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.

Introduction

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, Erasing cancer fears. The article said that oncologists were baffled why patients still go for CAM (complementary and alternative medicine) treatment when they get cancer. Why don't patients entrust their lives and fates to the oncologists? The newspaper reported the result of a survey carried out in August to September 2004 by the Oncological Society of Malaysia, involving some 1,200 women. The verdict came out loud and clear: only 20% think that radiotherapy and chemotherapy are effective and safe, the other 80% think that these treatments are not effective or have too many side effects. Over 90% admit that they would consider CAM therapies for cancer.

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 ). In Holland, a study by Veroort et al. ( ₁₁ ) showed that “breast cancer mortality reduction caused by present-day practice of adjuvant tamoxifen and chemotherapy is 7% “. Guy Faguet, after 28 years of research, came to a startling conclusion that chemotherapy for cancer is based on “flawed premises with an unattainable goal. Cytotoxic chemotherapy in its present form will neither eradicate cancer nor alleviate suffering” ( ₁₂ ). Lee et al. concluded that chemotherapy doesn't work and is merely “an attempt to poison the body just short of death in the hope of killing the cancer before the entire body is killed” ( ₁₃ ).

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 Post-traumatic Growth Index ( ₁₅ ), a 21-item inventory that measures the positive changes that an individual experiences after a traumatic event. The instrument comprises of 5 factors that determine the major domains of post-traumatic growth: relating to others better (7 items with α = .87), recognizing new possibilities (5 items with α = .90), a greater sense of personal strength (4 items with α = .86), spiritual change (2 items with α = .68) and greater appreciation of life (3 items with α = .77). Patients answered ratings which asked the extent of change cancer has brought to their life (0= I did not experience this change as a result of my experience with cancer, 5= I experienced this change to a very great degree as a result of my experience with cancer).

Findings

Coping Strategies

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).

Figure 1

Table 1: Coping strategies adopted by participant towards her breast cancer (maximum score = 4)

Post-traumatic Growth

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).

Figure 2

Table 2: Post-traumatic growth experienced by participant (maximum score = 5)

Transcript of Video-taped Interview

Chris: I am going to ask about your cancer experience – would that evoke a sense of anger, distress or uncomfortable feelings? You see, for certain people, they may feel agitated or distressed if I were to mention something that they don't like, especially when I talk about their illness such as cancer.

Cindy: It has been 12 years since I was diagnosed with cancer. Now, the mention of the word cancer does not make me feel anything. No, I don't feel agitated or hurt at all. Cancer is just a word which I have accepted a long time ago. And it is a word not to be feared. So I don't feel hurt if you mention that word. I feel normal.

OK, living your life now with cancer, does it give you any feeling of fear or uncertainty – wondering if it can come back again?

No, I don't feel insecure at all. After 12 years of experience with cancer, I do not feel that cancer is going to kill me. I think I am going to die a natural death or due to some other ailment but definitely not cancer.

During the 12 years of journey with cancer, was there any time that you felt you have lost hope and wanted to give up?

No, not at all.

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?

I knew nothing about cancer then. And if someone mentioned something about cancer, I was sure that I would not get it. I did not have any preconceived idea of what I would do if I were to get cancer then. This thought never occurred to me. Also to me at that time, if someone were to get cancer, it just means death. That's it.

Unfortunately, 12 years ago, you were diagnosed with breast cancer. How did you know that you had cancer in the first place?

I felt a lump in my left breast. I detected it when I was doing self breast examination. So the next day I went to see a doctor who told me that I had cancer.

What was your first reaction to that unexpected news?

I was shocked but it was not serious enough to stunt or immobilize me.

Were you angry after being told of this diagnosis?

Yes, I was angry. Prior to this diagnosis, I was taking care of my health – I took care of my diet, I did my exercises, etc, etc. I tried to keep myself healthy and now I got cancer. It was a real let down and this made me angry.

Your anger was directed at whom?

I was just angry at things that had happened to me. I was angry at “whatever” and to a little extent I was angry at myself.

Did you ask: Why me?

Yes, of course. I asked why me of all people. I also thought it was so unfair!

