In a previous blog (1), I discussed how hope is essential to one’s ability to endure the diagnosis and treatment of cancer, and in separate writings, I have suggested that two key ingredients to such hope are total trust of one’s doctors and conclusions derived from optimistic scientific data; more simply said, a good prognosis. After all, more people in the USA survive cancer than at any time in history, a fact borne out by a current 64% overall five-year survival rate, and an estimated 9.8 million Americans with a cancer history who are alive. Many cancers are cured 90 percent of the time. Almost certainly, these facts help many endure the misery of treatment, which can be extraordinary. I have had a number of patients tell me that the proverbial light at the end of the tunnel—the thought of treatment’s end and a new beginning—are essential to “that endurance”. All of the definitions of hope include the expectation of good that is yet to be—achievement of the desired goal. While some fail to comply and drop out of treatment, the majority of patients are able to complete the program.
What is surprising, however, is that a number of patients do more than endure. They come to view the experience as a turning point in which they reevaluate former lifestyles, relationships, work habits, goals, and the general value system in which they previously functioned. While preparing to write the book, The Cancer Experience: the Doctor, the Patient, the Journey, I interviewed in some detail a number of patients, and many told of finding levels of love and companionship not previously felt with spouse and children. In fact many found a new level of value to life itself, often exercising the option to stop and smell the roses; and even more alluring to these individuals after the self-analysis was the desire to “pay back” and make a contribution to the improvement of the human condition—and in doing this, find more meaning in life. Of all of the rewards that I have received from treating cancer patients, the most gratifying have been those gained from witnessing productive post-treatment life changes by patients after going through this frightening and draining experience. Many stories come to mind, but three that stand out are briefly depicted below.
During the 1980s, when I was a member of the Head and Neck Surgical team at Memorial Sloan Kettering Cancer Center in New York City, a middle-age man (B.K.) was referred to me for a base of skull cancer of substantial proportions, and the treatment involved a prolonged course of radiation therapy. I served mostly as the quarterback—diagnosis, workup, and the appropriate referral. The patient was director of one of the three divisions of one of the largest and most successful corporations in the world. For him to be at that level at his young age was remarkable, and he was on track to eventually head this giant corporation. In all respects, he was a strong and enduring patient, bubbling over with drive and a positive attitude, but pleasantly free of arrogance—feeling no self-pity and committed entirely to winning the war in which he found himself. Win he did, and afterward, he took stock of his previous immersion in the corporate jungle, decided on other outlets for his considerable energy, and retired. He became the president of a nonprofit foundation that linked cancer patients with other individuals from around the country with similar cancers. This pro-bono job occupied much of his time, during which he raised money and provided important organizational leadership for a number of years. Recently, my wife and I joined him and his wife for dinner in celebration of his twenty-fifth year of freedom from cancer, and during the course of the evening, he actually said to me that in a perverse sort of way, undergoing the cancer experience was one of the most positive events of his life. It had forced him to take stock and reevaluate, and the adjustments and actions that resulted were substantially more fulfilling and gratifying than his previous activities. An added bonus was that he and his family enhanced their relationships by sharing the afterglow of cure.
Another of my Memorial Sloan Kettering patients that I treated was a young superstar from one of the iconic financial institutions of New York City. J.C. had been educated in economics, and in her late twenties was well on her way to a stellar career on Wall Street. Fortunately, I was able to successfully operate on an aggressive malignancy of her soft palate. Her attitude was upbeat and combative toward the cancer, and during this very stressful time, she proved what an outstanding person she was. So affected by the whole cancer experience was J.C. that she quit her job, went back to undergraduate school to get the prerequisites for entry into medical school, and then went on to attend Johns Hopkins School of Medicine in Baltimore. She stayed at Hopkins to complete a residency in emergency medicine. Somewhere along the way, she married, had a couple of kids, and even found time to train for and run a marathon. Her yearly Christmas cards were each heartwarming rewards for me.
