Medical conditionCancer - page in progress
introductionIn the early 1990s, when I was training to be a GP, cancer was associated with a certain and unpleasant death. The word ‘cancer’ was unspoken being referred to as the ‘Big C’. The hospice movement was in its infancy. One of the first books I remember reading that honestly discussed cancer even avoided using the word cancer in its title; ‘C’ by John Diamond. Now, the reader can find a whole genre of books and media articles in which patients and clinicians shared their experiences of life and death with cancer.
Key insightsOne in three of us will receive a diagnosis of cancer at some point in our lives.
Being diagnosed with cancer is a significant life event.
Cancer is now openly discussed by clinicians and their patients in both the medical setting, the media and in art.
General OverviewDespite many cancers now being curable and diagnosed before symptoms occur, people still associate the diagnosis of cancer with suffering and a reduced life expectancy.
Cancer is now so openly discussed and written about it may lead us to believe that we can anticipate how someone might react to its diagnosis. How people respond to having cancer and make choices about treatment and care is a uniquely individual experience.
Art ResourcesArt offers a way to express and explore the experience of cancer . These works invite reflection, discussion, and new perspectives on cancer.
-
Reproduced under Creative Commons license
Possibly the most well-recognised painting associated with chronic pain is Frida Kahlo’s ‘A Broken Column’. She painted this picture just after she had spinal surgery to correct the consequences of a life-changing traffic accident.
In what way does Frida convey her pain and suffering in this picture?
Poetry
Julia Darling
1956- 2005
‘Julia united humanity, creativity and health in her poetry, prose and plays.’
Julia was a prolific, and well-respected UK writer, poet and playwright. When she developed breast cancer she used her talent for writing poems to help her take control of her illness, improve her health and communicate with her doctors.
‘I wrote poetry in waiting rooms. I made up poems while I was having scans. Somehow this was defiant and empowering. I forgot to be a patient; I was so absorbed in another world’ ‘
I believe that poetry can help make you better. Poetry is essential, not a frill or a nicety. It comes to all of us when we most need it. As soon as we are in any kind of crisis, or anguish, that is when we reach out for poetry or find ourselves writing a poem for the first time.’
I have used Julia Darling’s wonderful poems many times in teaching. The two poems I have found to be most impactful are End (reproduced on the page about dying and death) and Too Heavy (reproduced below)
Why not buy Julia’s anthology of poems to use as a resource for teaching.
Words
Too Heavy by Julia Darling
Julia Darlings poem, Too Heavy, helps us to reflect on the words we ‘give’ to patients when talking to them about cancer. Words are impactful. They can give hope. They can show compassion and understanding. They can also be misunderstood and create a barrier between patient and clinician.
Think about the terms you have heard used to describe the impact of cancer on someone’s life. You may recall how many times military metaphors are used when talking about cancer.
Cancer invades a patient’s body, leading to the patient battling with symptoms, hoping to conquer the aggressive enemy within, but it’s not a fair fight and so cancer often wins, and the patient loses his or her battle. Patients often say they don’t have cancer they fight it, and drug companies and charities use this language in their fundraising campaigns to conquer cancer.
Metaphors can be helpful, but care needs to be taken that their use is helpful to the patient.
This Radio 4 podcast is an excellent discussion of the impact of words and language on people who have cancer.
-
Reproduced under Creative Commons license
Possibly the most well-recognised painting associated with chronic pain is Frida Kahlo’s ‘A Broken Column’. She painted this picture just after she had spinal surgery to correct the consequences of a life-changing traffic accident.
In what way does Frida convey her pain and suffering in this picture?
Paintings
2002
The Three Oncologists by Ken Currie
Reproduced for educational use.
How are the doctors portrayed?
Where is the patient?
What thoughts does this painting provoke?
FilmsThere are many films in which the lead protagonist has cancer. Many are overly sentimental, and the illness portrayed do not reflect the common forms of cancer seen in real life. All can be used in teaching as a catalyst for learning. If you have a film to recommend for this page please use the contact me facility to share it with me.
This article discusses how Hollywood films portray cancer.
-
Vivian Bearing (played by Emma Thomson) is a professor of English Literature, who is diagnosed with advanced ovarian cancer. The film is her story of diagnosis, treatment and reflections on dying. One of the most powerful scenes is where her consultant breaks the news of her diagnosis, it’s a masterful portrayal of how not to break bad news.
-
This film stars William Hurt as Jack McKee, a doctor who undergoes a transformation in his views about life, illness and human relationships following his diagnosis of laryngeal cancer.