To whom were you directing these comments?

Whoever – perhaps, up there!

Did you feel ashamed for getting cancer?

No, not at all. I was an easy person when it came to sharing problems with my colleagues in the office. You see, in our insurance company we were taught about positive thinking. Because of that I learned how to share and be open with my colleagues. So, after asking “why me” and saying “it was not fair”, I did not wallow on such things. After a few days, I got out of it. I accepted the fact that I had cancer. The point I like to share with you is this: I was never afraid to tell all my colleagues and even my insurance clients that I had cancer. I had no qualm sharing my problem with people. This helped me to unload.

Did you ever try to “distance” yourself, or “avoid” this issue about cancer?

No. I opened up and shared my problem with my colleagues in the office. With that I found a lot of answers, through the help of all my friends. This sharing was important because it opened up to more information.

With too much information given to you, were you not stressed or confused?

Yes, to a certain extent I was overwhelmed. So I did not read everything that was given to me. My heart knew what I wanted to do. So, I picked and chose the relevant or suitable information. In other words, I formulated my own healing path. No one influenced me and I made all my decisions. Somehow, I knew in my heart that I had the answer.

Did you feel isolated at anytime, after you were diagnosed with cancer?

No, I never felt that way. I never felt alone in spite of the fact that at that time information about cancer was scarce.

Did you have friends who avoided you after knowing that you had cancer?

No, no. They accepted me the way I was. None of them ever avoided me. No, I never have such friends.

Did you at anytime, felt that since you had cancer, you were “inferior” or “inadequate” compared to other healthy persons?

No, not at all. I felt normal. It was just that I happened to have cancer. So, that was all.

Did you try to do something else so that you could divert your mind away from this cancer?

No. What I did were things that I loved to do all along. For example, I like going to the movies, shopping, listening to music, etc. I love to do all these things even before I had cancer. As I have said before, I learned to share and let go my feelings. I liked to talk to express myself. I talked to my friends very often and with that too, I also cried. I was never short of tears. After all these, I would laugh. I love jokes and humor. All these make me feel good.

Was there a time when you felt you needed to cry? What was it that upset you and made you cry?

Yes, I cried. This was the time when I felt lonely when I was at home. In the office, I had my friends and that was no problem. But when I was in my room at home all alone, negative thoughts crept into my head and I felt lonely. But this did not happen too often. Whenever I felt lonely, I picked up the phone and talked to someone. I often did that with my sisters. In actual fact, I was not short of such friends who helped me in time of need.

Now, back to your cancer, what did you do after being diagnosed with breast cancer?

After accepting the diagnosis I took action and asked: What to do next. I know I have to make changes to my life. Remember, I was and am a proactive person, so I set out to find out what to do next. I asked my doctor what I needed to do. My doctor outlined all the conventional medical treatments that I had to undergo. Then I asked him: How soon must I give you the answer? He replied: About three weeks. I told him that I was about to go off to China for a two-week holiday trip. I would like to enjoy the trip first and would give him my answer as soon as I came back from the trip.

So, during this period – from the time of diagnosis to making a decision of what to do, I was not distressed. I started to look for alternative treatments – searching for what to do apart from the medical treatments. My colleagues in the office and other friends rallied around me and they gave me books, newspaper cuttings and various information. So, deep down in my heart I told myself that there must be another way.

Did you go ahead with all those medical treatments?

No, I declined further surgery or medical treatments. You see, the doctor took out the lump and then sent it for testing. It was cancerous. That was all that he did. After I came back from China, I called him and said: Doc., I am not going to do the surgery. He replied: Don't be silly, you are still young. The rate of recovery is very good. I responded: Yes, the rate of recovery is very good but I think I need to do something else so that I can recover even faster through alternative treatments.

Did he say that the margin after lumpectomy was clean?

No, he told me that it was not and that I have to come back to have my whole left breast removed. He also told me that my right breast needed to be removed too, to prevent the cancer spreading to that side.

So, you agreed to that suggestion?

No, absolutely not. It was not only that I got a shock because I had cancer, now I have to remove both of my breasts. I told myself: No, I am not going to do such a thing.

