01.04.2011 Naturopathy

Living Well With Death

A cancer diagnosis can be the platform to launch us into a life of greater wellness, suggests Chandrika Gibson

Back in the 1970s a cancer diagnosis was considered an almost certain death sentence. In reality just under half of all adults diagnosed survived longer than five years.

These days survival rates are much higher. Treatments are more targeted, more effective and diagnosis tends to happen earlier, when tumours are smaller.

Now more than 75% of cancer patients survive at least five years beyond diagnosis. That means there are many more people walking around with cancer in their history than ever before. Nearly half of those survivors are under 65 years of age. So unless they are very wealthy or have some other support structure, most cancer survivors intend to return to work.

The unseen shadow side of cancer is not the surgical scarring, the fatigue of chemotherapy or the side effects of radiation; it is the impact it has on the rest of life, including relationships and career paths.

Outside of those experiencing cancer first hand or beside a loved one, we can easily believe that society takes care of people when they are sick. The image of cancer care in the community is of a well funded, well oiled system that has multiple avenues of support for a diverse range of sufferers.

It is true there are wonderful organisations, many not for profit, funded by philanthropists and community fundraising drives. But none of those support networks can help a long term cancer survivor remove the stigma of their health history in the eyes of employers or insurers.

The highest rate of survival is in the 40 - 54 year old age group who can expect to live almost as long as their peers who have never had cancer. It is an age group and phase in many people's lives where career consolidation occurs. Any lengthy gaps in a resume need to be explained, despite anti discrimination policies.

So what happens when two candidates apply for a job and one has a history of cancer?
Some employers might recognise that this person has experienced a life changing process and respect and admire the fortitude they have shown. But others will consider the economic bottom line and slide the resume to the bottom of the pile out of fear of recurrence of cancer, the expense of paid sick leave and the unspoken expectation that the cancer survivor may die prematurely.

It is not always necessary for cancer patients to leave their full time work, but it is very difficult without a supportive workplace to attend treatment while keeping up all work related duties. If there is not an agreement in place to secure the position, many cancer patients will opt to prioritise their health and wellbeing and voluntarily leave the job.

This shifting in priorities is sometimes experienced as a positive effect of a cancer diagnosis. The Cancer Council of WA reports that many survivors experience increased perception of well being and a greater work/life balance. They choose to focus on relationships, self care and cultivating an increasing level of gratitude for the small beauties of life. That may not gel with an outcome driven workplace atmosphere. There is no obvious financial reward for personal transformation and that can hurt.

Post cancer, some survivors become advocates or work as a support service provider for others with cancer. Others may pursue the interests they previously put on hold. But if they have a dream that requires funding, they may find yet again that cancer has changed their life. In a newly tightened up financial market, banks are loathe to lend money to people with cancer. Health insurance is hard to get or prohibitively expensive, as are life insurance and even travel insurance where an existing condition changes health status. That disadvantage continues even after long term survivorship indicates a very low probability of return of cancer cells.

If cancer happens earlier in life it can thereby affect the ability to buy a home, to see the world and to pursue higher education. Later on, it may necessitate selling or mortgaging property and the subsequent repayment of debts must rely on the income a survivor can generate.

While government policies and individual companies are finally beginning to treat pregnancy as a normal, healthy interruption to a career path, there are no such formalised plans for health crises. When more than a third of adults will face a cancer diagnosis at some point in their lives, this seems a glaring oversight.

Of the estimated 340,000 Australians living with a history of cancer, up to 84% will eventually rejoin the workforce. Yet when they do, they face both blatant and subtle discrimination from employers and colleagues.

The upside is that cancer survivors who take a wellness perspective, often feel grateful that the disease changed their life path.

Instead of striving for upward mobility, they instead take time to savour all of life's experiences. Maybe it is a blessing that they find some career avenues blocked - it may just be an impetus for a positive reshaping of their career, a stimulus for entrepreneurial endeavours. Certainly, most would not choose to fight for their rights in a law court; to have to battle a business for perceived discrimination is a waste of vitality better directed elsewhere. Creative solutions are a healthier option.

The deep effort required to face death and seek to understand it can unleash previously untapped aspects of the self. Whether a spiritual perspective had been developed before cancer, for many people, the reality of mortality brings existential questions to the fore. The possibility of losing all of one's attachments is usually scary. It confronts us with a sense of loss, injustice, fear or frustration. Yet we all know death is a part of life, we just do a great job ignoring it most of the time. Cancer removes the blinkers and places everything we value into a new perspective.

Our predominant culture and most of the medical profession seem to think prolonging life is a worthy goal. Maybe it is, but if we genuinely face up to the prospect of dying, it tends to lose much of its terror if not its mystery. Death can be seen as a continuation of having lived well. Dying is another transition time, like birth or adolescence, where parts of the self must be let go of in order to allow the new forces to express themselves. Professor John W. Travis in The Wellness Workbook points out that all the healthy choices we make cannot vaccinate us against death. There is no cure.

For those who have experienced the trial by fire of a cancer diagnosis and treatment and lived to tell the tale, the future has undoubtedly shifted to accommodate their new selves. The question for each of us is, how do we want to live? If facing our mortality directly or by empathising with others causes us to reflect on our deeper values, that is a movement towards greater wellness. No matter what the external circumstances life throws at us, despite the incredibly disruptive diseases we may suffer, we all have scope for a rich inner life.

Maybe it's true that the closed doors of certain career paths can help to clarify an alternative life path.

Hopefully, cancer serves to remind us all to seek our happiness in sustainable ways by investing in the relationships that will matter to us on our deathbed. That includes our relationship with ourselves, our loved ones, nature, life and the universe itself. There's no insurance policy better than having loved and been loved in return. There's no career that will matter more in the scheme of things than having done our life's work, with or without tangible rewards.

Chandrika Gibson

Chandrika Gibson ND is a holistic yoga teacher and naturopath