In examining troubling narratives surrounding breast cancer, one thing I often think about is the framing of breast cancer patients as ‘heroes,’ as though you get a cape and mask with your diagnosis. That attitude is reinforced in the language people use about going through cancer treatment; patients are ‘battling’ or ‘fighting’ cancer, and they never die, they always ‘lost a long fight with.’ Behind their backs, people may say they are ‘giving up’ if they aren’t treating their cancer the way society thinks they should.
There’s tremendous pressure on breast cancer patients to behave a specific way, to fit into the hero framework. Some of that is rooted in the origins of the breast cancer movement, which took something taboo and brought it into the light, worked on changing the perception of breast cancer from something shameful and embarrassing to a disease that some people get that needs to be treated. Along the way, though, other things started to attach themselves to breast cancer and cancer patients, who now had to behave with ‘courage’ and ‘bravery,’ to be inspirations to the people around them.
This fits into larger narratives about disability and chronic illness, where people are expected to perform for the benefit of the people around them, who act as both jury and audience. A breast cancer patient is supposed to conceal pain, nausea, fatigue, soreness, frustration, depression. Breast cancer patients must be chipper and happy, always ready with a joke, prepared to go the distance in treatment, to do whatever it takes to fight back that nasty cancer.
There are lots of ways to handle a cancer diagnosis and to manage treatment. They depend so much on the individual and the circumstances, and are ultimately intensely personal. One person might choose palliative care for an advanced cancer combined with dangerous comorbidities. Another might opt for very aggressive treatment. In a lot of the conversations about how people are choosing to manage their care, the cancer becomes more like an entity than an illness, a tangible thing, a third party in the room.
Cancer, along the way, becomes anthropomorphised into an actual physical enemy that someone can fight. And maybe some people find that metaphor helpful, but others may find it frustrating; cancer is a collection of rogue cells that are growing out of control. It is not sentient, it is not capable of engaging in rational decisions. Its aggressiveness is predicated by genetics, the patient’s physical condition, the specific type of cancer involved, not any moral or ethical imperatives. Breast cancer isn’t out to kill people; it’s just a collection of cells that want to grow, and grow, and grow. There’s no conscious effort involved here, no vendetta against the patient.
The insistence that cancer patients be brave puts the burden on patients when they don’t want to be and can’t be. Cancer sucks. A lot of cancer treatments suck; chemotherapy makes you feel like crap, and so does radiation therapy. The drugs you take to treat the side effects sometimes don’t make you feel much better. Cancer can be painful, especially if it develops metastases that reach into the bone. There is no pain quite like deep, unrelenting bone pain, and even very strong pain management drugs can’t keep it totally at bay. It can be extremely difficult to put on a happy face when your body is screaming and you want to curl up in a ball and cry, or when you’re taking medications known to cause depression and a sedating effect.
Hey, sometimes just having cancer is depressing. Ill health in general can be a risk factor for depression. Cancer is an illness that can sneak up on you abruptly and then drag out for months or years, requiring you to follow a grueling schedule, endure endless medical appointments. You may have to stop working, and you sometimes have to constantly monitor your environment because you may have a compromised immune system. You can become intensely isolated, especially after the first few weeks, when all your supporters wander off, and that can contribute to a sense of depression too, thinking you are all alone.
If viewing cancer as a battle helps people through treatment, I say go for it. Individual patients who want to think of cancer as a living, breathing opponent they can meet on the battlefield and slay should absolutely incorporate that into their treatment plan, and there’s some evidence to suggest that can be helpful for patients who want to take that approach. But for patients who don’t work this way, who don’t think this way, the constant pressure to perform can be extremely difficult on top of everything else associated with the cancer. You are no longer a person, or even a patient receiving treatment, but A Cancer Patient, and your goal is to ‘win’ a battle with something that isn’t even sentient and then go on to become a ‘Survivor.’
Empowering patients in general is critically important, and no one approach is right or wrong in all cases. The ability to selectively consider options and have those choices respected, though, is also critically important, and cancer patients who opt against aggressive treatment, who don’t want to go to war, well, they deserve support too. And so do the patients who do want aggressive treatment, but still treat cancer like a disease, not an entity. And these patients deserve to be loved, and they deserve to be honored. And they probably don’t want their obituaries to say that they ‘lost a battle’ if their treatment is unsuccessful or when they eventually pass away. Nor do they want their friends to say that they ‘gave up,’ as though the choice is either full-tilt jousting or turning tail and running.
Sometimes, cancer is just a disease, and a hospital room is just a hospital room, not a gladiatorial arena. And that’s okay.