Guest Columnist Dr. Roy Sessions: Spirituality and the Cancer Patient

RoySessionsSometime during the 1990s, while I was practicing at Georgetown University Medical Center in Washington, D.C., I was asked to see a diplomat from one of the Middle Eastern countries. He was an educated and worldly man who had a throat cancer that required extensive surgery and post-operative radiation therapy. Just before the actual operation, I met with him and his wife in the bed-holding area, normally a hostel of heightened anxiety. As I approached the bedside, the couple greeted me with pleasantness and an extraordinarily relaxed demeanor – no doubts, no hesitation, only a mellow countenance in each. I remarked how calm they seemed. The man said “We are devout Muslims, doctor, and I have put my life and your skills in the hands of God. Once that was done, I stopped worrying because I know he will take care of me, and will guide you.” I remember this vividly because it was so definite and sincere. He really was fine with both the process and the inevitability of an outcome; essentially he had turned his fate over to Allah. I envied that intensity of faith under such important and scary circumstances.

As I reflect on many years of caring for patients, I realize that such faith is not unique to Islam but can be found in all religions, and surprisingly even among deists. It has been my experience that people with strong faith in the Deity and an associated afterlife generally are able to go through the cancer experience more easily than those who do not possess such beliefs. I say this as an observation, not a promotion, and undoubtedly it’s an observation that will stimulate the disagreement of some; however, in my experience, this is unequivocally the case. Much like those patients who approach death with equanimity as a result of a family support system that comforts by the chemistry of love and friendship, the transition from life to death seems easier for spiritual individuals. Faith in a supreme being and an afterlife is the nuclear weapon of support for true believers! Many believe that they will be reunited with deceased members of their family, and in the mind of those with this belief, this reunion is actually what defines heaven. Others believe that to spend eternity with God is what defines that mystical place. Many devout people believe that life is merely a trial that must be endured in order to enter heaven, and therefore, in a sense, death is welcomed. In some, the only real negative aspect to dying is the separation from loved ones; otherwise, they are looking to something better than life on earth. To some extent, this is rooted in antiquity -people of medieval and other primitive times endured miserable lives, and looking forward to a better afterlife was completely understandable. This concept was the norm rather than the exception in times of yore. Given the relative comfort of the developed contemporary world, however, it is a testimony of spiritualism’s power that so many continue to think of a better life after death. The letting go and entry into the unknown just seems to be less frightening to this subset of people. This being said, I should relate that I have overseen the death of a number of atheists, some of whom were stalwart and fearless in their resolve. Based on this experience I would challenge the cliché that in combat, there are no atheists in the foxholes!

Those patients of deep faith seem to handle the cancer experience better, and I admit to having exploited this in my dealings with them. Without commenting on my own beliefs, I will say that in cancer patients and families that I thought to be religious, I have always encouraged them to look for spiritual help. Even though I never claimed to be such, I always let them think of me as religious if they chose to; and importantly, I never avoided the issue of spirituality. Many cancer patients will say “God bless you, Doctor.” My response to this is “Thank you; God bless you too.” Whether God hears such admonitions is somewhat uncertain in my mind, but what is certain is that such patients are comforted by the notion, and I have always felt that the use of these methods was well within my purview. I’m basically for that which helps!

According to a February 2009 feature article in Time magazine that was written by Jeffrey Kluger, a growing body of scientific evidence suggests that faith may bring better health, and to quote one of the expert contributors to this article, Dr. Andrew Newberg, a professor at the University of Pennsylvania, “A large body of science shows a positive impact of religion on health.” For the power of faith and prayer to have an impact on the biology of cancer seems to be somewhat of a stretch, and even more so to say that miracles occur. That said, I should note that I have seen some amazing things in people who I thought had no chance to get well. Important to remember also is the rare but real occurrence of cancer’s spontaneous remission. Not uncommonly, tumors cease growing and exist in a relative state of dormancy for years.

Whether the result of the body’s immune system, an aberration of tumor biology, or the miracle that many religious people firmly believe in, the reader is urged not to automatically label these events as the quirky fantasies of religious fundamentalists. The surgeon/scientist part of me has trouble buying this as being controlled from above, and I only put it out there as food for thought. I plan to emulate one of my role models and paraphrase Benjamin Franklin; he wasn’t sure about many of the claims regarding the mysteries of heaven, and rather than think about them, he planned to wait until after his death, and get the true bottom line from those who were in charge.
These contemplations are not confined to places of worship or cults of spiritualism – the following are just a few of the research institutes devoted to studying the association of religion and medicine as their main focus: Center for Spirituality and the Mind, University of Pennsylvania; Center for Spirituality and Healing, University of Minnesota; Center for Spirituality, Theology and Health, Duke University; and National Center for Complementary and Alternative Medicine, National Institutes of Health. There are a number of very intelligent scholars who are studying the body’s physiologic link to spiritual forces, and as with all alternative approaches to human disease, we should offer support and succor to such investigations. While doing so, however, we should continue the implementation of standard, science-based cancer evaluation and treatment. Knowledge begets more knowledge, and molecular biology and genetics have fostered a scientific revolution that is probably only the beginning of a period of exponential intellectual growth. Our understanding of the neurochemistry that links the brain and disease is still in its infancy.
I submit that this matter is intertwined with the neurochemistry that I touched on in a previous Tidelines essay in which I discussed the importance of hope in the cancer patient. Without attempting to advocate spirituality, I submit for your thought that matters concerning divinity, the after life, and the solace of “that better place” are part of a complicated synergy of the autonomic nervous system, various hormones, and the placebo effect of it all.
Roy B. Sessions, MD, FACS
Seabrook Island, SC

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