A Family Member's Cancer Is Not Your Fault; There Is No Need to Blame Yourself

The day before yesterday I met with a patient's family member—a young woman of twenty-six who had just graduated from college and was working as a teacher in a small city. Her father had just died of COVID during last year's pandemic, and her mother had this year been diagnosed with mid-to-late-stage gastric cancer. Moreover, the last two chest CT scans showed nodules in both the left and right lungs; the larger nodule was over one centimeter, with spiculated margins, multiple in number, and classified as a high-risk nodule.

Her mother is currently receiving immunotherapy plus chemotherapy, and the control of the gastric cancer is at present tolerable. The doctor asked her to sign consent for a distal radical gastrectomy on her mother, after which thoracic surgery would assess the lung nodules. Her relatives pressured her to listen to the attending Western gastroenterologist, and she was very torn. She came to ask me for advice, because she had also looked up a great deal of material and worried that after this surgery her mother's survival time and quality of life would actually be worse than without it. Her judgment was in fact quite correct, but external pressure was tormenting her.

As she talked with me she was anxious and uneasy, constantly rubbing her hands, her brows knitted, very unrelaxed, and from time to time in tears. She was an only child; although already engaged to her boyfriend, she was not yet married. Having just suffered the loss of her father, within less than a year she now had to face the cruel reality of her mother's cancer. Her income was not high; if her fiancé did not subsidize her, the cost of her mother's current treatment would be a heavy burden. The attending Western doctor did not ask about her family circumstances but simply urged her to sign consent for surgery.

This young female teacher hoped to give her mother conservative treatment, but under the urging of the attending Western doctor and her relatives, she felt her own decision might be wrong and was wracked with guilt. I gave her some advice: continue the previous chemotherapy regimen, while also adding some medicines for the lung nodules (such as Xihuang Wan, Compound Banmao Capsules, and Kanglaite Capsules), and observe for a month before deciding.

Because once the patient's stomach is totally removed, if the lungs contain metastatic lesions or a second primary cancer, the progression of the lung tumors will accelerate, and rushing into surgery has little point. At the same time I also had her consider choosing an insurance-covered genetic test to check whether her mother had a gene mutation. If there is a gene mutation, targeted drugs can be considered. In that case one could use integrated Chinese-Western conservative treatment to prolong the patient's life, and surgery would not necessarily be needed.

I also had her look up some material on how Academician Jia Jialian, a leading Western authority on gastric cancer in China, advocates integrated Chinese-Western treatment of cancer. She later found a video interview of Academician Jia by the Physician's Daily, and after watching it felt much relieved. Because Academician Jia is a Western medical authority in gastric cancer and advocates integrated Chinese-Western oncology, whereas the Western doctor she had found is in no way comparable to Academician Jia in seniority or prestige in the gastric-cancer field. So such a junior Western doctor's rejection of integrated Chinese-Western treatment is not worth treating as an authoritative view.

I also suggested that the young teacher herself take some Jieyu Anshen Keli ( Depression-Relieving and Spirit-Settling Granules), because from our conversation I learned that she was now eating poorly and sleeping poorly, under great pressure, and very torn and self-blaming. Her experience is a little like mine: when my mother first fell ill I was only in my twenties, under enormous mental pressure, and eating and sleeping poorly too. Her present income is lower than mine was then, so her pressure is greater than mine was. Moreover, my father is still alive today, while her father has passed away; apart from her fiancé she has no other strong emotional support.

When choosing a medical plan, many cancer patients' family members, like this young teacher, face enormous mental pressure. The words of those around them and the views of biased doctors make these family members, when making a decision, not only fearful but also deeply guilty. They are terrified of making the wrong decision and ultimately causing their dearest loved one not to receive the best treatment.

Usually, when I meet such family members, I do some reassuring work. I tell them that the decision they can make now is the most appropriate decision they can make under present conditions; they should not agonize over it, much less harbor thoughts of self-blame. A loved one's cancer is a great misfortune not only for the loved one but for ourselves too, but this is not our fault; it is the arrangement of fate and the working of natural laws beyond our control. We should not bear too much pressure and guilt over it, but let ourselves relax.

Some emotionally detached family members of cancer patients abandon the patient once cancer is diagnosed. Other, excessively kind family members easily develop all kinds of guilt while caring for their loved one. Both attitudes are wrong: we certainly cannot abandon our kin, who are the people we love in this world and whom we have a duty to care for. But a loved one's cancer is not what we subjectively wished for, and cancer treatment plans are themselves diverse. Any choice we make in this process, after consulting with our loved one and according to our own financial means, is guiltless; we must not let the pointing fingers of others make us feel guilty.

The closest relatives of cancer patients, while caring for the patient, usually easily develop guilt over medical decisions. My personal principle is that so long as the family does not abandon the patient, I do not judge any decision the patient and family make. Every patient and family member who makes a decision has their own reasons; we must respect their decision, and whether our advice is adopted is the patient's and family's business. We need only, when the patient needs professional help, use the skills we possess to help the patient solve the problem.

On receiving a cancer diagnosis, both the patient and the family suffer a tremendous mental blow. At such a time, apart from the patient, the family member is also worthy of sympathy. To increase the family member's guilt is wrong; we may provide them with information and let them judge according to their own circumstances, but we must not make any moral evaluation of the patient's and family's final choice. Family members also have no need at all for feelings of self-blame; life and death are fated, and with a disease like cancer, any decision carries risk, and which decision is ultimately better is truly hard to say.