When Friends and Family Encourage a Fight With Cancer
One week after receiving a grim brain cancer diagnosis, Senator John McCain delayed his cancer treatment to return to Washington, DC, to cast a vote against the GOP's "skinny repeal" of the Affordable Care Act. On July 31, he began a standard postsurgical regimen of targeted radiation and chemotherapy at the Mayo Clinic. He is planning to return to Washington at the conclusion of the August recess and reported to the media that he is feeling good and exercising.
When someone is diagnosed with cancer, it is very common for friends and family to encourage them to fight. But in a recent Medscape article, bioethicist Arthur L. Caplan, PhD, criticized McCain's friends and admirers for this type of response. The article has sparked over 500 responses from medical professionals, including many who have treated cancer patients as well as some who have cancer or whose loved ones have cancer.
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."
Kindness and Support Should Replace the Battle
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.
Kindness should replace the battle cry, said another clinician. "The 'fight at all costs' attitude often leads to futile, and even cruel, medical interventions. For example, I had one patient who was dying of pancreatic cancer which, among other things, was causing intestinal obstruction.
"In the name of the fight," continued the commenter, "seven unsuccessful attempts were made to bypass the obstruction. It was painful to be a part of that, particularly when I knew such attempts would be unsuccessful. The patient died shortly after the seventh attempt. Dying with cancer should not be a war and it should not be approached as a war. It is better to put aside the battle cries and give more thought to kindness."
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."
Questioning Treatment in the Final Days
One clinician whose husband died from cancer was adamantly against physicians recommending treatment to terminally ill cancer patients. "Doctors also often insist on treating, and in the case of my husband it did him no good at all while completely ruining the quality of his last 6 months. His doctors could not face not treating him for their own reasons; he would have accepted his imminent death and enjoyed our last months together. But they outright lied about the treatments they wanted to give him and refused to acknowledge how sick he was right up until his last week. I will never forgive their selfishness."
Cancer patients need support instead of encouragement to be courageous, noted one reader. "I see no pessimism in allowing people to face fatal illness in their own way, according to their own beliefs, and not pushing them to do what you think they should do. John McCain is not a 5-year-old; he doesn't need people to tell him to be courageous. He needs to be told that he has support for whatever he wants to do."
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.
"Sometimes in our haste to treat we forget that there is dignity in disease. Instead of being hooked up to IV machines, endless tests, and treatments, sometimes the best way to live life is to enjoy it even as it is about to end," added 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."
Another healthcare clinician put his thoughts more simply. "Everybody dies... no way around that and not helpful to avoid the fears connected to it... let's not contribute to the myth that immortality is possible."
It's Okay to Fight
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.
Another clinician believes that telling cancer patients to fight isn't wrong. "I think people have a hard time figuring out what to say in this situation. We have good intentions and try to convey hope to the individual. That's why we use terms such as 'fight,' 'beat this thing,' etc. I don't think we mean that you have to try every medical option available to you or else we will view you as a coward.
"Who cares whether what we say is PC?" she continued. "There is too much emphasis on that anyway. I think we as healthcare professionals should provide the information for all of the options for treatment to the patient, let the patient and his family think about it, and then ask what the patient wants done. It is ultimately the patient's choice. I would follow the patient's wishes and continue to give hope to the patient...BTW, thank you, Senator McCain, for your great service to this country. I wish you well," said the healthcare provider.
Medscape Family Medicine © 2017 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Sandra Levy. Should Well-Wishers Urge McCain to Fight His Cancer? - Medscape - Aug 18, 2017.