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The Strategy of Fighting Cancer
William M. Buchholz, M.D.
There is so much to do when you're faced with a diagnosis of cancer
(or other life threatening disease) that it is easy to get overwhelmed.
This article will help you organize your thoughts and develop a
personal strategy to deal with your disease. It is presented as
if you were in my office for a second opinion, knowing the diagnosis
and some of the treatment options, but wanting guidance in choosing
the ones that are right for you.Studies have shown that the majority of people use both conventional
and complementary treatments. Deciding amongst a confusing array
of options requires evaluating the effectiveness, side effects and
purpose of each treatment. I can't make the decision for you. I
can, however, help you make the best decision you can.Because each person will have unique needs and abilities, this
discussion is somewhat general. To make it more personal, write
down your answers to the questions. I hope the article will stimulate
you to ask your own questions. Don't worry if you don't have all
the answers. Nobody does. If you ask the questions enough times,
and can quiet yourself long enough, you will hear the answers. (See
also, ¦Asking the Right Questions² in
the Publications section of our web site.)
GOALS OF TREATMENT
What
is the goal of treatment?
A. Cure: eliminate all disease (and die of something else)?
B. Healing: becoming whole, personal transformation (with or without
cure)?
C. Quality of Life: highest quality of life, fewest symptoms from
treatment or disease?
D. Length of life: live as long as possible even if quality of
life is compromised?
E. Maintain Hope: avoiding despair, anxiety, depression?
F. Maintain Self: being true to your own values and style?
The
correct answer to the question is YES.
Most
people want all of these, to be cured, transformed, and have a high
quality of life throughout the process (hopefully with a guarantee
of success at the start of the treatment). That is easier said than
done. Cancer is a complex disease and generally requires treatments
that involve some risk and discomfort. No treatment is guaranteed.
The outcome is always uncertain.
Often compromises are necessary. How much are you willing to ¦pay²
for a cure? Are you willing to lose your hair to chemotherapy? Are
you willing to change your lifestyle and diet, losing many of the
pleasures you enjoy now? Are you willing to dip into savings accounts
to pay for a special treatment, available only from a certain doctor
or medical center? What can you afford in the way of time, energy,
or resources?Look carefully at the list again and rank these goals from most
important to least important. Pretty difficult, eh? What if you
could not be cured? What would be most important then? The issues
that I have seen most often influence treatment choices (beyond
extending life) are maintaining hope and retaining a sense of self.
Cure may not be accessible. Transformation cannot be guaranteed.
Both treatments and the disease process may compromise the quality
of life. The bottom line is that you must be clear what your goals
are and work toward them.
How large do you want to live?
The real question is not ¦How long will you live?² but ¦How large
will you live?² Life is not linear but three dimensional. Life is
measured by the height of the quality of life and the depth of meaning
as well as by the length of days. In considering treatments, their
effects on the quality and meaning of life must be considered, as
well as their ability to extend life.It is harder to measure the quality of life than how many days
you live. The overall quality of life is really the sum of the qualities
of many areas of your life, adjusted for the importance of each
area. The areas that contribute to the quality of life include physical
sensations and function, emotional states, relationships, social
functioning, economic and physical security, spiritual wellbeing,
etc. In each area there may be positive or negative experiences.
You may at one moment have pain from a headache and then pleasure
from a hot bath. You may have some relationships that are nourishing
and some that are destructive. The overall satisfaction with the
quality of live in any area is the balance between good and bad,
times the importance of that area. If physical function and independence
is more important to you than body image, then a broken leg would
impact the quality of life more than a mastectomy.
Meaning and purpose also affect the size of your life. If you feel
that what you do gives purpose to your life, then even physical
hardships become bearable. When confronting adversity, knowing that
what you're doing is meaningful does not necessarily make things
easier, but it may make them worthwhile. Finding or developing purpose
in life requires putting things in a larger perspective, either
spiritually, socially or philosophically.
I would propose that the goal of treatment is to make your life
as large as possible. Certainly it is worthwhile to do those
things that extend the duration of life. It is likewise important
to increase the quality and meaning of your life. If you have unpleasant
symptoms from treatment (nausea, weakness, etc.), treat them or
add positive sensations like laughter or massage. If you are depressed
or anxious, seek out other people and ask for a friendly ear. If
pain or other symptoms interfere with the quality of your life,
get medical treatment. If your life feels meaningless, talk to others,
such as clergy or counselors, who can help you see beyond your current
dilemmas.
The
following questions will help you focus attention on the areas of
your life that could make your life larger. Use your answers to
help you decide what you can do for yourself and what other treatments
to fit into your overall plan
What
do I feel? (What physical or emotional symptoms do I have?)
What do I want? (What desires or goals do I have?)
