There are very few of us who would give up a chance to look into an accurate crystal ball if we had the opportunity, even though we realize full well that we may not like what we see. It may hurt us. It may depress us. It may scare us. It may diminish our quality of life. But still we would look if we could.

Similarly, there are very few cancer patients who would not ask their physician what their prognosis (medical future) is. And why not? We are talking about a life-threatening disease. To fail to ask the question would imply that the patient feels there is no hope or that the patient thinks their physician feels there is no hope. If the doctor felt it were minor or could readily be successfully treated, he would certainly have volunteered the information. By not even asking their prognosis, the patient brings on doom and gloom.

Most patients, family members and friends find ways to deal with the reality of illness and the possibility of death, even when it involves themselves or their loved ones. They find the strength to bounce back from situations that seem to cause unbearable grief. Life is very short for everyone. Since there are no guarantees, we should make the most of each day.

It is important that the patient know the complete truth in every detail of the diagnosis. The patient, family and friends usually learn the diagnosis sooner or later. Most people find it easier for all if everybody can share their feelings instead of hiding them. This frees people to offer each other support. Patients agree that hiding the diagnosis from them robs them of their right to make important choices about their life and their treatments. Keeping the diagnosis secret denies loved ones the chance to express love and to offer help and support.

Family and friends also bear great emotional burdens and should be able to share them openly with each other and the patient. Even children should be told, as they sense when something is amiss and may imagine a situation worse than it really is. By sharing the diagnosis, patient, family and friends build foundations of mutual trust and understanding.

There is no such thing as a bad question. There are only bad answers. Asking the question brings on a whole array of possibilities. Remember, this book is being written to help you in supporting a cancer patient. Their problem can be anywhere from a pre-malignant condition that is theoretically 100% curable to a wildly metastasizing systemic disease with only a 2% chance for recovery. This extreme variance is magnified geometrically by the inherent characteristics of not one but two distinct individuals.

The first is the characteristics of the physician. He may be qualified and know about the up-to-the-minute state-of-the-art therapy for this particular type and stage of cancer, or he may be living in the antiquated world of last year or last decade. He may be trying to play God and demonstrate his importance and knowledge, belittling anyone else's potential role in helping. He may be of the old school and not believe in being completely honest with the patient. He may have gotten up on the wrong side of the bed, had an argument with his wife, be worried about a malpractice suit or thinking about the golf game he is missing. In other words, maybe his prognosis to the same patient the day before or the day after would have come out completely differently. And maybe the prognosis by a more experienced expert in this particular type and stage of cancer could present a far more accurate picture.

Second comes the variability in patients. Maybe the patient is in generally good health or bad. Maybe they are 29 or 92. Maybe they are truly happy, feel loved and needed, useful and productive, or maybe they have no reason to try to recover. Maybe they are going to keep all their doctor's appointments on time, take all their treatments as recommended, eat a well-balanced diet, seek support, say prayers, practice relaxation and visual imagery and do all the other things they can to help themself fight the disease. 

At most, all a physician can do is tell a patient about the statistics of their disease. If you took 1,000 patients with this particular type and stage of cancer, "x%" would be cured. But this patient is not a statistic. They are not 1,000 patients. There is no possibility that they will end up "x%" cured. If they make it, their chances are 100%. If they don't, their chances are 0%. There is no in-between. Furthermore, any statistics are for patients getting this cancer and starting treatments at least 5 years before this time. Possibly as much as half of the progress in cancer treatments has come in the past 5 years. And maybe this patient caught their cancer earlier, is using better medical assistance, is doing more things right and has a stronger will to live. 

I have even heard some ridiculous forecasts such as, "You have 3 years to live, and there is nothing that can help you." Who in the world knows what is going to be discovered next week or next month to say nothing of next year. If the person is going to die this afternoon or tomorrow or even later this week, they are probably terminal. But stating 3 months or 3 years is just a physician saying that he personally is unaware of what is possible or could be done. After all, I was given 3 months to live in 1978 with "nothing else that could be done." 

And this brings around another philosophical line of thinking. We are all terminal and knew this from the time we were born. No one ever gets out of this world alive. One hundred years from now, we are all going to be together. Therefore, the problem is not to keep from dying. That's impossible. The problem is to delay dying as long as possible while maintaining the maximum quality of life. Quality of life is every bit as important as quantity. 

Quality of life should be considered in two distinct aspects: the physical side and the emotional side. Both sides are equally important. 

The physical side of the quality of life for a cancer patient must first concern itself with an absence of pain and suffering. Dr. Vincent T. DeVita, Jr., former director of the National Cancer Institute, stated, "Only 20% to 30% of cancer patients get severe pain: the rest don't. For those patients who have pain, there are plenty of drugs on the market to cover almost every kind of pain." 

Next would be to examine the effects of treatments. There are so many myths about the horrors of cancer treatments that I have heard people say a painful death would be preferable to treatments. They know not what they say.

As explained in Part II, many of the current therapies have little or no side effects. The fact that they did years ago is of no consequence today. Great advances have been made in reducing the side effects of treatments. Further, the patient should adopt the attitude that the idea is not to take treatments but to defeat cancer. With this feeling, any side effects are welcomed rather than dreaded with the idea that they are fighting the disease.

This brings us around to the emotional side of the quality of life. The dominant factor is that it is much better to fight to live than wait to die. A physician completely ignores this fact when he arbitrarily recommends nothing or palliative therapy with the idea that the patient is too old or the statistics are too poor and it would hurt their quality of life. Nothing can hurt it worse than doing nothing. The patient should have the right to choose.

It is a foregone conclusion that the patient will and should ask their physician for a prognosis. The quantity and quality of their future must be the most important factor on their mind. Don't expect, encourage or accept a one word answer. Ask for a detailed explanation and question any aspects that appear unclear or incomplete. Don't elicit positive guarantees or possible outcomes. Seek only his ideas of what can be expected for this specific patient with this specific problem. Reduce it to writing at the time it is given along with all options.

Chapter 7, Replacing depression