Previous chapter: 1. Introduction
2. The psychosocial situation
As mentioned above, it is primarily those patients with rapidly advancing cancer and/or an acute case of aggressively treated cancer whose condition affects those around them as a demonstration of illness, disability and deterioration, finally creating the impression that cancer is equivalent to death.
Hence, if the patient hears the diagnosis, "cancer", he often finds himself – in addition to his own prejudice against the disease – in a difficult psychosocial situation among his family, friends and acquaintances: Here, he is often perceived as bound to die from the beginning. The well-meant attempts to hide this view only make things worse, because naturally the person concerned is sensitive enough to be aware of the thoughts of the people closest to him, even if they are not verbalised. Thus, it often happens that his only choice is to accept the unspoken role of suffering "fatal illness" for his last days, weeks, years, - and in the worst case, even for decades. Inability to work, weakness due to therapy or the illness, frequent doctor’s appointments – these all seem to be evidence for this unhappy role of being "fatally ill" both to those in contact with the patient and to the patient himself. Hardly any person is strong enough in this situation to free himself from such a role with his own resources.
A short-term improvement may be induced by news from the doctors that e.g. a strenuous course of therapy has been "completed" and that the illness has been adequately treated from a medical point of view. However, it is not rare for patients to have the feeling that this news only means that now not even the doctors have any further advice to offer. During the following period, at least the patient recovers from the serious side-effects of the courses of therapy, which allows him to hope that the disease has in fact been overcome.
How shattering the effect on a patient’s psychological health is when a tumour reappears depends largely on the extent to which doctors and the patient himself have suggested that the disease was cured successfully. With the assessment of the recurrent disease possibly the doctor will know of a new, additional aspect which allows hope for cure. In general, this will be disappointed again after a certain time, and so on.
Thus, the patient is often subjected to an emotional roller-coaster ride between hope and disappointment, which reinforce and stabilise his family’s and his own perception of being "doomed to death". At some point, the only question remaining is, "How much longer?". Omniscient doctors will also be able to answer this question – and often be far from the actual outcome.
Next chapter: 3. What effect do words have?