Overall societal change: families and cancer
Because
our society, as well as most other societies is family oriented, the impact of
a family member getting, being treated for, or dying from cancer affects not
only the immediate family, but also others such as co-workers, friends,
healthcare workers, and a list of other people and organizations seemingly
unrelated to cancer. In other
words society in general. Cancer
is a pervasive type of disease that can affect anyone at any time and its
occurrence can cause a “ripple effect” throughout society. When an individual gets cancer he or
she becomes the focus of attention, but may not actually be the specific person
who initiates social/medical changes mentioned in this report. Often, because of the plight of the
patient, family members, friends, physicians, and nurses are the ones who begin
to institute new practices and approaches to cancer in response to the
patient’s condition.
For instance, one
example of this initiation of change by others is the effort to develop cancer
treatments that are less painful and or stressful to the patient by physicians
and scientist. Immunotherapy is
such a treatment because in its purest form it does not require the use of
chemotherapy to combat the cancer.
Since it makes use of the cancer patient’s own immune system, the side
effects of such treatment are minimal.
In the future, it is quite possible that treatments such as these may
allow the patient to lead a normal life while being treated (Alexander
2011). Without having to think too
hard about how the development of such a treatment could be given high priority
one only has to think of the fact that almost everyone involved in the
decision-making process of immunotherapy’s development has or has had a family
member treated for cancer with chemotherapy and they have watched them suffer
from its toxic side effects. This
is also a demonstration of the “ripple effect” caused by cancer in our
society. The family unit and the
members in it are conduits, which funnel emotional responses and in many cases
policy and practice-changing ideas out to the larger society.
Often
when the words “family unit” are used the concept that comes to mind is the
traditional family: consist of a mother, father, and siblings. However, most of the family units in
our society and others are of the non-traditional type. The 2000 US Census Bureau figures
reveal that less than 14% of American households are of the traditional type
(US Census Bureau 2005). The other
households consist of a complex arrangement of individuals consisting of a
sustainable family unit. With this
complexity comes a complex response to one member being diagnosed with
cancer.
Even with
traditional families, the response varies depending upon which member (mother,
father, or sibling) contract the disease.
Each situation brings with it various types of responsibilities and
stress in response to the stricken family member. For instance, breast cancer in a traditional family is very
stressful for the other members and can result in long-lasting emotional problems
within the family. Since it can be
inherited through the discovery of the BRCA gene, there can be guilt associated
with its discovery in a mother.
With prostate cancer, issues of sexual performance and incontinence put
a strain on a married couple’s relationship. Problems such as these also occur in non-traditional
families and result in a significant amount of emotional turmoil. Addressing this emotional turmoil is
one of the major changes society has gone through in recent years and will
continue to be an area of increasing importance as far as cancer is concerned.
As
mentioned in the Individual who gets
Cancer section, how cancer patients deal with stress in some respects is as
important as the anti-cancer therapy that they receive for the disease. Excessive stress lowers the body’s
ability to not only fight the cancer, but also heal from the deleterious
effects of chemotherapy. In
addition to these effects associated with having cancer, caregivers (husbands,
wives, same-sex partners, or friends) undergo tremendous stress dealing with
the day-to-day events surrounding their loved one with cancer.
Psychological
intervention methods (psychotherapy) methods such as mentioned in the previous
section are available for both cancer patients and their family members. However, many non-traditional family
members such as same-sex partners face discrimination when participating in
such programs that are usually tailored to patients or family members of
traditional family units. In many
cases these programs are vital to either the patient, who is undergoing cancer
treatment and needs to deal with the stress associated with it, or a partner
who needs the feeling that they are not alone in their struggle to cope with a
loved one who has this disease.
Another
area of change that has taken place because of the advanced technology involved
with cancer treatment and the resuscitation of patients near death is the do
not resuscitate (DNR) option. In
many cases a family member(s) is asked (when the patient is incapable of making
the decision) to sign a document (DNR form) that would allow the physician to
end further treatment and care when a crisis occurs and the patient is near
death. There are two factors that
have impacted this aspect of cancer treatment and care.
First
there is the technology. A person
can now be kept alive using advanced technology that allows a persons body to
exist in a coma-like state for extended periods of time. During that time it is possible (in a
minority of cases) that the patient not only survives the cancer, but also
heals their body during the coma state.
Thirty years ago this technology was unavailable and when a patient went
into crisis they died. However,
today the physician must consult either the patient or a family member and make
them aware of the situation at which point the DNR form may come under
consideration.
This is a complex
issue because there is a shred of hope that the resuscitation and further
treatment for the disease may actually free the person of cancer. Then there is the suffering involved
with the treatment and many patients opt to sign the form to not only alleviate
their own suffering, but the suffering of loved ones who must witness the pain
and anguish of continued treatments.
