When the patient distrusts the treatment.

Explaining why chemotherapy is indicated for their treatment to a newly diagnosed cancer patient is part of a day’s work for oncology nurses and physicians. Oncology nurse navigators are no exception—I am relied upon to reinforce patient education and answer questions.

While many patients come to us with the attitude “I’ll do whatever you say, let’s fight this cancer!” others present with a deep distrust of health care. Some of their distrust is justified, a result of corporate greed, Big Pharma, and federal regulations, coupled with misunderstandings of the treatment approval process of insurance companies. Depending on the intensity of these patient conversations, it sometimes feels as if we, the oncology team, are under attack, when it is our intent to help.

Despite good health habits, a cancer diagnosis.

Held / Julianna Paradisi / colored pencil and ink on watercolor paper 2018 – adapted from image author drew during cancer treatment

I was a pediatric intensive care nurse when I was diagnosed with breast cancer. My oncology experience was limited to monitoring young patients with a high risk of tumor lysis syndrome during induction of chemotherapy. The actual chemotherapy was administered by pediatric oncology–certified nurses who knew how to keep the patients safe.

I was previously healthy, a vegetarian since high school with good exercise habits; not perfect, but solid enough that a nurse colleague remarked, “I’m going to eat, drink, and be merry, because if you got cancer, no one is safe.”

Her statement was partially true: none of us are safe from a disease like cancer. However, good health habits in the face of a cancer diagnosis are beneficial. Good health is a checking account you can make withdrawals from, an aid to tolerating treatment side effects.

The holistic option.

Initially, I convinced myself the lump was fibrocystic. There is no history of breast cancer in my family, as is true for 80% to 85% of women diagnosed with the disease. I tried holistic treatment to diminish it. I gave up caffeine, chocolate, dairy. I became attuned to a level II in Reiki, practicing on myself every morning. In the evenings, I meditated. Antiinflammatory spices such as turmeric weren’t as popular as they are currently, but if I’d known about them they’d have been incorporated into my self-treatment plan too.

Three weeks later, the “lump” had grown on ultrasound and I submitted to biopsy. The lump was identified as a tumor, and I needed chemotherapy.

Resisting chemotherapy.

Many things have changed in breast cancer treatment since I was diagnosed nearly 20 years ago. Despite new staging guidelines, genomic testing, and treatment of some early-stage cancer with endocrine therapy alone, today chemotherapy is still indicated for the biology of the breast cancer I had.

I fought it, consulting with two different oncologists, hoping for an alternative. I submitted to treatment after the second oncologist spent over an hour explaining the tumor’s pathology to me. Knowing what I know today, I was lucky to find her.

Giving back.

Today, I also have lengthy conversations with patients who resist chemotherapy. It’s part of giving back with gratitude.

There’s a caveat, however. There was never a guarantee the chemotherapy I received was going to work. Even today, with targeted treatment, there are no guarantees. It behooves us, the oncology community, to humbly consider the requests of our patients seeking holistic treatment for their cancer. Not doing so is a subtle form of arrogance, and risks the patient fleeing from integrative care altogether to alternative therapies that can do harm.

A place for complementary therapies.

It’s a fine line to walk: keeping up with information about complementary medicine, teasing out the maybes from the definitely nots. Some medical oncologists fear supplements taken to nourish and strengthen the immune system and healthy cells during chemo may also feed the cancer cells. In fact, some herbal supplements are known to interact poorly with chemotherapy by weakening its efficacy or increasing its toxicities. Others deserve further investigation. Mostly, however, there’s a lot we just don’t know.

When a patient comes to me resisting the recommended cancer treatment, I remember my own fears in a similar situation. Sometimes it’s helpful to ask about their previous experiences with traditional health care.

The most important thing to remember is that we are not just treating their cancer; we are treating their spirit and emotional state as well. By respectfully honoring their beliefs and concerns, I hope to build a bridge of understanding. It doesn’t always work.

Honoring patients’ beliefs and priorities.

My greatest concern for patients forgoing traditional treatment is although chemotherapy comes with many side effects, and no guarantee of success, aggressive cancers can lead to metastatic disease, with potentially lethal results. However, if this is not the patient’s greatest concern, I have to honor their beliefs. In the end, it’s about making choices that provide the peace an individual needs to sleep at night. For me, this peace of mind came from knowing that if the cancer was going to kill me, I had at least done what I could to fight it. But this perspective does not provide peace of mind for everyone.

Lastly, my holistic-minded patients are a gift. A wise woman told me when I was going through cancer treatment, “This sounds weird, but there will come a time when you will miss this period of your life.”

What she referred to was the magical space I was living in. She was right. During recovery from surgery and chemotherapy, I worked light-duty, and fewer hours, away from my role as at the bedside in the PICU. Stepping back from the intensity of my usual nursing role created time for mindfulness, Reiki, answered prayers, and self-discovery. The illustration accompanying this post is an adaptation of an earlier image I “saw” while meditating and drew during cancer treatment. It was during treatment I decided to be a “real” artist, although in retrospect, I always have been.

More than just our bodies.

My holistic patients remind me of the importance and joy of meditation, prayer, and paying attention to my body’s needs, of savoring all of it. They make me wonder why I stopped practicing Reiki and consider that maybe I should return to it. They remind me there is more to this world than what we can touch, or view under a microscope—that we are more than just our bodies.

For this, I am grateful.