By Jocelyn Selim
The Fairest of All
Audrey Hepburn died of appendix cancer at 63, leaving behind a legacy of style and good works
By Jocelyn Selim
In a way, that’s good news: Because the cancer cells don’t travel through the blood, they very rarely metastasize to distant sites like the lungs or liver. And this means that if doctors can remove all of the tumor cells from the abdominal cavity via surgery and chemotherapy, a patient can conceivably become cancer-free, with very little risk of recurrence, says Esquivel. But it also means that traditional chemotherapy is much less likely to be effective, because the drugs, which are typically injected into the bloodstream, don’t always reach cancer cells that are isolated in the abdominal cavity.
Less than a week after Hepburn finished her first treatment, another bout of severe abdominal pain caused her doctors to schedule another surgery. “They weren’t in there very long,” says Ferrer. “They came out and said that it had grown exponentially.”
Today, in cases like Hepburn’s, in which the cancer has spread through the abdomen, the No. 1 predictor of long-term survival is whether the surgeons can remove all the tumor cells. “It’s often a very invasive surgery,” says Levine. “We open up the abdomen and remove all the tumor we can see. If we can do that, then the next step is something we call HIPEC, or hyperthermic intraperitoneal chemotherapy wash: We bathe the abdominal cavity directly with chemotherapy drugs to get any of the cells we can’t see.” For this “hot wash” to be successful, the surgeons must not have left any pieces of tumor more than a few millimeters deep, because the drugs can’t penetrate them. If the patient survives the surgery, which can last up to 14 hours, and the therapy is successful, the procedure offers real hope of long-term survival, says Levine.
But very few medical centers offer HIPEC today, and while Hepburn’s doctors considered intraperitoneal chemotherapy—a procedure similar to HIPEC, but without heat—they ultimately decided that her cancer was too aggressive and widespread to justify the procedure. “The doctors described it as ‘sprinkled everywhere,’ ” recalls Ferrer. “The whole thing happened so quickly; it was just a few weeks. I was looking at these desperate alternatives, and then an opportunity came up to fly home, so we did that.” After returning to Hepburn’s 18th century farmhouse in a quiet corner of Switzerland, Hepburn, her longtime partner Robert Wolders, and her two sons spent a final Christmas. Ferrer describes the experience in his biography, Audrey Hepburn: An elegant spirit: “Since she couldn’t leave the house to go shopping, she had chosen things she owned to give to each one of us: a scarf, a sweater, a candle. This made it so touching and all the more valuable.”
Over the next few weeks, Hepburn slept more and more as the disease progressed. On Jan. 19, 1993, her doctor prescribed morphine for her pain, and she was barely awake for more than a few minutes at a time. On Jan. 20, she died quietly in her sleep at age 63.
Although Hepburn will always be remembered as one of the most beloved film actresses of classic Hollywood, she was more concerned about leaving a legacy that would inspire people to help others who are less fortunate than themselves. “I don’t know if she realized how long-lived her image would be,” says Ferrer. “I just read a news report, maybe a week ago, quoting Angelina Jolie as saying she wanted to follow in my mother’s footsteps.”
Hepburn, no doubt, would have been pleased that Jolie, and so many modern celebrities, followed her example by committing to humanitarian work. Hepburn “was among the first big names to do that sort of thing,” says Ferrer, who along with his brother and Wolders started the Audrey Hepburn Children’s Fund in 1994 to continue his mother’s efforts to raise money and awareness for needy children worldwide. “It was something we felt she would have wanted us to do,” he says. “I think she was more proud of the work she did as an ambassador for UNICEF than anything else.”