Watch Where You Sit!

Rebecca Bechhold, MD

A study published in the September issue of Network Science by Jeffrey Lienert, MS, a fellow of the National Institutes of Health Oxford-Cambridge Scholars Program, and colleagues, examines the influence of social interactions between cancer patients during chemotherapy treatment sessions. The study authors concluded that patients who spent time with other patients who had died within 5 years had a 72% chance of dying within 5 years themselves. If they spent time with patients who lived for more than 5 years, they had a 68% chance of dying within 5 years.

Pardon me for being underwhelmed.

First of all, there are myriad variables in any patient’s interactions in the treatment suite. I truly do not know how you can tell years ahead of time who is going to live and who is not. It might be more obvious for some patients, but are we going to now discriminate against the person having a bad (no) hair day and feeling a little piqued?

There are patients who complain about “seeing all those awfully sick people” in the waiting room when they come in for routine follow-up and are doing quite well. “It’s just so depressing,” they say. Really! Maybe a kind thought or encouraging smile would be appreciated by those people.

In truth, the upshot of the paper in Lienert’s own words is “positive social support during…moments of great stress is crucial.” That, I can support. However, the manner of that support can be tricky. Recent news stories have discussed how being called a cancer “warrior” is stressful and not particularly effective. Patients can be scared, anxious, and worried about their illnesses, and should not be forced to take on others’ idea of what a “fighter” should look like. Some of my most strong-willed patients are very quiet.

How your friends and family show support may vary. I have never been a fan of the entourage with feather boas and hats and loud voices. I find it disruptive and distracting, and I myself would not want anyone in the way of my oncology team trying to deliver very serious and often complicated treatment.

Most patients seem to sleep or occupy themselves with personal electronics. Though, I do remember one of my patients who was a world-class Scrabble player; he was not going to make it to 5 years, and we knew that from day one, but there was one day that he forced me to play Scrabble with him while he was getting his drugs infused. I would come in and play my attempt at a word between patients. He would then score 58 points with a single well-placed letter. I play Scrabble as a family sport, but I triumph best over children or others with limited vocabulary or adults who are enjoying a cocktail during the game. He massacred me and gleefully! The entire suite was watching and cheering him on-it was a gloriously fun morning at work even if it came at the expense of my pride. His parting gift to me was the Official Scrabble Players Dictionary and the advice to memorize all the two-letter words, particularly those with the letter “Q.”

My point here is that if you are going to pick and choose who you think will do well and limit your interactions to those who look to be more robust, you might be short-changing yourself. I think every one of my patients has something to offer.

While it is difficult when patients pass away and we, fellow patients and staff, are left behind with only the memories of how much we liked them-how noble, witty, pretty, kind, or irascible they were-they all have left us with some morsel of wisdom.

It would be a mistake not to point out the role of the oncology nurses in the role of patient support. These nurses are truly the backbone of the team. They are managing the electronic medical records, drug mixing, and handling multiple toxic drugs, as well as educating patients and their families, all while watching for drug reactions and maintaining a positive, happy, upbeat atmosphere in the treatment suite. They are mentally, physically, and emotionally spent at the end of the day, and they come right back and do it again in a few hours. They are always a source of positive energy.

In the meantime, when you arrive at the waiting room or treatment area, take a seat, any seat!