By this stage in my career as you can imagine, I've explained the diagnosis of cancer to hundreds of people. As you may or may not be able to imagine, it never gets easier.
I wrote this article through the eyes of a doctor who has seen, diagnosed and treated many cancer patients over the years. I have only see a glimpse of what these people are going through. But I hope this piece can provide some knoweledge and maybe some inspiration.
There are a few words in the English language that conjure up as much fear and anxiety as a diagnosis of cancer. The thought of the cells of our bodies developing limitless replicative potential, giving them the ability to evade the evolutionary mechanisms put in place to protect us is a terrifying concept. It is indiscriminate and it is ruthless having no respect for age or status or gender.
So this article is dedicated to the domestic workers, the bankers, the train drivers, the market stall owners, the sex workers, and the teachers; the mothers, the uncles, the daughters and the friends; those that campaign and research and teach….to everyone that has felt he scourge of cancer either directly or through family and close friends. I hope it helps.
The Diagnosis.This is usually where it starts. Your head is spinning wildly and you feel like the life has been sucked out of you, all in one moment life as you know it is gone. ‘Getting diagnosed throws your entire universe into freefall’ . It’s almost guaranteed that 90% of what the doctors says after he’s given the diagnosis falls on deaf ears, so taking as much information in form of writing is essential. You should have leaflets describing in some detail, the type of cancer and it’s prognosis, as well as sources of spiritual and clinical support within the hospital and out in the community.
The most important thing to remember is that you are not alone. There are thousands of support groups online providing an immense amount of inspiration and information for newly diagnosed patients and their families. Nobody understands you quite like another cancer survivor; they are a very valuable resource to tap into.
Management
My veins are filled, once a week with a Neapolitan carpet cleaner distilled from the Adriatic and I am as bald as an egg. However I still get around and am mean to cats.
John Cheever, letter to Philip Roth, 10 May 1982, published in The Letters of John Cheever, 1989, concerning his cancer and its treatment
‘How are we managing her?’ my consultant often barks out me. ‘Management’ is another one of these umbrella terms; we’ve invented to encompass everything we are doing for a patient. By using terms like these we are able to neatly divide a persons entire future into a series of succinctly delivered bullet points, one of the many strategies we adopt to avoid involvement in thire so vividly shattered lives, which like a tragic subplot , we encounter during almost every surgery and ward round. Of course every patient needs a plan of management, but sometimes in our rush to concoct our plans, the patients own wishes are neglected or ignored.
The management of cancer is complex and involves a whole host of professionals making decisions on each case individually. Communication between all those involved is vital, it is of utmost importance that the doctor acknowledges and explores the ideas and concerns of the patient, but it is also important for patients to voice their management preferences and expectations. As the patient your opinion matters and it facilitates you being as involved in your management as you want. So look on the internet, read books, speak to friends, family and those invaluable support group members, having some opinion or preference for how you want to be managed will inevitably help you doctor give you more personalised help, tailored specifically to your own individual needs.
That said, it is important to remember the internet is no substitute for your oncologist who has passed gruelling exams and managed countless cases, dedicating his entire career to cancer research, diagnosis and treatment. If you could get everything you needed to know about medicine from Wikipedia, then none of us would have gone to medical school and certainly not bothered with the 10 or so subsequent years of 50 hour weeks, on-calls, research, audits and professional exams that follow it.
Below are some of the most common management options
1) Surgery: In many cases a tissue diagnosis of cancer is made with either a tissue diagnosis or an operation to remove the tumour. Although it is sometimes the only treatment required in early tumours of the GI tract, soft tissue sarcomas, and gynaecological tumours, it is often the case that the best results follow a combination of chemotherapy and surgery. Surgery also has a role in palliating advanced disease.
2) Radiotherapy: This is the use of ionising radiation to kill cancer cells. Radiotherapy can be used in active treatment or palliative treatment eg for bone pain
3) Chemotherapy: This is the use of drugs to fight the cancerous cells. Chemotherapy can also be active or palliative.
Management lies in the hands of the doctors informed by the patient, it’s important that what ever plan that is formulated meets your needs.
Healing
One must not forget that recovery is brought about not by the physician, but by the sick man himself. He heals himself, by his own power, exactly as he walks by means of his own power, or eats, or thinks, breathes or sleeps.
