July 28, 2017 -
Plagiarism warning! This topic is of major importance to me. So much so that I have published on it before (see below). But the problem hasn’t gone away, and I wanted to make sure to share my thoughts with you – my most important audience.
As you know, Sen. John McCain returned to Congress this week, just a few days after a surgery that revealed the six-term Arizona Republican has glioblastoma.
Words of encouragement appropriately flooded in. And there was bipartisan agreement: Sen. McCain is a tough guy who was going to “beat” a tough diagnosis. “He has never shied from a fight and I know that he will face this challenge with the same extraordinary courage that has characterized his life,” Senate Majority Leader Mitch McConnell said. Everyone from former President Barack Obama to current President Donald Trump called McCain a “fighter.”
I don’t disagree that Sen. McCain is a fighter, and needless to say we wish him the best possible outcome from his cancer. But, and no fault of his, that kind of language is a disservice to him and every single person diagnosed with a malignancy. Having cancer isn’t a battle a patient wins or loses. Cancer is a stubbornly clever, tragically common set of diseases that scientists, doctors, and advocates work every day to better understand, prevent, and treat. Using the battle metaphor implies that if a patient fights hard enough, smart enough, or long enough, they’ll win the war. That has a horrible implication. If the patient succumbs (and some cancers simply do not have a meaningful cure rate despite the patient’s attitude or treatment course) it must mean they didn’t “fight” hard enough. Wrong. If a person dies of cancer it’s due to biology and our lack of scientific or medical understanding. Putting the burden of cure on the patient is a tragic misunderstanding of how cancer works.
This is particularly true for glioblastoma. Tumors like Sen. McCain’s almost inevitably recur after surgery and the standard course of radiation and chemotherapy, usually less than year after initial treatment. Median survival is 12 to 18 months. Ted Kennedy, Beau Biden, Ethel Merman, George Gershwin, and Gene Siskel all died of brain cancer, despite having access to top-notch oncologic care. Sen. McCain, a decorated Vietnam War veteran, will no doubt aggressively treat his disease and face this treatment with courage. His mettle isn’t in question. But I am questioning the “war” metaphor around cancer, and the expectation that anyone will beat a nearly uniformly fatal disease.
In April 2015, my SWOG colleague Dr. Lee Ellis wrote an opinion piece, co-authored with me and Fight Colorectal Cancer Founder Nancy Roach, calling for an end to the cancer “war.” You can read the JAMA Oncology piece here but I’ll paraphrase. We argued that a “battle” with cancer implies a level of control that patients don’t have. We said this language minimizes the nausea, pain, fatigue, isolation, and fear faced by patients every day – challenges they often are able to overcome. We added that our society’s need to “battle” cancer, to always “do something,” can have very real negative effects, like unnecessary treatment, decreased use of hospice care, and severe financial stress.
Changing how we talk about cancer may change how we think about it, and how we approach research and active treatment. We should focus on facing – not fighting – cancer with the best weapon we have: medical science. Our best shot at helping anyone with hard-to-treat malignancies is a clinical trial.