There are also ethical issues involved when the patient can not make the
decision themselves because unfortunately in some cases it is in the best
interest of the family member to allow the patient to die because they would be
the beneficiary of the patient’s estate.
All of these issues were never dealt with before in society and the hope
is that many of these cases are resolved properly, ethically, and in the best
interest of the patient and their family members.
The next area of
social change as far as families and cancer is concerned is the “cost” of
cancer. There are two types, which
are emotional and financial. Both of
these areas leave long-lasting effects and can literally change the course of
events in many people’s lives. The
emotional effects of cancer have been discussed at length in both of these
sections, but what hasn’t been thoroughly discussed (except in this section)
are the repercussions (“cost”) associated with those emotional aspects of the
disease. For instance with couples
and cancer, many times intimacy (emotional or sexual) is negatively affected
because often one partner withdraws from the relationship during a critical
phase of the cancer treatment.
This may cause resentment by the cancer patient. This resentment may never go away even
though the cancer has gone.
Situations like
this can lead to a break-up many years later and the fact is that neither
partner may realize that it began during cancer treatment. Cancer treatment itself can alter the
psychological wellbeing of an individual in ways that are just now being
understood. It has been
found that survivors of childhood leukemia are often found to have maturity
problems because often when any trauma occurs in youth a part of the adult is
“stuck” there. What happens as
they become adults is that their minds often drift back to that time of trauma
(cancer treatment), but unknown to them is the fact that they are
re-experiencing the emotional state of say, a 12-year old, which was their age
when they were treated and cured of their disease.
This condition can
cause severe emotional problems for some adult cancer survivors, but with the
help of psychological counseling the problem can be identified and the person
can recover. These are just two of
many long-term psychological effects of cancer. Not long ago, conditions such as this went unrecognized,
which resulted in continual suffering from a disease that had been cured.
The
financial cost of cancer in many cases, but not all, are obvious due to the
fact that even with insurance cancer is an expensive disease to treat. It can be observed that in many cases when
families are put in these situations where insurance doesn’t cover the cost,
they must alter their finances.
This affects society because not only are banks affected, but also
businesses that no longer provide services to these families because the money
has been diverted to pay for expenses associated with the cancer treatment of a
family member.
Cancer cost can
also affect retirement savings and in some cases houses are sold or have to be
re-mortgaged to meet this new financial responsibility. Then there are the hidden expenditures
associated with having a family member with cancer. Hospital visits by family members cost money such as lost
wages, transportation, food and lodging.
Many times the family simple runs out of money after long periods of
treatment and relapse where the process becomes repetitive and financially
draining. Often friends and
extended family members hold fund raising events to offset these cost, which at
times can spiral out of control.
Because cancer care became increasingly expensive over time, the fund
raising efforts grew into what is now considered a small industry.
By
the 1990s the cost of cancer care and research had increased dramatically and
the death rate from cancer, despite being reduced, was over a half-million
annually (Anderson 2002). Many of
these grass-roots efforts to pay for the cancer care of an individual were
converted into non-profit organizations, which began to raise money to
financially support the care of other patients and fund cancer research. The 1990s heralded several significant
social changes associated with cancer.
As mentioned previously in the section, in the late-1980s, where there
was an even higher cancer death rate, major cancer fund raising organizations
such as The John Wayne Foundation, The Susan G. Koman Foundation, and Alex’s
Lemonade Stand Foundation were formed and begun to raise billions for research
and cancer patient care. Many of
these organizations such as the Vince Lombardi Foundation raised money for the
establishment of cancer center (patient and research) facilities and sponsored
events to raise money for cancer research. This was a significant change in society as far as cancer
was concerned, but the latest area to be impacted is cancer awareness. As well as raising money for cancer
research many of these organizations such as the Susan G. Komen Foundation
began to publicly advocate the promotion of cancer awareness, mostly through
TV and print adds. In addition,
the government has been increasing its efforts to educate the public about
cancer by using several government-funded organizations such as the American
Cancer Society (ACS), National Cancer Institute (NCI), and the Centers for
Disease Control (CDC). These organizations
disseminate cancer information not only to the public, but also to physicians,
scientist, and administrators involved in cancer care, research, and treatment.
It
is apparent that during the mid-1980s an explosion of activity occurred
concerning cancer in society.
Family members of those stricken with the disease initiated most of the
public efforts. These efforts were
not only in response to the suffering and death of family members, but also the
“cost” of cancer as described above.
Never before in the history of cancer in society has there been so much
activity as that seen in the 1990s.
Despite the fact that the death rate from major cancers has fallen,
nearly 5,000 people a day are diagnosed with the disease. Because of these cancer fund raising
and awareness initiatives many of these people will be successfully treated
because of advancements in cancer treatments through research and early
detection through awareness of cancer symptoms. The family has played a major role in the progress toward a
cancer-free society and the hope is that this will continue into the future.
