January 13, 2016 | by Vijay Trisal, M.D., F.A.C.S.
Doctors and scientists have made substantial progress in the early diagnosis and treatment of many cancers, increasing life expectancy to the extent that many patients can maintain hope to be cured or to live with cancer as a chronic disease – a fact we can and should take comfort in.
We have made tangible advances in technology and have a better understanding of the molecular mechanisms of the drivers of cancer. This has advanced our ability to interrupt the growth of cancer. However, we need to take a step back and seriously examine the social and psychological harm that the disease can cause.
In the United States, one in two men and one in three women will be diagnosed with cancer during their lifetime.
We already have almost 15 million cancer survivors, and by 2024 that number will expand to near 19 million.
Approximately 60 percent of all cancers occur in patients who are 65 years or older, 40 percent of cancers occur in the age group of 20 to 64 and around 1 percent are age 19 or younger.
Even with the possibility of cure, treatment-related damage can significantly impact patients’ lives. These various impacts shift with age, but a worry of all but the youngest patients seems to be the anxiety of whether they are getting the best treatment.
While the following fear is nowhere near the same impact or magnitude, I often compare that anxiety to one some people experience with car repair. When one mechanic advises you to service the transmission or the engine will “seize,” and another tells you there is nothing wrong with the transmission and that the noise is coming from the tail pipe, it engenders little faith in the system.
The fear is understandable. The complexity of cancer and the rapid progression of knowledge have not lent themselves to having experts in the field that understand the disease completely. To combat that fear, it is essential that patients get a second opinion from a reputed center that is at the forefront of technology. Faith in treatment is a crucial first step in fighting this disease.
Another common worry is that of recurrence, the threat of which constantly plagues survivors. Patients coming for their follow-up repeatedly relive their initial fear and even despair, especially while they are waiting for the results of blood tests or CT scans. For example, we at City of Hope understand that and try our best to make appointments that are either on the same day or very close to the date of scans and blood tests.
A little fear is healthy, encouraging patients to bring their issues to the health care professionals who can help them, but excessive worry can impact sleep and deteriorate normal functioning – none of which is healthy for patients or survivors.
Fear can intertwine with guilt and shame in both normal relationships and in day-to-day functioning. Many patients often feel that they are being judged and pitied, often without a tangible source. Some patients feel guilty at either not having given up risky behavior or continuing the behavior that may have contributed to the development of the cancer. A perfect example is a lung cancer patients’ guilt at having smoked or continuing to smoke even after diagnosis.
When it comes to relatives, friends and co-workers, they may feel awkward discussing the illness and may remain silent, avoiding patients or pretending that everything is normal. This creates a different level of tension in relationships, and it is important to diffuse the tension and break the communication barriers.
Most patients who have survived cancer will feel both a sense of “survivor’s guilt” and a sense of doom whenever there is a complication or progression in a patient who has similar disease. This brings back the memories and the feelings similar to the post-traumatic stress disorder that is found in war veterans. Added to the “chemo brain” that can occasionally complicate complex thinking, a survivor can have a tough time wrestling with the news of similar diagnosis in a colleague or a friend.
On a hopeful note, many survivors find that life takes a new meaning after cancer. Most patients find comfort in support groups where they feel that others understand what they have gone through. Many will celebrate their “new birthday” as the one when all their treatment was over and they had a new lease on life, contributing to a newfound zest for life and spirit of thankfulness.
To summarize, the social and psychological aspects of cancer in longtime survivors is widespread and substantial. Recognition of these issues and prompt attention to some of the treatable symptoms is essential if we’re truly to improve cancer care for our growing population of survivors.
For tips, tools and resources on how you and your family can address the many emotional and physical issues that arise during and after cancer treatment, please visit Living with Cancer.
If you are looking for a second opinion about your diagnosis or consultation about your treatment, request an appointment online or contact us at 800-826-HOPE. Please visit Making Your First Appointment for more information.