Thursday, July 17, 2008

Cancer and Self-Image

Cancer and its treatment cause big changes in how patients look. Sometimes a tumor is visible and directly alters the patient’s appearance. Some cancer surgeries are disfiguring. Chemotherapy causes hair loss. Chronic steroid use can change the way a patient’s face looks. Cyclosporine, used to prevent and treat graft-versus-host disease, causes hair growth in unusual places.

Photo Credit

These changes can be even more profound when the patient is a child. Radiation causes bones to stop growing, so as the rest of the child grows, the irradiated bones do not, and scoliosis or other changes can develop. Chronic steroid use impairs growth. Bone marrow transplantation and brain radiation cause significant hormonal changes whose importance is magnified in the developing child or adolescent.

Photo Credit

Adolescence is a time when appearance is terribly important and often central to a person’s developing self-image. Imagine, then, how hard it can be to be diagnosed with cancer and then be treated for it when you’re that age – when all you want to do is fit in!

What can be done about this? One important source of help is people who have been through it before. One woman, Marianne Kelly, started a program in Baltimore called Image Recovery Centers. Ms. Kelly was diagnosed with a brain tumor in 1987, and that experience, along with the experience of losing a sibling to leukemia and having a daughter diagnosed with leukemia, led her to work with cancer patients to help them maintain a positive self-image despite the changes caused by their diagnosis and the treatments they need. I send my patients to the Image Recovery Center at our hospital as often as I can.

Another source of support can be the stories of patients who cope particularly well with the effects of their cancer treatment. My patient M, for example, dyed her hair purple (and sometimes pink or blue) as it grew back after she lost it during chemotherapy.

My favorite story, though, is about Warren (not his real name). Warren was 9 when he was diagnosed with retinoblastoma, cancer arising in the back of the eye. Most retinoblastoma patients are infants, and Warren is the oldest retinoblastoma patient I have ever cared for. When he was diagnosed, his tumor was so advanced that there was no hope of saving the vision in his right eye, so it was removed, a procedure known as “enucleation.” After healing from the surgery, Warren received a prosthetic eye. The prosthesis was so real looking, that one of my colleagues had to ask Warren which eye he had lost!

Photo Credit

But the best part of the story is not the quality of his glass eye, but what Warren did with it. The first summer he had the eye, he spent a lot of time swimming in his pool. While other kids in the neighborhood would toss a penny into the pool to dive after it, what did Warren and his friends dive for? You guessed it – his eye!

How’s THAT for making the best of what life gives you?

(Follow this link to see how easy it is to remove a prosthetic eye)

For more information about coping with the effects of cancer treatment, click here for beauty and comfort tips from the Image Recovery Center at Johns Hopkins.

Related posts:
The Story of D
One of My Patients is Famous


rlbates said...

I love this post, Dr David!

Doctor David said...

Thanks! Isn't it the funniest enucleation story ever?

jaime said...

man! You stole my line! Great post - we're looking at that right now at MSKCC.....and it's such an important issue, especially for teens and young adults - that time of life is hard enough, let alone with cancer!

Jen said...

Thank you so much for this post. My daughter's 12 now, and 3 1/2 years out from her treatment for a germ cell tumour. We've just spent all day yesterday doing tests to make sure that she's not having a recurrence (I don't think that she is), but being back in the hospital going through the same things that we did when it was found the first time...let's just say it wasn't a fun day.

We're actually having more problems with her self-image now than we did through treatment...I think mainly because of her age. She didn't really react badly at all to chemo (she slept for about 10 weeks, basically), and she was one of the kids who dyed her hair all sorts of different colours, and then we'd put temporary tattoos and funky wigs on her after she was bald :-) It also helped that some of the kids in her class (and their parents), also shaved their heads, and the child life team at her hospital used to give her regular "spa days" with makeup and pedicures and glamour photos etc.

But now that she's a pre-teen it's pretty hard for her, even so long after treatment. She's a triplet, and she's at least 4 inches shorter than her siblings, as well as being far and away the smallest girl in her middle school. Chances are that she's probably going to catch up (at least according to her doctors), but it's pretty difficult for her when she now looks like she's about in grade 4, and a lot of her friends are wearing c-cup bras and towering over her. Obviously we do everything possible to boost her self-esteem in every way (she's an amazing kid, as well as being absolutely gorgeous), but she told me last week that it sometimes feels to her that she's always going to be "cancer kid" and she'll never get away from it. That sucks for her on so many levels- we're obviously very lucky in that she had a very survivable condition that is unlikely to re-occur, but even aside from the likely health problems in the future from the chemo protocol that she was on, it still has an effect on her everyday life.

And the enucleation story is great...we've got a relative with a glass eye, and it has a tendency to pop out whenever he sneezes. It's a conversation stopper, but it's also pretty damned funny to get whacked across the dinner table with someone's eye. I think that he aims for people on
purpose :-)

Doctor David said...

Jen, thank you so much for your thoughtful comments. They really add so much to my post. Your first hand experience carries far more impact than anything I could ever say. Your daughter sounds like a wonderful girl, and you sound like a great mom. And I'd LOVE to meet your relative ;)

Anonymous said...

I loved your article – it was some great information. I think you and your readers might be interested in another article I found on Medical and Dry Eyes.

viagra online said...

There's always a ray of hope for every people who suffers cancer! thanks for the inspirational post!