The Angry Silence

Angry SilenceMy last post discussed the findings outlined in the recent report from MacMillan Cancer Support, Cancer: Then and Now.  Previously, I concentrated on the improvements in cancer survival rates over the last 40 years and described how this was due to improvements in diagnosis and treatment options.

But in this post I’m going to talk about another thing that the MacMillan report highlighted as having changed dramatically since the 1970’s.  Something which also has a major impact on the quality of life for cancer patients and can also, as we are now beginning to understand, contribute to increased chances of survival.

Talking.

30-40 years ago, cancer was a taboo subject.  People didn’t talk about it.  In those days, cancer was seen as a Bogey man, a terrifying spectre that shouldn’t be mentioned in case it tempted fate.  A diagnosis of cancer was seen as an automatic death sentence, so the very mention of the word struck terror in the hearts and minds of even the strongest and most courageous.

So someone diagnosed with cancer 30 years ago would suddenly find the world a dark, terrifying place.  Not only were survival rates poor, but they would often find themselves isolated, unable to speak to anyone about their fears.  One patient is quoted as saying, “In the 1980s there was no one to help or advise.  I felt very alone and frightened, and thought I was going to die.”

But, also, not only did cancer patients find it hard to talk to friends and loved ones, there was also very little information available to them from medical professionals.  This is backed up by the medical staff involved, as one oncology nurse who worked in the 1980’s explains, “Cancer was hush, hush.  Our job was to explain what cancer was in the kindliest way as there were no story lines in television soaps, no magazine features about people with cancer to relate to.”

So, up until the ‘80’s, being a cancer patient must have been utterly terrifying.  They had no information.  They wouldn’t have gotten any from medics or nurses.  They wouldn’t be able to share their experiences to anyone outside of their immediate families or close friends – and that’s assuming their friends & families would want to talk about it at all.

And even if they did survive, there was nothing, nothing in the way of aftercare or psychological support to help them cope and process the extremely traumatic experiences they had been through.

Think about that for a minute.  A diagnosis of cancer is incredibly stressful. Undergoing treatment is incredibly stressful.  And even surviving is incredibly stressful.  Imagine doing all of that with virtually no support, no help, no one to turn to.

No one to talk to.

But that has changed in the last 30 years. Oh, don’t get me wrong, a cancer diagnosis is still a stressful experience.  And treatment and recovery is no picnic either.  But one big difference (other than the improvements in diagnosis and planning I’ve already spoken about) is that cancer is not a dirty word anymore.  There’s not anywhere near the same level of secrecy and taboo associated with cancer diagnosis as there was back then, so current cancer patients won’t be as isolated as they would have been in the past.

The information available for patients nowadays is vast.  MacMillan themselves offer advice and support and CRUK’s webpage is a huge resource.  Also, the number of personal testimonies out there, in the form of books, movies, blogs etc. mean that there are plenty of reassuring voices.  And all of this can make the experience for patients less stressful.  Not stress-free, you understand, but infinitely better than it used to be.

And this can be important for another reason.  One which is remarkable, but still not well understood.  It can help improve survival.

Studies through the years have found that a patient’s psychological state can influence the success or failure of their treatment.  Generally speaking, patients who experienced depression, distress or a lack of social support had poorer outcomes.  In contrast, those patients who had large, supportive social networks had a lower relative risk of cancer mortality of between 12-25%.

But what could be causing this?  Well, according to this review, stress can induce the production of mood-altering hormones, which can affect normal bodily functions such as the immune system, inflammation and blood-flow.  And these alterations in bodily function can make the environment more favourable for tumour growth and spread.

So, if anyone reading this has cancer or if you know someone who does, make sure you keep talking.  Not only will the patient feel better, it might actually help make them better too.
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Lutgendorf, S., & Andersen, B. (2015). Biobehavioral approaches to cancer progression and survival: Mechanisms and interventions. American Psychologist, 70 (2), 186-197 DOI: 10.1037/a0035730

MacMillan Cancer Support (2016). Cancer: Then and Now. Diagnosis, treatment and aftercare from 1970–2016 MacMillan Cancer Support

ResearchBlogging.org
AG McCluskey (2016). The Angry Silence Zongo’s Cancer Diaries

Live Long & Prosper!