Were you sure that you did not want medical treatments?

I was very sure that I did not want to go through that mastectomy, chemotherapy and radiotherapy which he suggested. Even though at that time I was not sure what alternative treatments to go for, one thing I knew for sure – I would not go for medical treatments.

Why were you so sure about the medical treatment – why such strong feelings about that?

I don't know but there was this feeling within me, coming right from the heart that there was another way. Even though I did not know what “another way” was, I felt strongly that there was another way. This feeling was so strong in me that I never went back to see the doctor anymore. I told myself: Should I need to die, I would want to die with everything intact. You don't take anything away from my body. Also, you don't destroy my body. Should I die, I want to die whole.

If someone is going to “cut off” your breast and you know that you are going to loose that breast, how would you feel?

Haaar – I would feel lost. I would feel like an incomplete woman.

Is that the reason?

Yes.

Is that really the reason?

Yes, yes. I am a woman and breasts, to me, are important.

In coming to a decision to forgo medical treatment, were you under pressure from any people?

No, it was entirely my own decision. Of course some of my friends did tell me: Don't be stupid, go for medical treatments. One thing about me was this, once I had made up my mind, I became adamant and would stick to that decision. I was only accountable to myself. I was and am not married and so my decision was my decision. In fact, there was only one person who did not know about my cancer – that was my mother – even, to this day she does not know that I had cancer. I have two sisters. They knew about my cancer from the start and they were very supportive of what I was going to do.

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?

When I found the lump, I went to see the doctor immediately. The doctor scheduled for lumpectomy early morning the next day. That morning, the doctor even picked me up from my house and we drove together to the hospital. He took out the lump. So there was no distress. The only time I felt distressed was when I was in the surgical gown lying on the cold trolley waiting to be wheeled into the operation theatre. I was upset about that. Apart from that I was alright. The decision-making of me going for alternative was definite. There was no distress in that.

To recollect, the only stressful period of my journey, was the six months after my lumpectomy. I was more worried about what I could eat and what I could not eat. That was more stressful than the surgery. This was the time when I have to learn how to clean “my system” – to detoxify, to eat “healthy food”, etc., etc. I have to learn by myself, what food was good for me and what food I had to avoid. I read books to learn all these. There was no one to guide me and I have to find and piece up all the information by myself. So, the most stressful thing I encountered was the FOOD because I knew I could not eat the food that I normally ate. If only there was a CA Care at the time, I am sure I would have not been that stressed out. Here, you have all the ready information that any cancer patient needs to know.

Apart from the food, what other things stressed you?

You see, I have to wake up in the morning, 5.30 or 6 a.m. to do the qi kung. I did this exercise regularly and religiously. That was alright. I went for my homeopathic treatment regularly. That too was OK. At night, I went for my meditation – three times per week. All these I did without any grudge and I was happy about them. So, there was no stress at all. Ah, the food part – that was the most stressful. But it only lasted for six months and then I was alright after that.

One more thing – people told me that the critical period for cancer patients was at three years after diagnosis – this period would determine if you make it or you die. And if you survive the third year, then there was another critical period at year five. If you survived the fifth year, then you are safe. I was counting the calendar. After I hit year three, I did not have any problem but as I was approaching year five, negative thoughts got into my head. I was very distressed. Fortunately during that period, I had a group of friends who helped me through. They told me: You can do it! So, I did not wallow with this wrong idea for too long. After a couple of days, I got over it.

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?

Yes, exactly.

In the process of coping with your problem, what was it that helped you most?

The most important thing was that I knew I was not alone in this journey even though at that time there was no CA Care – no place to go to for ready information, no support group, etc. Even then, I knew that I was not alone. I know that there was this Force helping me cope. I was also fortunate to have this group of friends in the office that nurtured a positive environment. This positive environment helped me a lot. Besides that, my work as insurance agent had taught me to be positive and how to solve problems positively. So, when I had my cancer, I solved it the way I was taught to handle the daily problems we often faced in our office work.

With my opening up to people, I started to attract like-minded people to come in to help me. I wouldn't deny that there were negative mind or influence but my mind was already made up, so I rejected the negative and accepted the positive. With that I began to discover more and more about myself, with the help of these like-minded people.

