The many shades of hope

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Ads for the Cancer Treatment Centers of America, many of which I find morally reprehensible, stress that "hope is a mainstay, hope is everything". It may be a mainstay, but it ain't everything; not in the manner they're offering it.

Still, hope is a term that pervades cancer chatter. Patients need hope. Caregivers and loved ones need hope. Even oncologists and health pros need hope.

Cancer is that kind of disease. It has a sufficiently gloomy reputation. It elicits hope on reflex.

Everyone who is diagnosed with cancer has the right to hope they will beat it. Not everyone will. In 2007, 7,900,000 people worldwide succumbed to cancer, hopeful, hopeless or somewhere in between, suggesting that in order to remain an effective weapon in the battle against cancer, hope needs to be re-understood.



Physician and author Sherwin Nuland wrote that all the definitions of hope … "deal with the expectation of a good that is yet to be, a perception of a future condition in which a desired goal will be achieved." He continues:

"I would argue that of the many kinds of hope a doctor can help his patient find at the very end of life, the one that encompasses all the rest is the belief that one final success may yet be achieved whose promise vanquishes the immediacy of suffering and sorrow."

Don't misread that. Nuland says 'one final success, NOT 'one final treatment option'. Unfortunately,

"… most people would rather take a chance with slim statistics … usually they suffer for it, they lay waste their last months for it, and they die anyway, having magnified the burdens they and those who love them must carry to the final moments."

They're able to do this because, writes William Bean, doctors can delay death by putting into action "the busy paraphernalia of scientific medicine, keeping a vague shadow of life flickering when all hope is gone."


Nuland believed that with regard to the care of advanced cancers, hope needs to be redefined because there is more than one variety: Some people hope they'll make it to some calendar landmark—a bar mitzvah, an anniversary, a child's birthday. Others simply hope that they stay who they are up to the end—of sound mind, if not body.

A widely used oncology nursing text puts it in a way that I, as a person without cancer so far as I know, can most identify with:

"Hope is always appropriate. People must be allowed to hope for a miracle that can save their life … [nonetheless] some people are in denial until the end. It is our task to be present to patients wherever they are. In our love and support they may find that the miracle for which they had been hoping is the nurse who is an excellent pain manager and who is present in their time of suffering and need."


If we cherry-pick that text, we can find a definition of hope that's universally applicable to all of us in how we search for hope in the context of cancer: Be present for people with cancer, wherever they are in their fight against the disease—not just in their time of suffering and need, but all the time.

By Ross Bonander

Resources and additional material:

- Gates, Rose A., Fink, Regina M. Oncology Nursing Secrets, 2nd Edition. Hanley & Belfus Inc., Philadelphia. 2002.
- Nuland, Sherwin. How We Die. Vintage Books, New York. 1995.
- Red's monologue on hope from The Shawshank Redemption

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