Run’
Writing in the Journal of Clinical Oncology, Kirsten Bell and Svetlana Ristovski-Slijepcevic note that opponents of the term “survivor” in the context of cancer assert that the word whitewashes the differences between cancer types and the demographics of people who are afflicted. Others dislike the word’s implied emphasis on “the mere existence of life” versus quality of life, the University of British Columbia researchers said.
But many people identify with the term, they add. “Taking on the mantle of the cancer survivor seems to play an important role in allowing people diagnosed with the disease to integrate the experience into their identities,” they wrote. “Evidence suggests that embracing the label may lead to a more active approach to dealing with cancer and its aftermath, reducing anxiety and depression and improving self-esteem.”
Nixon appears to support the latter approach. “My mother died…of cancer at the age of 82½, almost 35 years after her initial diagnosis, and if you told a room of people you had been married for 35 years or held a job for 35 years, they would applaud,” she said.
“Why? Because it means, as we say in the theatre, that you had a good run. It means it was a success. I think that my mother’s 35-year war with breast cancer was a success in the end even though the death certificate lists the cause of death as cancer.
“So I think, after much consideration, I will continue to say when I make a speech such as this one, ‘Hello. My name is Cynthia Nixon. I am a proud cancer survivor. And an even prouder daughter of a cancer survivor whose name was Anne Elizabeth Knoll Nixon.’”