Early Detection, Intuition, Relationship and Spiritual Awakening Made Her Whole: Experience of a 12-Year Breast Cancer Survivor
C Teo, I Teo, C Im-Teo
C Teo, I Teo, C Im-Teo. Early Detection, Intuition, Relationship and Spiritual Awakening Made Her Whole: Experience of a 12-Year Breast Cancer Survivor. The Internet Journal of Health. 2006 Volume 5 Number 2.
Cindy was 34 years old when she was diagnosed with breast cancer, Stage 1. She underwent a lumpectomy. Since the margin was not clear she was asked to undergo a mastectomy to be followed by chemotherapy and radiotherapy. She felt very strongly that there was another way of dealing with her cancer which she would be more comfortable with. She declined further medical intervention. She changed her lifestyle and diet, went for qi kung, did meditation and seek homeopathic therapy. Twelve years since her diagnosis, Cindy is doing fine. She attributed her success to early detection, positive actions on her part, strong emotional help from her friends and a new spiritual awakening.
Declaration of Interest
The senior author is a retired professor of botany / teacher, respectively, and currently practising herbalists. He has partial financial interest in the use or marketing of herbs.
Breast cancer is the most common malignancy in women. Over the past decade, breast cancer presented as the number one problem encountered by CA Care, an organization which provides non-medical help to cancer patients via counseling and herbal therapy. Our strategy at CA Care is to heal the whole person and we advise patients to change for a healthier diet and lifestyle, exercise and employ religious beliefs to find peace within ( 1 ). Our statistics show that females between 41 to 50 years old were the most vulnerable to breast cancer. This group constituted one-third of the breast cancer cases we encountered. Patients who came to us have already undergone medical treatments: surgery (61.7%), chemotherapy (34.2%), radiotherapy (33.6%) and hormonal therapy (25.8%). In spite of these, 20.7% of patients suffered metastasis or recurrence.
Our local newspaper, The Sunday Star of 14 November 2004, featured an interesting article entitled,
The study by the oncologists themselves testifies to the truth of the situation that prevails in this country or for that matter, the world at large. What baffles us is that the oncologists were baffled why patients prefer CAM over the so-called scientific and proven method of treating cancer. They should not be baffled. Instead, they need to review what they have to offer patients. Healing for cancer is a complex process, involving the body, mind and soul. The emotional and spiritual aspects of healing have often been side-stepped or totally ignored by doctors ( 2 ).
The changing concepts of medicine today include evidence-based medicine and patient-centered care. The predominant function of doctors to only diagnose and cure diseases are based on “antiquated” system since chronic illnesses place a different set of demands on patients and their family members than do acute illness and injuries ( 3 ). Therefore, medicine needs to shift its system of care that is based on acute care and cure to patient-centered care for the chronically ill (2 ).
At CA Care we provide evidence-based care based on love and compassion. This is in conformity with current medical concept of patient-centered care based on mutual respect ( 4 ). Wagner et al. pointed out that “the paradigm for high-quality chronic illness care now seeks to promote a fuller understanding of the patient's life and preferences, empowerment of patients and tailoring management to patient preferences” ( 3 ). Unfortunately, such ideals are rarely seen put into practice.
Even though much has been said about patients' empowerment, relatively little is known or documented about patients' actual experiences when they come face to face with their doctors ( 4 ). We believe real healing can only be achieved when both patients and caregivers are in consonance with each other and together they seek to do their best. At CA Care we conducted numerous in-depth interviews with cancer survivors. In this article, we present the experiences of a breast cancer survivor. Perhaps, her experiences can contribute to some understanding on how cancer patients, like herself, may perceive their problems, how they cope and most important of all, to what extent their beliefs had helped them overcome their cancer.
Breast Cancer Treatment
More often than not, women with breast cancer are subjected to a battery of treatments: surgery, chemotherapy, radiotherapy and hormonal therapy. The most important question that patients may wish to ask after undergoing these treatments is: Am I cured after all these treatments?
