‘Good cancer’? Views vary on a sunny phrase

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‘Good cancer’? Views vary on a sunny phrase

Many patients and doctors refuse to apply the ‘g’ word to highly curable cancers, but some survivors draw hope from the ‘good’

Nov. 10, 2016
'Good' cancer illustration

Illustration by Breanna Welsh / Fred Hutch News Service

The “good” word is in a bad place.

Derided by some survivors and embraced by others, the phrase “good cancer” surged in use as cure rates rose for some malignancies, pushing that upbeat description into the fervent world of cancer language.

It is a linguistic domain ruled by both persona and perspective, where one patient’s rosy mantra can clash with another patient’s pragmatic prose, where the etiquette of expression often depends on who’s talking — or who’s listening.

“We need to eliminate that statement — it doesn’t sit well and it confuses patients,” said Joan Shey, a thyroid cancer survivor from northern New Jersey.

Through the thyroid cancer awarness foundation she launched, called Light of Life Foundation, Shey is using a Facebook campaign to urge doctors and the public that “there is no such thing as a ‘good cancer.’” Within that same community of survivors, however, others recall hearing the term after diagnosis — and liking the sound. 

Image: Jerry Dipoto

Jerry Dipoto, pictured looking through the microscope, was diagnosed with thyroid cancer in his mid-20s while pitching for the Cleveland Indians.

Photo by Robert Hood / Fred Hutch News Service

“Yes, that phrase was used with me,” said Jerry Dipoto, who was successfully treated for thyroid cancer in the mid-1990s while pitching for the Cleveland Indians. “Frankly, at the time, I found it to be encouraging.

“We all know there is no ‘good’ form of cancer but the simple, positive reference gave me an immediate sense of, ‘OK, this is doable. …’ said Dipoto, now general manager of the Seattle Mariners. “Positivity is a lot of the battle.”

Thyroid cancer, which is slower growing and often less aggressive than other malignancies, gained the “good cancer” label because patients who are diagnosed at early stages of various subtypes have a “near 100 percent” five-year survival rate.

That cheery depiction is also commonly applied to Hodgkin lymphoma. Patients who are diagnosed at early stages of that blood cancer have five-year survival rates of about 90 percent. Among patients diagnosed at stage 4, well more than half are alive five years later.

“I believe I first heard this (phrase) from a medical provider when describing the cure rates … because it is beatable,” said Tori Fairweather, treated three years ago for Hodgkin lymphoma at Seattle Cancer Care Alliance, clinical care partner of Fred Hutchinson Cancer Research Center.

As a survivor, did those two words stick in her vocabulary?

Image: Tori Fairweather

Tori Fairweather is a Hodgkin lymphoma survivor who lives near Tacoma, Washington.

Photo by Robert Hood / Fred Hutch News Service

“Yes. I myself have used this phrase before when describing my type of cancer,” said Fairweather, a junior high school teacher who lives near Tacoma, Washington. She describes herself as “indifferent” to the language but adds, “I do not believe there is such a thing as cancer being good.”

When talking with patients diagnosed with Hodgkin lymphoma, Dr. Ryan Cassaday has occasionally acknowledged, “You may have heard people say that is a good cancer to have.” Cassaday, an oncologist at SCCA, believes there are proper moments to recognize the phenomenon exists. But he makes it a personal point, he said, never to utter that message “as my own sentiment.”

“While the prognosis or outcomes for Hodgkin lymphoma are better than some other cancers, those good outcomes do not happen for everyone,” said Cassaday, who treats patients with Hodgkin lymphoma, non-Hodgkin lymphoma and acute lymphoblastic leukemia. He’s also an assistant member of the Clinical Research Division at Fred Hutch.

“For someone first diagnosed, using that (language) to sort of boost their hope is generally done with good intentions. But the reality is, for any individual, you can’t guarantee they’re going to have a good outcome. People die from Hodgkin lymphoma and it’s terrible,” Cassaday said. “To give people the idea that you don’t have to worry about this, particularly when the diagnosis is first made, is a bit of a dicey proposition.”

That cautious message is not lost on Connor O’Leary, who was treated in 2010 for stage 2A testicular cancer, a malignancy with a survival rate of 99 percent when the disease is localized and 73 percent when the cancer has spread to “distant” parts of the body. Based in part on those numbers, it’s another type often referred to as “a good cancer.”

When he was diagnosed, O’Leary recalls hearing only three words: “You have cancer.”

“No amount of reassuring words on how it is a ‘good cancer’ or any statistic on how beatable it is could console me,” said O’Leary, who lives in Salt Lake City and works as chief mission officer with the Austin, Texas-based Testicular Cancer Foundation. “That initial diagnosis is tough news to hear. You are headed into uncharted waters, and ‘good cancer’ or not, things can happen, things can go wrong.”

Of course, many physicians do seek to inject realistic hope in patients with testicular cancer without busting out the words “you have a good cancer.” Some, like oncologist and Fred Hutch researcher Dr. Michael Schweizer, say they simply use clear language, for example: “I’m hoping we’re going to cure you, that’s our goal here, and there’s a very good chance we’re going to beat this.”

“So you do have to infuse a little optimism and try to rally them. But I avoid the term (‘good cancer’) because you don’t know if it’s going to be off-putting to someone,” said Schweizer, whose clinical expertise includes prostate, bladder, kidney and testicular cancers.

“Patients are always scared,” Schweizer said. “I mean, nobody wants to have cancer, period, whether it’s good or bad.”

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Bill Briggs is a former Fred Hutch News Service staff writer. Follow him at @writerdude. Previously, he was a contributing writer for NBCNews.com and TODAY.com, covering breaking news, health and the military. Prior, he was a staff writer for The Denver Post, part of the newspaper's team that earned the Pulitzer Prize for coverage of the Columbine High School massacre. He has authored two books, including "The Third Miracle: an Ordinary Man, a medical Mystery, and a Trial of Faith." 

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