What do I need? (What identity, transpersonal, social needs
do I have?)
What gives my life purpose?
TREATMENTS
OR TREATMENT PLANS
Many patients have come to me with shopping bags full of pills and
powders, requesting help in deciding which ones to take. The various
medicines and supplements had been prescribed by different doctors,
each with a rationale, but often without considering the whole picture.
Similarly, patients have been concerned they are not getting enough
treatment because a friend was taking something and it had not been
prescribed for them.
It is important to distinguish between tactics (specific treatments)
and strategy (the overall picture or goal to be achieved). Just
because something can be done does not mean that it should be done. It is not necessary to have three drugs doing the job that
one can do. Sometimes a theoretical benefit does not translate into
a practical advantage.
Having examined what your goals of treatment are you are in a better
position to chose not only what you do but when you
do it. The essence of strategy is to fight smarter, not just harder.
You may decide that you want to have surgery and chemotherapy to
help with cure, herbs and supplements to help your host defenses,
antioxidants to prevent cancer, to change your diet, do imagery
and meditation for stress reduction, and take time off from work
to ¦follow your bliss.² This is too much to do at once. Your energy
and focus becomes dispersed. You may eventually do them all, but
do one or two at a time so you don't lose sight of your real goal,
which is to have the largest possible life. Don't become a professional
cancer patient, whose every moment is spent fighting cancer, with
nothing left over to enjoy the life you have right now!
Do you play to win or do you play not to lose?
People vary in their willingness to risk. Some people are naturally
more conservative than others. You may be comfortable in refusing
a treatment that doesn't have a benefit commensurate with the risk.
Conversely, you may be so committed to your goals that you will
take even the 1 to 2 % chance of success it offers.
When one's life is at stake, most people are willing to take more
chances; the ¦win² is bigger and justifies taking higher risks.
Yet the loss of life may not be the worst loss. Many people can
think of something that is truly ¦a fate worse than death.²
Complete the sentence, ¦I would rather die than...² Say it out loud.
By listening to the tone of honesty in your own voice (or having
someone else judge it) you may discover where you draw your line.
Thus you can make more genuine decisions about what is worth trying
and what is not.
King Lear and the Butterfly
There are two images that reflect different but equally important
styles of fighting cancer. Each is necessary at some point in the
illness; neither is sufficient by itself. The first image comes from Shakespeare's King Lear (Act III, Sc.
2) in which King Lear, gray bearded and clutching his tattered cloak
around him, stands upon the heath, defying the storm about him,
shouting, ¦Blow, winds, and crack your cheeks! rage! blow!²
Sometimes it is necessary to fight fiercely, holding on to life
desperately, struggling against the forces that would take it away
from you. Such a battle requires courage, determination, and power--in
short, you must become a warrior.The other image is that of life as a butterfly, resting in the
palm of your hand. If you try to grasp it, you will crush it. To
entice it to remain there, you must make the nectar of your life
so intoxicatingly sweet that the butterfly is irresistibly drawn
to stay. This style is no less heroic. It is even harder because
there are fewer role models and many of us have not yet developed
the skills. This style requires patience rather than courage, wisdom
rather than determination, and strength rather than power.To make life sweeter you must add pleasure rather than discipline,
seek love rather than accomplishments, recognize and meet your own
needs rather than sacrifice and meet the needs of others. By making
the quality of your life better, you have more to live for. When
your life grows richer, it becomes larger as well as longer.
To survive cancer you must learn how to be both a warrior and a
gardener. You must know when to defend yourself with every weapon
at your command. You must also know when to pause in the battle
and cultivate your life so that it flowers and bears fruit.
The secret is in finding the right balance and right timing.
How do people make decisions about treatment?
A.
Statistics: Analyzing the data, making logical choices based on
facts?
B. Testimonials, anecdotes: Relying on other people's experience?
C. Gut feeling: Intuition, this ¦feels right,² natural knowing?
D. Need to please others: Following the advice of others to maintain
relationships?
E. Getting ¦sold² by doctors, friends: Following advice because
others are persuasive?
Again,
the answer is YES.
All of these methods are used and are potentially useful. Using
statistical data requires knowing how valid the data are, and how
they apply to you. When studies of specific treatments are done,
even with good controls, there is always a range of results, not
one single answer. The ¦median² survival is not a life expectancy,
like a parking meter that gives you a certain time to live (and
you have to leave when the flag goes up or you'll get a ticket!).
Other
people's experience can give you insight into what happened to them,
but may or may not apply to you. You are relying on their conclusions.
For people you trust, this can be valuable. Similarly, intuition
is a powerful resource, as long as it is based on wisdom, not fear.
¦Gut feelings² include both transient feelings and dependable information.
It takes experience to separate them, knowing when to give credence
to internal guides and when to ignore them.
