Balancing cancer's reality with your belief in miracles

This is a really tricky topic. Nothing is more central and personal to an individual than his/her religious beliefs and convictions. It has long been my experience that people of faith, whatever that faith might be, have a slightly easier time with advanced cancer and end of life issues. Some people have held fast to their faith for all their lives, and others return to it and find solace during a serious illness.

Thinking about the possibility that a strong religious faith, as expressed in a belief in miracles or the certainty that God is going to cure you, can be problematic is a new consideration. Understanding the facts and reality of one's cancer is critical in thinking carefully and clearly about priorities and choices. No one wants to hear it, but, if the results of a scan or other test, are bad news, we must have the facts honestly shared, and we must be given a chance to consider our values and wishes for our remaining time.

To quote from a recent study in Cancer: "In a multi-site, prospective cohort study, 158 patients with advanced cancer, whom oncologists expected to die within 6 months, were assessed before and after the visit at which scan results were discussed. Before the visit, religious belief in miracles was assessed; after the visit, patients indicated what scan results they had received (cancer was worse vs. cancer was stable, better, or other). Before and after the visit, prognostic understanding was assessed, and a change score was computed."

Here are the results: approximately 78% of the patients expressed some belief in miracles, and almost 73% held a strong belief in this possibility. Not surprisingly, patients with these beliefs did not change their views or understanding of their prognoses after hearing bad news. I suspect that their doctors thought that the information had been gently and honestly shared, and that some kind of discussion about next steps ensued. However, it seems very likely that there was a giant chasm between what the doctor was thinking and anticipating and what the patient was hearing and believing. If you truly believe that a miracle is likely, it does not much matter what statistics or numbers are presented.

Here is where I think this becomes so hard. Of course we all need hope and want to believe that life is going to continue. Also, of course, we all know that we are mortal, and that no one gets out of this world alive. When we are truly faced with our mortality, it is much easier to block out the hard and sad facts and hold tightly to belief that we will stay well. In the very short term, that may not matter and may improve the quality of our days and our lives. But, if holding on to this false certainty, a kind of denial, means that we don't make the best use of our remaining time or that we don't make choices that most honor our lives and our values, we are missing a chance to have truly precious time. There is no easy answer and certainly no single correct one, but it does seem that realistic knowledge, always paired with hope, is most likely to prepare us and our families to live our best lives for as long as we can.

BIDMC's Department of Spiritual Care and Education, staffed by chaplains from many religious traditions, is a wonderful and valuable resource if you wish to talk with someone or think more about these issues.