Dr. Buckman explains what you need to know about cancer

Dr. Buckman explains what you need to know about cancer

beingwell magazine Fall 2007
By: Leigh Beihl

Other than his own books, the first title Dr. Robert Buckman would recommend any cancer patient should read is The Hitchhiker's Guide to the Galaxy.

"Actually," he said, "you don't even have to read the whole book. What you need to know is right there on the front cover: Don't Panic. Once you've got that down, read the rest of the book because it's funny and will cheer you up."

He laughs before emphasizing patients still need to read his book because the information is innately more useful to their new situation; a hitchhiker's guide to cancer, if you will. Though somewhat less funny, with no Pan-Gallactic Gargle-Blasters, bi-cranial aliens or answers as simple as 42, Dr. Buckman liberally applies his dry British wit to the subject and is optimistic his book, Cancer is a Word, Not a Sentence, will still have a cheering effect on patients, most of whom need the assurance: Don't Panic.

An oncologist at the Princess Margaret Hospital, Dr. Buckman is more widely known as an author, speaker and for his television work: most especially the Gemini Award winning documentary series, Magic or Medicine.

"A diagnosis of cancer is shocking," said Dr. Buckman. "It may well be the most terrifying single word in the English language and most people hearing this word about themselves or about someone close to them ... it has a paralyzing effect on their brains: they don't think normally. They have questions but can't process answers."

Helen Smith would agree. Diagnosed with breast cancer in 2002, Ms Smith recalls being immediately disoriented.

"I can't remember the first conversation I had with my doctor. I can't remember a word after I heard the word cancer. I don't remember the prognosis or the options ... I just remember thinking that this couldn't be happening," she said. "None of it was real until I told my husband. Then, suddenly, it was too real."

"I wrote this book for the ride home from the doctor's office," said Dr. Buckman. "There will be plenty to deal with in the weeks or months ahead. This book helps you deal with those first hours. It helps you balance. It provides a big map of your new landscape with a big yellow you-are-here arrow."

And the landscape is not nearly as bleak as most would expect.

Researchers have made tremendous progress in prevention, screening, diagnosis and treatment, all of which are still progressing, so the prognosis for a growing number of cancer patients is better than hopeful. It's actually pretty good.

"It's very important to remember that cancer is actually more than 200 different diseases," said Dr. Buckman. "We group them together because of similar characteristics and behaviours, but they are not the same thing. That would be like saying a cold is the same as AIDS because they can both be described as infections.

"People recognize that a cold and AIDS present different risks, have different treatments and different probable outcomes — and it's very much the same with cancer. Your own cancer needs to be put in perspective."

To help put it in perspective, Dr. Buckman explains that cancer is best described as a process with three distinctive and characteristic stages.

All cancers are a mutation of our own body cells that grow in a manner defined as "disorderly and uncontrollable". It is not something foreign, such as an infection, brought into the body and which our body will naturally fight. Biologically, this gives cancer a bit of an edge in being able to develop without resistance or producing symptoms while it is in its earliest and most vulnerable stages.

Given that growth is the first step in the cancer process however, time is on the patient's side. It takes time for cancer to grow to the point where it becomes a danger; some grow so slowly they will never pose a threat to health in the span of a person's life, while other cancers reach that critical mass much sooner. But, with each division of its cells, cancer's chances of being detected grow with it.

"Cancer is not an emergency," said Dr. Buckman. "I think people become confused because testing — to determine exactly where and to what extent the cancer has developed — as well as treatment are undertaken with urgency and often while the patient is still reeling from hearing that word.

"There is this idea that, if you have cancer, you are going to die. And you're going to die next week," said Dr. Buckman. "That simply isn't the case.

"Very rarely do people just get cancer and die. Yes, they may die suddenly from an undiagnosed cancer — just as they may die suddenly from an unseen bus. But like the bus, the cancer didn't just suddenly appear and kill someone: It arrived on a predictable course and there are any number of interventions that could have been made at any number of stages that may have changed the outcome."

In fact, very likely would have. While the statistical rate of cancer incidence is on the rise, the relative rate of associated death is declining. Earlier diagnosis, greater treatment options, improved technologies and procedures — all are adding up to better prognosis for cancer patients.

More than half of the people diagnosed with cancer will overcome the disease and live, as Dr. Buckman credits one of his patients as saying, "long enough to die of something else."

"Realistically, people do die of cancer — that's just a fact," Dr. Buckman said. "But more people are living through cancer, they are living with cancer and, as soon as you are diagnosed with cancer, odds are in your favour that you will not die of cancer."

Ms Smith's cancer was detected in a routine self-examination: a lump in her breast less than a full centimetre across that her doctor later confirmed was cancerous.

The lump was surgically removed, followed by a chemo — therapy regime and a recovery period.

"It was such a relief to be done with it," said Ms Smith. "Emotionally, the process had been exhausting. I spent so much time worrying about what was going to happen not just to me, but to my daughters.

"Happy is not quite the right word: knowing what I had been through, knowing what this disease did to me and to my family ... knowing that it could have been worse ... there was always this underlying anxiety. Even as the follow up tests were coming back clear, the relief was just a reprieve until the next round of tests."

In October 2005, the reprieve ended.

A lump, almost identical to the one found earlier, appeared in her other breast.

