Cancer: a life sentence even if it doesn’t kill you
Here is some cheering news about a depressing subject. Day after day, all around the world, new, effective treatments for cancer mean that survival rates are going up. I’ve recently returned from chairing a European cancer conference in Brussels, where it was noted that common cancers – breast, prostate and others — now have more than 80 per cent survivability in many countries around the world.
But a distinguished oncologist who has been treating cancer patients for some 40 years made a bold statement, which echoed like a pistol shot through the conference. Medical successes, she said, had become so great that in some cases it was “easier to cure cancer” than to cure the social consequences for survivors.
All around the room, people who have lived through lung, bowel, blood and other cancers nodded in agreement. They told their own stories of being discriminated against while trying to obtain a mortgage, a bank loan, travel insurance or a job. Several spoke of feeling forced to “suffer twice” – first with cancer, then by being marked as somehow different after the disease.
Several spoke of mental health problems. One young man said that when his cancer was diagnosed, his friends divided into two groups: those who avoided him and those who spent too much time fussing over him. “I just wanted to be treated as normal,” he said. That desire was expressed repeatedly around the room.
The simple fact is that cancer is both a terrible disease and, at the same time, normal – at least in the sense that one in three, almost one in two of us will suffer from it and everyone else will have someone close to them diagnosed with it. One in five of us will die from cancer even if, perversely, that’s another sign of medical success, simply because other causes of death, such as heart disease, are increasingly avoidable and treatable.
And here is the cancer paradox. Cancer is so common – so “normal” – and survival increasingly so much more likely, that more must be done to help those who have lived through it return to some kind of regular, everyday life.
Throughout the conference when cancer patients told their survival stories, many of the eminent doctors who were present admitted, as one put it, to being “humbled.” One said he had spent his professional life treating the disease but was only now truly confronting its non-medical consequences. The really good news came as delegates bubbled with new ideas for cancer care.
Some hoped for a “European Cancer Plan”, which might become a model for the continent and the rest of the world. The idea has been endorsed in principle by some MEPs and health experts within the European Commission. The plan would aim to raise diagnosis, care and treatment standards across Europe, through centres of excellence and rigorous comparisons of outcomes. A survey for the conference showed that different European countries have different strengths, and that the rest could learn from the best.
Next, came ideas on prevention. In Britain, for example, an estimated 40 per cent of cancers could be prevented by better diet, reducing obesity and cutting out smoking. Conference delegates disagreed whether repeatedly raising taxes on cigarettes would work. Some thought it would encourage smuggling and make smoking seem like an aspirational pleasure, because only the rich would be able to enjoy it. Others saw increased taxes as a key determinant of behaviour.
Many delegates also wished to confront insurance companies by challenging what they saw as outdated attitudes to cancer survival. Some suggested shaming the insurers for this unfairness. Others thought there were so many cancer survivors now in Europe that it could be profitable to set up an insurance company specially for them.
Even a debate on the often high cost of treatment ended positively by considering not just the price of drugs but more importantly the wider value of screening, early intervention and prevention. Aggressive treatment over several months, which
People spoke of feeling forced to suffer twice – first with cancer, then by being marked as different after recovery
saves the life of a 20- or 30-year-old could help to avoid costlier treatment later, and produce a healthy person who will make a full contribution to society.
The most encouraging, life-enhancing, moments at the conference came when survivors spoke of how cancer had changed their lives. Some had become activists. One group, War On Cancer, set up by Fabian Bolin and Sebastian Hermelin, is a digital health company that aims to address the mental health issues of everyone affected by cancer.
Fabian and Sebastian were inspirational in sharing their personal stories and encouraging others to do the same. That message of sharing and communication, online or in person, turned out to be the biggest lesson of all. The very word “cancer” remains terrifying, but the disease is no longer the death sentence it was when many of the medical specialists present began their training.
Every day, there are improvements in treatments, drugs, and in public attitudes. Yes, cancer is a depressing subject, but the brighter message from the speakers, and survivors comes down to one simple word: hope.