Cancer, COVID-19, Black Lives Matter: The common thread
Like most of us, I have been transfixed by the social commentaries of the staggeringly higher death rates of black Americans from COVID-19 compared to the rest of the nation and the unhinged anti-racism civil unrest sweeping across their nation.
I was challenged to find a common thread. I found myself being pulled towards lessons learnt from the 20th and 21st centuries’ evolution of cancer care through an explosion of cooporation and altruism. This is how the former – current disproportions in America – bleed into the latter – our cancer issue. There is a magnitude of the support as more persons globally have the time and energy to pay attention to issues and do something about issues they have an interest in. And yet still, we have a much further way to go as we tackle the concerning reality that the Caribbean – with majority Afro-European ethnicity – has a higher cancer death rate compared to North American and European nations.
The Caribbean has a concerningly high cancer death rate and an increasing amounts of persons being newly diagnosed, despite the advances in knowledge of cancer and its management. For example, 60 per cent of cancers are preventable through lifestyle changes and the discovery of pre-cancerous curable states. One of the reasons for the Caribbean’s higher cancer death rate is that a lot of patients seek care when cancer symptoms are prolonged and the disease is advanced. This ‘delay’ in presenting for care emanates from fears of receiving detrimental news about one’s health. Next is the diagnosis of cancer that has been uniquely viewed over centuries as a vicious, debilitating, unpredictable and indestructible enemy with imminent threat to livelihood and life. Surveys in North America and Europe have cited cancer and Alzheimer’s disease as neck to neck being the most feared diseases.
Centuries ago when the disease was far less understood and incurable, cancer was viewed as originating from black bile or melancholia. This precise description embodied the biological nature of the disease and its depressing suffering. One of the earliest documentations on the experiences of cancer is found in an 1800s Russian-authored story, The Death of Ivan Iilyich. Here, we see the existential despair of a magistrate whose cancer diagnosis was hid from him by doctors and his suffering unacknowledged by his family. To reveal a cancer diagnosis to a patient was considered inhumane and cruel, as the patient would perceive it to be the equivalent of death and could cope better not knowing. He tried to reconcile the truth of his physical suffering supposedly as a result of a floating kidney and/or diseased appendix with his perhaps imprudent earlier life choices on morality. Like centuries before and centuries after (today), humans popularly subscribe to the philosophy that ‘if it’s not said then it’s not real’.
FEAR OF CANCER
Carcinophobia, or the fear of cancer, may be caused by a personal, traumatic cancer experience, watching someone endure the suffering of the disease, losing someone to it, or even hearing of an experience that shows the suffering. If we are all to be honest, this fear is real and ubiquitous. This fear leads to avoidance, deliberate ignorance, gross mental and physical unpreparedness, ill-informed decisions, and irrational behaviours. This fear lowers one’s chance of survival from missed opportunities for early detection and treatment. This fear worsens the progress of the disease. This fear undermines the quality of one’s survival, eating away at the dignity with which the best possible life may be maintained unto death. Cancer fear is systemic and systematic, and is only addressed through the evolving cohesion of Jamaica’s cancer care. Many are unaware of the intentionality of total cancer care in addressing the unique fears that accompany cancer.
“If you are unable to understand the cause of a problem, it is impossible to solve it.” – Naoto Kan
The multiple disciplines of cancer care happened, and continues to happen, through an evolution of human kindness in infirmed health systems throughout centuries past and to come. It did not all come together in any one place, at any one time. Today, we can appreciate the ‘luxuries’ of a formalised system of primary, secondary and tertiary standard of cancer care. Primary care harmoniously tackles the promotion of wellness, cancer-specific prevention, and early detection through the offerings of family physicians and nurse practitioners. Secondary and more specialised tertiary care tackle curative and palliative treatment through the offerings of medical and radiation oncologists, nurses in oncology, surgeons and radiotherapist. All synergised by the multilevel linkage of supportive care through the offerings of the aforementioned, physiotherapists, psychiatrists, social workers, dietitians, community palliative care teams, chaplaincy, and user involvement.
As we partake in the upsetting social commentaries of Black Lives Matter, let us remember like a crew experiencing difficultly at sea, all hands are needed on deck! The science is cancer and the art is care.
Dr Tamara Green is a family physician, committee member of International Psycho-Oncology Society and member of the Jamaica Cancer Society. Email feedback firstname.lastname@example.org; email@example.com.