The social support that you received – can you group them into any specific groups, and to what extent each group had helped you?

There were three groups. First, the colleagues in my work place. Second, a small circle of personal friends, and third, my two sisters. These people, depending on where I was, helped me greatly.

Which group gave you the most help?

Oh, the colleagues in my work place. This was because I spent most of my time in the office. My colleagues provided me both emotional and physical support. They listened to my problems, they drove me to places that I needed to go, etc. In fact, I was never short of helpful people and I was never short of people with shoulders to cry on whenever I needed. In fact, I had such support not only from my colleagues but also my small circle of friends.

Did you have many friends whom you needed for your support?

I had two buddies who were always available for me. They helped me in many ways. I also have a friend who lived far way – my long-distance friend.

Did you derive similar benefits even if this person was so far way?

Oh yes. We talked over the phone and this relationship lasted for almost seven years now. We talked about anything. Even though this person is half a world away, by hearing his voice is enough to comfort me.

Did you find the people in the qi kung and meditation groups a great help emotionally?

Emotionally no, physically yes. I basically went there to learn how to do the exercise or meditate.

Let us go back to the days before you had cancer. What would you say about your belief in religion or your spiritual awareness?

Before I had cancer, I was a free thinker. I couldn't care less about religion. The questions about “why I am here” or “What is the purpose of my life here” never occurred to me. I was more interested to do my work, chasing after materialistic things. My perceptions of life before I had cancer and now, after I have cancer are totally different.

Oh, before you had cancer, what would be your reply if I say: Let's go and pray?

I would not dismiss that idea outright but I would say: Not necessary! I didn't feel the need to do that. There was no meaning in doing that. Perhaps, it was not time yet to think about such a thing.

Now that you have cancer, spiritually are you different now?

Yes. This cancer experience had awakened me. After I was diagnosed with cancer I began to wonder aloud: “There must be a purpose why I got this disease”.

Did you then searched for that purpose?

Yes, initially I tried to find the answer from the outside. I was a bit frustrated because I could not find the answer. Then, someone told me that the answer must come from right inside me. As I did my qi kung and meditation, I slowly found the answer to myself.

What was inside you that gave you this meaning?

The first thing that happened was I changed the priority of my life. I did less work and devoted more time to myself and took things as they came. Surprisingly, even if I worked less, my work productivity remained the same. As I started to love myself more, I started to grow spiritually. I opened up and felt the need to share and help others. There was this “warm” feeling after you did things not for materialistic rewards but for the sake of helping others.

Before that did you have such a feeling?

No. Before I had cancer, I was more interested to earn as much money as I could, etc., etc. But with meditation and qi kung and from the books that I read, I began to learn how to calm my mind and find peace within me. I realized that money is not all important in my life. So, after I found myself and “my truth”, I realized that when I talked to people, I felt I was a changed person and the people whom I interacted with me felt that change too.

I became more appreciative of things around me. Even small things attracted my attention. I now see things that I never noticed before. I now realize that a smile would bring more smiles back to me. I now “give” naturally. Previously, for what I gave, I expected something in return or reward of some sort. Now, my giving has become unconditional. That is the discovery I made after my cancer.

You have grown spiritually, but was this spirituality related to any religion?

No, I do not associate myself to any religion. I practised the Buddhist ways of life. But I did not go to temple, pray or take part in any religious ceremonies, etc.

Having gone through this cancer experience, would you say that you have found “meaning” in this cancer?

Oh, yes. Cancer has made me see another view about life. In fact, I would say that I was “blessed” to have this cancer.

Are you sure that it was a “blessing”? Or are you just saying this to make you feel “happy”?

I know it to be true. If I did not have cancer, I would have continued with life the way it was before I had cancer. And I do not think I would like myself. I don't think I would have made “fast” friends that I had acquired after my cancer. This cancer experience has opened up a new meaning about what life and friendship are all about. As such, I experienced a more meaningful and purposeful life. I don't deny that at times, I do feel stressed or depressed but these “bad” moments are not long enough to adversely affect me. This is because I know that I have within me the strength to cope with such problems and I know for sure that I have friends who will support me physically and emotionally. I know that I cannot overcome my problems alone, no matter how strong I am. But with the support of my close buddies, whether by picking up the phone or seeing them personally, I know I can go through life without problem.

