Tuesday, October 9, 2012

Cancer as a War Annaology

There is one word in medicine that I can guarantee will strike fear when heard or thought about late at night: cancer.  I can also bet that there is a second word that is inextricably linked to that scary word: fight.

Have you ever thought about the symbols we adorn cancer with? He fought cancer, she battled cancer, he won the war on cancer, she's a survivor, he was so brave and didn't give up, and he beat cancer. 

No wonder the word cancer evokes fear, with phrases like that it sounds like a malicious enemy stalking us.  It also implies that our character has something to do with treatment, because who wins wars? The courageous and persistent warriors win.

I'm here to break it to you. Cancer is a disease, and just like heart disease, kidney disease, lung disease and liver disease, it can cause death.  There are also treatments for cancer, just like those other diseases, which can prolong life. However, your willingness, bravery and strength of character have little to do with those treatments.  We don't tell patients taking their hypertension meds, "You are doing great on your war against hypertension!" Or that patient with COPD, "Every time you use your inhaler you are battling lung disease!"

We don't use war analogies for other diseases because we know we can't separate out the disease as bad, and ourselves as good.  Yet, we do this for cancer, by naming it an enemy.  This immediately makes cancer much more personal and raises the stakes of fighting it, to a moral obligation.

Here is the harm that making cancer a war analogy does: To the patient with stage 4 cancer that cannot be cured, they are now a failure. To the patient who chooses not to undergo chemotherapy that may diminish his quality of life, they are now a coward. To the patient who has tried to overcome cancer with various therapies but is now exhausted and wants to quit, they now feel guilty for letting their family and doctors down.

When cancer becomes a battle, then anything outside of a cure becomes a failure, and with failure comes guilt, shame, and anger.  It's hard enough dying with cancer without those added emotions. 

I know many of your loved ones, or you yourself, have survived cancer or are currently in treatment. Please know that your victory is meaningful and by all means continue treatment if it is helpful.  However, we should equally praise those who daily battle diabetes and obesity.  To those who struggle with depression or overcome smoking addictions, we should call you survivors too.  In other words, let’s celebrate life and mourn death equally, no matter the cause.

To those who cannot be cured or chose quality of life over longevity, let's give them permission to do so. Let us be the first to remind them that usually it takes more courage to face a disease realistically than it does with a metaphor.  And most importantly, if hospice is involved, it doesn't mean that a battle was lost, only that the focus changed from treating an “enemy” to treating oneself. 

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