Editing Cancer (section)

== Society and culture ==
Although many diseases (such as heart failure) may have a worse prognosis than most cases of cancer, cancer is the subject of widespread fear and taboos. The [[euphemism]] of "a long illness" to describe cancers leading to death is still commonly used in obituaries, rather than naming the disease explicitly, reflecting an apparent [[social stigma|stigma]].<ref>{{Cite news | vauthors = Barbara E |author-link=Barbara Ehrenreich |title=Welcome to Cancerland |newspaper=[[Harper's Magazine]] |date=November 2001 |issn=0017-789X |url=http://www.barbaraehrenreich.com/cancerland.htm |archive-url=https://web.archive.org/web/20131108181820/http://www.barbaraehrenreich.com/cancerland.htm |archive-date=8 November 2013}}</ref> Cancer is also euphemised as "the C-word";<ref>{{cite journal | vauthors = Pozorski A |s2cid=160969212 |title=Confronting the "C" Word: Cancer and Death in Philip Roth's Fiction |journal=Philip Roth Studies |date=20 March 2015 |volume=11 |issue=1 |pages=105–123 |doi=10.5703/philrothstud.11.1.105 |url=https://muse.jhu.edu/article/577333/pdf |access-date=13 April 2020 |language=en |issn=1940-5278}}</ref><ref>{{cite news | vauthors = Wollaston S |title=The C-Word review – a wonderful testament to a woman who faced cancer with honesty, verve and wit |url=https://www.theguardian.com/tv-and-radio/2015/may/04/the-c-word-review-sheridan-smith-cancer-wonderful-testament |access-date=13 April 2020 |work=The Guardian |date=4 May 2015}}</ref><ref>{{cite news |title=Avoiding the 'C' Word for Low-Risk Thyroid Cancer |url=https://www.medscape.com/viewarticle/901265 |access-date=13 April 2020 |work=Medscape}}</ref> [[Macmillan Cancer Support]] uses the term to try to lessen the fear around the disease.<ref>{{cite news |title=The C word: how we react to cancer today |url=https://www.networks.nhs.uk/news/the-c-word-how-we-react-to-cancer-today |website=NHS Networks |access-date=13 April 2020 |language=en-gb |archive-date=22 October 2020 |archive-url=https://web.archive.org/web/20201022210915/https://www.networks.nhs.uk/news/the-c-word-how-we-react-to-cancer-today }}</ref> In Nigeria, one local name for cancer translates into English as "the disease that cannot be cured".<ref name=":0">{{Cite book|url=https://books.google.com/books?id=Tmrp7dkvJk4C&pg=PA196|title=Handbook of Psychiatry in Palliative Medicine| vauthors = Chochinov HM, Breitbart W |date=2009|publisher=Oxford University Press|isbn=978-0-19-530107-6|page=196|language=en}}</ref> This deep belief that cancer is necessarily a difficult and usually deadly disease is reflected in the systems chosen by society to compile cancer statistics: the most common form of cancer—non-melanoma [[skin cancer]]s, accounting for about one-third of cancer cases worldwide, but very few deaths<ref name="Bolognia">{{cite book | vauthors = Rapini RP, Bolognia JL, Jorizzo JL |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |isbn=978-1-4160-2999-1 }}</ref><ref>{{cite web |title=Skin cancers |url=https://www.who.int/uv/faq/skincancer/en/index1.html |publisher=World Health Organization |access-date=19 January 2011 |url-status=live |archive-url=https://web.archive.org/web/20100927065836/http://www.who.int/uv/faq/skincancer/en/index1.html |archive-date=27 September 2010}}</ref>—are excluded from cancer statistics specifically because they are easily treated and almost always cured, often in a single, short, outpatient procedure.<ref>{{cite book | vauthors = McCulley M, Greenwell P |title=Molecular therapeutics: 21st-century medicine |publisher=J. Wiley |location=London |year=2007 |page=207 |url={{google books |plainurl=y |id=aG3SNAEACAAJ0470019166}} |isbn=978-0-470-01916-0 }}{{dead link|date=July 2023 |bot=InternetArchiveBot |fix-attempted=yes }}</ref>

Western conceptions of [[patients' rights]] for people with cancer include a duty to fully disclose the medical situation to the person, and the right to engage in [[Shared decision-making in medicine|shared decision-making]] in a way that respects the person's own values. In other cultures, other rights and values are preferred. For example, most African cultures value whole families rather than [[individualism]]. In parts of Africa, a diagnosis is commonly made so late that cure is not possible, and treatment, if available at all, would quickly bankrupt the family. As a result of these factors, African healthcare providers tend to let family members decide whether, when and how to disclose the diagnosis, and they tend to do so slowly and circuitously, as the person shows interest and an ability to cope with the grim news.<ref name=":0"/> People from Asian and South American countries also tend to prefer a slower, less candid approach to disclosure than is idealized in the United States and Western Europe, and they believe that sometimes it would be preferable not to be told about a cancer diagnosis.<ref name=":0"/> In general, disclosure of the diagnosis is more common than it was in the 20th century, but full disclosure of the prognosis is not offered to many patients around the world.<ref name=":0"/>

