Routh, a native of Merrimac, Massachusetts, was nine months old when she was diagnosed with atypical teratoid rhabdoid tumor, or AT/RT, a rare brain disorder that usually kills its victims within a year.
Doctors at the Dana-Farber Cancer Institute in Boston, using a multi-prong therapy regimen that in some cases has overcome the tumor, succeeded in prolonging the child's life.
In August 2011, the hospital staged a pretend wedding at which Routh, a passionate Bieber fan, became "Mrs Bieber." Six months later, after a Facebook campaign, Bieber invited her to New York to spend Valentine's Day with him.
She said afterwards how she and her "husband" ate cupcakes and played Candy Land, a children's board game, leaving her parents with the more grown-up task of raising public awareness of her disease.
Only about 30 new cases of AT/RT are diagnosed in the United States every year. Patients have a survival rate of just 10 percent.
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