The statistics on cancer do not make for pleasant reading, but if we are to take a cool and objective look at this disease, we had better confront them. Cancer intrudes on many individual lives and has a major impact on the national life of many countries. One in three people will develop a cancer and about one in four will die of cancer. These statistics must be viewed against the fact that we can successfully treat and have almost eliminated a number of other diseases. Life expectancy has increased in the richer parts of the world. This will lead to more cancer cases because the disease is commoner in older people. The human and economic cost of the incidence of cancer is enormous and defies accurate assessment. A vast range of cancer treatment services, from surgery to terminal care, are provided by the health-care systems of developed countries. Sometimes these treatments produce cures and sometimes they fail. They are always expensive. A recent conservative estimate by the government of the cost of hospital care for cancer in the United Kingdom was ?2 billion each year. The cost in terms of the suffering for patients and their families cannot be gauged. Over ?100 million is spent annually on cancer research in the United Kingdom, mainly from charitable donations, and large sums are spent by government and international agencies throughout the world on registering, studying and analysing the information about cancer patients.
Above and beyond these daunting statistics lies the very special fear that cancer generates in people's minds. Even though expert modern cancer care can sometimes cure and almost always control the major symptoms of the disease, many people stiff fear cancer more than the other common serious and life-threatening diseases of our times. They see it as an especially 'sneaky' disease, often lurking unrecognized and symptomless until discovered by accident. They may view cancer with despair as 'the enemy within' - an uninvited attack by die body on itself. They use euphemisms like 'the big C' as if uttering the very word 'cancer' will render them vulnerable. Misplaced fears of acquiring cancer by contact with cancer patients still persist and it is not unknown for cancer patients to feel lonely, guilty or inadequate (emotions which are not usually associated with other common diseases).
Health-care professionals themselves are not immune from emotional responses to this disease. For doctors, cancer generates a number of challenges. Some of the surgeon's largest and most complex operations will be carried out on cancer patients. For the physician, cancer presents some of the most difficult diagnoses and testing questions about appropriate treatment. Experts in diagnostic procedures in the laboratory or in the reading of diagnostic X-rays and scans are faced with the challenge of detecting a cancer when it is early and treatable. It is hardly surprising that cancer care can generate the most tremendous satisfaction for the doctor who is successful in curing or controlling the disease. Nor should it surprise anyone that the most dismal sensations of frustration and failure are sometimes felt by doctors when they confront the results of cancer care. The care of cancer patients may present particular challenges to nurses too, placing heavy demands upon their dedication. Those who manage health care are under constant pressure to find more resources for cancer treatment and care against competing demands on their limited budgets. The very success of modern medical science in understanding, curing or eliminating other diseases which were once viewed with horror raises the emotional stakes for those involved in cancer research and therapy.
Cancer is 'news'. Unfortunately, the news is often presented with morbid glamour. It can give an impression of cancer as some kind of scourge which has been visited upon us or which we have brought on ourselves. New cancer hazards are presented to us at every turn - in our choice of food, in the nature of our occupations, in the location of our homes, in our technological advances and in the simple act of drinking water from a tap - and we may be left feeling guilty, bewildered or helpless.
Early diagnosis by screening is a very topical subject, but the success of screening remains restricted to a few types of cancer at present. Cancer treatment by surgery, radiotherapy, chemotherapy and, more recently, biological therapy is having an impact and great improvements in outlook have been achieved with some cancers over the last two decades. Great strides are being made in the biological sciences and we need to consider whether these are likely to generate major advances in cancer treatment in the near future.
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Cancer
