Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The complicated existential dilemma of living with cancer

Don S. Dizon, MD
Physician
August 20, 2013
55 Shares
Share
Tweet
Share

asco-logoMaybe I should’ve noticed how she looked.  “She” was a new patient, Louise*, and she had been diagnosed with stage IV cervical cancer. Only in her 40s, the diagnosis had hit her extremely hard. At her first meeting, she wanted the “truth,” and I had told her what I felt to be most relevant — that her cancer had spread, that it was not curable, and someday it would probably kill her. However, she was not dying now, and we could certainly treat her cancer, which could help her thrive, keep the disease in check — and perhaps even place her into a remission. While a remission was not the same thing as cure, remission was a reasonable and realistic objective.

She had come back to clinic after our initial meeting with hair shorn and a new sense of mission as she exclaimed, “Let’s do this, I’m ready.” She decided to embark on chemotherapy and did well with her first three treatments, from which she experienced minimal side effects. Although she lost her hair, she took even that in stride–and discovered a passion for scarves along the way. “I may not go back to long hair; heck, I might stay with my Sinead O’Connor look!” We both laughed.

However, at her fourth visit, she was more reserved, almost sad. “I think it’s this weather; I always feel lousy when it rains continuously. And this cancer isn’t helping.”

“Well, on the positive side,” I had told her, “I am pretty optimistic that things are going well. I can’t feel your tumor anymore and your symptoms are gone, suggesting treatment is really working. I think that’s terrific news.”

She looked me in the eyes as I talked and when I finished, she replied, “Explain what you mean by optimistic?”

“I agree that treatment is working, and I am grateful for that. But, by optimistic, do you mean that I could be cured, or that I’m fine for now? Should I be less scared that I might die in a couple of years or can I go into remission and be fine until I’m 90, all because of this optimistic treatment regimen? I need you to explain to me exactly why you are optimistic.”

It is not often that questions of long-term outcomes arise during active treatment, especially when treatment is working. For an instance, I was confused about how to respond. Had I not been truthful with her? Had I unknowingly confused her with my talk of “optimism” and her “responding to therapy”? After all, our first conversation had been about how her metastatic disease was incurable and potentially fatal.

As an oncologist, I often ask my patients to live for today (in the words of Robin Williams’ character in Dead Poets Society, “carpe diem”). I’ve come to realize that my emphasis in “today” influences my assessments, evaluations, and how I communicate with my patients. When treatment works, I feel like I am doing something worthwhile — helping someone in the journey with cancer, and I am happy for them. When it is not, I adopt more emotional restraint as we think through prognosis, treatment, and endpoints together.

However, while this approach works for me, it may not work for some of my own patients, especially  those who find living with cancer a far more complicated existential dilemma — even more so in the context of advanced disease. As Louise helped me see, living for today might be good advice, but thoughts about the  future are never far away.

Ultimately, oncologists are here to treat cancer, including our continual assessments of treatments, their toxicity and whether or not they are helping. However, we can never forget the person living with cancer. Indeed, meeting the psychosocial needs of patients is part of a comprehensive treatment approach. Taking the time to explain what is happening now in light of what we anticipate for the future is important. I guess in the end, seeing the trees is just fine, but our patients never lose sight of the forest, which remains an ever present reality, and perhaps, far more important.

*Name and characteristics changed to preserve privacy.

Don S. Dizon is an oncologist who blogs at ASCO Connection, where this post originally appeared.

