October 30, 2013

Vital Signs

Cancer is not a single disease entity. Rather, it includes a spectrum of disorders that share a common mechanism. Advances in diagnostic capabilities and the use of population-screening techniques have resulted in cancers being detected in their very early stages—even in “precancerous” stages. It’s this capacity to diagnose early cancer that may have softened its image in the minds of many; but cancer is still a malignant and often lethal condition. On the other hand, fear often induces denial or paralysis.

Svetlana was a young Russian physician, newly arrived in Canada with her two delightful children. She was studying for Canadian exams that would permit her a medical residency slot. Her engineer husband supported them financially. She came to see me for routine Pap smears. To my surprise, the report came back indicating “abnormal cells of unknown derivation.” The pathologist I used was a proven expert, and I took the report extremely seriously. Colposcopy, endocervical curettage, and endometrial biopsy were all noncontributory to a diagnosis, so I performed a laparoscopic exam. 

Upon first viewing the peritoneal cavity, it appeared pristine and healthy, just like its 34-year-old owner. Closer inspection, however, revealed a gelatinous, pale, blueberry-sized lesion on the left ovary. I carefully biopsied it, and then turned my scope to visualize the rest of the cavity. Aided by the magnifying capacity of the laparoscope, I found the peritoneum to be dotted with tiny salt-grain-sized flecks, also of a clear, pale, jelly-type nature. These, too, I biopsied.

A few days later the reports came back, indicating “ovarian/peritoneal cancer.” It was clearly widespread and at a late stage, although of very recent onset. She had a particularly virulent form of cancer, and despite the full panoply of therapies, she was dead within five years—as would be 84 percent of people with such widespread cancer.

I recount this story to emphasize the lethal nature of some cancers. I could equally tell of astounding recoveries that, even to a seasoned, skeptical clinician such as I, appear miraculous. I have experienced 50 years of mind-boggling advances in medicine and seen dogged, relentless physicians battle this disease; and yet, I’ve also witnessed a mysterious groundswell against “standard treatments” that seems to mirror a postmodern mind-set of there being no absolutes, only what we as individuals personally believe. In such a milieu the repeated call for an evidence-based rationale for therapy often goes unheeded.

Alternative Therapies

Many people decide to use what they erroneously term “alternative therapies.” An alternative route would take you to the same destination; in the case of cancer, an alternative therapy should provide equal or nearly equal chances of cure. People often do not realize that once a therapy has been shown to be an “alternative” with supporting evidence, it becomes a part of the “standard therapy”—although possibly rated as a second or third alternative.

In Adventist circles, lifestyle elements that have been shown to possibly reduce risk of contracting cancer are often promoted as cures. An illustration of the difference between prevention and cure is that of behaviors that lower the risk of a broken leg and the measures required to promote its healing. Prevention and cure are totally different “animals,” and while we strongly recommend lifestyle measures for prevention, it’s dishonest, negligent, and frankly dangerous to suggest that such measures are curative.

There is absolutely no reliable statistical basis to suggest that diet can cure cancer. In the community of church members are those who sometimes choose to interfere with the treatments being recommended by health professionals. Such self-appointed “experts” may hold a degree in some different field, but without trepidation opine about another person’s best course of action. Some go so far as to indicate that a person taking standardized therapy must lack faith. What can one know about another’s level of spirituality or faith? No wonder the Lord commands us to “judge not.” Does this mean lifestyle measures are useless for treatment? No, but the evidence isn’t there. It’s not “illogical” to suggest lifestyle might be a good “adjuvant” approach, but not an “alternative.” 

Undergoing Tests

Many hesitate to undergo all the tests their doctors suggest they take. Indeed, there are doctors who order more tests than are necessary, often from a mind-set of covering every base and protecting themselves against claims of negligence. In situations of cancer, however, exact staging of the disease strongly influences the selection of treatment, so full exploration permits a more appropriate selection.

Finding a Doctor

A question some ask is “How can I find a suitable doctor to treat my cancer?” Experiences recounted online are not always reliable. One rule of thumb is if a primary-care physician is routinely careful, thoughtful, and gives you full attention, you can safely trust that they will use the same concern in finding you a specialist. 

Good doctors encourage second opinions. Very often physicians associated with a teaching institution are more knowledgeable, while the doctor running a high-volume practice might be more “technically skilled.” Never feel awkward about asking for a second opinion, but keep in mind that it’s “bad form” to switch doctors without including the referring physician in the decision. Perfect honesty with your physician will be appreciated, and may actually teach the caregiver about patients’ perceptions.

Supporting Someone With Cancer

Perhaps an important area to explore is how to be supportive of that friend, church member, or family member who has been diagnosed with cancer. Unsolicited opinions are probably about as welcome as insistence of your favorite color scheme or sofa for your friend’s new family room. Unless you are a qualified expert, you would be wise to keep your opinion to yourself; indeed, if you are an expert, your advice will probably be to listen to the patient’s own similarly qualified experts.

Support should be given in a general—not a specific—way. Hope is the greatest gift you can give a patient with cancer. Despite dreadful statistics, there are always those who defy the odds. Hope can positively influence outcomes. Hope builds faith, so build the patient’s hope and faith.

You want the patient to feel uplifted by your contact, and you transmit support more fully with loving, prayerful interaction rather than prescriptive, dogmatic talk. A hug and a touch often do far more than your favorite lecture on the benefits of pomegranate juice.

When an individual chooses a course of action—especially if it has been based upon expert advice—the wisest course of action for a friend is to affirm such a choice. If you feel compelled to share your “cherished beliefs,” do so as an addition, not a replacement, of the chosen therapy. It’s often forgotten that the good Lord gave us all freedom of choice. If He is so gracious, shouldn’t we be gracious too?

Messengers of Hope

Everyone who contracts cancer or has a family member with cancer is barraged with advice. In the Adventist community there are “guilt trippers,” who assert the condition is a direct consequence of some neglected lifestyle imperative, as well as some “extremists,” who insist their particular concoction is a “surefire” cure. The advice to all of us would best be to “lay off” of such gratuitous, often ill-founded advice. Be kind, loving, hopeful, reassuring, optimistic, and pleasant. Take the person out for a nice meal or other happy diversion. Pray with them, but don’t be too sanctimonious. Rejoice in the gospel message, but don’t paint a dark picture of sin and its effects.

Ask yourself, “How does my interaction buoy this dear soul’s spirit?” If you can’t make the patient cheerful, at least don’t contribute to depression. 

The gospel is good news—so let’s be messengers of hope!

 

Send your questions to Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, Maryland 20904. Or e-mail them to [email protected] While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend you consult with your personal physician on all matters of your health. 

 

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