George Groddeck, The Book of the It, 1923
Whilst management lies in the hands of the doctor informed by the patient, healing lies in the hands of the patient the doctor merely assists in this process. Healing concerns not just the cancer itself. But every area of your life the cancer has damaged.
Sexuality can be impacted hugely by a diagnosis of cancer. Not everyone who has cancer will have changes in sexual desire or how they feel about themselves sexually. You may not notice any changes at all. Other people lose interest in sex and feel very tired. But you may find that the changes cancer causes to your body image affect the way you feel about yourself and having sex. At the other end of the scale, some people say that they want to make love more than usual. If you are in a relationship, a crisis can sometimes bring couples very close together.
Because we’re all so different and have different sexual needs, it’s impossible to say exactly how cancer will affect each person’s sexuality and sex life. Some types of cancers and their treatments affect your ability or desire to have sex more than others. If you are already in a loving relationship your concerns may be different than for someone who is single.
If your feelings about your body and having sexuality change during your cancer treatment, it doesn’t mean that it will last forever. If you are able to talk to your partner or a health professional about your worries, it can help to lessen them. And they may be able to suggest ways to help improve any problems you’re having.
Self esteem and self image also tend to take a bashing. Cancer and its treatment can change the way you feel about yourself (your self esteem). This may be because of physical changes to your body or it may be about less obvious changes.
The intense emotions that cancer can cause may also lower your self esteem. You may feel that you have lost some of your independence and can't do things that you used to enjoy.
You may feel so tired and worried that activities you used to find easy now seem too difficult to do. Your future plans may have to be put on hold. You may begin to feel as though you have no control over your life. All these things can make you feel less confident about who you are and what you do. Having confidence and a healthy self esteem are very important to us all.
It can be very difficult to boost your self esteem when you feel so low. But there are things that you can do. The most important thing is to talk to someone about how you are feeling. This can be a close relative or friend or a health professional. Just talking about your feelings can help you to feel better. Give yourself some time to come to terms with all you’ve been through. It will take time to raise your confidence and self esteem again. But it is possible.
‘Once I was able to change my focus desperation led to inspiration’
Get creative and design a healing plan for yourself. A combination of lifestyle changes, input from the complementary therapies and of course your friendly oncologist; is helping people with cancer lead healthier lives.
Research into complementary and alternative medicine (CAM) has increased over the last few years. This is due to a significant change in how health professionals and patients see alternative therapy. There are several reasons for this shift in views:
•A general increase in the use of CAM to almost 6 million people in the UK each year
•The number of people with cancer using these therapies is estimated at over 3 in 10 (30%). Some recent research has shown that as many as 4 in 10 (40%) use them .
•Reports showing that some therapies do improve quality of life for people with cancer
Alternative therapies such as aromatherapy, reflexology, massage and meditation have helped countless cancer survivors by empowering them to take charge to their own healing journey.
The American Institute for cancer research, which funds research studies that focus on the role of food and exercise in cancer prevention and treatment recommend a diet that’s at least two third’s vegetables, fruits, whole grains and beans.
A 2005 study showed that 92% of nearly 3,000 women with breast cancer who walked or did other exercise three to five hours weekly were still alive 10 years after diagnosis, compared with 86% of those that exercise less than an hour a week.
This shows that changing lifestyle factors has a least some role in cancer outcomes.
Kris Carr puts it more eloquently than I ever could when she says:
Here’s the deal, cancer is a just a silly metaphor, like it or not, it’s in each of our lives in some way. For me it’s tumors, for you it may be a bad job, your weight or a dead end relationship. It’s spooky but it doesn’t have to be taboo. It’s just life, so we have to wake up to it! Some skeptics have asked, “What’s so sexy about cancer, lady?” My response: the women who have it! We are crazy, sexy, whole, loving, surviving, delicious women, so get out of our way!
All of us have or will have things in our lives that change it drastcically and cause us pain. It is the inevitable companion of lives led authentically. Not only cancer patients need healing plans.
Life is a terminal condition which is never completely predictable. As a doctor, I’ve learned to use the word impossible with the greatest caution . We’re all going to die. On further reflection, as I look through photos taken on my 80 year old mothers trek through Thailand, I realise, cancer patients just have more information, but we all in some ways, wait for permission to live.
