McCain returns for health care vote despite a tough road ahead

Notoriously resilient and independent, the veteran senator faces his cancer diagnosis and rallies doctors, colleagues and family to his side

FILE PHOTO: U.S. Republican presidential nominee Senator John McCain (R-AZ) listens as he is introduced at a campaign rally in Fayetteville. BRIAN SNYDER—/Reuters

WASHINGTON, D.C. — U.S. Sen. John McCain (R-Ariz.), who was recently diagnosed with brain cancer, is planning to return to Washington Tuesday for a key vote on health care. His appearance is critical and some say symbolic of the Republican’s effort to make good on their campaign promise to repeal Obamacare, the signature policy initiative of the former administration. The controversial law has increased premiums and reduced health care options for millions of Americans since it’s passage seven years ago. Trump also ran on its repeal and has been stepping up the pressure on lawmakers behind closed doors and in social media over the past several days. Big day for HealthCare. After 7 years of talking, we will soon see whether or not Republicans are willing to step up to the plate!— Donald J. Trump (@realDonaldTrump) July 25, 2017
Health and Human Service Secretary Tom Price told reporters on Monday that he believes the Senate has at least fifty vote needed to repeal the healthcare law on Tuesday and move forward with additional legislation, although what that legislation looks like is still up in the air. In the meantime, McCain has been spending time with his family after news of his health broke last week. He went on a hike with his daughter on Saturday, according to a tweet from Meghan McCain.”Amazing hike with Dad @SenJohnMcCain this morning. Thank you all for your best wishes!,” the senator’s daughter said in a tweet that included a picture showing the backs of two unidentified people sitting on a bench overlooking countryside resembling the senator’s home state of Arizona.McCain, 80, a veteran senator and former Republican presidential candidate known as a strong and sometimes fiercely independent voice on defense and security issues, was found to have an aggressive form of brain tumor, glioblastoma, after surgery last week for a blood clot above his left eye.McCain’s doctors said he was recovering from surgery well, and praised his underlying health as excellent with no sign of neurological impairment before or during his surgery.”John McCain is an American hero and a fighter through and through,” said Sen. Thom Tillis (R-N.C.). “Courage and fearlessness have always defined his distinguished career of public service. Susan and I join all North Carolinians in praying for Sen. McCain’s recovery and return to the United States Senate.” He has been recovering at his Arizona home since his initial surgery at the Mayo Clinic in Phoenix last week. He heads to Capitol Hill for the vote Tuesday.So great that John McCain is coming back to vote. Brave – American hero! Thank you John.— Donald J. Trump (@realDonaldTrump) July 25, 2017
McCain has not given his schedule after the vote, but he and his family have a road ahead to determine the best course of action for his cancer. Treatment optionsThere is at least one approved device and scores of experimental treatments being tested that could improve the odds of longer-term survival for patients with the type of extremely aggressive brain cancer afflicting McCain. Glioblastoma took the life of former U.S. Sen. Edward Kennedy (D-Mass.) in 2009. Surgery is performed to remove as much of the tumor as possible, but cancer cells are left behind that infiltrate the brain and quickly grow. The survival rate with standard treatment is generally about 15 months, with only about 25 percent of patients alive after two years.Standard treatment is a combination of 30 doses of radiation administered over six weeks along with the oral chemotherapy Temodar (temozolomide) sold by Merck. After a three- to four-week break, additional four-week cycles of Temodar are given.The treatment is usually very well tolerated, said Dr. Maciej Lesniak, chair of neurological surgery at Northwestern Memorial Hospital in Chicago who is not involved in McCain’s treatment. “Generally, people can maintain normal quality of life during therapy, including their work in the majority of cases.”According to experts, McCain could be a candidate for a trial in newly diagnosed patients. There are about 150 clinical trials for glioblastoma under way, most at very early stages, and the majority for patients for whom initial therapy has stopped working.”Glioblastoma tumor cells are incredibly heterogeneous. No two tumor cells are alike,” said Dr. John de Groot, professor of neuro-oncology at the University of Texas MD Anderson Cancer Center, adding that a multipronged approach was likely needed.One promising approach being tested in early stage clinical trials by various institutions and companies involves injecting viruses into the tumor to destroy cancer cells and spur an immune system attack.Duke University generated publicity last year with reports of early success using the polio virus against brain cancer. In a study published in May in the journal Nature, Duke researchers reported early success with a vaccine that delivers high doses of Temodar to the tumor. Among 11 patients in that study, the median survival was 41.1 months.Dr. Roger Stupp, co-director of the Northwestern Brain Tumor Institute, who is credited with pioneering the radiation/Temodar combination therapy for glioblastoma, said patients like McCain might be helped by a now-approved device shown to extend survival.Called Optune and sold by Novocure, it delivers an electromagnetic field that interferes with cancer cells’ ability to divide and survive, said Stupp, who led trials of the device.It involves electrodes placed on the scalp operated by a small battery pack. With Optune worn nearly 24 hours a day, the two-year survival rate in the trial that led to its approval jumped to 43 percent, with some patients living four years or more.”My recommendation is to use it early in the disease course,” Stupp said.Political implicationsWhile McCain, his family and doctors sort out the best next step, his role of dealmaker and leading voice on national security is being widely discussed on Capitol Hill. A former U.S. Navy pilot, McCain spent five and a half years as a prisoner of war in Vietnam. He is outspoken on a range of issues, from defense spending to immigration to demanding a thorough investigation of alleged Russian meddling in the 2016 elections.Asked how the Senate was different without McCain, his close friend Sen. Lindsey Graham (R-S.C.) said, “It’s quieter. John is a fighter and John’s into every cause no matter how hard it might be.”A Russia hawk, McCain has expressed skepticism of improving ties with Moscow and emerged, with Graham, as perhaps the most vocal Republican critic in Congress of President Donald Trump’s foreign policy. He chairs the influential Senate Armed Services Committee.”I realize that some of President Trump’s actions and statements have unsettled America’s friends,” McCain said in a speech in Australia in May. “They have unsettled many Americans as well.”McCain is also known for an independent streak and a willingness to work with Democrats. He has participated in almost every major bipartisan legislative effort in the Senate in recent years, such as the “Gang of Eight” immigration push in 2013. He called for more defense spending but also criticized what he sees as inefficiencies in U.S. weapons programs.”McCain is McCain, and he has needled people and programs that he does not think are performing,” said Mark Cancian of the Center for Strategic and International Studies International Security program.To carry out the agenda of his party’s long-awaited Republican president, Senate Majority Leader Mitch McConnell (R-Ky.) needs the backing of at least 50 of the 100 senators. Republicans control the Senate by a narrow majority of 52 to 48. “Obviously, I think more people are worried about his health than thinking about the math, but you know, you understand the math,” Sen. Bob Corker (R-S.C.) told reporters. “Obviously, it makes things difficult.”For now, they will have McCain for the critical health care vote and, according to close allies, he is expected to remain active in the Senate and the party.