It is difficult to find a word in the English language other than “Cancer” that causes more anxiety. There are a great many human situations that cause horror and devastating fear, including torture, near death, extreme deprivation, and violent observed death of a dearly loved. There are many disease states which are at times worse, in the sense of loss of body parts, severe pain, loss of mental and physical function, but all the rest seem to be, for some reason in the mind of humans, events which occur at the hands of their God, and not so much a curse. Cancer is considered a curse, something that, in religious terms, occurs at the hands of the Devil. Once that diagnosis is placed, all those other images come to mind. Those so afflicted are greatly in fear of disfigurement, loss of limb, loss of mental and physical capacity, great pain, great unhealed wounds, loss of loved ones, and eventually, loss of life. And all of that, in many cases, can be true. It is an unforgiving disease, often requiring monumental effort to overcome it.
And that fear of cancer is also justified in that sense that it represents a failure of our immune system to cope with that threat. We spend all of our lives developing various forms of cancer in various organs of our bodies, all of which are recognized by our immune system and defeated by that immune system. When we started using immunosupressants for treatment of patients with organ transplants, we became for the first time more acutely aware of just how many cancers we are developing on a regular basis, and overcoming with sound immune systems. If that immune system is compromised for some reason, then that cancer is able to get a foothold and grow, eventually causing great damage to that organ and/or surrounding organs. The development of one cancer is the beginning of the end, so to speak. If we can’t handle that cancer, which may require major effort to overcome, there are surely other cancers to follow, if we live long enough. It is just a matter of time.
Of course, we are getting better at handling these pain causing and life threatening illnesses. Most people who develop a cancer are relieved of it for long periods of time, usually years, and many cancers have cure rates in the 70 to higher percent range. We are not there yet, and probably never will be, in our search for cure of all cancers. The majority of us, depending on how long we live, will develop some form of cancer, requiring minor or major treatment. And as we develop an older population base, various forms of cancer have become more prevalent. We still have hospital wards full of cancer patients; we still have cancer clinics, chemotherapy clinics, radiation clinics, and surgical suites burgeoning with patients needing cancer care. The human race is still heavily weighted by the burden of this particular affliction.
Those are the reasons why cancer patients need special care. When we established our cancer unit in our community hospital, we emphasized, to our newly gathered nursing staff, that we always wanted their care to be compassionate. We never wanted to hear that some patient need was left for someone else to provide. We wanted each of them to, at all times, consider every patient need their responsibility, no matter what their job description was. We wanted them to consider at all times that they should treat that patient as if they were themselves in that bed. We wanted them to always understand that the concern of their relatives, who were looking at loss of love, loss of life, loss of income, loss of stability, as deep concerns which should be always met with attentive care. We wanted them to always know that these were special patients who had special needs, and that their families also had special needs. That nursing staff took that message to heart. That cancer unit always has had, since that time, the best scores for good patient care in that hospital system, and always has been ranked highly in comparison to national scores. Patient calls are answered promptly, medicines are given on time, and pain control is high. That is as it should be, for treatment of patients with cancer diagnoses.
There are several things that have always bothered me about cancer care, however. One is the sometimes failure of surgeons to fully explain to their patients the full nature of the risks versus the benefits of whatever procedure they are recommending. It is the nature of surgeons to be optimistic. They know that they have met difficult cancer problems and have overcome those problems, often providing cure of what would be otherwise a devastating illness. They prefer to not think of their failures in the past, but to think of their successes. They need to stay optimistic in order to do what they do. It is not right, however, for any of them to not fully inform their patients as to all the risks as well as all the benefits of whatever surgery is indicated. Patients need to know all the bad things that can happen as well as the good things. Then they can weigh the balance, and decide, with that surgeon’s help, what they want to do. It should always be their body, their life, and their choice. They need to have full understanding of the advantages, disadvantages, and where that brings the balance, before they decide. Their surgeon should always be their guide and servant, to provide them succor, and never their dictator.
Oncologists also have bothered me, for similar reasons. We have had, over the years, a whole raft of oncologists who have come to our institutions touting various new drugs in the cancer armamentarium, providing erudite lectures and multiple drug trial results, which most of the time show a few month increase in survival rate with certain drug treatment regimens. They get excited about these small increases in survival. It is well that they do investigate new drugs and do new trials, trying to find better ways to treat patients, and prolong life. Because of their efforts, cancer survival rates have steadily increased in most cancer treatments. It is not right, however, to put patients through drug treatment programs which offer a few additional months of survival, while going through vomiting, diarrhea, hair loss, weight loss, fatigue, and generally feeling miserable during that remaining life, without having received full disclosure of what the side effects and disadvantages of that treatment will be. Yes, we all want to provide hope for those with cancer. Yes, we all want to provide treatment for someone in need. There is serious question as to the value of a few additional months of life, however, if all of that time is spent in various aspects of suffering. Oncologists, to do what they do best, must be completely honest with their patients as to what bad can come out of that treatment, as well as what good may come out of it.
I am particularly angry at the greed of pharmaceutical companies, who develop new chemotherapy drugs, and then charge thousands of dollars for each dose. They claim they need that money to foster research and development of new drugs, to treat cancer patients. I certainly agree that they need some profit, in order to continue to develop new drugs. When you see what profits are announced on Wall street, however, it is clear that they are stuffing money in their own pockets by the millions, at the expense of those patients who have the most devastating diagnoses, who are the most desperate for some kind of cure, and often will bankrupt their lives in order to live a little while longer. It is clear that these drug companies are raking in money from the US government and private insurers, at the expense of all the rest of us, who are paying taxes and buying our insurance. These pharmaceutical executives don’t care, as long as they can create immense wealth for the elite who run those companies. I despise that attitude, which takes advantage of those patients who need affordable compassionate care the most.
The other sad part about cancer care is that we do much of it to ourselves. Smoking raises the risk of developing cancer in all the major organs by five to ten times normal. There has been, in the last few decades, a burgeoning increase in AIDS related cancers, and oral cancers related to unsafe sexual practices. Obesity increases the risk of multiple cancers several times normal. If we don’t take good care of the one and only body our creator gave us, that divinely gifted body will fail early and often, because we have developed that dreaded diagnosis: cancer.
Cancer care represents some of the best and some of the worst that our health care system has to offer. On the one hand, we find deeply compassionate care, immensely skilled surgeons, highly intellectual oncologists, remarkably technically exact radiation therapists, a public that is united in its support of cancer cure programs, and an entire organization, the American Cancer Society, which is raising funds to fight this scourge. On the other hand, we find widely publicized cancer treatment programs which are just in it for the money, less than honest surgeons, oncologists who put patients through a bit of Hell on earth in order to further their own publications and career, and pharmaceutical companies who don’t give a damn what their drugs cost as long as it puts money into their own pockets. What will it take for each of us to fight cancer with only one motivation: How would I like to be treated when it is my turn to have this dread disease?
I have seen too many deeply loved ones succumb to this disease. It makes my heart ache to see how some of them have been manipulated and used, when faced with this dread disease. Help me out. My soul pains when I think about how some of these people, who need compassion the most, are being abused.