This piece is an extract from the latest issue of Spectator Health, out this Thursday.
The good news about cancer is that more people are being cured, thanks to earlier diagnosis and better forms of treatment. For example, new hormonal and chemotherapy drugs have transformed the outlook for many patients with breast cancer, while recent dramatic developments have resulted in new immunotherapies for treating advanced melanoma, the most aggressive of the skin cancers. At higher doses, some of these drugs can cost up to a million pounds a year, but they have produced positive responses and long-term remissions in a way we have never seen before.
The bad news about cancer is that it is becoming more common, mainly because people are living longer and because many are ignoring warnings about lifestyle risks such as tobacco, excess alcohol intake and, especially, obesity.
About a third of cancers are diagnosed in people over 75, when physical and mental decline, isolation and other illnesses also take their toll. However, half of all people with cancer in the UK are still alive ten years after diagnosis, and the vast majority are cured. Pancreatic and lung cancer have the worst prognosis, while testicular, melanoma and breast cancers have the highest-year survival rates. In fact it’s better to have a cancer with a good prognosis than it is to have many ‘benign’ conditions, such as type 2 diabetes, which is invariably induced by obesity.
The first painful hurdle for newly diagnosed patients is to accept and understand their position. This a time when compassion, support, accurate information and a defined treatment plan are most reassuring. Information from ‘Professor Google’ does not help with patient specifics and can be misleading.
The impact of a cancer diagnosis on patients and families can never be underestimated. The agony suffered by parents when the patient is a child or young adult is unimaginable for most of us. Suddenly, the certainties of life are replaced by a sense of fear and vulnerability. Emotional difficulties and morbid thoughts are often compounded by practical problems of physical disability, employment and finance.
Nevertheless, after 30 years as a consultant cancer surgeon, my enduring memory is of the courage shown by my patients and their determination to overcome side-effects, either of treatment or of their disease, and return to normal life. My field was sarcoma, which means a cancer of muscle or bone. Although amputation is rarely required, the procedure is a major challenge for patients. Two of mine have allowed me to describe their cases, in the hope that their stories will be an inspiration to others…
Sue Walker was 20 years old when she developed Hodgkin’s lymphoma of the neck, which was treated by radiotherapy. Years later, at the age of 51, she developed breast cancer, requiring a right mastectomy. Undeterred, Sue returned to her job as a teaching assistant in a primary school. Then, at 55, she developed a sarcoma of the right shoulder, which was when I met her for the first time. The only treatment option was a forequarter amputation, which means the removal of the arm and the shoulder.
Sue was right-handed and her hobbies were golf and painting wildlife. Understandably, she was devastated by the extent of the surgery needed, but she quickly turned her attention to the practicalities of learning to be left-handed and returning to her painting. She made an emotional return to the classroom and spoke of the overwhelmingly supportive responses of her pupils.
As if that was not enough to endure, when she was 58 it was discovered that Sue’s sarcoma had spread to three sites in both lungs. Her main concern was to stay well for her daughter’s wedding, which was brought forward. Fortunately, her tumour responded to chemotherapy and after two operations she remains well and is almost certainly cured of sarcoma.
Every Christmas Sue sends me a photo of one of her nature paintings. Each year’s is more detailed and intricate as her left-handed dexterity improves. The first was called ‘Don’t Ever Give Up’, which typifies the bravery of so many patients with cancer.
Stan Bembenek (pictured) was 40 when he was referred with a recurrent sarcoma of the hip joint following two previous operations. He had been a keen footballer and had recently taken up golf, but his only treatment option was a hindquarter amputation, which involves loss of the leg and part of the pelvis.
Stan is an indomitable character, and after his operation he dispensed with his heavy artificial leg, preferring to get around at speed on his custom-made aluminium crutches. Stan threw himself into work, starting up eight different telecoms businesses, and gradually he returned to playing golf at the disabled-friendly Sand Martins Golf Club in Wokingham, Berkshire. He plays with wooden clubs, longer than the usual iron variety, so he doesn’t have to lean forward and risk losing his balance. The face of his driver is at a higher degree than standard, which helps make his shots more accurate, at the expense of distance. But he can now drive a ball 200 yards and demonstrates his skills at charity events to encourage others.
With his unique interpersonal skills, Stan has persuaded people with many physical, neurological and psychological disabilities to play golf. He is now chief executive of the Disabled Golf Association and has represented England in tournaments. He says golf is an ideal sport for the disabled because a personal handicap means that everyone can play competitively. Almost 22 years on from his hindquarter amputation, Stan’s own handicap is now 22.
These two unique patients have taught me how resilient humans can be when faced with severe adversity. A combination of personal bravery and sheer doggedness has allowed them both to overcome significant disadvantages, maintain their chosen ways of life and continue to make a contribution to society.
There are countless others with similar stories, as well as people who put their experiences behind them and carry on regardless. In a few weeks I shall be cycling 50 miles a day around the battlefields and cemeteries of the first world war with George Granville, my patient and friend who is determined to prove to me and himself that he has fully recovered from treatment for a thigh tumour which involved radiotherapy and losing all his hamstring muscles in one leg.
When cancer is first diagnosed, people naturally assume the worst, but the eventual outcome may be much better than they fear. In the past few decades, treatments have changed and improved to become more patient-centric and holistic.
Although I warned of the dangers of Professor Google, one area where the internet can help is in providing access to support groups and chat rooms where patients with similar difficulties can discuss their experiences. I recommend the National Cancer Survivorship Initiative, a legacy website which will also lead you to Living With and Beyond Cancer, which can be read as a document or watched as a YouTube video.
Despite the occasional episode of bad press, I can reassure patients that today’s cancer services in the UK are excellent and, most importantly, all treatment is decided on the best and latest evidence. It will be similar or identical in all specialist cancer centres.
Although it is still one of the most frightening of life’s experiences, no patient with cancer need feel alone or isolated from the support systems and information they need. So let optimism prevail!