The Word “Cured” When It Comes To Bladder Cancer
A recent thoughtful post by Sarah Wallin, a member of the Editorial Team and a moderator on BladderCancer.net, asked whether bladder cancer can be cured. The post also explained the difference between the concept of being “in remission” and “cured.”
A cure vs. remission
Sarah stated: “According to the National Cancer Institute, ‘cure’ means that there are no traces of cancer and that the cancer will never return. ‘Remission’ takes place when cancer signs and symptoms have been reduced either partially or completely. Some doctors may consider your cancer to be cured if you have been in complete remission for 5 or more years.”
This is a very helpful distinction as I believe the words “cured” and “remission” are often used without thought to their complexity or their impact. Note that “cure” is defined as no traces of cancer and that the cancer will never return.
No one knows whether cancer will return
But it is in those italicized words that there is a catch: none of us knows whether the cancer will ever return – until it returns. And this is where it is very complicated – and potentially psychologically dangerous – when clinicians use the word “cured” with patients.
I lost my first husband, Ahmad Khoshroo, to bladder cancer. He was originally diagnosed with low-grade, early-stage bladder cancer. After a partial cystectomy, the urologist told us he was cured.
The word "cure" can bring relief
“Cured” is an incredibly powerful word for cancer patients and their families. It is as positively powerful as “you have cancer” is negatively powerful. “Cured” sets in motion a wave of relief and a moving forward free of the burden of cancer. This is a most wonderful feeling. We moved forward with our lives and basically forgot about cancer.
The problem with this language
But the problem (I realized a couple years later when his cancer returned metastasized with a vengeance) is that no doctor ever knows for sure that a patient is cured.
Time spent cancer-free
The only certainty of a cure comes with the passage of time. Time spent free of cancer. As noted above in the definition, some doctors may consider you cured if you have been in complete remission for five or more years. Even then, though, there is no guarantee that the cancer won’t return in more than five years.
And so, it is impossible to know at the point of one year or five years or eight years whether a person is cured. Is the likelihood greater than not that they are cured? Yes. Is it a certainty? No.
Using other terms instead of "cure"
I would encourage patients, caregivers, and clinicians to tread lightly with the word cured. Saying someone is cured is kind of like a person who has never had cancer declaring that he or she never will have cancer. How can anyone possibly know that? They can’t. And the same is true of the concept of being cured.
Many patients prefer the descriptor “no evidence of disease” or NED. They describe their current status as NED. And the more time that passes in which they have NED, the better. But they are often careful not to declare themselves “cured.”
Perhaps claiming themselves “cured” feels too much like tempting fate. After my experience, I don’t think I will ever use the word “cured” again in relation to bladder cancer.