When
people feel vulnerable, under pressure from circumstances or from
other, often powerful people, the decision process can be weakened.
Depression and the inability to imagine a positive outcome (see
also HOPE in Publications section of our web site) can result in
decisions that would not be made if the person were not depressed.
Feeling pressured, even by loving people, confuses their goals with
yours. Hence, your best interest may not be the only one served.
You may have to translate others' suggestions to do something as
really messages of concern and love. Separating the emotional content
(or perhaps their own needs) from the information they offer can
help you take only what you need.
How do you separate fear from danger?
Too often decisions about treatment are based upon fear rather
than a clear assessment of danger. This can lead to impulsive rather
than thoughtful choices. Fear occurs when we perceive danger or
are confronted by the threat of loss. Although there may be danger
in the present (i.e., there is a fire in the room now), fear is
always in the future or past, anticipating or remembering something
unpleasant (i.e., expecting a fire outside when you leave the room).
Both danger and fear may be present at the same time, but fear is
not the same as danger and often requires a different response.
If you are in danger, you may need to take action to avoid the
source of harm. If you are in fear, however, you may need to confront
the fear rather than avoid it. Besides indicating a threat or loss,
fear can be a signal of an unmet need. The nature of that need,
too, must be recognized before you can respond appropriately.Although there are countless specific fears, they can be grouped
in three categories: threats to or needs for Identity (who I am),
Love (relationships), or Safety (physical and psychological integrity).
Some fears may fit into more than one category. Similarly, there
are three components to any fear: the cognitive, emotional, and
physical. For example, you may simultaneously have thoughts about
having surgery, feel the emotions accompanying these thoughts, and
experience your body's responses including a rapid heart rate, increased
sweating, etc.Although sometimes difficult, it is very useful to look at fear
in an objective fashion, becoming an observer rather than a participant.
This way you can learn to distinguish the thoughts from the feelings,
and separate them further from your body's responses. By dividing
the fear into its component parts, it becomes weaker and you become
stronger. You learn to discriminate between the danger and the fear
of danger. You gain enough emotional distance to make calmer and
perhaps better decisions.Sometimes the only satisfactory reply to fear is not an answer
but a response that goes directly to a solution. The mnemonic, ¦HALF,²
which stands for Hope, Action, Love, and Faith, is a reminder of
the ways you can respond effectively to fear. These broad categories
suggest ways to organize your response depending on the nature of
the fear and your specific circumstances. (For a detailed discussion
see ¦Overcoming Fear² in the Publications
section of our web site.)
ACTIONS vs OPTIONS
Any overall strategy includes both what you do and when you
do it. A good strategy is like playing chess, you think several
moves ahead. You position yourself favorably so you can respond
to new developments. A conflict may occur when you are forced to
act and choose either plan A or plan B. There is never assurance
that plan A will work, so how can you give up the possibility of
something else that might be better?Just as there is a balance between fighting hard and making your
life more pleasant, there is a balance between action and planning.
Opportunities are lost if you don't act in time. You may have to
act in the face of uncertainty, even taking risks that are uncomfortable.
How can you know if you have to act now?Sometimes the circumstances compel action. If you are short of
breath because of fluid in your lungs, something must be done promptly
to give you ¦breathing room.² If doctors tell you to have surgery
tomorrow because of they are going on vacation and not because of
a crisis, you have more time to consider the issues. Most decisions
are a balance between facts and intuition. After gathering information
there is a subconscious process that must ¦ripen² while it integrates
the imponderables. Often there is a ¦click² inside when the wheels
stop turning and your inner voice eventually says yes or no.What prevents the ¦click² of a decision is generally fear of being
wrong or unwillingness to risk leaving what is known for the unknown.
Not making a decision is really the same as making one. In one case,
you are active, in the other, you are passive. However you answered
the question about ¦playing to win or playing not to lose,² there
is more control over events if you take an active position. You can judge the quality of your decision by imagining yourself
a year from now and asking ¦Did I make the best choice I could at
the time?² If the treatment worked, you'd probably be pleased with
your decision. What if the treatment didn't work? Would you be critical
of the way you made the decision? What would you have done differently?