Not infrequently, cancer survivors volunteer to work in or around treatment programs at cancer centers. On many occasions, I used former patients to counsel those who had the same tumor for which they had been successfully treated. Few actions are more useful to a frightened patient than to spend time with a functional person who has previously faced the same problem—same cancer—same treatment—the same fears—and treated by the same medical team. Additionally, I have always attempted to match people with similar profiles and life experiences, thus enhancing the ease with which the patient identifies with the volunteer. Importantly, the volunteer is encouraged to be honest and not to mitigate the “misery factor” with an unrealistically rosy depiction of what they are facing. This “tough love” counseling is far more creditable then a disingenuous avoidance of unpleasant situations that are soon to be encountered during treatment. A cheerleader has limited sustained value at this point. This concept of matching has proven valuable and rewarding to patient and volunteer alike. The construction worker might have different anxieties than a college professor; thus the matching of each with an appropriate counterpart usually proves to be more productive.
One of the most heart-wrenching memories of my career involved the pairing of two young career women—both in their early forties—each of whom had tongue cancer. B.C. was a television reporter for a prominent channel in a major city. I treated her by surgical resection and reconstruction that was followed with radiation therapy. All indications favored a cure, and for a year she worked diligently with a speech therapist, all the while determined to regain the ability to articulate at a level that would allow her to resume her career in front of the camera. Initially, I doubted that this was possible, but determination and hard work happily overcame all else while she scoffed at my skepticism. In the meantime, I had seen another patient—a businesswoman—with a similar problem who required identical management. Although B.C. was only one year out of treatment, we were optimistic that she was cured; therefore, I introduced her to the new patient, E.C. They quickly found commonality in their affliction, and became fast friends. B.C. even used E.C. to make a television documentary on oral cancer, using interviews with the patient and her doctors to discuss the disease and its treatment. Importantly, the articulation of the commentator—B.C.—was precise, and in a powerful closing sentence to the documentary, she faced the camera and said that, “This subject is of great personal interest to me because I too have been a victim of tongue cancer”. That is the happy and gratifying part of the story; unfortunately, the following year, B.C. developed lung metastasis and died, and the year following that, E.C suffered the same fate. These young women had found new purpose in life, although ultimately the demon that is cancer prevailed in both. The love and support shared by them came from careful matching in a useful volunteer program.
A number of high-profile individuals who have undergone cancer treatment went on to become active in public service. Prominent examples of cancer victims who have used their star status for important public announcements and awareness messages include Lance Armstrong, who has devoted much energy and time to the promoting public awareness of testicular cancer, and the prominent actor Jack Klugman, a survivor of laryngeal cancer, was very active in the antismoking campaign associated with that disease. During the last part of his life, the actor Yul Brynner was an avid antismoking campaigner. He had been a “chain smoker” for years, and, not surprisingly, died of lung cancer. In another format, I spoke of two women, Ambassador Shirley Temple Black and first lady, Betty Ford (2), who helped bring the subject of breast cancer out of the shadows of shame by going public with their own personal and successful struggles with this disease. Their efforts were groundbreaking and have undoubtedly since saved countless lives over ensuing years. Most recently, film icon Michael Douglas, himself an oral cancer survivor, has lent his support to a public service organization, The Cancer Alliance. These are but a few celebrities who have found purpose and meaning in a life after cancer. The list is much longer, and the exclusion of others is not meant to diminish the importance of their service.
Many patients find gratification by giving money or even by actively fund raising on behalf of cancer related projects. The various research programs require large sums and even though the national government participates heavily, private sector money is essential, much of which results from activities of former cancer patients. Whatever the method(s) used, there can be a fulfilling life after enduring the cancer Olympics (3).
Roy B. Sessions
1. Psychology Today Blog, Sessions, R., July 5, 2012.
2. The Cancer Experience: the doctor, the patient, the journey; Sessions, R, p142, Roman and Littlefield, 2012
3. ” Cancer Olympics”, a phrase borrowed from Choices, by Marion Morra and Eve Potts, New York: Avon Books, 1994