Wisdom from the Strangest Places

Wisdom from the Strangest Places

I’m sentimental about Halloween the way most people are sentimental about Christmas.

Fall foliage and pumpkins bring the tang of childhood to my tongue like nothing else. So I spend the month of October watching new horror movies or horror mini-series, if there are any good ones. And if there aren’t, then there’s always the classics—Halloween and The Shining—to enjoy again.

In recent years, the director Mike Flanagan has become a favorite, and his notable Netflix series The Haunting of Hill House is even popular among people who don’t generally like horror, mainly because he’s willing to expose the deepest, darkest secret of the horror genre.

And that secret, if you didn’t already know it, is this: horror isn’t actually about death, hate, or despair—it’s about life, love, and hope. All Mike does is make those themes of life, love and hope more apparent and accessible, while still scaring you.

So imagine my delight when, settling in to watch his newest mini-series The Midnight Club (which premiered on Netflix recently), twenty minutes into the first episode the main character (a young cancer patient) has a conversation with her doctor about how wrong-headed the “battle against cancer” rhetoric is.

DOCTOR: “The thing I didn’t understand when we talk about cancer, or any terminal illness really—look at the language we use. The language of battle. ‘We’re going to fight this thing. We’re going to fight with everything we’ve got. Be brave for the fight.’ And then people say, ‘They lost the battle’. It’s so backwards. I get it. To talk about the fight it’s active, it’s visceral. Don’t look at the hard part. Look at all these shiny sharp weapons we’ve developed for you to try. It’s about permission to leave the battlefield. To focus on living instead of fighting. We aren’t about a fight and it certainly isn’t losing a battle. Every living day here is a win.”

I couldn’t believe my ears. It might have been cribbed verbatim from past blog posts, or from conversations I’ve been hearing in the clinic lately.

Though it’s not my place to tell people how to think about their illness (especially since I’ve never had cancer) I’ve worried about the “battling cancer” rhetoric for years, for a lot of reasons. First, battle implies a certain casualness about casualties and collateral damage that’s never ok. Second, an “all-or-nothing” mentality doesn’t gel with what an actual course of treatment looks like, which requires flexibility and adaptation, advance AND retreat.

But most of all, I dislike it because it disrespects another aspect of the cancer experience for some—dying.

Though death isn’t the result we want, it can be experienced with dignity, comfort, and peace—if we face it honestly and with acceptance when it becomes inevitable. But that’s something an all-or-nothing mindset cannot do.

There probably are times when the metaphor of “fighting a battle” can be very helpful for people with cancer, and I’m not here to take that away from anyone. But like any metaphor, it oversimplifies reality to gain clarity. That means there are other ways in which it distorts or omits very important truths.

Most notable among them are:

  • There are ways to win, even when cure is impossible
  • People who die from cancer aren’t losers

Thanks for putting this message out there on blast, Mike. I couldn’t agree with you more.

Survivorship: What Lies Beyond Cancer

Survivorship: What Lies Beyond Cancer

“Now what?” This is at the top of patients’ minds after completing cancer treatment.

For many, it comes with a significant amount of worry. You have achieved the “end goal” so it’s common to wonder, what’s next?

Patients are used to being supervised on a daily or weekly basis and that may abruptly change to monthly or yearly follow-ups. This can increase nervousness prior to lab tests and exams. Common fears include recurrence, symptom management, social and financial concerns, and chronic health problems that have accompanied or been delayed since their cancer diagnosis.

We’re here from the start, through the darkest days, and to help patients live beyond cancer. Survivorship is an all-encompassing term that refers to a patient at any point along their cancer journey. Cancer is a dramatic life-altering diagnosis that changes patients’ and their loved ones’ outlook on life. Learning to adapt following the burdens of treatment takes a village.

Our team of experts will guide you to resources aimed to help you survive and thrive during and after cancer treatment.

  • SUPPORT: No one should carry the burden of cancer alone. A cancer diagnosis can make you and your loved ones feel isolated and alone, just when you need support the most. We know that meaningful connection brings strength and healing. Sharing the experience in a safe space with others on a similar path is often powerful and therapeutic. That’s why we offer a free monthly virtual cancer support group facilitated by our social workers for you and your loved ones. Wherever you are on your cancer journey, you are always welcome.
  • FINANCIAL: Our Navigating HOPE® financial counselors are dedicated to easing the financial toxicity that too often accompanies a cancer diagnosis. We understand that financial and insurance issues can be stressful and confusing. Let us go to battle for you.
    • SERVICES INCLUDE: Consultation to discuss insurance benefits and financial concerns to establish a joint path forward.
      • Review out-of-pocket expenses
      • Liaison between you and the insurance company
      • Collaborate with your care team
      • Verify in/out of network insurance coverage
      • Obtain insurance authorizations
      • Appeal insurance denials
      • Co-pay/Medication/Foundation Assistance
      • Disability referrals
      • Assistance with Medicaid or Marketplace enrollment
  • NUTRITION: Patients often ask what dietary changes they can make during treatment. We recommend working with our team of dietitians. They will guide you and take cardiac or diabetic needs into consideration.
  • MEDICAL: Our providers bring cancer treatment close to home, which helps with accessibility and allows for education, discussion, and support of long-term symptoms. We participate in clinical trials which investigate active treatments, preventative care, and symptom management. We also collaborate on mental health and with physical therapy to provide holistic survivorship care.

FOR MORE INFORMATION ON SURVIVORSHIP VISIT: The American Cancer Society – Survivorship During & After Treatment

Rethinking the War on Cancer

Rethinking the War on Cancer

We talk about cancer in warlike terms. Patients “battle the disease”. Physicians treat “aggressively”. In 1971, President Nixon “declared war on cancer” by signing the National Cancer Act which created much of the current research structure. Without this bellicose spirit, we may never have re-imagined cancer as an enemy to be defeated rather than a shameful curse to be borne in silence.

But if we continue to think only in this simplistic way, we must conclude that we’re already in a stalemate. I think it’s past time for cancer treatment to get a better metaphor.

For three generations, cancer medicine resembled Winston Churchill’s philosophy of World War II; we poured toxic drugs into patients until every cancer cell was “sponged and purged and, if need be, blasted from the surface of the earth”.1 For a handful of highly curable and very chemotherapy-sensitive cancers, this can still work: testicular cancer, many lymphomas, and some leukemias, for instance. But we’ve learned the hard way that more treatment doesn’t always give better results. Sometimes more treatment only increases side effects, not cure rates.

Treating cancer requires us to carefully balance the side effects of treatment against a realistic expectation of results. Modern cancer survivors experience far fewer side effects and hospitalizations than in the early days of cancer medicine, and live better and longer than ever before. This is because supportive care is better than ever before, and because the kind of “scorched earth” tactics that defined cancer medicine of the last century is largely a thing of the past.

Another revelation: cancer, far from being an invasion, is one of the natural perils of aging. And it’s one of the more common ways multicellular organisms (like humans) die. Read Mark Wolverton’s recent article in Wired for a nuanced view of the topic.

This is not an admission of defeat, but merely a change in tactics. There are many cancers that patients can live with quite well, needing only periodic treatment. Prostate cancer, sluggish types of lymphoma, and some forms of breast cancer can behave like this. Many newer drugs are aimed at stopping growth, rather than eradicating; the cancer isn’t cured, but the cancer isn’t growing or making patients sick, either.

1. Prime Minister Winston Churchill’s Speech to the Allied Delegates, James’s Place, London, June 12, 1941. http://www.ibiblio.org/pha/timeline/410612bwp.html