If you responded, ¦I didn't fully consider my options,² it is time
now to think about them. Before you judge yourself harshly, remember the decisions you make
depend upon who you are at the time you make them. Hence, the person
who will have to respond to the next crisis or decision point doesn't
exist yet. She or he will be different from who they are now as
a result of the experiences they have had in the interval.What you can do now, however, is to consider what you might encounter
in the future and what you might need then. This requires considering
all possible outcomes, good and bad. There is a common sense wisdom
that says hope for the best but prepare for the worst. If you position
yourself so that you are prepared for either outcome you cannot
lose. Some of the longest lived patients I know made arrangements
for their funeral at the time they were diagnosed so they could
get that out of the way and live fully (which they have continue
to do!).It is frightening to consider one's own death. There is often the
thought, ¦If I consider dying, won't that make it more likely?²
I don't believe acknowledging the thoughts that come up spontaneously
make the imagined event come true. Trying to ignore such thoughts
takes too much energy. It's as if there's a monster in the closet
and you are stuck holding the door shut. You're not free to let
it go. You don't have to dwell on unpleasant thoughts, just recognize
that they will arise anyway. If they require a response, whether
an ¦I'll deal with you later² or ¦I'll take care of that now,² do
it. Then you can leave the closet door and get on with living.Positioning yourself strategically also means evaluating the results
of treatment. If you are considering doing either chemotherapy or
some complementary treatment, decide how you will judge the outcome
and how long before you can decide whether it is working. For example,
if chemotherapy is given to treat leukemia or cancer, the response
is measured with either blood tests or X-rays. You can expect to
see whether the treatment is working in 2 to 3 cycles (about 2 to
3 months). Some complementary treatments have less defined measurements of
response and require longer to judge their effectiveness. It is
as important to evaluate them critically as it is treatments with
potentially more severe side effects since, if they're not achieving
the results you want, you may wish to try something else.
For each treatment, consider how it fits into the larger picture.
What is its purpose? Is it needed now or can it wait until you have
done something else? If you do that one, does it interfere with
something else? Does the treatment provide hope or really improve
your chances of living longer/being cured? Since hope is also a
rightful goal of treatment, is the cost of the hope provided (in
money, time, effort) worth it? If your resources are limited, could
you find the same inspiration for hope at a lesser cost?
USING YOUR SUPPORT SYSTEM
Survival is a collective effort. Just as an army is more powerful
than a single soldier, so patients who use their support system
have a better chance to conquer cancer. There are as many kinds
of support as there are needs. Some people naturally turn to others
for help. Others have to learn to do this. Some kinds of support
are easier to find or receive than others. Sometimes you may need
support and it won't be there. Other times you'll be overwhelmed
by offers you can't use.To make best use of whatever support system is available, decide
what you need and then specifically ask for it. Almost
everyone confronting cancer will need 1) information, 2) trained
medical help, 3) emotional support, 4) financial resources, 5) someone
with whom you can discuss options and choices. Additional specific
needs will require other kinds of help.
At the same time you are considering treatments or doctors to see,
make a list of possible sources of support. These should include
physicians, other practitioners, clergy, counselors, friends, people
you know who have had a similar illness, and anybody else who comes
to mind when you ask the question, ¦Who can help me?² Just as the president of a company relies on others to help him
or her, you should think in terms of delegating certain tasks to
the people around you. One person can research the Internet for
information, another can find out which local doctors and clinics
offer the desired services, etc. However, before these people can
do their jobs, they must be told what to do. The following list
of tasks can help you organize your support. You may wish to delegate
some of these to other people or do them yourself. Share your goals
and decision making style with them so they can act as an extension
of your thought process. Remember, you can't do all of them yourself
at the same time: get help!
(The following brief list is just a starting point. Expand it as
you think of new questions and sources of help.)
1) Information gathering:
Nature of disease, range of treatments, effectiveness and side effects
Check Internet, library, hospital library, informed friends, cancer
society and various organizations.
2) Trained medical help:
Physicians, hospitals, other practitioners (chiropractors, herbalists,
healers, acupuncture, etc.) Ask friends, esp. nurses who often have
¦inside information), check medical associations, local Universities
and medical schools.
3) Emotional support:
List of family, friends, co-workers, fellow members of groups (e.g.,
church, school, etc.), counselors, clergy, etc. You may be surprised
both by people who are unexpectedly supportive and by those who
are not.
4) Financial resources:
Check insurance coverage but don't be limited by it. Budget for
medical services you want but insurance does not pay for. Consider
other sources of money including family, loans and fund raising.
Be willing to fight for what you want, too.
GOING FORWARD
W.H. Murray, the leader of the Scottish Mt. Everest
expedition, noted, ¦Until one is committed, there is hesitancy,
the chance to draw back, always ineffectiveness. Concerning all
acts of initiative there is one elementary truth--the ignorance
of which kills countless ideas and splendid plans--the moment
one definitely commits oneself, then providence moves too.² The German writer Goethe noted that ¦Whatever you can do or dream,
you can begin. Boldness has genius, power, and magic in it.²
Whatever you have decided, go forward with it. Perhaps you will
add your story to those of countless others who have been successful,
too.
Post Script: We invite readers to tell us about ways they have made
decisions, and whether they have been satisfied with the process
and the outcome.
©Buchholz 1997 All rights Reserved
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