I was brought to tears today, suddenly, unexpectedly, by the ringing of a bell. I had passed a small sign earlier, and I knew that the ringing signified the completion of someone’s chemotherapy. As I heard cheers, I thought how amazing this group of individuals (who I could not see, closeted as I was behind a curtained space) had a shared experience of crossing the finish line.
There is a lot of good news related to the dreaded word, “cancer.” City of Hope summed up five oncology breakthroughs to bring joy this holiday season. As a physician myself who treats skin cancer, I am always interested in cutting-edge cancer cures. I have only become more interested as I was diagnosed with early-stage breast cancer a little less than two months ago, and I am at the start of my own chemotherapy journey. It is, according to my doctor, “chemo-lite”: just one traditional agent (Taxol/ paclitaxel) and one targeted treatment (Herceptin/trastuzumab).
People hear the word “cancer” and may turn away from the subject, but everyone should know two things about chemotherapy in this rapidly changing field. One, there are numerous medications and potential treatment plans. Two, not every cancer is the same, and because of individual differences, the choice of chemotherapy may differ. And, amazingly, some may not even need chemotherapy.
Why is this important to know? Cancer is on the rise, and personalized medicine is as well. You or someone you love has a 40 percent lifetime risk of being diagnosed with a cancer. Even if you have finished chemotherapy yourself, your experience (from the past) may not be the same as someone else’s experiences in today’s changing world of oncology. Even if you know they have the “same” cancer – like “breast cancer” – there are different types of breast cancer, in situ or invasive lobular or ductal carcinomas, angiosarcoma, etc…. Depending on the exact type of cancer, treatment can be different. Even the exact same diagnosis in a pathology report (“invasive ductal carcinoma“) might have different prognostic markers (e.g., molecular data or tissue stains) that will direct treatment. You should not assume that you know how someone will be treated based on your own experience or someone else’s prior experience. And you must not predict side effects based on your own experience or your friend’s experience.
For the multiple and variable medications and treatment plans, side effects can overlap or be different. By recognizing diversity, we might be better able to support cancer patients who need it. For example, paclitaxel causes hair loss in almost everyone who receives it. The association with nausea or vomiting is much less common. Knowing about hair loss, I can prepare by warning my kids that I will start to look different, get a wig prescription, or try to prevent hair from falling out with scalp cooling therapy. I opted against the latter because I hate being cold, and at this point, my hair is not that important to me (so I think). Maybe my feelings will change!
Right now, speaking strictly for myself, alone time is what I need and crave. Being a mother, physician, and wife, I habitually consider others and their needs first, and I am accustomed to doing so. Because of my upbringing, a lifetime of conditioning makes thinking of others first seems natural. Even with a diagnosis of invasive ductal carcinoma of the breast, to put myself first feels unnatural and, quite frankly, stressful. When I am alone, I am not lonely, and the aloneness helps create self-care, allowing me to put my needs first. I know others who crave having company and think that feeling alone would be the worst thing. There is a difference between feeling alone vs. being alone, and a certain amount of quiet time with myself is the highest form of self-care that I can think of.
Cancer and chemotherapy treatment is yet another arena in which we can see how individual differences cannot easily be molded into a collective, generalized experience. Take the time to ask, if you want to give support, how someone who has cancer might best feel supported. Everyone is different, and I imagine the answers will not be the same.
For myself, I look forward to ringing that bell with excitement.
The author is an anonymous physician.