Prev

When evaluating mental health patients, go beyond snap decisions

August 20, 2013 Kevin 5
…
Next

How fear affects cancer survivorship

August 20, 2013 Kevin 1
…

Tagged as: Oncology/Hematology

Post navigation

< Previous Post
When evaluating mental health patients, go beyond snap decisions
Next Post >
How fear affects cancer survivorship

More by Don S. Dizon, MD

  • As an oncologist, this is the hardest role I play

    Don S. Dizon, MD
  • Why physicians should acknowledge the validity of second opinions

    Don S. Dizon, MD
  • A patient who taught an important lesson in doctoring

    Don S. Dizon, MD

More in Physician

  • Unlearning our habits: a journey from intelligence to wisdom

    Brian Sayers, MD
  • Beyond pizza and pens: National Doctors’ Day should be about saving lives

    James Young, MD
  • Maximizing physician potential: How coaching can aid in conflict resolution, enhance health care leadership and build stronger teams

    Asha Padmanabhan, MD
  • Physicians are a finite resource we need to protect

    Jack Resneck, Jr., MD
  • Tom Brady’s legacy and the importance of personal integrity in end-of-life choices

    Kevin Haselhorst, MD
  • The hidden truths of hospital life: What doctors wish you knew

    Emily Stanford, DO
  • Most Popular

  • Past Week

    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Beyond pizza and pens: National Doctors’ Day should be about saving lives

      James Young, MD | Physician
    • Physicians are a finite resource we need to protect

      Jack Resneck, Jr., MD | Physician
    • From clocking in to clocking out: the transition to retirement

      Debbie Moore-Black, RN | Conditions
    • Unlearning our habits: a journey from intelligence to wisdom

      Brian Sayers, MD | Physician
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
  • Recent Posts

    • Unlearning our habits: a journey from intelligence to wisdom

      Brian Sayers, MD | Physician
    • Lessons from an orthopedic surgery journey [PODCAST]

      The Podcast by KevinMD | Podcast
    • Beyond pizza and pens: National Doctors’ Day should be about saving lives

      James Young, MD | Physician
    • Maximizing physician potential: How coaching can aid in conflict resolution, enhance health care leadership and build stronger teams

      Asha Padmanabhan, MD | Physician
    • The future of education: AI empowerment, YouTube college credits, and the impact on traditional colleges

      Harvey Castro, MD, MBA | Tech
    • The beauty of a patient’s gratitude

      Dr. Damane Zehra | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 11 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Moderna's Steep COVID Vaccine Price: Corporate Greed or Capitalism?
  • House Republican Argues Against FDA Budget Increase
  • Prescriptions for Stimulants Jumped During the Pandemic
  • Federal Judge Strikes Down ACA's Preventive Care Coverage Requirements
  • Pandemic Jump in ED Visits for Firearm Injuries Continued Into 2022

Meeting Coverage

  • VTE Risk in Recurrent Ovarian Cancer Increases With More Lines of Chemotherapy
  • Obesity's Impact on Uterine Cancer Risk Greater in Younger Age Groups
  • Oral Roflumilast Effective in the Treatment of Plaque Psoriasis
  • Phase III Trials 'Hit a Home Run' in Advanced Endometrial Cancer
  • Cannabis Use Common in Post-Surgery Patients on Opioid Tapering
  • Most Popular

  • Past Week

    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Beyond pizza and pens: National Doctors’ Day should be about saving lives

      James Young, MD | Physician
    • Physicians are a finite resource we need to protect

      Jack Resneck, Jr., MD | Physician
    • From clocking in to clocking out: the transition to retirement

      Debbie Moore-Black, RN | Conditions
    • Unlearning our habits: a journey from intelligence to wisdom

      Brian Sayers, MD | Physician
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
  • Recent Posts

    • Unlearning our habits: a journey from intelligence to wisdom

      Brian Sayers, MD | Physician
    • Lessons from an orthopedic surgery journey [PODCAST]

      The Podcast by KevinMD | Podcast
    • Beyond pizza and pens: National Doctors’ Day should be about saving lives

      James Young, MD | Physician
    • Maximizing physician potential: How coaching can aid in conflict resolution, enhance health care leadership and build stronger teams

      Asha Padmanabhan, MD | Physician
    • The future of education: AI empowerment, YouTube college credits, and the impact on traditional colleges

      Harvey Castro, MD, MBA | Tech
    • The beauty of a patient’s gratitude

      Dr. Damane Zehra | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The complicated existential dilemma of living with cancer
11 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...