In the United States and some other [[Cultural differences in breast cancer diagnosis and treatment|cultures]], cancer is regarded as a disease that must be "fought" to end the "civil insurrection"; a [[War on Cancer]] was declared in the US. Military metaphors are particularly common in descriptions of cancer's human effects, and they emphasize both the state of the patient's health and the need to take immediate, decisive actions himself rather than to delay, to ignore or to rely entirely on others. The military metaphors also help rationalize radical, destructive treatments.<ref name="Gwyn">{{cite book | vauthors = Low G, Cameron L |title=Researching and Applying Metaphor |chapter-url={{google books |plainurl=y |id=8aOxMvo_ag8C}}|year=1999|publisher=Cambridge University Press|isbn=978-0-521-64964-3| chapter=10}}</ref><ref>{{cite book | vauthors = Sulik GA |title=Pink Ribbon Blues: How Breast Cancer Culture Undermines Women's Health |url={{google books |plainurl=y |id=_it2CwAAQBAJ |page=78}}|year=2010|publisher=Oxford University Press|isbn=978-0-19-974993-5|pages=78–89}}</ref>
In the 1970s, a relatively popular [[alternative cancer treatment]] in the US was a specialized form of [[talk therapy]], based on the idea that cancer was caused by a bad attitude.<ref name=Olson/> People with a "cancer personality"—depressed, repressed, self-loathing and afraid to express their emotions—were believed to have manifested cancer through subconscious desire. Some psychotherapists claimed that treatment to change the patient's outlook on life would cure the cancer.<ref name=Olson/> Among other effects, this belief allowed society to [[Victim blaming|blame the victim]] for having caused the cancer (by "wanting" it) or having prevented its cure (by not becoming a sufficiently happy, fearless and loving person).<ref name=Ehrenreich/> It also increased patients' anxiety, as they incorrectly believed that natural emotions of sadness, anger or fear shorten their lives.<ref name=Ehrenreich/> The idea was ridiculed by [[Susan Sontag]], who published ''[[Illness as Metaphor]]'' while recovering from treatment for breast cancer in 1978.<ref name=Olson>{{cite book | vauthors = Olson JS |title=Bathsheba's Breast: Women, Cancer, and History |url={{google books |plainurl=y |id=gp9aMBieClMC |page=145}}|year=2005|publisher=JHU Press|isbn=978-0-8018-8064-3| pages = 145–70 | oclc = 186453370 }}</ref> Although the original idea is now generally regarded as nonsense, the idea partly persists in a reduced form with a widespread, but incorrect, belief that deliberately cultivating a habit of [[Optimism|positive thinking]] will increase survival.<ref name=Ehrenreich>{{cite book | vauthors = Ehrenreich B |author-link=Barbara Ehrenreich |title=Bright-sided: How the Relentless Promotion of Positive Thinking Has Undermined America |url={{google books |plainurl=y |id=wxJlvB7bCO4C |page=15}}|year=2009|publisher=Henry Holt and Company|isbn=978-0-8050-8749-9| pages = 15–44 }}</ref> This notion is particularly strong in [[breast cancer culture]].<ref name=Ehrenreich />

One idea about why people with cancer are blamed or stigmatized, called the [[just-world fallacy]], is that blaming cancer on the patient's actions or attitudes allows the blamers to regain a sense of control. This is based upon the blamers' belief that the world is fundamentally just and so any dangerous illness, like cancer, must be a type of punishment for bad choices, because in a just world, bad things would not happen to good people.<ref>{{Cite news |title=A Sick Stigma: Why are cancer patients blamed for their illness? |date=24 September 2013 |url=http://www.slate.com/articles/health_and_science/medical_examiner/2013/09/cancer_stigma_don_t_blame_patients_for_their_disease_no_matter_what_the.html |newspaper=Slate | vauthors = Huff C |url-status=live |archive-url=https://web.archive.org/web/20131011120507/http://www.slate.com/articles/health_and_science/medical_examiner/2013/09/cancer_stigma_don_t_blame_patients_for_their_disease_no_matter_what_the.html |archive-date=11 October 2013}}</ref>

