MEDICAL MATTERS:We all need time and space to deal with life- changing consequences; this process must not be forced
BRIAN LENIHAN’S brave, yet understated, public response to his diagnosis of pancreatic cancer has received widespread public acclaim. All the more so given the crass manner in which TV3 chose to deal with the politician’s personal health affairs just a week earlier.
Judging by the letters page and e-mails from readers, the saga has triggered different discussions. Is it reasonable to expect someone undergoing intensive cancer treatment to continue working? And what role does being positive play in dealing with a cancer diagnosis?
One reader asked whether the view that there was no reason for Mr Lenihan not to continue working was a reasonable one? This reader, who is himself living with pancreatic cancer, says: “I feel this places unfair pressure on the thousands of people like myself who are on extended sick leave or those who took the decision to retire early from work upon a cancer diagnosis. Dealing with the effects of cancer, surgery and chemotherapy is tough enough without the added burden of being available for the demands of work . . .
“Some [very few, from my personal experience of oncology outpatients] opt to continue work during treatment – most remove themselves from the pressures of the workplace and should be allowed do so without feeling in any way diminished . . .
“Fatigue, nausea, a compromised immune system and the threat of a recurrence of the disease, are not insignificant medical factors.”
Indeed, they are not. Nor is the effect of treatment predictable. Some cancer patients experience minimal side effects when given chemotherapy. And even for those people who do experience tiredness, nausea and other symptoms, many find that each cycle of chemotherapy is different. Each person’s experience is unique; how they deal with the issue of returning to work is also unique, rendering an overly prescriptive approach inappropriate.
Another e-mail referred to the use of terms such as “my battle with cancer”.
“It seems to place a huge burden of personal responsibility on a patient for the outcome of their disease. We don’t usually hear of a struggle with, say, heart disease other than making the necessary lifestyle changes as medically advised. I can appreciate that adopting a positive attitude to sickness can make life more comfortable, and reduce stress but does it radically alter the outcome?” the correspondent asked.
This strikes a personal chord. I worry about the effect of such language on patients. We ask them to “beat” illness and to “keep up the good fight”. But what of the meek or those who are depressed? They may be neither inclined nor able to respond to exhortations to fight back. And unable to respond, it is possible that certain people will feel they have “failed” themselves, their families and their medical team.
Is there any evidence that engaging a fighting spirit will protect you against a cancer recurrence? A large UK study suggests this is a fallacy: a long-term follow-up of cancer patients at London’s Royal Marsden Hospital found that a high fighting spirit confers no survival advantage.
Psycho-oncology expert and consultant psychiatrist at St James’s Hospital, Dr Ann-Marie O’Dwyer, has spoken about a “tyranny of positive thinking” that is adding to the stress of cancer patients.
She says she is concerned about the view that positive thinking is essential for people who have been diagnosed with cancer; when someone has a bad day this adds to their upset because they feel that their negative thoughts are making them ill.
O’Dwyer says some people are made to feel that they are to blame for their cancer, because of their stressed lifestyle, “but there is no concrete scientific evidence to support that”.
Returning to the Minister’s experience, he was, in my opinion, robbed of one very important opportunity. As soon as someone hears the bad news of a cancer diagnosis, they go into shock. Studies have shown that only a fraction of what you hear actually registers in the brain. We all need time and space to deal with the life- changing consequences; this process must not be forced.
By assuming the right to give Brian Lenihan just 48 hours to discuss his diagnosis with family, friends and colleagues, TV3 forced him to respond to his illness in a false and potentially damaging way.
- mhouston@irishtimes.com