It is a common belief that with early stage breast cancer the standard medical treatment can “cure” the disease ( 5 ). However, it is noted that 20 % to 85% of patients diagnosed with early stage breast cancer will develop recurrent and/or metastatic disease despite undergoing the required treatments ( 6 ). Metastatic breast cancer is generally considered incurable and the median survival is 2 to 4 years ( 5, 6,7 )
Following the progress of 1,581 breast cancer patients who had undergone chemotherapy at the M. D. Anderson Cancer Centre, Houston, Texas, USA, Greenberg et al. noted that only 49 patients or 3.1% remained in complete remission for more than 5 years ( 8 ) . Patients may wish to ask: What, if I do not undergo chemotherapy? Unfortunately there is no report comparing outcomes of medical treatments versus CAM treatments. However, the natural history of untreated advanced breast cancer based on the records of 250 women with inoperable advanced breast cancer from 1805 to 1933 in Middlesex Hospital, England, showed that although untreated, 18% of the patients remained alive after 5 years thus bringing to question the actual role of medical treatment ( 7 ).
How effective is chemotherapy?
In Australia, of the 10,661 people who had breast cancer, only 164 people survived 5 years due to chemotherapy ( 9 ). This works out to 1.5% survival rate contributed by chemotherapy. This observation led Segelove to report that “chemotherapy has been oversold. Chemotherapy has improved survival by less than 3% in adults with cancer” ( 10 ).
Participant, Questionnaire and Interview
Our interview with cancer survivors is based on a “willingness-to-share basis”. The presentation of this three-hour interview below, conducted on 1 August 2006, has the consent of the participant, and the purpose of which was well understood by her. The participant is Cindy, a 46-year-old, single, female of Chinese ethnic origin. She works as a life insurance agent. She was diagnosed with a Stage 1, left breast cancer on 29 August 1994. As of this date, Cindy is doing fine.
A week before the interview, we requested Cindy to answer a questionnaire that consists of two parts. Part 1 concerned coping strategies using the Brief COPE ( 14 ), a 28-item inventory. The instrument comprises two items of each of the 14 coping strategies: self distraction (α = .23), active coping (α = .72), denial (α = .59), substance abuse (α = .73), use of emotional support (α = .81), use of instrumental support (α = .82), behavioral disengagement (α = .60), venting (α = .46), positive reframing (α = .70), planning (α = .69), humor (α = .79), acceptance (α = .50), religion (α = .77) and self-blame (α = .67). Patients answered ratings which asked how often they employed a particular coping strategy regarding their cancer experience (1= I haven't been doing this at all, 4 = I've been doing this a lot).
Part 2 of the questionnaire measures post-traumatic growth using the
Cindy readily accepted her diagnosis accepting the fact that it has happened and as such she learned how to live with it the best she knows how. She is also not a person who would brood over her illness but rather tried to find something good in the “bad” that had happened. She took steps to find out what needed to be done – physically and emotionally, by seeking help from friends (Table 1).
In the face of adversity, Cindy found cancer to be a blessing. Her cancer had nurtured a new meaning and purpose in her life and she became more appreciative of the value of her own life. She cultivated a strong bond of friendship with her “buddies” whom both parties can depend on each other for comfort and support (Table 2).
Transcript of Video-taped Interview
OK, living your life now with cancer, does it give you any feeling of fear or uncertainty – wondering if it can come back again?
During the 12 years of journey with cancer, was there any time that you felt you have lost hope and wanted to give up?
Let's return to 12 years ago – the time when you did not have cancer yet. At that time, did you know anything about cancer?
Unfortunately, 12 years ago, you were diagnosed with breast cancer. How did you know that you had cancer in the first place?
What was your first reaction to that unexpected news?
Were you angry after being told of this diagnosis?
Your anger was directed at whom?