=== Economic effect ===
The total health care expenditure on cancer in the US was estimated to be $80.2&nbsp;billion in 2015.<ref>{{cite web |title=Economic Impact of Cancer |url=https://www.cancer.org/cancer/cancer-basics/economic-impact-of-cancer.html |website=American Cancer Society |date=3 January 2018 |access-date=5 July 2018}}</ref> Even though cancer-related health care expenditure have increased in absolute terms during recent decades, the share of health expenditure devoted to cancer treatment has remained close to 5% between the 1960s and 2004.<ref>{{cite journal |vauthors=Bosanquet N, Sikora K |title=The economics of cancer care in the UK |journal=Lancet Oncology |volume=5 |issue=9 |pages=568–74 |year=2004 |pmid=15337487 |doi=10.1016/S1470-2045(04)01569-4}}</ref><ref>{{cite journal |vauthors=Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML |title=Projections of the cost of cancer care in the United States: 2010–2020 |journal=Journal of the National Cancer Institute |volume=103 |issue=2 |pages=117–28 |year=2011 |pmid=21228314 |pmc=3107566 |doi=10.1093/jnci/djq495}}</ref> A similar pattern has been observed in Europe where about 6% of all health care expenditure are spent on cancer treatment.<ref>{{cite journal |vauthors=Jönsson B, Hofmarcher T, Lindgren P, Wilking N |title=The cost and burden of cancer in the European Union 1995–2014 |journal=European Journal of Cancer |volume=66 |issue=Oct |pages=162–70 |year=2016 |pmid=27589247 |doi=10.1016/j.ejca.2016.06.022}}</ref><ref name=EJC2018>{{cite journal |vauthors=Hofmarcher T, Lindgren P, Wilking N, Jönsson B |title=The cost of cancer in Europe 2018 |journal=European Journal of Cancer |volume=129 |issue=Apr |pages=41–49 |year=2020 |pmid=32120274 |doi=10.1016/j.ejca.2020.01.011|doi-access=free }}</ref> In addition to health care expenditure and [[financial toxicity]], cancer causes indirect costs in the form of productivity losses due to sick days, permanent incapacity and disability as well as premature death during working age. Cancer causes also costs for informal care. Indirect costs and informal care costs are typically estimated to exceed or equal the health care costs of cancer.<ref>{{cite journal |vauthors=Luengo-Fernandez R, Leal J, Gray A, Sullivan R |title=Economic burden of cancer across the European Union: a population-based cost analysis |journal=Lancet Oncology |volume=14 |issue=12 |pages=1165–74 |year=2013 |pmid=24131614 |doi=10.1016/S1470-2045(13)70442-X}}</ref><ref name=EJC2018 />

=== Workplace ===
In the United States, cancer is included as a protected condition by the [[Equal Employment Opportunity Commission]] (EEOC), mainly due to the potential for cancer having discriminating effects on workers.<ref name="EEOC">U.S. Equal Employment Opportunity Commission. "Questions & Answers about Cancer in the Workplace and the Americans with Disabilities Act (ADA)." https://www.eeoc.gov/laws/types/cancer.cfm</ref> Discrimination in the workplace could occur if an employer holds a false belief that a person with cancer is not capable of doing a job properly, and may ask for more [[sick leave]] than other employees. Employers may also make hiring or firing decisions based on misconceptions about cancer disabilities, if present. The EEOC provides interview guidelines for employers, as well as lists of possible solutions for assessing and accommodating employees with cancer.<ref name="EEOC" />

=== Effect on divorce ===

A study found women were around six times more likely to be [[divorced]] soon after a diagnosis of cancer compared to men.<ref>{{cite journal | vauthors = Glantz MJ, Chamberlain MC, Liu Q, Hsieh CC, Edwards KR, Van Horn A, Recht L | title = Gender disparity in the rate of partner abandonment in patients with serious medical illness | journal = Cancer | volume = 115 | issue = 22 | pages = 5237–5242 | date = November 2009 | pmid = 19645027 | doi = 10.1002/cncr.24577 }}</ref> Rate of separation for cancer-survivors showed correlations with race, age, income, and [[comorbidity|comorbidities]] in a study.<ref>{{cite journal | vauthors = Stephens C, Westmaas JL, Kim J, Cannady R, Stein K | title = Gender differences in associations between cancer-related problems and relationship dissolution among cancer survivors | journal = Journal of Cancer Survivorship | volume = 10 | issue = 5 | pages = 865–873 | date = October 2016 | pmid = 26995006 | doi = 10.1007/s11764-016-0532-9 }}</ref> A review found a somewhat decreased divorce rate for most cancer types, and noted [[study heterogeneity]] and [[Methodology|methodological]] weaknesses for many studies on the effects of cancer on divorce.<ref>{{cite journal | vauthors = Fugmann D, Boeker M, Holsteg S, Steiner N, Prins J, Karger A | title = A Systematic Review: The Effect of Cancer on the Divorce Rate | journal = Frontiers in Psychology | volume = 13 | page = 828656 | date = 9 March 2022 | pmid = 35356338 | pmc = 8959852 | doi = 10.3389/fpsyg.2022.828656 | doi-access = free }}</ref>