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Karen Cohn is a retired middle school special education teacher who was diagnosed with follicular lymphoma in July 2020, considered to be highly treatable, but chronic and incurable, which is currently in remission. She is also a fifth-degree black belt in TaeKwon-Do, and is the assistant instructor of a TaeKwon-Do class. She enjoys working part-time with special education students, crocheting, walking, indoor rock-climbing and talking to and petting any dog she sees.
It was disconcerting to me when my oncologist was unsure about the treatment he was giving me and knew what the next would be without giving the first a chance.
Cancer treatments have been highlighted in the news of late, especially since two members of the British royal family have been diagnosed with undisclosed forms of cancer. Articles about how cancer is treated — whether they mention the royal family or not — abound at the moment. One such article I read discussed the idea that oncologists are prescribing “one more treatment” even to patients who are within weeks of death. But is it truly the oncologists who are promoting such treatments, or is it patients and their loved ones who are asking for them? I suspect it’s a combination of both.
Many people are afraid to die. They are convinced that one more treatment — no matter how unlikely — could be the cure they are seeking. A friend of mine went through that; she was diagnosed with metastasized lung cancer, for which conventional treatment was unsuccessful, and she ended up at a "miracle cure" facility in Mexico, one which charged her an excessive amount of money for what amounted to a two-week spa vacation. At least she enjoyed it, but it didn't have any impact on her cancer; she died less than two months later.
When that cure is backed by science, it's even harder to say no to just one more treatment. Part of that is the perception of cancer patients as "warriors," and the common perception of those who die of cancer as having "lost the fight." This is a societal belief as much as a medical one, a belief that is so pervasive that many people don’t question it. It simply is what one does, no matter what — fight with any tool available to push off death as long as possible.
As a cancer survivor myself, treated successfully for follicular lymphoma (a form of blood cancer that has a significant chance of recurrence over time), and knowing people with the same cancer who have been through as many as eight different types of treatment, I've thought about this a lot. Some people I know have never reached remission at any point in that process and are continuing to try “one more treatment” in their search for a cure, or at least more time.
When I was diagnosed, my friends all encouraged me to fight. But I wasn't fighting during treatment, not in the way most people think of fighting — I was enduring. It wasn’t something I did; it was something that was done for me and to me. I showed up when I was told, was given the medications I was told I needed, gave blood, went to scans to be monitored, and so on. I was reacting much more than anything else; like many other people diagnosed with cancer, I was in a state of emotional shock that precluded much active thought.
As early as halfway through treatment, my oncologist had identified what my next treatment modality should be before we even knew if the current treatment was working. Fortunately, it was, and the remission has been held, so far, for over three years.
On one hand, knowing that there's another treatment — the first that has the potential to be an actual cure — is reassuring. On the other hand, it's disconcerting to know that my oncologist was so unsure about the treatment he prescribed that he knew what the next one would be before he knew if the current treatment was working. None of my friends understood why it bothered me; they saw only the reassuring side. To me, this exemplifies the attitude toward cancer in both medicine and society: to cure it at any and all costs, financially, physically, psychologically and emotionally. It is indeed a conundrum, one that few people recognize, because the culture of “fighting” illnesses, and particularly cancer, is so pervasive.
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