Defining Perceptions

We often receive letters from readers who have pointed comments about the meaning of being a cancer survivor or how one is never healed or cured. The word survivor itself is disliked by some because it implies that cancer defines their existence. Others share with us that they cannot really draw the line between being cancer-free or living with cancer. Yes, there may be technical ways to define this, such as “your scans are clear,” or “your risk of recurrence is near zero,” but our reality is what we perceive, and that affects our day-to-day life.

Like everything else in biology and medicine, the concept of cure and healing runs over a continuum. From a medical standpoint, there are chronic forms of cancer that are never likely to be cured but have such a long natural history that the chances are the patient will not die of that disease, but of something else. On the other hand, there are cancers that can be cured but carry a higher rate of secondary complications, or chronic symptoms due to surgery, radiation or chemotherapy. As the field of oncology has matured, we are systematically examining long-term side effects. This is evidenced recently by the American Society of Clinical Oncology publishing guidelines on monitoring and treatment of heart and lung side effects in the years and decades that follow treatment. (An article on this topic can be found on page 30.)

The San Antonio Breast Cancer Symposium, recently covered by the editorial team for CURE and Heal with daily web updates and summaries, is devoting more attention to study results dealing with the post-cancer therapy realm, including bone health, menopausal symptoms and emotional health.

And then there are the exceptional patients I have seen over my career, those who are living with advanced and incurable cancer yet have found peace and harmony within — a calm after the storm that makes me wish I could bottle their psyche and apply it to others (if not myself). It reminds me of the potential we all have within ourselves to deal with adversity and, in a sense, heal ourselves no matter the medical outcome.

Our reality is what we perceive, and that affects our day-to-day life.

There are more cancer survivors alive today than ever before, each unique in his or her story and clinical details. The three scenarios I described above about patients’ experience represent a spectrum, but are also a component of each individual living with or beyond cancer. What might seem like a trivial nuisance to one could be a crippling emotional or physical blow to another. Chronic leukemia or early stage breast cancer may mean trouble around the corner or clear sailing for years — an uncertainty more troubling to some than others.

As an oncologist, I am often asked to define “cured” or “healed.” There is no universally accepted definition, but in my mind, a cure means that the cancer will never return (or at least the chances are close to zero). Of course, we know that even “highly curable” cancers might relapse, but if the probability is extremely low, then from a medical standpoint, one would be considered cured following the appropriate treatment. Healing is a more complicated amalgam of a clinical, emotional and spiritual state that is embodied in the spectrum discussed above. In a sense, it is a choice that we can control.

However, one thing is clear: There is a menu of solutions that can be your vehicle on a road to healing. Heal magazine is dedicated to presenting these to you so that one or several might apply. It might be a story, a hobby, travel or just inward meditation — but we are all endowed with the capacity to heal ourselves. Heal is just mapping out some possible routes for your consideration.

Debu Tripathy, MD,

Editor-in-chief,

for the Heal team