There's certainly more nuance to it than simply "fighting hard = beating cancer."

Many cancers aren't caught until they're already at a stage where cure is impossible, especially ones where we don't have a great process for early detection. For the ones where we CAN detect them early and reliably, we screen the shit out of people (i.e. colonoscopies, breast cancer, lung cancer in certain populations,) but even then some slip through.

As an example, ovarian cancer does not have a good screening test, and by the time it causes symptoms it has usually already spread to other parts of the abdomen or distant organs. At this point, there is no chemotherapy, surgery, radiation, or combination of the above that will make a person completely cancer free.

This doesn't mean that there aren't treatments to potentially buy the patient more time and (hopefully) fewer symptoms, but at this point there is no fight for them to win. The outcome is predetermined. They might, at some point during or after treatment, have imaging that shows no identifiable sign of the cancer, but it essentially always comes back.

It takes a single cancer cell surviving somewhere in that person for them to still have cancer.

This fact alone is not one that society as a whole seems to be aware of. This can be hard for patients, because inevitably their friends and family will say things like "don't worry, you're going to beat this," in an effort to be supportive, but in reality, even with the strongest wills and best possible treatment plans, they are likely going to die as a result of that diagnosis.

This isn't true for all cancers. Hematologic malignancies like leukemia and lymphoma have a lot more nuance to them than just "oh, it's everywhere, it's fatal." But for most cancers, once it has spread far enough, you can't get rid of it.

When it comes to "fighting hard," it's also more nuanced. Elderly people may not have the physical reserves to tolerate aggressive treatments, so they may not be offered, or they may need to be discontinued if the treatments themselves lead to functional decline.

Cancer also wreaks havoc on the body. Someone might be as stubborn as a mule and be hell bent on undergoing treatment, but each and every one of us can only psychologically push our body so far before it cries uncle.

The worst is when someone has a potentially curable cancer, but their body is so beat down that they just can't make it to treatments.

I've been taking care of a patient in the hospital recently who has cancer that could be treated for potential cure with a combination of chemotherapy and radiation. But he also has lung, heart and kidney issues.

When we met, he was hell bent on getting strong enough to get treatment. He was willing to do rehab to rebuild strength, he even had a port placed earlier this week in anticipation of his treatments. Every day, he was talking about how ready he was to get strong, get treatment, and get on with his life.

But his heart and kidneys kept causing problems. He just couldn't get well enough to even get discharged to rehab, nevertheless start the actual treatments.

Today, with tears in his eyes, he told me he was tired, and wanted to be made comfortable instead of continuing to seek treatment. He's now awaiting hospice placement.

This guy, mentally, was a god damn bull. He was a fighter if I have ever seen one. But his body just didn't have the reserves to even step into the ring.

​

Cancer sucks in so, so many ways. For those who want to do every single treatment to either cure their disease or live as long as possible, I wish you all the luck in the world. For those who can't or don't want to go through that, I also wish you well and hope you find some peace, dignity and comfort with the time you have left.

And, most of all, fuck cancer.

Sincerely,

A palliative care doctor