The role of hope in cancer has also come under scrutiny. Psychologists at the Royal Marsden Hospital in London and Sutton studied women with early-stage breast cancer and found that risk of recurrence or death increased significantly among those who lacked hope. There was nothing mysterious or mystical about it: Hopeful patients managed their illness themselves instead of letting outsiders pull the strings. They often chose the most aggressive treatments. And envisioning the light at the end of the tunnel helped provide the strength they needed to get through each difficult day.
Yet hope was not a given for them; it was an attitude they wrested from despair. Despite being an expert on hope, Farran could not muster any when she herself was diagnosed with breast cancer. She met the news with anger, grief, and fear of death. Panic propelled her through treatment, in a total daze. Only when she went in for breast reconstruction was a wise nurse able to penetrate her panic: "A year from now you'll be where you want to be, but there is no way to get there except by going through this experience, now."
As despair loosened its hold on Farran, she tried to embrace the flexibility she had studied in others. "I told myself to get a grip," she says. Finally she thought of her love of playing piano and decided to buy a metronome, a symbol of what she called "slow time." It was a palpable reminder to calm down, confront her fear of death, and think things through. "You can start in despair but arrive at hope," says Farran, 18 years later. Hope can be learned.
Once empowered by hope, cancer patients have been known to search out cures in the face of daunting odds. Jerome Groopman, a Harvard cancer specialist and author of Anatomy of Hope, tells the story of a patient, a pathologist with advanced metastatic stomach cancer that was considered fatal. Soon word spread around the hospital that the pathologist intended to do something "mad." Without any evidence that his cancer was survivable, he insisted on doses of chemotherapy and radiation so toxic they were, by themselves, probably lethal. To Groopman and other cancer doctors on staff at the time, the effort seemed "like a desperate, wrong-headed, ultimately futile effort to resist the inevitable." Surely the treatment would deprive the pathologist of a peaceful end at home. Indeed, Groopman, stopping by the man's bedside, found him bleeding as tissues were literally burned away by the strong treatment he had engineered.
Twenty-five years later, while researching his book on hope, Groopman found that the pathologist was still going strong. "If I'd been treating him, I wouldn't have authorized the therapy and he would have died."
Similar tenacity gripped Sean Patrick, a business strategist and extreme sports enthusiast from Aspen, Colorado, whose rare form of ovarian cancer was diagnosed in 1998. Instead of simply agreeing to follow her doctor's treatment advice, she hired a research firm to comb the scientific literature and come up with a list of experts studying her specific disease. She quickly learned that her doctor had recommended the wrong treatment and if she followed through she might not survive the year.
So she fired her oncologist and hired a medical team known for experimental use of drugs. The side effects of her radical treatment were devastating. "Flu symptoms magnified a thousand times," Patrick said. There was nausea, vomiting, disabling body aches, extreme weakness, chills, and diarrhea. "I would shake so hard my teeth would knock and then have a fever so high I would sweat through my clothes." She nicknamed the side effects "shake and bake." Still, she persisted, at one point even electing a surgery so risky she was not expected to wake up. "If I hadn't taken the risk, I wouldn't be here today," she said in 2006. Her grit gave her a full decade more than anyone expected; she died just before this article went to press, in 2009.
Most people don't have the financial resources to seek such customized or experimental options, but even patients dependent on treatment approvals by an insurance company can choose the most aggressive courses that might confer even a slight survival edge. That explains why so many women with stage-one breast cancer opt for removal of both breasts instead of the watch-and-wait approach. It also explains why ovarian cancer patients subject themselves to multiple rounds of chemotherapy, often rejecting studies contending the treatment will fail.
"Even if it is a long shot, someone is going to fall at the end of the bell curve," notes Groopman.
Soldiering On
Research shows that, even while dealing with the disease, large numbers of cancer patients deploy their tenacity in other realms of life, as well. Take Elizabeth Cowie, 44, a career sergeant in the Army who was headed to Iraq with her troops. There was only one problem: Months before deployment, in a routine Army physical, Cowie was diagnosed with early-stage breast cancer. Instead of going home to attend to treatment, Cowie poured her energy into finding a way to get to Iraq along with the soldiers she'd trained. She forsook the more extreme course of mastectomy for circumscribed lumpectomy, dramatically shortening surgical recovery, and decided against weeks of radiation therapy in favor of a new technique she learned of, called Mammasite, which delivers radiation directly to the tumor over the course of days. She underwent the procedures quietly, without telling the soldiers reporting to her until she was declared cancer-free, and went on with her deployment, gritting her teeth only when her vest chafed the still-healing surgical wound. Cowie endured the heat of Iraq while still recovering, all the while watching over and counseling the soldiers she'd become so close to.
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