It is a seasonally cold fall evening in Long Island, NY, and I am standing in a field in the middle of what should be a darkened park. Still, I am truly amazed by how bright it is lit up by lanterns with different colors demarcating patients, families, and remembrances.

As an oncologist who treats blood cancers, this event, called Light the Night, sponsored by the Leukemia and Lymphoma Society, was both uplifting and sorrowful. Indeed, these are two extremes of emotion between which cancer patients fluctuate, and as their oncologist, I share the highs and lows of remission and relapse with my patients. This is one of the many challenges we encounter together.

Cancer is commonly framed as a war, perhaps to derive purpose in the unfairness of trying to destroy a part of us that has become a malignant enemy. Patients often feel empowered to take up arms and fight. They set their goals on achieving the best possible outcomes, some are determined to educate themselves as much as possible about the diagnosis, and many find strength in supporting the mission of cancer organizations.

Becoming involved in clinical trials and philanthropy are two extraordinary acts of empathy that are especially important to advancing cancer treatments. Given the many patient advocacy organizations, local and national cancer support groups, and various rallies to support the anti-cancer mission, such as races and other activities, cancer patients have no shortage of comrades with which to share their battle. Therefore, it may come as a surprise to learn about those who have kept their cancer a secret and fought in silence.

The fact that few people were aware of Norm Macdonald’s leukemia diagnosis and Colin Powell’s multiple myeloma diagnosis until shortly before their recent passing are examples of how even those in higher profile positions may go through their treatment in an almost clandestine way.

This is as much a testament to their personal choice for discretion and the measures that their care team must have taken to protect their privacy as it is to the modern cancer treatments and scientific advances that allow patients with aggressive cancers to survive longer while not even appearing ill.

There are many reasons why individuals may keep their cancer diagnosis under wraps. To name a few, some may see a cancer diagnosis as a stigma that will distract from their life’s goals. Others may want to stay focused on their treatment without being identified as someone who is sick, while others may feel that they are protecting their loved ones from the burden of stress that inevitably comes with a cancer diagnosis.

This is obviously an individual decision that each patient may choose, and as an oncologist, I am obliged to support that choice. Although I do believe that talking to others, whether they be confidants or clinicians, can be therapeutic, we really should not judge how any individual person wishes to negotiate their cancer journey. In a sense, the actions taken by Norm Macdonald and Colin Powell should not be admonished but rather celebrated for their bravery.

There are many opportunities for celebrities, advocates, and philanthropists to show their selfless support for the battle against cancer. But there are few symbols of admiration, even retrospectively, for those individuals who have made a personal decision to fight their cancer war in private. Our job as clinicians is and will always be to support patients during their journey through serious illness, including when they decide to keep the process silent beyond the walls of the treatment center.

Marc Braunstein is a hematology-oncology physician and can be reached on Twitter @docbraunstein.

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