Simon Kelner: How C for Cancer became C for Cautious Optimism

Kelner's view


A close friend of mine was diagnosed with cancer last year, and just before Christmas he had a very complicated and lengthy operation to remove his bladder. A little more than two years ago, I had a far less serious operation to excise one of my kidneys after I, too, had been diagnosed with cancer.

Last weekend, we were playing table tennis like a pair of youngsters. In fact, we beat an actual pair of youngsters, both of whom, as far as I know, had all their organs intact. In this rich, privileged world of ours, we take many things for granted, and even for cancer sufferers there is a level of expectation that medical science will deliver. I'm not saying that we have made light of our recovery, but we don't spend much time thinking about what might have been.

This, however, made me wonder: how long ago would our respective conditions have killed us off? The next day I was having lunch with another good friend, an eminent doctor, and I asked him that question. He was unequivocal: when he was a junior, 20 or so years ago, the scenario for those with cancer was entirely different from today.

He prefaced his answer by saying that while survival rates for many cancers – including bladder and kidney – have improved beyond recognition over the past few decades, there has not been the same progress in the treatment of lung and brain cancer. Clearly, advances in medicine have been significant, but other – often overlooked – factors have altered the landscape, too.

For a start, he said, there was still something of a taboo about cancer in those days. "A patient who had lung cancer," he explained, "would be told that they had 'a little spot on the lung'. There was relatively little awareness of the disease, and for most people, the Big C meant certain death.

"So fearful were patients that they presented their symptoms at a much later stage. Women would visit me with enormous tumours on their breasts, and men would have been coughing up huge amounts of blood. They must have known, and yet were so terrified of the consequences that they didn't want to confront the situation."

Today, awareness is high and there is much more openness about cancer. This creates a virtuous circle. Patients present much earlier, which makes it more likely they will survive, which takes some of the fear out of diagnosis, which in turn encourages others to seek early consultation, and so on.

There is much more discussion about the disease these days, and I was struck by the provocative comments in a newspaper yesterday by a doctor who contended that he'd rather die than endure the pain of treatment for advanced cancer. There was no point, he wrote, in prolonging life if there was no quality to it.

I'm paraphrasing, but he seemed to say: better to retire with a gin and tonic and a good book, and wait for the end. Research on the subject, however, indicates that the vast majority of patients would choose six months of painful treatment followed by six months of life rather than six months of life. I tend to agree.

The longer you hang around, the better. Who knows? Maybe they'll find another wonder drug.


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