A bit of good news today.

Macmillan Cancer Support have released a report, Cancer: Then and Now, which shows that people diagnosed with cancer are twice as likely to survive for at least a decade they were in the early 1970s.

Cancer incidence rates UK 1979-2013Now this is a great thing to see.  Quite often, I’ve heard people complaining about the fact that cancer incidence rates have risen since the 1970s.  And it’s true, more people are diagnosed with cancer nowadays, as you can see in this graph from CRUK.  For both men and women, while the lines may wobble a bit, the overall trend is an increase in cancer incidence.  On average, the incidence rate in 1979 was 450 per 100,000.  By 2013, this had risen to 600 per 100,000.  Or, to express it as the relative risk so popular in the media, cancer incidence rose by 33.3% in that timeframe.  Now this can seem down-heartening.  Depressing, even.  And Scary.  But what does this increase actually mean?

I’ve heard complaints that this increase is down to our lifestyles.  E numbers in food….GMOs….poor diets…..pollution…..you name it.  And, in one sense, these people are right.  In a sense, increased cancer incidence is down to our lifestyles.  Just not in the way that they imagine.

UK Life expectancy 1980-2012As I’ve mentioned before – waaaaay back in Chinese Whispers – cancer is, generally, a disease of aging.  The longer you live, the bigger the probability that you’ll get cancer.  And that’s the point.  Yes, it’s true that cancer incidence has increased since the 1970s, but so has life expectancy.  This figure from UK National Statistics, and it covers, more or less, the same timeframe as the cancer incidence figure above.  Now, what you can see right away is that life expectancy is also increasing on average, from 71 & 77 for men and women respectively in 1980, to 78.7 & 82.6 in 2010-12.  And this equates to a rise of approx 11% for men and 7% for women.

So we are living longer.  And as cancer is more likely the longer you live, cancer rates would be expected to rise.  “But!” I hear you cry, “Surely cancer incidence is rising faster than life expectancy!”  Why would that be??”

Well, for a start, this is a logical fallacy.  There’s no direct connection between the two sets of statistics, so there’s no reason to expect that they will go up or go down by exactly the same amount.  And people do die from other things, so this will lower life expectancy.

But it is also down to one of the factors highlighted in the MacMillan report.  We are getting better at diagnosing cancer – and in early diagnosis.  So, 40 years ago, people might have cancer for a long time before diagnosis.  Some may even have died from undiagnosed diseases.  But improvements in scanning technology and in the development of tests for cancer-specific markers mean that this is less likely.  So we can spot these things earlier.  And the earlier a disease is found, the more treatable it is.

Marginal Gains 2I’ve shown this figure from CRUK before – and I’m more than happy to show it again!  This one shows how the survival rates for the commonly found cancers in the UK have changed from the early 70s until 2010.  And, as you can see, all the arrows are pointing to the right.  Survival is increasing across the board.  So, yes, cancer incidence rates are increasing.  But detection & survival rates are increasing too.

Better chemotherapy treatments are available.  Cancer patients are fast-tracked to ensure their treatment starts earlier.  The improvements in scanning technology which allow better diagnoses also give surgeons a better view of tumours – where they are, how big they are, whether they’ve spread.  And that makes successful surgery more likely and also increases the potential for other treatments such as radiotherapy.

Does this mean everything is Okay-Dokay-Fine?  No, of course not.  There’s still a lot to do.  But, in a time where it seems as if everything’s going down the crapper (Hi there, Brexit!  Yo, President Trump!), it’s nice to have a wee bit of good news for a change.  And if you are suffering from cancer, or know someone who is, then that’s what you’ll get today.  This is the (ahem) “best” time there’s ever been to be a cancer patient.  Your chances of surviving, of living a long & happy life are better now that they’ve ever, EVER been.  Might not seem like much, but that tiny sliver of light can mean a helluva lot, if all you see is darkness.

So have a good day, folks.  Live Long & Prosper.

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MacMillan Cancer Support (2016). Cancer: Then and Now. Diagnosis, treatment and aftercare from 1970–2016 MacMillan Cancer Support

ResearchBlogging.org
AG McCluskey (2016). Life Long & Prosper! Zongo’s Cancer Diaries