Did you ask: Why me?
To whom were you directing these comments?
Did you feel ashamed for getting cancer?
Did you ever try to “distance” yourself, or “avoid” this issue about cancer?
With too much information given to you, were you not stressed or confused?
Did you feel isolated at anytime, after you were diagnosed with cancer?
Did you have friends who avoided you after knowing that you had cancer?
Did you at anytime, felt that since you had cancer, you were “inferior” or “inadequate” compared to other healthy persons?
Did you try to do something else so that you could divert your mind away from this cancer?
Was there a time when you felt you needed to cry? What was it that upset you and made you cry?
Now, back to your cancer, what did you do after being diagnosed with breast cancer?
Did you go ahead with all those medical treatments?
Did he say that the margin after lumpectomy was clean?
So, you agreed to that suggestion?
Were you sure that you did not want medical treatments?
Why were you so sure about the medical treatment – why such strong feelings about that?
If someone is going to “cut off” your breast and you know that you are going to loose that breast, how would you feel?
Is that the reason?
Is that really the reason?
In coming to a decision to forgo medical treatment, were you under pressure from any people?
After undergoing lumpectomy and then went through your healing journey for 12 years, can you tell us which period of time or event in the journey that you found most stressful?
Apart from the food, what other things stressed you?
Let me get you right, from day one up to almost year five, you did not worry at all about the possibility of a relapse. But as you were approaching year five you suddenly realized that you might get a relapse?
In the process of coping with your problem, what was it that helped you most?
The social support that you received – can you group them into any specific groups, and to what extent each group had helped you?
Which group gave you the most help?
Did you have many friends whom you needed for your support?
Did you derive similar benefits even if this person was so far way?
Did you find the people in the qi kung and meditation groups a great help emotionally?
Let us go back to the days before you had cancer. What would you say about your belief in religion or your spiritual awareness?
Oh, before you had cancer, what would be your reply if I say: Let's go and pray?
Now that you have cancer, spiritually are you different now?
Did you then searched for that purpose?
What was inside you that gave you this meaning?
Before that did you have such a feeling?
You have grown spiritually, but was this spirituality related to any religion?
Having gone through this cancer experience, would you say that you have found “meaning” in this cancer?
Are you sure that it was a “blessing”? Or are you just saying this to make you feel “happy”?
If you have a chance to live life again and make a choice between your life before you had cancer and the life you are now leading, what would be your choice?
Why do you say this? Is it because you have been influenced by those people who wrote the many books that you read?
You experienced a life before cancer, and you are now living a life after cancer. And you think that you feel the difference?
Do you fear death? Is there anytime in life that you think: Ah, tomorrow, I am going to die and you are afraid of it?
Before you had cancer, would you dare to talk or joke like this?
So, to sum up, am I correct to say that the benefits that cancer brought to you is the appreciation of life – taking life the way it is. And arising from that too you realized the need to cultivate strong and close friendship with others. Is there anything else you need to add?
Now, you are happy?
OK, one last question. If the cancer is a person and is sitting right out here in front of you, what would you say to this cancer?
Would you really say that?
Is that what you really want to say? You don't hate or regret having cancer?
So, as a summary what would you say are the things that you did that had helped you along this 12-year journey?
We have been dealing with cancer patients for over a decade now and we realize that like in medicine, not all patients who tried to find their own healing path succeeded. This is not for want of “proven” therapies but rather due to lack of full commitment. Cindy was fully committed to search and follow her healing path. At CA Care only about 30% of those who came to seek our help benefited while the remaining 70% failed for they came only to seek for “magic bullets” that do not exist. Patients are reminded that wanting an easy way out of problems and being not prepared to go that “extra mile” to heal, is never a way to success. Healing of cancer requires more than just “drinking herbal concoctions” or “swallowing pills”. It demands full participation and commitment on the part of both patients as well as healers, to do what are deemed right and helpful such as a change of lifestyle and diet, exercise, meditate and seeking peace from within and without.
