How to Talk about Cancer: Reflections on What Really Helps

MSK psychiatrist William Breitbart speaking to a patient
Summary

Cancer is not a single disease. And there is no single way to talk about it, whether the conversation is taking place around the family dinner table or roaring across the television screen.

But some ways of thinking and talking about cancer can be more helpful than others.

William Breitbart is Chair of the Department of Psychiatry and Behavioral Sciences and Chief of the Psychiatry Service at Memorial Sloan Kettering. Below, he shares his reflections on how everyone touched by cancer can communicate about it with compassion and respect.

The language of engaging in a “battle” with or “fighting” cancer is ubiquitous in our culture. This language can be helpful for some, and even inspiring as a call to rally resources and support to deal with the illness.

But the problem with using the terms “battling” or “fighting” cancer is that it implies that some individual characteristic of a person determines the outcome, rather than the biology of the cancer or the effectiveness of the treatments. Losing a battle with cancer could suggest that perhaps you are at fault — that you didn’t fight hard enough. You lost, and so you are deficient and a loser. It has the potential of blaming the person or causing the person to feel that he or she is responsible for the lack of success of a cancer treatment. Think of the obituaries that refer to someone “losing their brave battle” with cancer.

A better mindset may focus not on the battle but on the bravery. It is in bravery that the truth really resides. Bravery and courage are the key elements of dealing with cancer. I think better terms would be “living with cancer,” “confronting cancer,” or “surviving cancer.”

Surviving cancer implies living with cancer while choosing the attitude of rising above individual concerns and connecting with people and values that transcend the disease. Living with cancer requires the courage to still live, love, and care. Living with and surviving cancer really mean facing cancer with courage.

A better mindset may focus not on the battle but on the bravery. It is in bravery that the truth really resides.
William S. Breitbart
William S. Breitbart psychiatrist

Some recent encounters with patients whose cancers were very advanced showed me what surviving with courage truly means. They told me their biggest problem wasn’t figuring out how to face death, even though they knew they would die. Instead, they wanted to focus on finding the most meaningful way to live with cancer while they were still alive. To keep loving and staying connected to life and the people they cared about. To keep themselves whole and forgive themselves for just being human. I told them that’s what we’d focus on — living.

Courage does not mean having no fear. Having nothing to fear wouldn’t require courage. Courage means living with an open heart and embracing our human frailty, vulnerability, and mortality. Continuing to live and love. Still having hopes and dreams. Creating and experiencing meaning in our lives, even in the face of cancer and under the threat of death. Courage also is required to accept our fate and our mortality.

There are no winners or losers. There are just human beings facing life and death with the hope to preserve courage, meaning, and purpose.

Comments

Thank you so much. Very meaningful. I just had a conversation with my friend who is having a difficult cancer recovery. I have been communicating by email and snail mail, and very very cautious in my choice of words. I finally made a phone call and we spoke for one and a half hours. I did use the word "brave" and was concerned that it was in the category of "battle" which I wanted to avoid. I think the way I phrased it was OK. She has been through so much, and this isn't her first bout with cancer, but she (not because she has cancer), but who she is as a person, is someone who has extraordinary resilience in the face of many challenges.

As a MSKCC patient, I very much appreciate Dr. Breitbart's kind words and sensitivity. Indeed, the cancer journey is a lonely one. Quite often, family and friends avoid discussing the patient's concerns, which leads to more isolation. I suggest that during follow-ups, physicians and nurses inquire how patients are doing emotionally.

Dear Cindy, thank you for sharing your experiences. Best wishes to you.

I visited Dr. Breitbart for nearly a decade. I had three cancers I believe have been cured at MSKCC. Dr. Breitbart is a wonderful person and has helped me immensely. I no longer see him since I feel his valuable time needs to be spent with active cancer patients. I miss talking with him.
Joseph Aiello

Dear Joseph, we are so glad to hear you're doing well. We will share your comment with Dr. Breitbart. Best wishes to you!

Many thanks to Dr Breitbart, for this concise and brilliant piece. The essence of these conversations around cancer holds true in developing countries (such as in Africa), as well.

I had visited Dr. Breitbart for a short time after
a recurrence in 2000. He was able to get me to
really open up and discovered in his suttle way
what was needed to get me on track.
My sense of humor really helped me to laugh more, when I first saw him I said, " I'm an auto mechanic should I get under the couch?" Of course I was kidding..

I wish some of the doctors at MSKCC had a session with Dr. Breitbart, to learn how to be compassionate and emphatic in dealing with their own patients. Sometimes it feels like we are only a number on the chart.

Dear Bo, we're sorry to hear that you didn't have a good experience at MSK. If you would like to discuss this with one of our patient representatives, you can call 212-639-7202. Their office is committed to ensuring that your rights are respected and that your concerns are addressed. Thank you for your comment, and best wishes to you.