The ability to move to other areas is one of the defining behaviours of cancer, and is its most threatening characteristic as a change to the affected area may also change the prognosis. Even an aggressive cancer can be considered treatable if it remains in only one area. The same cancer occurring elsewhere may present a much different scenario.

With breast cancer, the second breast as well as the lymph nodes present the most likely opportunities for the cancer to spread. Once a cancer is able to move into nearby parts of the body, it may then move to parts of the body distant from the original occurrence, undermining treatment opportunities.

"Where I was very emotional and overwhelmed with the first diagnosis, the second made me angry," said Ms Smith. "I think I was too overwhelmed the first time to consider more than how to cope with this; how to get myself and my family through this.

"When I was diagnosed the second time, I couldn't accept that it was just bad luck."

In instances of breast cancer, the return of the original cancer in either the original site or nearby area after treatment is relatively rare, with only about a 15 per cent reoccurrence rate. But the prognosis for that small group of women is rarely good.

What shocked and relieved Ms Smith's oncologist was that the cancer in the second breast was not a reoccurrence at all. It was an entirely new cancer.

"One of the frightening things about cancer is how random it can be," said Dr. Buckman. "It really doesn't make sense to us that it can just happen."

But the fact is most instances occur without a known causal influence. It just happens.

For Ms Smith, the diagnosis made it hard to tell the good news from the bad news — but underlying both was the fact this could not possibly be random: there had to be a causal influence. And, since breast cancer is one that has known genetic predicators, a new avenue of possibilities — and testing — opened up with a view to not only protecting Ms Smith, but her three daughters as well.

With no family history of cancer, a grandmother that lived to 92 and a mother and aunts all living well into their senior years, the genetic link was not obvious. Still, Ms Smith was tested for the BRCA1 and BRCA2 genes, a component involved in the repair of chromosome damage that, if damaged itself, makes the growth of tumours possible.

Not all tumours are related to these genes, however, if these genes are deficient a person's chances of developing cancer are greatly increased.

"This made sense," said Ms Smith. "This was frightening but it made all of this something I could understand and deal with."

Having completed treatment for her second cancer diagnosis, Ms Smith intends to have a bi-lateral mastectomy to prevent any further cancers from developing.

"Just being free of the anxiety makes this worthwhile," she said.

Anxiety, guilt, sadness and anger: there are a lot of mental and emotional implications involved in receiving a cancer diagnosis.

Dr. Mark Katz is a psychiatrist at Southlake who specializes in treating patients with cancer and he says depression is the most common emotional or psychiatric condition experienced by those with cancer.

"And chronic depression may affect the patient's ability to recover," he said.

"There is some evidence to suggest depression may alter immune function in a negative way, contributing to worse health outcomes. We hope, but don’t yet have the scientific evidence to support the idea, that treating depression will help in patients’ physical recovery. Treating clinical depression certainly helps quality of life and allows patients to cope with their illness better."

Dr Buckman agrees; while there is value to maintaining an up-beat attitude, the patient should not feel that he will suffer for not doing so.

"Our brains are wired to accept cause and effect," he explains. "We have a hard time time accepting something like cancer could just happen. We have a terrible need to know how this happened, why this happened — what we did to deserve this.

"Most cancer patients — more wrongly than rightly — already have feelings of guilt associated with their diagnosis."

Guilt is not the only emotion related to patient depression, however.

"The most prominent cause for depression is the patient's change in role function," said Dr. Katz. "They can become less independent, they can't perform usual duties at work or at home, they can't pursue their interests: this can be a profound disruption in how people perceive themselves.

"Cancer also undermines a sense of safety about the future as patients deal with the uncertainty around whether it will come back."

And patients aren't the only ones to feel the psychological pressure of illness.

"My daughter was eight-years-old and she told me I was going to die," said Ms Smith. "She said, you won't live to see me graduate — you won't live if you have cancer."

Because of this, Dr. Buckman's book also addresses issues that relate to those closest to the patient and the new regional cancer program at Southlake will offer an expanded psychological and social component to support these needs.

"I'm anxious to see the regional cancer program come to fruition," said Dr. Katz whose own role with the program will become more concentrated on the specific psychiatric needs of cancer patients including counselling services, medication management, stress management and support groups.

Dr. Buckman says holistic therapies too can have a place in a treatment plan.

"I think the most important consideration is what the patient expects," said Dr. Buckman. "If they are expecting treatment that will have the same or better results than they will find in conventional medicine, they will be disappointed — potentially crushed.

"Approached as a complement to conventional treatment , however, many do offer a benefit to the patient. Most alternative treatments, for example, encourage relaxation and meditation — and patients do need to relax and clear their mind. These practitioners also have more time to spend one-on-one with their clients than the average oncologist in a busy cancer centre  — having that time and attention helps the patient feel he is being cared for: there's a very human element to that. There is also a greater sense for the patient that they are involved in their treatment, it doesn't just happen to them."

Still, Dr. Buckman cautions patients away from any practitioner of any therapy who makes unreasonable claims. "If it sounds too good to be true, it is."

And he would know. With more than 30 years as a cancer physician, Dr. Buckman's Magic or Medicine television series investigated every known therapy and every claimed cure — not one of which offered a measurable benefit significantly greater than improving the patient's sense of optimism about their health. A good thing, certainly, but no replacement for conventional, evidence-based treatment especially when dealing with serious illness.

"I love what I'm doing,"said Dr. Buckman. "I love my work. I think of it rather like being a firefighter."

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