World Cancer Day Special: Understanding Cancer – What Have We Missed? – Hiba

You hear the word “cancer” and it shocks you. You feel sorry for the person and it takes you some time to get your head around it and while your mind slowly starts to accept it, you are convinced it means nothing but a death sentence. There are various aspects of cancer, be it symptoms, management and prognosis, so a flexible perspective about it not only helps to keep the unnecessary anxiety at bay, but also enables to seek help efficiently.

There is no denying that cancer is next only to cardiovascular diseases in terms of mortality and continues to rapidly increase in frequency throughout the globe, reasons being many, some of which are modifiable while others not. Tobacco, radiations, unhealthy diet, obesity, and certain viruses are carcinogenic. However, most of the time, the cause remains unknown. Subsequently, timely screening remains the only modality to detect cancer as it results in seeking help early, which increases the chances of malignancy going into remission. Commonest malignancies among women in Pakistan viz Breast and Cervical, can be 100% cured if the tumour has not metastasized. A simple self-breast examination and a pap smear does the job for these two respectively.

A healthy lifestyle including intake of fresh fruits and vegetables, physical activity and engaging in recreational activities that are beneficial for the body, mind and soul must not be overlooked as they play a pivotal role in easing away the daily chaos.

Late Dr Paul Kalanithi had a long battle with lung cancer and the irony was that he had never smoked, a well-known risk factor for this malignancy. Being a doctor himself he understood the prognosis quite well and knew what laid ahead of him which he so wisely narrated in his internationally acclaimed book “When Breath Becomes Air”. He wrote that: “Any major illness transforms a patient’s – really an entire family’s life!” What do we understand from this? It simply tells us the most neglected aspect of patients’ management, that is proper counselling of both the patient and his family. We as doctors might think what good of a use it will be to waste our time on counselling them; the truth however contradicts this notion. It’s of utmost importance to educate patients and answer all their queries in the most patient manner. Not only this, but education of caregivers and making them realize their role in helping the patient get through this malignancy cannot be neglected. This can be better understood by Kalanithi’s practice that he has mentioned in his book:

“As a resident, my highest ideal was not saving lives-everyone dies eventually-but guiding a patient or family to an understanding of death or illness!”

I know for the fact that many, if not every attendant tends to keep the diagnosis to themselves. Ethically speaking, the patient has the right to know it, the reasons being manifold. First of all, it’s his or her body and not knowing what they are going through will keep them in the dilemma of why they aren’t getting better. Maybe they have some matters that need to be sorted out. Perhaps they want to make peace with someone and if they are unaware that they have a terminal illness, you take away that opportunity from them. Maybe they haven’t made a will, and now might seem the right thing to do.

Doctors might have given you the prognosis if it’s the terminal stage, or the family might have asked themselves, but it varies from one individual to another and so giving exact numbers to someone who hasn’t yet fully gotten accustomed to the newly revealed diagnosis is not a wise thing to do. Alternatively, the patient must be told the facts, and the management plan discussed with them, giving them support and hope, something they may have lost along the way. Simultaneously, it’s the utmost responsibility of caregivers to support their loved one, giving them hope, praying for them and with them, reminding them of their achievements and that they are not alone in this fight. You will be surprised to know that a patient who is morally supported by his loved ones deal with his illness much better than the ones that are not. It might have to do something with the spiritual well-being, but this does happen and it’s very real. No matter how hard it may seem, caregivers have to fight with the patient and give it their all. I would once again quote Kalanathi as his words are very relatable in this context: “Most patients live many months to a couple of years.”

This was, to me, a more honest description. The problem is that you can’t tell an individual patient where she sits on the curve.

“Will she die in six months or sixty? I came to believe that it is irresponsible to be more precise than you can be accurate. Those apocryphal doctors who gave specific number (“The doctor told me I had six months to live”): Who were they, I wondered, and who taught them statistics?”

Talking to people or families who are or had undergone the similar experiences of having a malignancy can be very fruitful. Many online groups are available, or you can always form your own and share your experience as a patient or caregiver.

Palliation is a term associated with terminal illnesses such as cancer. It means to support and treat a patient symptomatically and easing their pain and worries when drugs or surgery are out of options. I remember being so grateful when a doctor guided us to seek help from a palliative care physician for our grandfather who was battling with end stage malignancy.

Let’s pledge to take care of our health, to remain active and to fight cancer with the options out there, never excluding hope and prayers. To all those fighting with cancer, may Allah bless you with Shifa-e-Kamla and for all the caregivers, to give you hope and courage to fight this with your loved one. Aameen!

Image by Colin Behrens from Pixabay

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