Thank you for this beautiful piece. I am constantly encountering people with cancer stories and revealed to one friend of my recent cancer and how it has changed my life. Her husband, a doctor, was home with cancer. She said, "Aren't you glad you are standing here right now?" Since then, I treat every day as a gift.

My son is going through hodgkins lymphoma he has medicaid and they are not accepting him. While his father who passed 6years ago and had the means at that time to bring hundreds of kids with heart deffects to this country and help them to get better they stayed in my house and we found them foster homes after they got better we sent them home. Now that we have no means to afford accept Medicaid and my son is born in this country they refused him. Where is the humanity here a doctor gave him 6 months to live if he doesn't get the proper treatment. Is this country only help foreigners and not their own? My son he was 14 when those kids stayed in my house he took care of them after our money is gone and now he needs help.

Dear Araxy, we're very sorry to hear about your son's diagnosis. Memorial Sloan Kettering provides financial help to patients in need because of lack of health insurance or health insurance does not cover the hospital bill in full.. You can go to this link to learn more:

http://www.mskcc.org/cancer-care/hospital-information/financial-assista…

Thank you for your comment, and best wishes to you and your family.

Good morning all,. I too have been a patient with MSKCC. In my Journey, I have found turning towards faith in God a must and has helped me. I have diligently done everything the best doctor's ask, take my medication, follow up on all tests, eat wisely (organic and raw veggies), stay physically and mentally active, have positive people support around me, stay away from stress, get good sleep. Most of all, I go all out to never give up regardless of how dark or light the situation may appear. I pray and read scriptures. May I share with you now my favorite scripture for my cancer diagnosis is Ephesians 1:18-23. May we know and receive within us the power of God, the same power that raised Jesus Christ from the dead. May that very power of God set up His throne on every nucleus in every cell of my body and bring in under His great power and authority and bless me with a Cure. This is how I pray and believe daily. God has heard my prayers. I have been alive for two years, five months, and seven days with diagnosis of stage 4, grade 1 and in remission for over one year now. Only God knows the time and place. Believe!

The best thing that MSK can do is to expand the pool of participants in their "liquid biopsy" trials so that cancer can be discovered before symptoms appear and before the good Dr. has to engage patients on their journey, Cancer screening occurs too late.

Thank you for posting this. I have struggled with the notion that one must be "battling" and "warrior" and even "positive" because it makes me feel if you are not these things, and if you die from cancer, then it is somehow your fault. I guess I am picky about word choices sometimes, but I would choose to say that I have "hope" when it is realistic to have hope. But I don't like to be told I must be "positive" and "fight."

This is truly a very compassionate way of dealing with and accepting that every o e deals with their struggle differently. My 52 yr old husband recently died of pancreatic cancer that challenged his world for 21 months. He was the kindest most nonjudgmental person yet others were disappointed that he didn’t rally in a way that they thought made sense. He did it his way and he suffered so much in the end breaking many hearts.

Dear Debra, we are very sorry for your loss. Thank you for sharing your thoughts. Best wishes to you.

I turned 70 in May 2017 but I don't look it. I felt fit and happy for my age except for an occasional sharp pain in my pelvic area. Eventually found time to have tests and was diagnosed in late June with stage 3 serous fallopian cancer, one tumour the size of a grapefruit, the other the size of an apricot! It was a huge shock, no cancer either side of the family going back 3 generations and I'm still in denial I think, as I've been through 6 chemo treatments and am now 'in remission', although I'm sure it will come back on the lining of my abdomen as the surgeon had to leave behind some 'grains of sand' although no other organs, lymph etc involved. He's given me a 50/50 five year chance of survival, which has made me take stock of a lot of things! I was moved to write here as the hardest thing for me to cope with, after the awful chemo side effects, has been how to deal with the reactions of my family and friends. I feel I have to protect them and tell them I'm fine (which I am at the moment) and agree with their comments about how 'brave, positive, strong' etc I am. I feel a bit of a fraud, because I'm none of these things and don't feel involved (yet!) in a 'battle' with cancer or think in terms of winning or losing, but 8 months of Year 1 have already passed and 5 years isn't very long! I often don't take phone calls as I don't want to have to deal with the whole 'how are you' process. I live in Australia so can't come to your centre, but I do strongly agree with the sentiments expressed by Dr Breibart and good on you for providing this opportunity for comments.

Dear Robin, we're sorry to hear about your diagnosis. Thank you so much for sharing your thoughts and experiences. Best wishes to you.

Thank you Doctor Breitbart for your great thoughts. The compassion shown by every member of the staff at MSKCC was remarkable. It was always given with support and understanding. From the Doctor Bochner,the nurses and the volunteer staff members like Phil(didn’t get his last name but he is a saint) all were uplifting as I faced what might be a completely life changing procedure
That uplifting care kept me knowing that cancer treatment takes Hope, Faith ,and Courage.
Those are the words I live by now.
Thank Sloan Kettering

Dear Matt, thank you for your kind words. We have shared your comment with Dr. Breitbart and Dr. Bochner. Best wishes to you.

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