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?

I definitely choose this present life with cancer rather than my life before I had cancer.

Why do you say this? Is it because you have been influenced by those people who wrote the many books that you read?

No, no. Admittedly, I have read books but I did not feel or experience what I read. I only read about it. But, right now I am telling you that I am experiencing what I have read. So that experience is my “truth”.

You experienced a life before cancer, and you are now living a life after cancer. And you think that you feel the difference?

Yes. Now, every day when I wake up in the morning, I feel blessed because I am still breathing. I am full of gratitude and am appreciative for everything that happens in life each day. This sense of gratitude is always there. In fact, I and my friends are going to start a project called the “gratitude tree”. We are going to make a tree without leaves. Then each day we are going to hang a leaf onto this tree. On this leaf we are going to write each blessing that we experience for the day. For example, thank you for the wonderful meal, thank you for the pretty dress that we wear, etc. etc. So with time we will have a tree full of leaves with many blessings.

As I have said, I am now more appreciative of things that happen now. Before, there is no such thing. All things that happened were taken for granted – and this went on all the days of the year. I am telling people now, I would rather live a short, meaningful and purposely life than a long life which is sickly and full of worries. I appreciate a simple life. Never mind if I have less money provided that I am comfortable and have my three simple meals each day. So to me, even if I have to “go” tomorrow, I am happy.

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?

No, I am not afraid to die. In fact, my friends and I used to joke about death. We often talk about dying. I even told my friends to play my favorite music during my wake.

Before you had cancer, would you dare to talk or joke like this?

No. I would be scared to do such a thing. Why should I die? I was earning so much money and I thought I would still have a long way to go yet. I used to dream that I would have a high position, run a big organization, bla, bla, bla. Now, all this materialistic things do count much anymore. Because of this awareness, my work ethics and attitude have also changed. The way I approach my clients is not the same as before any more. My concern is to explain to my clients the need to have adequate life coverage. They don't have to buy the life assurance policy from me, that's alright.

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?

You may wonder why I am still single and not married. Let me tell you my viewpoint from a single woman. To me what counts is a relationship. I have some very close friends and had established a very strong relationship with them. I know that I can count on them. At the same time I also let them know that they too can count on me, a cancer survivor. Whether you are married or not married, it all boils down to establishing a relationship. So, in whatever relationship you are in, make sure that you appreciate it and keep it intact.

Now, you are happy?

Yes, I am very contented with what is happening now. There is no such thing as a need to do things to leave a legacy for people to remember me when I pass on. I am contented that I have lived my life and I am happy that I don't intentionally hurt other people. As I have told you earlier, even if I have to “go” tomorrow, I am happy to accept it because what I am supposed to do in life, I have done it. What I do not do, I don't regret for not doing it.

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?

I would say: Thank you for coming into my life.

Would you really say that?

I have told you. It was a blessing. And it was because of this cancer that I am living this new way of life now.

Is that what you really want to say? You don't hate or regret having cancer?

I am not saying this because I am in front of a camera and you are videotaping me. No. Cancer has changed me. Without this cancer, I would not have been what I am today. Even if I don't survive 12 years let me say again, that cancer has changed my life. It has given me a new meaning about life and I am happy and satisfied with it.

So, as a summary what would you say are the things that you did that had helped you along this 12-year journey?

First, it was the early detection of the lump in my breast. This, I believe, was the most important thing. Then, my acceptance of the diagnosis followed immediately by action. I had this strong belief in what I was trying to do – that was to decline further medical treatments and opted for alternative therapy. I would do anything to heal myself but not mastectomy, chemotherapy or radiotherapy. If I have to die, I would like to die as an intact person, not to be mutilated or destroyed in anyway. Coupled with all these basic beliefs, I had strong support from my colleagues and friends whom I could rely on. All these resulted in me being a changed person with new views about life and living. I had grown very much spiritually and I am still on my journey.

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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.