The good news is that more people are being cured of cancer because of earlier diagnosis and because of better treatments. For example, new hormonal and chemotherapy drugs have transformed the outlook for many patients with breast cancer, but among the most recent dramatic developments have been the new immunotherapies for treating advanced melanoma, the most aggressive of the skin cancers. Some of these drugs at higher doses can cost up to a million pounds a year but produce responses and long term remissions, the likes of which we have never seen.
The bad news is that cancer is becoming more common, mainly because people are living longer and because younger people are ignoring warnings about life-style risks like tobacco, excess alcohol intake and especially, obesity. About one third of cancers are diagnosed in people over 75years of age, when physical and mental decline, isolation and other illnesses also take their toll.
A cancer survivor is defined as someone who is living with or beyond their cancer, and in this context, it should be remembered that half the people diagnosed with cancer in UK survive beyond ten years, and the vast majority of these are cured. The cancers with the highest survival rates at ten years are testicular cancer, melanoma skin cancer and breast cancer. Sadly, pancreatic and lung cancer have the worst prognosis. Better to have a good prognosis cancer than many benign conditions, such as Type 2 diabetes, which is invariably induced by obesity.
Accepting and understanding the diagnosis is the first painful hurdle for patients newly diagnosed with cancer, and is one of the times during the illness when compassion, support, accurate information and a defined treatment plan is most reassuring and appreciated. “Professor Google” cannot give patient-specific information, but is unregulated, and can be misleading but the internet does give access to support groups and chat rooms, places where patients with similar difficulties can meet and discuss.
My recommendation is the “National Cancer Survivorship Initiative”, a legacy website leading to “Living with and beyond cancer” which can be read or watched as a video on YouTube. Despite the occasional piece of bad press, patients can be reassured that cancer services in UK are excellent and most importantly, that all treatments will be evidence-based and similar or identical in all specialist cancer centres.
The impact of a cancer diagnosis on patients and their families can never be underestimated. The agony suffered by parents when the patient is a child or young adult, for most of us, is unimaginable. Suddenly, the certainties of life become undermined and are replaced by a sense of fear and vulnerability, something previously unknown. The emotional difficulties and morbid thoughts about prognosis are often compounded by practical problems relating to physical disability, employment and finance.
Nevertheless, having worked as a Consultant cancer surgeon for thirty years, my enduring memory is of the courage shown by my patients and their determination to overcome side effects, either of treatment or of their disease, in order to return to normal living. My field was sarcoma, which means a cancer of muscle or bone and although amputation is rarely required, the procedure is maximally challenging for patients. Two of my patients have allowed me to describe their cases, in the hope that their stories will be an inspiration to others.
Sue Walker was twenty years old when she developed Hodgkin’s lymphoma of the neck, which was treated by radiotherapy. At the age of fifty-one, she developed breast cancer, requiring a right mastectomy. Undeterred, Sue returned to her job as a teaching assistant in a primary school. Her hobbies were golf and painting. She was right handed.
At the age of fifty-five, she developed a sarcoma of the right shoulder which was when I met her for the first time. The only treatment option was a forequarter amputation, which means removal of the arm and the shoulder. Initially, Sue was devastated by the extent of surgery needed, but quickly she turned her attention to the practicalities of learning to be left-handed, and returning to her hobby of painting wildlife. She has described her emotional return to the classroom and the overwhelmingly supportive responses of her pupils.
As if that was not enough for one person to endure, at the age of fifty-eight, Sue developed three sites of spread of sarcoma in both lungs. Her main concern at the time was to stay well for her daughter’s wedding, the date of which was brought forward. Fortunately, Sue’s tumour was highly sensitive to chemotherapy and after two operations, she remains well and is almost certainly cured of sarcoma.
Every Christmas, Sue sends me a photo of one of her nature paintings. Every year the paintings become more detailed and intricate as her left-handed dexterity improves. “Don’t ever give up” was the first, and typifies her bravery and that of so many patients with cancer. Hopefully, this image will bring strength and comfort to others.
Stan Bembenek was forty years of age when he was referred with a recurrent sarcoma of the hip joint following two previous operations. The only treatment option was a hindquarter amputation, which involves loss of the leg and part of the pelvis. He had been a keen footballer and had recently taken up golf.
After his operation, Stan being the indomitable character he is, dispensed with his heavy artificial leg, preferring to get around at speed on his aluminium, custom-made crutches. He threw himself into work starting up eight different businesses, all within the telecommunications industry. Gradually he returned to playing golf at the disabled-friendly Sand Martins Golf Club in Wokingham, Berkshire. He plays with wood clubs, which are longer than iron clubs, so that he doesn’t have to lean forward and risk loosing his balance. The clubface of his driver is at a higher degree than standard in order to achieve accuracy, if at the expense of distance. He can now drive a ball 200 yards on a regular basis and by way of encouraging others, demonstrates his skills at charitable events.
With his unique interpersonal skills, Stan has persuaded people with a variety of physical, neurological and psychological disabilities to play golf. He is now the Chief Executive of the Disabled Golf Association, and has “disabled international status” having represented England in golf tournaments against Scotland and Wales. He describes golf as an ideal sport for the disabled because a personal handicap means that everyone can play competitively. His handicap is 22, and his hindquarter amputation was performed almost 22 years ago!
These two unique have taught me how resilient humans can be when faced with severe adversity, both physical and mental. The combination of personal bravery and sheer doggedness, allowed them both to overcome significant disadvantage, maintain their chosen way of life, and continue to contribute to society. Although they may be extreme examples, there are probably countless other people who have similar stories, or who have put their experiences behind them, and carried on regardless. For example, in a few weeks time, I shall be cycling fifty miles a day around the battlefields and cemeteries of the First World War with George Granville, my patient and friend who is determined to prove to me and to himself that he is fully recovered following treatment of a thigh tumour, which involved radiotherapy and loosing all his hamstring muscles in one leg. When the diagnosis of cancer is given, people naturally assume the worst, but the outcome may be quite different.
Over the past few decades, the treatment of cancer has changed and improved, to become more patient-centric and holistic. The primary emphasis remains on cure whenever possible, but treatment also focuses with equal intensity on every other aspect patient need. Although still one of the most frightening of life’s experiences, no patient with cancer need feel alone or separated from a plethora of support mechanisms and sources of information. Optimism should prevail!
J Meirion Thomas
This article was published in the Spectator magazine in April 2016