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McCain halts treatment for deadly brain cancer

U.S. Sen. John McCain, who has outlived the odds time and again, has stopped medical treatment for his aggressive brain cancer diagnosed more than a year ago. "The progress of disease and the inexorable advance of age render their verdict," his family said.

McCain announced that he had been diagnosed with glioblastoma, an form of brain cancer, last July after he had an operation to remove a two-inch tumor.

"In the year since, John has surpassed expectations for his survival," his family said Friday morning.

"With his usual strength of will, he has now chosen to discontinue medical treatment," the McCain family said in a statement released by his office.

Related: What happens if McCain resigns or dies in office?

"Our family is immensely grateful for the support and kindness of all his caregivers over the last year, and for the continuing outpouring of concern and affection from John’s many friends and associates, and the many thousands of people who are keeping him in their prayers. God bless and thank you all."

"My family is deeply appreciative of all the love and generosity you have shown us during this past year," one of the senator's daughters, Meghan McCain, added in an Instagram post. "Thank you for all your continued support and prayers. We could not have made it this far without you — you've given us strength to carry on."

Outside medical experts said it's unclear what McCain's prognosis might be at this point; the decision doesn't necessarily mean the senator is on his deathbed.

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The 81-year-old Republican from Arizona — set to turn 82 on Wednesday — has not taken a vote in the Senate this year, but has issued a steady stream of statements on political issues. In addition to his usual backing of bolstered military spending, McCain has kept up his criticisms of President Donald Trump, blasting what McCain has deemed a fawning relationship with Russian leader Vladimir Putin.

But this month, the pace of those statements has slowed, even as Congress passed a major defense spending bill named after him.

"God bless and keep this wonderful man and his family," fellow Arizona Republican Jeff Flake tweeted after the statement was released.

"John McCain is an American hero, always putting country before self," Arizona Gov. Doug Ducey said. "From Vietnam to the halls of the U.S. Senate, the spirit of service and civility that has guided Sen. McCain's life stands as a model for all Americans, regardless of political affiliation."

"John McCain personifies service to our country," Speaker of the House Paul Ryan said.

"John McCain's life has been one of service and sacrifice. His strength and resolve enabled him to endure 5.5 years as a prisoner of war, and to continue to serve his country for decades," said U.S. Rep. Martha McSally, a Republican running to fill Flake's seat.

"No man this century better exemplifies honor, patriotism, service, sacrifice, and country first than Senator John McCain. His heroism inspires, his life shapes our character. I am blessed and humbled by our friendship," former GOP presidential candidate Mitt Romney said.

Neither Trump nor the White House had any comment on McCain's announcement Friday. Trump spend the morning raging at his own attorney general, Jeff Sessions, in a series of tweets.

The six-term senator has a form of cancer that is the most aggressive type that begins in the brain, with early symptoms that may include personality changes, headaches, and symptoms similar to those of a stroke.

Related: What to know about glioblastoma

Glioblastomas generally recur, despite surgery and cancer treatments, and most patients live 12-15 months after diagnosis. Less than 3-5 percent live longer than five years, with those patients who are not treated dying within three months.

Glioblastoma is the same variety of cancer that killed Sen. Ted Kennedy, D-Mass., in 2009. Kennedy was diagnosed in 2008 after a seizure.

McCain has had less-aggressive cancers before. McCain had surgery to remove Stage IIa melanoma in 2000, including removing the lymph nodes on the left side of his neck. He has had four operations to remove skin cancers since 1993, and at least one non-cancerous mole removed as a precaution, in 2008.

McCain had a two-inch blood clot removed from his brain above his left eye last July. Surgeons at the Mayo Clinic in Phoenix performed the operation, which required a craniotomy near his eyebrow.

Pathology "revealed that a primary brain tumor known as a glioblastoma was associated with the blood clot."

Prognosis

Neurosurgeons and brain tumor experts said Friday it’s hard to tell how the decision to halt treament will affect McCain’s prognosis.

Dr. Walter Jean, a professor of neurological surgery at George Washington University Hospital, said prognoses, treatment plans and life expectancies vary widely depending on a patient’s health, age and reaction to treatments, which typically include surgery, chemotherapy and radiation.

