The vernacular surrounding a diagnosis of cancer is intense: We speak of fighting the disease. Those who endure treatment are survivors and warriors. We battle against it and, ultimately, we dream of a world where cancer is eradicated.
I’m a proponent of the concept of a war on cancer. I know we need to be aggressive in order to have any success in beating this disease. I’m happy to be a part of the frontline of defense and I toil hard to treat patients and provide them with longer and happier lives. Yet, there’s one term related to cancer that’s guaranteed to fracture my assertive exterior and cause me to stumble in my dialogue with owners. The word is cure.
Owners will ask me what the cure rate for a particular tumor is, or if their pet will ever be cured, or when and how I will know their beloved companion is cured. When the topic comes up, I always feel somewhat anxious and unsettled. The irony isn’t lost on me: How can the one word that embodies the very thing I wish for my patients simultaneously instill such intense insecurity within my soul?
To answer candidly, it comes down to the pressure imparted by the accurate meaning of the word cure that’s the most overwhelming. "Cure" implies the disease was eradicated from the body and will never return. To me, stating that a patient is cured from cancer is akin to offering an impossible guarantee of future health.
I’m not being negative and I’m not trying to perpetuate the pervading sense of hopelessness surrounding a diagnosis of cancer. Believe me, I’m there fighting just as hard as the next doctor. But if I treat a patient and find their cancer is in remission, it’s extremely difficult to say if or how long the remission will last. Remission simply means I’m unable to detect the disease using conventional diagnostic tests. It doesn’t guarantee eradication of every last tumor cell and it doesn’t equal a cure.
I'm not alone when it comes to my careful word choice in relation to my patients. Human oncologists speak more frequently in terms of 5, 10, and 20 year survival rates rather than label people as cured. Though I appreciate how frustrating it would be to hear a physician say “You have a greater than 80% chance of living 20 years from your diagnosis” instead of “you’re cured,” I also know what it feels like to face someone who desperately wants to hear me say their pet is cured and know deep down I can’t reliably mean it. It’s not because I’m afraid of being wrong. It’s because I’m afraid of not being honest.
I would urge pet owners to be wary when they hear phrases such as “We got it all” or “There’s no evidence of spread” or “We caught it early.” Though they may be exactly what you are so desperately hoping to hear, these “cancer colloquialisms” are likely inaccurate representations of your pet’s health.
The only way we can say a patient is cured from cancer is for them to pass away from an unrelated cause with their cancer being completely undetectable at the time of their death. Many owners are surprised at my candor when I tell them this is my definition of cure, but I would rather be authentic and considered forthright than to give an owner a false sense of optimism.
This doesn’t mean we should lose sight of the most important term related to a diagnosis of cancer: Hope.
If we didn’t have hope, we would lose our motivation to attempt to treat patients.
If we didn't have hope, we would not have the motivation to battle this disease.
And most importantly, if we didn’t have hope, we would never even have the ability to envision the concept of a cure.
I hope one day the word cure no longer instills a sense of apprehension within me and I’m able to utter it with confidence and candor. Until then, I’ll keep fighting the battle along with the remarkably brave four legged warriors I have the privilege to meet.
Dr. Joanne Intile