The news that Sen. John McCain was diagnosed with brain cancer has been greeted with a deserved bipartisan outpouring of sympathy. But in their efforts to honor the legacy and fighting spirit of an American hero, many well-wishers are reacting in a way that is counterproductive and unhelpful to those faced with a horrible disease.
In an effort to be gracious to his 2008 opponent, former President Barack Obama tweeted, "John McCain is an American hero & one of the bravest fighters I've ever known. Cancer doesn't know what it's up against. Give it hell, John." President Trump, who once infamously criticized McCain for getting captured, also released a statement describing the long-time senator as a "fighter." Similar sentiments proliferated social media after the sad news broke. "John McCain has a brain tumor and based on his history of fighting like hell, I almost feel bad for the brain tumor," one Twitter user wrote, encouragingly.
Now, at the outset, it's worth remembering in detail why McCain's reputation as a fighter is well-deserved. As a pilot during Vietnam, his airplane was struck by a missile, and he was forced to eject, which resulted in him breaking his leg and both arms and rendering him unconscious before landing in a lake. After regaining consciousness, he nearly drowned as he was weighed down by all his gear, but he was able to reach the surface by hopping on one leg, and he somehow managed to inflate his life vest. Upon washing on shore, he was beaten. Only after that ordeal did he begin five and a half years in North Vietnamese captivity, during which time he was tortured and subjected to solitary confinement. As the son of a prominent naval officer, he was offered release several times, but in keeping with the code of conduct and not wanting to be used for enemy propaganda, he refused. After he was finally let out, he went through excruciatingly painful physical therapy just to be able to fly an airplane again. All of this is remarkable and heroic, but none of it has anything to do with his current medical odds.
Many cancer patients and patient advocates have written against the "warrior" rhetoric associated with the disease. Employing such rhetoric can make those dealing with cancer feel they are failing and letting people down during especially hard times. It can make terminally ill patients feel that they are weak, or giving up, by deciding to choose palliative care options without undergoing another series of painful treatments that could only marginally prolong their lives. And it also contains the unintended but pernicious implication that those who don't live as long simply didn't fight hard enough.
A member of my extended family died with glioblastoma four Julys ago. He was a man who was born in a Stalin-era gulag, where he spent his early childhood. A victim of anti-Semitism, he fled the Soviet Union for Israel with his mom as a teenager and served as a soldier during the Yom Kippur War. He eventually immigrated to the United States, where he built a family. Possessing a rare combination of grit and cheerfulness, his formative experiences made him unflappable during events in life that others would have considered crises. When diagnosed, he took it in stride and tried every treatment available to him — surgery, chemotherapy, radiation, clinical trials — and he even dabbled in homeopathy. At every step, his loving and supportive family was at his side. But he passed away 20 months after his diagnosis. And it wasn't because he was less courageous, or had any less fight in him, or had a worse attitude, than somebody with the disease who might have hung on for a few more years.
Lancaster University professor Elena Semino, author of one psychological study on the effects of war metaphors on cancer patients, said of her research, "Blame is being put on the patient, and there's almost a sense that, if you are dying, you must have given up and not have fought hard enough."
Writing about her cancer in the Guardian in 2014, Kate Granger explained, "I do not want to feel a failure about something beyond my control. I refuse to believe my death will be because I didn't battle hard enough."
Jenn McRobbie, an author who had dealt with breast cancer, was quoted in Prevention as saying, "We're called 'fighters,' 'warriors,' and we're told to 'win the battle.' This imagery may help some people feel more in control of their experience, but it can also make you feel like you're doing it all wrong if you're having a bad day."
Due to people's natural discomfort with anything involving mortality, people who haven't experienced cancer up close tend to gloss over the details. Such details include the fact that, even in the best of cases, cancer remission is not a cure in the way most people conceive of it; cancer cells almost always remain in the body. Beyond this, not all cancers lend themselves to the best case scenario. Because people hear about those who receive treatment and go on living for many years, they may not be aware of the vast variety among different types of cancers and the similarly large variation in relative survival rates.
Glioblastoma, with which McCain has been diagnosed, is sadly among the most aggressive, vicious, and unrelenting forms of cancer. The median survival time from diagnosis is 15 months, according to the American Brain Tumor Association, and just 30 percent of patients survive more than two years. Available treatments are limited, compared to many other types of cancer.
The survival time for glioblastoma patients depends on many factors. Age may have an effect at the margins, but there are other, more important factors. Even if a glioblastoma tumor is removed, it's hard to get all of its tentacles, so remaining cells can spread rapidly, and to portions of the brain that are not operable. Glioblastoma tumors have many different types of cells that may respond differently to different treatments, so multiple approaches are typically necessary. A number of treatment options are available only to patients whose tumors have a specific genetic makeup.
Patients who have exhausted conventional treatments may start looking for clinical trials only to find out that they are not eligible for many of them because they previously took medication that could interfere with what medical researchers are trying to test. While there may be benefits to patients trying to stay hopeful and keep their spirits up, personal bravery isn't going to affect outcomes, and it's detrimental to suggest that it can.
This isn't to say that people shouldn't honor the legacy of McCain or offer well wishes or prayers for him and his family in the tough period ahead. But they should also try to avoid the suggestion that his demonstrated toughness has any bearing on how this disease will affect his body.