While it is good for newspaper headlines – talking and thinking about cancer as a war is not always helpful and might in fact have adverse effects on some patients.
Speaking at a breast cancer awareness breakfast hosted by People Living With Cancer (PLWC) ahead of breast cancer awareness month, oncologist Dr Marc Maurel said it’s time to rethink the battlefield paradigm, arguing that the war metaphor is outdated and in some cases, inappropriate.
“A war situation implies that if there is enough of a fight or you throw enough arms at it, then you should be able to overcome it. Traditionally there must be a winner and a loser. However, this doesn’t work in terms of a cancer journey as many people are not in a position to overcome cancer. ‘Losing’, thus may lead to the feeling that one did not try hard enough, or long enough, or well enough – which is simplistic and unfair,” he says.
Internationally marked Breast Cancer Awareness Month aims to raise awareness for breast cancer – the most common cancer affecting women in South Africa. According to the Cancer Association of South Africa (CANSA),one in 35 women will be diagnosed with breast cancer.
According to global statistics published by WHO, breast cancer accounted for 521 000 of the 8.2 million cancer deaths in 2012. With cancer incidence rates rising, it is understandable that the term “war on cancer” has become a globally used catch phrase.
But Dr Maurel says that while seeing cancer as a war may have been appropriate 40 years ago when we knew little about the disease or how to treat it, times have changed. “We have come a long way since then, and we need to replace it with something more positive and gentle,” he says.
Inspired by a journal article titled Use of Metaphor in the Discourse on Cancer by Gary M. Reisfield and George R. Wilson, published in the Journal of Clinical Oncology in 2004, which explores metaphors of cancer as a battlefield and cancer as a journey, Dr Maurel advocates that it’s perhaps time to focus on a cancer diagnosis as a journey, rather than a war.
At the PLWC Breakfast he drew particular attention to the positive progress being made in the treatment of breast cancer. “There are a large number of treatment options available to treat breast cancer and recent research has proven that patients are living longer and longer,’’ he said.
In addition, cancer awareness campaigns set out to educate women about the importance of regular screenings. Although heightened during Breast Cancer Awareness Month, cancer advocacy has become a global movement, largely driven by social media and online mass media communications all year round.
While having an undoubtedly positive impact, many of these organisations advocate that ‘victims’ must fight and win the battle. Catch-phrases such as ‘fight back’, ‘fight like a girl’, ‘stand up to cancer’ or ‘kick cancers butt’ have become increasingly popular over the years.
Social worker, Clare Manicom who works for GVI Oncology and is a member of a social worker network established by the Independent Clinical Oncology Network (ICON) - an organisation driven to uphold the dignity of patients and empower them on their cancer journey, agrees that encouraging patients to become heroes may not work for every patient.
“Although the ‘heroic stance’ is a nice thought, it can be a huge burden’’, says Manicom. Women in particular, often become insecure and isolated in having to put on a brave face, which becomes amplified when they are battling an illness like cancer, she says.
“For so long, women have been under pressure to be like ‘wonder woman’; juggling being a wife, a mother, a career woman, having to keep things together all the time,” she says.
She says that in her experience, people with cancer just want to feel and be treated as normal but there is often no safe space to cry or deal with one’s emotions as we want to keep strong for everyone else.
“People facing cancer see their role-models and personalities on social media overcoming the odds and doing amazing things, but they feel inadequate when they are not able to achieve the same. People with cancer are ultimately, just people, and the heroic battle can be daunting for someone who is simply trying to survive.”
She says seeing a cancer diagnosis as a journey allows patients the space to take a step back and assess where they are currently, and how they will choose to navigate the road ahead.
“Cancer can be very disempowering and the ICON model advocates that the patient is handed back the reins,” says ICON operations executive Dr Ernst Marais. He says it is important that patients maintain their independence while being guided by their team of medical experts and support group.
“ICON has thus established an integrated network of oncologists, GP’s social workers and social support groups throughout South Africa to work together to ensure patients are equipped with the medical and social support to map the long road ahead,” he says.
“They get to decide, in collaboration with their doctors, how they would like to be treated – and this might include deciding to refuse treatment if it is not appropriate or if their chances of survival are very low,” he says.
Supporting ICONs approach, Dr Maurel says a journey approach opens up options for patients who will be faced with many tough decisions along the way.
“Embracing cancer as a journey gives one the space and flexibility to focus on other options, such as spending more time with family and friends rather than choosing to have more treatment.” The notion of a journey thus encourages patients to not only focus on winning, but to focus on living, he says.