Health·Analysis

Cancer sends shockwaves far beyond the patient: Nikhil Joshi

Families and friends caring for cancer patients are often forgotten, but they require a form of support themselves, writes Dr. Nikhil Joshi.

Rob Ford's cancer is the focus of news reports, but society must be mindful of what families endure

Toronto Mayor Rob Ford has been diagnosed with a rare and aggressive type of malignant tumour, but doctors are optimistic about treating it, according to the head of his medical team. (Darren Calabrese/Reuters)

Patients aren't the only ones who suffer when there's a cancer diagnosis.

There has been a great deal of media attention on Mayor Ford and his diagnosis, and what he is going through as a result. But beyond musings about how his brother Doug Ford has introduced some interesting dynamics by entering what may be the most widely reported mayoral race in Canadian history, there hasn’t been much insight into how the diagnosis has affected his family.

I think of a cancer diagnosis as being sort of like a nuclear bomb.

There’s the person at the epicentre - that’s the patient. They endure a special sort of suffering that involves a physical, mental and emotional component.

Doug Ford stepped in to run for mayor after his brother, Toronto Mayor Rob Ford, exited the race as a result of a cancer diagnosis. But beyond the campaign changes, there hasn't been much insight into how the diagnosis has affected the family. (Chris Young/Canadian Press)

The people on the periphery of the blast, though - they are caught too. And in many ways loving or being close to a person who is suffering is in itself harder emotionally and psychologically than the burden on the person battling the cancer. Would you rather watch someone you love suffer or suffer yourself? How many parents watch their children struggle with leukemia and think 'Why couldn’t it have been me?'

Watching Doug Ford attempt to work while awaiting his brothers’ diagnosis reminded me of my own brother who was finishing his fellowship in cardiology when I was diagnosed with Hodgkin’s Lymphoma.

I remember telling him and hearing his voice break on the phone: “…these things, they aren’t supposed to happen,” he said despondently.

It never occurred to me, before watching Doug attempt to fill the shoes of Mayor Ford, how difficult it must have been for my own brother - and for so many family members of people with cancer.

Their diagnosis is constantly on your mind. Every cough. Every blood test. Every word from a physician. Families are hungry for information, sometimes even more hungry than the patient because they are struggling with the crushing weight of helplessness.

As physicians, we’re working towards seeing families as the unit of care in medicine, rather than putting the focus solely on the patient - but it isn’t easy. Your immediate concern as a provider will always be the patient, and should always be because their care is medically complex and can change in a moment. However, we can’t forget those around them who are also very much a part of the battle against a serious illness.

The physical, mental and economic toll of looking after someone who is sick is a hidden cost to our society that doesn’t always come out in dollars and cents.

A close friend of mine, Dr. Q, is studying to be a general surgeon. When he learned about my diagnosis he was devastated, but wasn’t allowed time to come and visit. Even though he was in medicine, having a friend with cancer didn’t count as a reason to be able to leave work.

And perhaps that’s reasonable from an employer's point of view - what do I know? But after everything we had gone through together in our lives, it seemed strange to both of us that people could callously discount his need to be there for me.

Having it become generally accepted – and expected – that society support those who fill in that caregiver role through things like flexible working hours and specific leave, seems a reasonable idea to me.

It occurred to me that this regularly happens in Canada today. It's rare to be given time off to look after a loved one with cancer, or flex time to help people get to appointments. For those with children, a parent can't just put the rest of the family on hold when they're coming to grips with a spouse or child's serious illness.

Caring for someone who could be killed by something as relatively trivial as a cold during treatment is frankly exhausting, and in the course of any cancer there are multiple scans, blood tests and other procedures required. All of these things take a great deal of time, energy and vigilance on the part of those supporting a cancer patient.

Furthermore, patients in the throes of chemotherapy or radiation are often too ill to be able to do many things for themselves, especially during the later cycles.

Recognizing this and having it become generally accepted – and expected – that society support those who fill in that caregiver role through things like flexible working hours and specific leave, seems a reasonable idea to me. 

Perhaps putting more supports in place for patients' families would lead to abuse, but it seems that this attitude arises from a lack of awareness of how cancer affects more than just the patient.

That emotional shockwave from the nuclear blast of a cancer diagnosis can be devastating, but a bit of kindness and compassion - both for the patient and their loved ones – is an effective shield.

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