Take up the challenge

We usually think that the most important thing about curing cancer is relying on the best specialists or finding the most effective remedies or maybe the most advanced ones, those freshly baked by research. These things are important but probably it is more important to ensure that we pursue an intelligent treatment.

An intelligent approach to cancer care is more likely to be successful: we may  live longer and better live the time that we have left.

If we limit ourselves to do what it is usually done when treating cases similar to ours, the care is not intelligent but rather mechanical.

 

Each case is different in its own way and differs in each and every step of its own history: my case is not the same as that of people affected by my same type of cancer and my case today is not the same as it was yesterday or as it will be tomorrow. Furthermore, each person has his or her own experience of the disease, his or her own goals, wishes, and things that he or she can or cannot bear.

An intelligent cancer care is a very personalized care and tailored to the specific needs of my case, to the history of my disease and to my life. As soon as cancer appears, a series of moments in which there are decisions to make follow one another. No decision can be taken for granted. Each time one must make a personalized choice.

In order to be able to choose wisely we must have given wise answers to some basic questions: What is cancer? How can we deal with it? What do we want? What do we expect to achieve? The answers to these questions cannot be taken for granted and answering requires knowledge, rationality, wisdom and modesty. For example, many believe that cancer is a set of cells that have gone crazy and that can be killed with ‘magic bullets’ - drugs that are targeted to kill these cells, a bit like antibiotics that wipe out bacteria and brought extraordinary results for curing infectious diseases.

But contemporary biology suggests that cancer is something different. It looks like an organ, like a liver or any other organ, and it is made of a variety of cells  (not just cancer cells) and it has its way of functioning. However, it is an anarchical organ in that it does not live in harmony with the rest of the organism. According to scientific research of the past years, it is highly doubtful that the theory of the ‘magic bullets’, that dates back to Paul Ehrlich, a famous German doctor and scientist of the nineteenth century, can work in the case of cancer. When dealing with bacteria we have found ‘magic bullets’ but there are good and scientifically based reasons that suggest that this is impossible in the case of cancer. In any case, at the moment we do not have any ‘magic bullets’ against cancer.

The questions ‘What do we want?’, ‘What do we expect?’ draw us into a dilemma. Nicolas André and Eddy Pasquier summarize this well: ‘seek and destroy or live and  let live?’. Is our goal eradicating the cancer and removing it permanently from our body or are we okay with the idea that it will stay and live in our body as long as it will let us live well?

Instinctively, we think that we are supposed to permanently eradicate the cancer from our body. We think this because we believe that having cancer in our body necessarily means being ill. This is not the case. It’s possible to create a balance in which cancer exists but it is kept under control and we are well to the extent of being able to live a completely normal life. Judah Folkman and Raghu Kalluri talk about ‘cancer without disease’.

We must decide what we want because the strategies change depending on our choices. In one case we would be as aggressive as possible whatever the cost might be. In the other case our actions would be less aggressive and would control the cancer and contain it as much as possible, preventing it from turning nasty. Robert Gatenby uses the image of the pruning of a tree that grows in an unusual fashion. We don’t try to uproot it, we let it be but we try and prevent it from becoming problematic due to all its luxuriant branches.

Behind an intelligent care there is an aware and realistic philosophy of care that guides us through all the choices we make at every step.

An intelligent care is preferable because we may live longer and better live the time that we have left. But how can we make sure that we are treating cancer intelligently?