Living With Cancer

"If you're surrounded by people who are telling you, 'you've got to fight', you think, 'How about I rest today and fight tomorrow? How about, 'I'm scared and I don't want to battle'?"
"And some people talk about just feeling ready to let go. They've battled it for too long. But that's unacceptable. That's seen as failure. That's seen as losing."
"I always get these looks, deep in my eyes -- 'how are  you doing'?"
"It's the people who get kind of stuck there, and I find that difficult. ...I'm not there any more, and I guess that's part of the chronic thing. People who have had cancer for a long time, I'm sure they don't want to live as if their identity is, 'I'm a cancer person'."
United Church Minister David Giuliano, 20-year cancer patient

"Who wants to go to war with themselves? How is it ever helpful to think of oneself as a victim who was randomly attacked and now you're trying to kill your assailant in order to survive?"
"Some cancer patients may perceive themselves as a soldier going to war. But surely not all do."
Radiation oncologist Edward Halperin, New York Medical College

"Battle language is everywhere in my profession. [The message conveyed is] that there's a choice to fight or give up."
Dr. Seema Marwaha, internal medicine specialist, Toronto

"But cancer isn't an enemy -- it doesn't have an ideology, it doesn't have a political agenda."
"It comes from within us; it's part of the history of humanity. We rarely cure cancer unless we can cut it out. But things like long-term remission and disease control -- these are the goals."
"We're getting better at controlling cancer for longer periods of time."
Dr. James Downar, critical care and palliative care physician, University Health Network, Toronto 

"There are periods where the cancer needs treatment and periods where no treatment is given."
"Part of the challenge also is doing enough, doing sufficient visits and scans so that you have a good handle on what's happening so that you can adjust and adapt and intervene, but not overburden somebody with scans."
"This is all quite new, this whole notion of kind of being in-between [treatments]. It's a bit of a limbo state, sometimes."
Dr. Jonathan Sussman, radiation oncologist, McMaster University

At the present time, an estimated 800,000 cancer "survivors" exist in Canada, some living with cancers which never quite recede on a permanent basis, like lymphomas of a certain type, leukemia, and sometimes invasive beast cancers. This is cancer hovering, always in the background, seeming to recede, then returning years later. Low-grade lymphomas, for example, cancers of the lymphatic system, are among those which arrive, depart, return.

At one time melanomas were always lethal when they spread, having an average survival rate of a year, two years. At the present time, immunotherapies succeed in placing a robust proportion of patients with metastatic melanoma in a state that is controlled "where the thing is quiet, it's not really advancing", explained Dr. Sussman. But cancer is not an invited and a valued guest, and when it does decide to invade, the psychological burden is a heavy one when people are plagued by fears of a returning or progressing cancer.

The language of cancer, the nomenclature used, is an understandable one; after all this dread disease has decided to invade someone's body, threatening anguish, pain and death. And when people are constantly encouraged to put a positive spin on their fears  of what that cancer is doing to them, by 'fighting' it, an insidious state of mind can creep into the situation, where patients accede to brutal treatments or "maximum tolerated doses" of chemotherapy, despite the hope of survival being so dim.

If patients become so committed to 'fighting' when it's long past time to struggle with the disease, that they refuse palliative care to ease symptoms and alleviate the mind which in and of itself is capable of slightly prolonging life, the demand for aggressive treatment among others whose type of cancer would in all probability never threaten their existence, but leaves them subjected to pain and trauma represents two polarized states and outcomes, both linked to 'fighting' and 'defeating' cancer.

People who are encouraged to 'fight' and to remain 'positive' are likelier to succumb to emotional distress while putting on that proverbial brave face. Over one thousand Canadian women with breast cancer, part of a research program out of the University of Manitoba, revealed that those who considered their disease in 'enemy' terms and 'punishment' suffered higher levels of depression and anxiety three years later.

According to some experts the future holds out the promise that it may be possible to conceptualize a time when cancer, Ike controlled diabetes or HIV, becomes a chronic, manageable disease. Some medical scientists feel that if total destruction of cancer remains elusive, an alternative arises where tumour cells are contained, when it becomes possible to "box-in tumour cells with a discrete-focused strategy of containment."

Meanwhile, the drive to destroy cancer cells unremittingly leads, according to those experts, to survival of the fittest in the sense that the "moderate" cells, sensitive to chemotherapy are destroyed at the same time that the "extremist" cells are left intact, preparing to morph into even more deadly tumours. Whereas a middle ground between "appeasement and Armagedden is containment".

Survival of at least five years after diagnosis represents the reality for about 60 percent of cancer patients overall. That, in comparison to the 1950s, when fewer than 25 percent of cancer patients would survive their bout with cancer. As for most women going through breast cancer diagnosis and treatment, "the breast cancer is not going to be their length-of-life-defining illness", Dr. Sussman emphasizes.