As treatment continues to improve across Bermuda and the world, cancer patients have a better chance of survival than ever before.
Yet for all the success stories, each case of terminal cancer is a painful reminder that we still have so much further to go.
Some aggressive cancers seemingly appear from nowhere in previously healthy people – and by the time the warning signs appear, it’s too late.
For clinical oncologist Dr Chris Fosker, this is one of the harshest realities of cancer.
“Globally, cancer care has improved dramatically over the last 50 years or so,” said Dr Fosker, the medical director at the Bermuda Cancer and Health Centre.
“If you go back to the 1970s, about 50 per cent of cancers diagnosed were curable. Nowadays, it’s about 70 per cent. So, seven out of ten people diagnosed with cancer today will be cured.
“Even if it’s one of the aggressive ones, if you catch it early, you can cure it. But that does still mean that three out of ten people diagnosed with cancer will pass away because of their cancer.
“That is obviously the tougher part of treatment. It’s the tougher part of conversations.”
Between 450 and 500 cancers are diagnosed in Bermuda every year; about 120 to 130 people die from cancer annually, which is a lower mortality rate than Europe, Britain or the Caribbean, according to recent statistics.
“But if you or your family are just one of those people, then that doesn’t matter, the stats don’t matter. The individual person is what really counts in that sense,” Dr Fosker said.
Aggressive cancers include melanoma, pancreatic and glioblastoma, but Dr Fosker pointed out they don’t always behave in the same way; sometimes traditionally aggressive cancers can be slow growing, while traditionally unaggressive cancers can misbehave.
Every year, a handful of patients in Bermuda arrive at the doctor’s office with aggressive cancers that can only be treated with palliative care.
“By the time we have got in a position to talk about the treatment, the treatment intent is to try to help quality of life rather than cure the cancer, and often just trying to make a short period of time as valuable as possible.”
This means the patient and their family face incredibly tough choices.
“There is nearly always some form of treatment,” Dr Fosker said.
“I find myself often saying this isn’t a curable cancer, but it’s a treatable cancer. It’s not very often I find myself saying there is nothing we can do.
“It’s remarkable how some simple things can make a difference. For people who are feeling really breathless from cancer, actually just putting a fan on reduces that breathlessness.”
Dr Fosker’s job is to educate patients and their family about their options.
“Their choice might be do nothing. Their choice might be to go for the aggressive treatment option because it may buy you two more weeks,” he said.
“It’s not for me to say necessarily what’s right or wrong, it’s for me to help that person understand what those choices are and the impact they have.
“It’s about trying to figure out, in that moment, each step of the way, what’s the best next step. Doctors have a huge body of literature about what we’re taught to think is right or wrong, but what I’ve really learnt over my career as an oncologist is that I can never put myself in someone else’s shoes.”
Glioblastoma, a type of cancer that starts in the brain, for example, can be tackled with chemotherapy and radiation that might have significant side effects.
“I’ve absolutely no idea what I would do if that was me or one of my loved ones, because you’ve got a good chance you will make them live longer, but you’ve also got the same chance that that length will be less good quality.
“Who is it to say that three months of good quality is better than nine months of poor quality or vice versa?
“Someone may be diagnosed with a really nasty cancer where everyone tells them, really sorry, your time’s really short, and then here they are a year later still going.
“And then you have the other ones, who still are not curable but we’ve got a gentle chemotherapy with a 95 per cent chance of improving quality of life – and then they pass away two days later.
“It’s the uncertainty that just makes the decision so hard.”
PALS Cancer Care, which supports cancer patients and their families throughout the whole process, are “brilliant listeners and brilliant thinkers” in helping people make decisions that might seem impossible, Dr Fosker said.
Looking to the future, the oncologist noted that treatment continues to improve, with advances in fields such as immunotherapy, DNA research and radiation technology. These advancements are providing new hope and options, but he warned there will never be a magic bullet that wipes out cancer.
So what can people do to make sure their cancer gets spotted before it’s too late?
Sadly some cancers, such as pancreatic or glioblastoma, are nearly always found at an incurable stage because they are silent until they have spread to such an extent they cannot be cured.
But there are still things you can do to help yourself.
“We know men in particular are terrible at going to see the doctor, and they will ignore symptoms until the 11th hour,” Dr Fosker said.
“So you can live better, and you can also be more responsive to signs and symptoms that happen within the body.
“If the doctor tells you told to come back in a month but if in two weeks time you feel awful, advocate for yourself and return to the doctor immediately. Don’t wait for the month.
“Take control of what you can. All cancers are curable, if you can catch them at stage 1 or stage 2.”
While cancer treatment has made significant strides, Dr Fosker said early detection and patient empowerment remain crucial.
“Leading a healthier lifestyle and undergoing regular screenings can make a significant difference in outcomes,” he said.