-
How Much Pain Is Too Much Pain
by Hilary Mantel
A short story reflecting Mantel’s own experiences of chronic pain. She describes a consultation where, for the first time, she felt her pain was truly listened to — an encounter that was “therapeutic” in itself.
-
The Land of Pain
by Alphonse Daudet
Daudet’s journal of incurable pain contains vivid reflections:“Pain has a life of its own.”
“It’s bearable, and yet I cannot bear it.”
“Pain is always new to the sufferer, but it loses its originality for those around him.”
BooksThere are many books written cancer, many are written by patients and clinicians (who are sometimes also the patient). Here are some that are useful resources in teaching.
-
Before I Say Goodbye
by Ruth Picardie (1998)
When Ruth was diagnosed with terminal breast cancer it was not common to read about cancer in the media. Ruth’s sister, Justine, editor of the Observer Magazine, Life encouraged her to write a column about her experience cancer. The column was called ‘Before I Say Goodbye’. It quickly gained many followers. In the end Ruth only completed five columns before she became too ill to write. After Ruth’s death, Matt, her husband collated and published the columns and a collection of emails Ruth wrote to friends and family. These were published in 1998 as the book ‘Before I Say Goodbye’.
In her book, Ruth said, ‘what hurts most is losing the future. I won’t be there to clap when my beloved babies learn to write their names.’
I’m sure that Ruth’s book encouraged other people to share their stories and talk openly about their hopes and fears.
-
When breath becomes air byPaul Kalanithi 2016by David Biro (2010)
Explores how pain is invisible and often doubted by doctors, friends, and family. Biro suggests that what makes pain most painful is the inability to express it to others.
-
How Much Pain Is Too Much Pain
by Hilary Mantel
A short story reflecting Mantel’s own experiences of chronic pain. She describes a consultation where, for the first time, she felt her pain was truly listened to — an encounter that was “therapeutic” in itself.
-
The Land of Pain
by Alphonse Daudet
Daudet’s journal of incurable pain contains vivid reflections:“Pain has a life of its own.”
“It’s bearable, and yet I cannot bear it.”
“Pain is always new to the sufferer, but it loses its originality for those around him.”
-
This is a moving narrative of her experiences as a daughter and palliative care consultant. The book has been serialised on Radio 4 and can be heard on BBC Sounds.
When I read her the book one experience while she was a junior doctor particularly resonated with me. She refers to an event where she stopped active treatment for a patient with terminal cancer allowing him to die with dignity, she says how difficult she found it to do the right thing.
-
When breath becomes air byPaul Kalanithi 2016by David Biro (2010)
Explores how pain is invisible and often doubted by doctors, friends, and family. Biro suggests that what makes pain most painful is the inability to express it to others.
-
How Much Pain Is Too Much Pain
by Hilary Mantel
A short story reflecting Mantel’s own experiences of chronic pain. She describes a consultation where, for the first time, she felt her pain was truly listened to — an encounter that was “therapeutic” in itself.
-
The Land of Pain
by Alphonse Daudet
Daudet’s journal of incurable pain contains vivid reflections:“Pain has a life of its own.”
“It’s bearable, and yet I cannot bear it.”
“Pain is always new to the sufferer, but it loses its originality for those around him.”
prompt Now it’s your turn
Can you find a poem to help you understand chronic pain?
Can you write a poem about what it feels like to manage a patient in pain?
I wrote the next three poems after several frustrating visits to hospital outpatients where none of the consultants I saw seemed to believe I had a problem because my symptoms did not fit neatly with their list of possible diagnosis. (August 2015)
The tranquillity of my garden and the ability to slip back into things I loved as a child enabled me to maintain my sense of wellbeing despite the pain and fatigue. (May 2015)
The transition from a ‘highly functioning’ adult with many roles to patient was very challenging. (Oct 2015)
After a time off work with the support of amazing colleagues and the flexibility of my post I returned to work as a GP Training Programme Director. The statement ‘not all disabilities are visible’ helped me struggle back to work looking well but not feeling it. (Sept 2017)
This is something I did not previously understand. (March 2017)
The line of illness
by Nicola Gill (me)
March 2017
The line is invisible
to doctors
who think
they understand
the pain
the fatigue
the loss of identity
that is illness
The line is a border.
Patients have no visa no passport to cross back to the other side that is health.
The pain is ongoing, the care has improved, my wellbeing is good.
These poems have helped me make sense of my new world.
Medical resourcesChronic pain is complex, and new evidence shows it can be explained through a biopsychosocial approach. This should have resulted in a change in how clinicians talk to patients and the interventions they offer to help people live well with pain. However, many patients and clinicians still focus on identifying a single cause and treatment so there is more that can be done to use the evidence in patient care and education.
These are two excellent medical resources:
page updated september 2025