“It’s an impossible problem to guess at the answer,” he said. “It’s important for people to realize that we don’t have crystal balls.”

But Jean stressed that McCain’s prognosis cannot be based solely on his age – he was in good health to begin with, which has likely helped him fight the tumor.

“People perhaps initially had a very bad expectation because they look at him as, ‘Oh, he’s old and age is not in his favor from the get-go,'” Jean said. “But it was more driven by his baseline health than his age.”

Though glioblastomas are typically treatable, Jean said they are ultimately not curable.

Dr. Deepa Subramaniam, director of MedStar Georgetown University Hospital’s Brain Tumor Center, said that while older patients typically have a harder time fighting glioblastomas, McCain is currently at the median survival rate for all patients with the disease.

There are some “extreme survivors” who live for years with a glioblastoma, she said, but patients are typically expected to live a year or a year and half after their diagnosis.

Subramaniam said there are many reasons McCain could have chosen to stop treatment, and not all of them mean he is giving up hope.

Sometimes patients don’t want to deal with the side effects of the treatments and some patients who are weaker physically can’t handle the treatments, she said. Others just want to take control over the quality of the end of their life.

“It’s a redirection of efforts,” Subramaniam said. “We redirect our hopes from living longer to hopes of living better.”

There is lots of research currently being done on glioblastomas and Subramaniam believes doctors may be on the verge of a medical revolution. With the research being done now, she thinks glioblastoma could become a disease doctors can treat similarly to other forms of cancer.

McCain announced his diagnosis on July 19, 2017, less than a week after he had been hospitalized for removal of a suspicious blood clot over his left eye. The Mayo Clinic in Phoenix, where McCain underwent the blood-clot surgery, said at the time that McCain’s underlying health was excellent and his office said he was in good spirits.

But the Mayo Clinic website also said that glioblastoma is an “aggressive type of cancer that can occur in the brain or spinal cord,” and that it can “be very difficult to treat and a cure is often not possible.”

According to the American Cancer Society, glioblastoma tumors are a fast-growing category of brain tumors that begin in the glial cells, which surround the central nervous system. It is the same type of cancer that killed Sen. Ted Kennedy, D-Massachusetts, in 2009 and killed former Vice President Joe Biden’s son, Beau, in 2015.

McCain returned to the Capitol in late July 2017 when he cast a critical early-morning vote that salvaged Obamacare. He remained in Washington through the fall, and was honored in October with the National Constitution Center’s Liberty Medal in Philadelphia.

At that event, McCain made an emotional appeal for the U.S. to rediscover its values and to reject the “half-baked, spurious nationalism cooked up by people who would rather find scapegoats than solve problems” – an apparent reference to President Donald Trump, with whom he often sparred.

It was one of many awards, and several calls to action by McCain after his diagnosis. But by the time he was being honored this spring at his alma mater, the U.S. Naval Academy, the senator was back in Arizona receiving treatment and too ill to travel.

The Naval Academy honor was accepted on McCain’s behalf by Biden, a longtime Senate friend, who said the Arizona senator and Navy veteran had lived a “life of honor, decency, duty and devotion to his country like none other in modern American history.”

“Like my Beau, John has never bent, never bowed and never, ever yielded,” Biden said. “And he has never given up hope.”

The news of McCain’s diagnosis last summer brought an outpouring of support from friends and political foes alike.

Fellow Arizona Republican, Sen. Jeff Flake, said of McCain at the time, “Tough diagnosis, but even tougher man.” Former President Barack Obama tweeted: “John McCain is an American hero and one of the bravest fighters I’ve ever known. Cancer doesn’t know what it’s up against. Give it hell, John.”

McCain’s daughter, Meghan, called her dad “a warrior at dusk, one of the greatest Americans of our age, and the worthy heir to his father’s and grandfather’s name.”

“But to me he is something more. He is my strength, my example, my refuge, my confidante, my teacher, my rock, my hero – my dad,” she wrote.

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Cronkite News reporter Alexis Egeland contributed to this story.


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Paul Ingram/TucsonSentinel.com

McCain in Nogales in 2014.