For Cancer Patients, A Struggle to Prolong Hope as Well as Life

Despite more effective methods of treating cancer, the end results remain largely the same.
Despite more effective methods of treating cancer, the end results remain largely the same. (By Chris Hondros -- Getty Images)
By David Brown
Washington Post Staff Writer
Sunday, April 1, 2007

Why is it that Americans speak of trying to whip cancer, show courage in the face of it, and die after a long battle against it? Why at the same time do we tell ourselves cancer is the new diabetes, a chronic disease we can have for a lifetime?

It's because what F. Scott Fitzgerald said about the rich -- "They are different from you and me" -- is true of cancer among the multitude of bodily afflictions. We think it's different, too.

We take cancer personally. We talk about it in terms we would never use for heart disease, which actually kills more people, or stroke, the third most common cause of American death. We impute to it something like evil intent, and to some extent we make our response to it a measure of human character.

Cancer is the physiological equivalent of war -- hand-to-hand combat, specifically. Cancer talk often invokes a soldier's virtues, not only physical strength but a "fighting spirit."

But as in combat, there's a fair amount of wishful thinking and intentional disregard of calculable risk. There aren't many statisticians in foxholes. There is a curious lack of them in cancer clinics, too. Truth may not be the first casualty in the war on cancer, but it sustains a fair amount of collateral damage.

All of this was on display in the past two weeks as Elizabeth Edwards, wife of presidential candidate John Edwards, and Tony Snow, the White House press secretary, announced their cancers -- hers breast, his colon -- had reappeared.

At the daily briefing where she described Snow's news to reporters, White House spokeswoman Dana Perino said that "if you know Tony, then you know that he's a fighter. . . . He told me that he beat this thing before and he intends to beat it again." In a separate statement, President Bush said his press secretary "is not going to let this whip him."

At the news conference Elizabeth Edwards and her husband held, the emphasis was more on optimism, less on pugilism.

John Edwards spoke of the need to "keep your head up, keep moving, be strong." He likened her metastatic cancer to diabetes, a chronic disease in which "you take your medicine." Elizabeth Edwards said she does "not expect my life to be significantly different" for the foreseeable future.

It's understandable where these approaches to bad cancer news come from.

In many ways, the fighting metaphors make sense. Treating cancer is more like a military campaign than treating congestive heart failure. Cancer begins at a distinct place in the body's geography, but can spread to and overrun distant territory, often by surprise. Therapy involves destroying or recapturing occupied territory, or visibly weakening the invader.

The optimism, on the other hand, flows from the resilience and hopefulness of both patients and the doctors treating them. These are natural reactions to adversity. But like the disease itself, cancer optimism is different from ordinary optimism.

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