Unique human intuition plays no role in scientific medicine. Medical practices require evidence, based on clinical trials. Anecdotes generally fall on deaf ears and are of minimal value, if at all. However, in Cindy's case, her intuition was perhaps one of the main factors that had contributed to her success. She said, “I don't know but there is this feeling within me, coming right from my heart that there was another way”. She followed her heart's desire and found healing. How many in the medical fraternity would recognize or readily agree with Groopman when he wrote, “intuition can weigh as heavily as raw data in clinical judgment”? ( 16 ).
Medicine, following the philosophy of Rene Descartes, based its assumption that the human body is merely a complex physical machine devoid of mind and soul. Diseased tissues or organs that lack functions, can be “cut, discarded or replaced” when situations warrant it. Many women have no qualms having their breasts removed or have no reservation being administered cytotoxic drugs into them. But some women, we encountered, would resist or try not to undergo such procedures. As this case has demonstrated, Cindy was asked to remove her left breast and possibly the right breast too. She reacted negatively to such a suggestion. It was enough distress to be diagnosed with cancer but having to loose both breast would be too overwhelming. Perhaps it is worth repeating what she said, “Should I need to die, I would want to die with everything intact. You don't take anything away from my body (and) you don't destroy my body. I want to die whole. “ Removing her breast would adversely affect her psychologically – “I would feel like an incomplete woman (and) I am a woman and the breasts, to me, are important.” While Cindy's surgeon saw her as being “silly” for not wanting to proceed with the established medical treatments, in this case Cindy was not wrong by following her intuition. The surgeon, however, was also right by cautioning her. In theory, a lumpectomy with unclean margin posed a great risk of recurrence since a part of the tumor might have been left behind. In fact, cancer patients are often given a standard advice that without surgery or chemotherapy, etc., the tumors are going to grow, spread, and cause havoc in the body. While this advice appears logical, in practice such eventuality need not necessarily occur. Cindy's case is one example.
One episode we would like to highlight in Cindy's case is: she was counting the calendar to cross the five-year mark. Generally, if they survive five years, they are considered cured – so say the doctors. Negative thoughts started to creep into her mind as the deadline was approaching. We often tell patients – believe the doctors' diagnosis but not their prognosis. Unfortunately, this is one example in which medical statistics could cause serious psychological distress to patients. Doctors are not emotionally involved with the patients' cancers. Very often patients and doctors are not at the same wavelength even though they speak the same language and talk about the same thing. A doctor with a rational mind may tell things in an honest, factual way. The patient's emotional mind interprets the message differently. The doctors may talk about “5-year success rate” or interpret laboratory test results scientifically without any feelings but the patients take every “poor” or “bad” result as another blow that brings them nearer to failure or death.
In tracing the history of breast cancer wars in the US, Lerner concluded that “in contrast to what we had come to believe, chemotherapy and other therapeutic interventions actually “cure” only a fraction of those who received them. Other women would have recovered even without such treatment. Rather than feeling compelled to make decisions that are objectively right, women should choose what is right for themselves” ( 17 ).
By taking a healing path few dared to travel, Cindy found not only physical but also spiritual and emotional healing. Her confrontation with cancer had resulted in spiritual awakening which had sharpened her sense of gratitude and appreciation of what life brings each day. She had established a strong emotional support which she can rely on, through close friendship with friends. With that, Cindy saw her cancer as a blessing.
As a conclusion, let us comment on the methodology of this study. We conducted this study using two approaches. One approach was by questionnaire, i.e., using pencil-and-paper method. We found this approach rather impersonal for there was no rapport between the participant and the researcher. What we know about the participant is restricted to only the questions asked. The approach via in-depth interview, though time consuming, provided a much better result. Many salient points about human problems, aspirations, beliefs, etc. are revealed giving us a better understanding of the inner feelings of the participant.