Free
SURF  |   September 2018
Defining a “Fight” Against Cancer
Author Notes
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Matthew J. Hadfield, DO, University of Connecticut, Department of Internal Medicine, 263 Farmington Ave, Farmington, CT 06030-0001. Email: hadfiemj@gmail.com
     
Article Information
Addiction Medicine / Gastroenterology / Imaging / Medical Education / Pulmonary Disorders
SURF   |   September 2018
Defining a “Fight” Against Cancer
The Journal of the American Osteopathic Association, September 2018, Vol. 118, e84-e85. doi:https://doi.org/10.7556/jaoa.2018.138
The Journal of the American Osteopathic Association, September 2018, Vol. 118, e84-e85. doi:https://doi.org/10.7556/jaoa.2018.138
I nervously walked to my patient's room. It was one of my first patient encounters as a medical student, and my preceptor asked me to check in on a patient who had been admitted the previous day. As I walked through the dimly lit hallways, I tried to recount all of the aspects of conducting a proper history and physical examination. I could see the flickering television illuminating an otherwise quiet and dark room. My attending physician had given me little more direction than to check on Jimmy, a 61-year-old man with pneumonia admitted the day before. 
As I entered, Jimmy sat wrapped in a blanket, drifting to sleep. Immediately, his eyes widened and he began clearing some of the leftover cans of ginger ale from his tray table as he greeted me. “Hey, brother, you must be the medical student? Dr S. said you'd swing by tonight,” he started with a grin, pausing briefly to clear his throat. I felt almost instantly at ease by his warm personality and, within seconds, it felt like I was chatting with an old friend. I stood beside Jimmy and placed my hand on his shoulder as I began to listen to the left side of his left lung. I heard the rushing air of his breathing with intermittent crackles. I moved to his right side and heard nothing, no breath sounds at all. Puzzled, I began moving my stethoscope to different locations, not quite understanding this apparent lack of breathing. 
Suddenly, I heard Jimmy chuckle with a hearty satisfaction. “Sound like something's missin', brother?” he laughed. He went on to explain to me that a year ago he was given a diagnosis of lung cancer and underwent a lobectomy that involved removing a significant amount of lung tissue on his right side. We talked for the next 20 minutes about his life and his family. He explained to me with great pride the work he did creating stained glass windows, work that had taken him all over the country and the world. We spoke at length about his family and he especially lit up as he described his granddaughter and how much joy he got from spending time with her. 
As our conversation turned to his lung cancer, his demeanor began to change. Jimmy had smoked over a pack of cigarettes a day since he was 12 years old. As he told me about his smoking history, he began conveying a strong sense of regret and guilt. “I worked many years without a mask and breathed in all sorts of dust, but who am I kidding?” he paused. “I gave myself cancer with all the smoking I've done.” As we talked more I asked about the course of his diagnosis and treatment. I found out that he had gone to the hospital for a respiratory infection, and his cancer was found incidentally on a chest radiograph. He described travelling out of state to see multiple specialists, a long stay in a large medical center following a surgery to remove that cancer, and making multiple trips back. 
Finally, I asked about his current treatment plan. “Nothing,” he replied before a long pause, “I guess you could say I decided not to fight cancer.” Without probing his reasons for not wanting chemotherapy or radiation, he began explaining why he decided to forgo any treatment shortly after his first surgery. He knew his prognosis and he made a conscious decision to use that time creating stained glass and watching his granddaughter play outside his workshop. He was not interested in long hospital stays or the adverse effects of chemotherapy. He did not want his last days to be spent sicker from medications than from his original diagnosis. Despite knowing what he wanted, it was obvious he had a sense of guilt for not pursuing treatment. At times, he alluded to the fact that he was letting his family down and, in some sense, not fulfilling an obligation to himself to consent to the most aggressive treatments. 
As I left the hospital that night I couldn't stop thinking about Jimmy's somber resignation to the idea that he wasn't “fighting cancer.” In his mind, he was somehow less of a cancer patient for forgoing treatment and making decisions based on what he wanted for his family and for his last few months of life. It brought into focus for me how profoundly important the vernacular used with patients can be. If a patient undergoing radiation or chemotherapy is a fighter, does that automatically relegate a person opting for a less aggressive treatment course a coward? And with this same line of thinking, if a person dies of cancer, must he or she be classified a loser? In a 2016 interview, renowned medical oncologist and author Siddhartha Mukherjee, MD, said, “often it is stated that a patient failed chemotherapy, however, the more appropriate language would be the chemotherapy failed the patient.”1(p221)What we say makes a difference in how patients and families feel about their diagnosis, treatment options, and decisions. 
Jimmy was fighting cancer as much as every other person who is affected by this horrible disease. He chose to not let cancer steal his happiness and joy during the last few precious months he had to live. It's incredibly important that caregivers, advocates, and families contemplate the vocabulary used to describe the care of patients with cancer. Optimism and hope can change the entire outlook of a patient and, often, it can be just in how we frame different situations. It is time we broaden our scope of what “fighting cancer” means and appreciate how much of an effect the words we choose to use have on our patients. 
References
Mukherjee S. The Emperor of All Maladies: A Biography of Cancer. New York, NY: Scribner; 2010: 221.