Friday, July 28, 2017

Cancer doesn't care If you're a fighter

It is very common when learning that someone has been newly diagnosed with a life-threatening cancer that well-meaning family and friends weigh in with encouragement to fight. It is also unfortunate.

Cancer could not care less whether you are a fighter or not. What evidence there is does not show that adopting a fighting stance helps in terms of survival. I have seen many fighters die of cancer, and some who chose not to be seen as fighters live longer than others who did.

And there is an implication that if you are not a fighter, then you must be a coward or worse. This suggests that the only option available to anyone who is courageous is to choose to fight—to utilize every surgery, complementary medicine, chemotherapy, and experimental option. This is unfortunate as well, because it takes courage to decide not to battle fatal cancers, but rather to enjoy a better quality of life in the time that remains.

The latest example of this "you must be a fighter" ethic is John McCain.

The senator from Arizona just found out he has a glioblastoma, a very nasty form of brain cancer. Upon announcing his diagnosis, McCain was greeted by a chorus of friends and admirers urging him to fight and calling on him to be courageous in taking on the cancer. This is advice McCain does not need.

Here is a sample from Twitter. Barack Obama said, "John McCain is an American hero, and one of the bravest fighters I've ever known. Cancer doesn't know what it's up against. Give it hell, John." Joe Biden: "He is strong, and he will beat this."

Gabrielle Giffords: "You're tough! You can beat this. Fight, fight, fight!" Mike Pence: "Cancer picked on the wrong guy. John McCain is a fighter, and he'll win this fight too." A bunch of editorials in many newspapers across the nation echoed similar thoughts.

This is advice McCain does not need.

The odds of beating this cancer are long. Whether he does or doesn't has nothing to do with his character or courage. That is not, despite some incredibly disrespectful comments President Trump made about him in the run-up to the presidential election, up for dispute.

McCain is a military hero. The genuine article. The former Navy pilot spent five and a half years in a notorious North Vietnamese prison known as the "Hanoi Hilton," where he spent 2 years in solitary confinement and was brutally tortured despite being severely injured when he bailed out of his plane. Concerned about his fellow prisoners, he would not accept an early release.

Whatever cancer does to John McCain and however he chooses to treat it or not, he is a brave man who is certainly a fighter. As with anyone, he will find his own best path to dealing with a grim diagnosis. Whatever that is, he will remain a hero and a fighter.


  1. Telling patients to fight prevents patients from enjoying the time they have left, said one surgeon. "The media and his colleagues telling him to fight because 'he is a fighter' is sending the wrong message and is not fair to him given his prognosis. As a general surgeon I see this all the time. Patients with very poor prognoses are given false hope and put through unnecessary misery to try to prolong their life even a few weeks or at best a few months, and during this brief time the quality of life is nonexistent and it is only pure torture. He should be able to enjoy as much of the time that he has."

    One clinician who has cancer feels that telling people to fight it puts the blame on patients when they succumb to their disease. "As a cancer patient on my third cancer (and #3 has no cure) I don't think this has anything to do with healthcare costs. It has to do with telling someone, in effect, if you "fight hard" against cancer then you can beat this. If you don't then you will die; if you died you didn't fight hard enough. It blames the victim when they die.

    "Fighting cancer is no more appropriate a metaphor than fighting a stroke, heart attack, or the flu, for that matter," the commenter continued. "They are all illnesses that need to be appropriately treated to the extent that it is appropriate and the patient wants it. Perhaps we should be wishing them wisdom and strength as they deal with their illness."

    Another physician who has treated cancer patients for many years had an alternative to telling patients to fight cancer. "Provide the patient and his family with all the details they need. Answer all their questions passionately and honestly. Abide by the answer that the patient gives, not his family, and congratulate everyone for coming to an excellent decision," said the physician...(continued)

  2. (continued)One family physician said that encouraging a fight detracts from enjoying the final days. "Fight does not mean hope, nor is it a necessary requirement for hope. I see a diagnosis such as this as a huge opportunity to grow spiritually. Patients confronted with the reality of terminal disease must come to terms with very profound existential issues... In my experience, those who move expediently through their stages of grief, achieving a level of acceptance that allows them to face each decision in the moment, in a state of mental and emotional peace, enjoy a depth of appreciation for their remaining days rarely experienced by the rest of us.

    "Whether they choose this treatment or that or no treatment at all is irrelevant," he continued. "Whether the body survives an additional year or just a day—even if cured of the disease completely—the attitude of utter acceptance of 'what is' in the moment opens the individual to profound gratitude for and insight into the meaning of life."

    He added, "The attitude of 'fighting' to beat the cancer, whether that entails realistic or false hope, brings with it the threat of losing the fight and therefore imparts an existential anxiety that detracts from one's ability to fully embrace his or her remaining days to its fullest. And finally—this applies to all of us. The moment we are born, we are terminal; our days are numbered. So it behooves all of us to search for that source of ultimate peace we possess within ourselves."...(continued)

  3. (continued)A neurologist agreed that support from loved ones is more important than encouraging a fight against cancer. "I remember a story my old chairman shared with me from one of his old professors during my neurology residency. That was that if someone has a grim prognosis such as glioblastoma multiforme (especially the butterfly pattern you see on MRIs, spreading to both hemispheres, which at its most aggressive without treatment, you can expect a life expectancy of 6 months), that neurologist's best advice to the patient was: Get your affairs in order, surround yourself with loved ones, and do everything you wanted to do on this earth. I never forgot that story," said the neurologist...

    A surgeon couldn't agree more that enjoying one's remaining days is crucial. "What's needed is an honest assessment of the odds of cure, basically nil in McCain's case, and clear decisions on maximizing the quality of remaining life. My dear wife said, 'I'm stuffed' and she got on with enjoying her family and friends for the last month remaining to her instead of undergoing futile investigations and toxic therapy for the incompletely diagnosed metastatic cancer which was unexpectedly discovered. It worked for all of us."...

    Some physicians pointed out that the word fight can be interpreted in different ways. A radiologist said, "The comments about Senator John McCain by those who tell him 'to fight' are words of encouragement. They are just an expression of love and respect. John McCain is no fool; he knows what he is up against. He knows he is mortal and he knows he has a serious and devastating type of cancer. I hope he is taken care of in such a manner that he lives whatever time he has with dignity and one day dies with dignity as well. May he have the comfort of knowing how his decency and honor are respected and admired by so many people."

    An allergist who has cancer concurred with the sentiment above. "As usual, we are all getting too worked up about a word. I believe that since words or phrases are imperfect expressions of our true thoughts, it is often the unknowable intention behind them that really counts. This 'fight' may take on many forms, including spiritual. Neither do I want to be called a cancer victim or survivor as these words make me uncomfortable. John McCain is a hero to me and I take strength from his entire (albeit imperfect) life's example," said the allergist.