The CT scan showed that her already incurable cancer had worsened. I walked into the examination room dreading what I might find. Despite the scan results, she smiled, stood up and grasped my hand in both of hers. I expected to see a woman in suffering; instead, here was a person glowing with contentment.
Don’t all patients with advanced cancer suffer? Is her situation unique? An article in the Journal of Clinical Oncology [JCO 2007 (May 1); 25:1691-97] reports a study of nearly 400 relatively functional people with advanced, incurable cancers. These people had been referred for hospice care and were not expected to live more than a few months. The study found that:
- Half of the patients reported no suffering whatsoever, and one-quarter reported either minimal or mild suffering. One-tenth, however, reported severe or extreme suffering.
- Greater suffering was associated with depression and anxiety.
- Suffering was most closely associated with malaise, a sense of illness, weakness, and pain.
- Suffering was more closely associated with physical symptoms than either psychological or existential concerns
- A few of these terminally ill individuals worried about their own deaths, however, they were far more concerned about pain, stress, loss of function and control, and dependence on others.
I learned that my stereotypes of what "dying people" were supposed to feel and experience was wrong. As caregivers, we are charged with relieving pain and suffering when they occur, but we also provide support and a continuing presence when needed.
As frequently happens, my patient was also my teacher that day.
