Cancer Doesn't Choose Who Survives Based On How Hard Someone Fights

After Sen. John McCain ’s office confirmed Wednesday that the former presidential candidate has been diagnosed with brain cancer , many of his political colleagues, opponents and friends shared their condolences on social media  and expressed a similar sentiment: the Arizona Republican is a fighter and he will continue to be in the face of this disease.

The words of encouragement were warm and inspiring, especially considering the bitter partisanship that divides Washington. There’s also a comfort in giving and receiving support for a health issue.

But the well wishes leave out an important factor: Cancer doesn’t choose who lives or dies based on how hard someone fights.

The potential problem with the word “fight” is that it puts the onus on the patient to get better, sending the message that the outcome of their treatment is their responsibility. If they fight hard enough, their tumor will evaporate. If they fight hard enough, they will be cured. 

Some people took issue with the platitudes for McCain, airing their frustration on Twitter:

Support is critical for patients with cancer but the words you choose to convey that support matter, Len Lichtenfeld, the deputy chief medical officer at the American Cancer Society, told HuffPost.

“Cancer is a serious disease with potentially serious outcomes. Our natural instinct is to obviously want every person diagnosed to do whatever they can to overcome it,” Lichtenfeld said. “For some people that ‘fight’ concept is important. However, for many others, it’s not really the motivational driver that they need to hear at that particular moment.”

Lichtenfeld said that, for some people, this particular phrasing may make patients feel like failures should the outcome not be the best possible one.

“What happens if you’re not successful or the disease doesn’t respond to treatment? What do you say to that person? That you didn’t fight hard enough, that you didn’t commit hard enough or have the willpower to overcome the disease? Of course, the answer is no,” he said. “They could have done everything, they could have gotten the best treatment possible.”

In a 2015 article in JAMA Oncology, researchers said the problem with urging patients to “fight” the disease is that it doesn’t account for other options. Some patients choose to live out the rest of their lives either not receiving treatment or doing minimal therapies in order to have a higher quality of life. They wrote:

Patients do, of course, frequently die of cancer , but they are not losers in a battle. Once someone receives a cancer diagnosis, especially advanced-stage disease, a journey begins; sometimes the journey requires patience, tolerance, and courage, but at some point, most patients with advanced disease end that journey with loss of life. Although this difficult and tumultuous journey may have come to an end, dying should not be viewed as being defeated in some kind of skirmish.

Research does show that a positive outlook in the face of cancer treatment may have an effect on outcomes. And it’s true that it’s vital: Attitude is helpful for a patient’s mental health and it helps guide a person’s treatment plan, said Robert Fenstermaker, chair of neurosurgery at Roswell Park Cancer Institute in Buffalo, New York.

Fenstermaker also recommends that loved ones offer to go to treatment appointments with patients and help facilitate conversations with doctors. 

“It’s important to be supported by family in whichever way is helpful and to not be hesitant about exploring options with doctors and nurses and that includes psychologists,” Fenstermaker told HuffPost. “There needs to be support at many different levels.”

For some, that’s a “give it hell” attitude, but for others it isn’t. If you’re unclear about how to offer encouragement, Lichtenfeld said support can be communicated in ways that don’t imply there’s a battle to be won.

“Just sending someone a personal note or telling them you’re saddened by the news can make a difference,” he said. “Sometimes the simplest message is the best message.”