The news reports were cautiously optimistic (and maybe a little skeptical): Sen. Ted Kennedy would speak at the Democratic National Convention -- may be. Word had it that the senator, who has been undergoing treatment for a malignant brain tumor since May, was determined to make the trip. But family members were concerned: His imune system was in no condition for a crowd, which is what the convention, by definition, is.
And yet there he was, looking sturdy. His white shock of Kennedy hair was in place, but the odd camera angle caught a pink scalp peaking through a thinned patch on the side of his head. Without high definition TV, the IV port tucked beneath an ACE bandage on his left hand might've stayed hidden.
Kennedy's rousing 10-minute speech carried meaning for cancer survivors that went well beyond the words he spoke:
"My fellow Democrats, my fellow Americans, it is so wonderful to be here." As he left the stage, waving, throwing a thumbs up, "Still the One" blared from the speakers.
"When he came out, I thought, 'My God, what did that take for him to do that?' I don't know what treatment he's undergoing, but with that kind of tumor, to me, it was nothing short of a miracle," said Bill Howe, a 61-year-old Bath, Mich., man who is a seven-year survivor of metastatic prostate cancer. "That took more than people ever would dream for him to do that. I know they're appreciative, but they don't have a clue."
Kennedy is one of many celebrities who have remained in the spotlight despite a cancer diagnosis, choosing instead to present an image of determination and vigor in the face of a potentially deadly illness. Celebrities have been talking openly about cancer for years, but it's become nearly impossible to pass a grocery store checkout without some news of celebrity health.
Consider: Actress Christina Applegate gave an interview to ABC's Robin Roberts -- a fellow breast cancer survivor -- about having a double mastectomy after testing positive for the BRCA1 breast cancer gene. Swimmer Eric Shanteau put off treatment for testicular cancer to compete in the Olympics. Actor Patrick Swayze, diagnosed last spring with pancreatic cancer, continues to work on the set of his new television series. And, of course, there's the omnipresent Lance Armstrong; the nation's most recognizable celebrity survivor announced he would ride again in the Tour de France.
Research has shown that celebrity campaigns such as anchorwoman Katie Couric's efforts to promote colon cancer screenings are beneficial in raising public awareness, decreasing the stigma of cancer and encouraging people to see their doctors to catch cancer in earlier, more treatable stages, said Michelle Riba, M.D., M.S., director of PsychOncology at the University of Michigan Comprehensive Cancer Center. But there can be unintended consequences.
"Some people view it as very inspirational," she said. "But sometimes, for the patient who's struggling, they don't want it in their face every time they go to the newsstand or the supermarket."
Continuing to Perform
Once upon a time, privacy reigned. Barron Lerner, author of When Illness Goes Public, said when celebrities of earlier eras were diagnosed with cancer, they were expected to do nothing and keep quiet. But culture shifted, and a perceived obligation for celebrities to tell their stories crept in.
When Betty Ford went public about her breast cancer in 1974, she was one of the first public figures to talk openly about the disease. It still felt fresh to Jane Perlmutter, a member of the U-M Breast Cancer Advisory and Advocacy Committee, when she was diagnosed with the disease 11 years later at age 36.
"I think demystifying it and making it okay to talk about cancer is very useful," she said.
But because celebrities are celebrities, they feel obligated to put a particularly positive face on their illness, Lerner said.
"I think celebrities tend to feel that because they are role models, they have to think publicly as optimistically as possible," he said. "It's not good for them, and it can be misleading for others."
Howe is realistic: He said he realizes celebrities are projecting a positive image that shields the public from the uglier sides of cancer, which he thinks is probably best. He's more interested in learning about the treatments that help celebrities continue to perform -- a thought Riba says many patients echo, sometimes noting how unfair it seems that celebrities' money and stature offers them special privileges.
What frustrates Howe and Perlmutter, though, is the notion some people have that everything will be fine if you just stay positive.
Research has shown that stress can affect the immune system, but people have made assumptions lacking in scientific evidence about the role stress or a positive attitude plays in cancer, said Jimmie C. Holland, M.D., author of The Human Side of Cancer. People sometimes feel guilty, as though they've brought on their cancer by being negative, she said.
"We don't tell people who've had a heart attack to stay positive. We don't ask, 'Did you eat a lot of red meat,' and blame them," Holland said. "It's just a myth that adds pressure."
The best attitude is the one that works best for the person with cancer, Riba said. Many people come to appreciate their own mortality and they look for new ways to cope. For some, a positive attitude is part of that, while for others it isn't.
Howe said he's appreciative of each new day. But when he was still in treatment, slogging through bouts of fatigue and depression, he said he wanted to punch people in the eye when they said "all you have to do is have a positive attitude and watch funny movies."
I'm more of a realist than a projectionist," he said. "I think approaching it in a factual way like I did is positive, in a way. The idea was, 'We're going to fight this thing.'"
Fight. Battle. War. Few magazines tout headlines about celebrities "dealing" with cancer. "Fighting cancer" has become an invisible metaphor, Lerner said, a phrase that's become so engrained that people have forgotten it's a metaphor.
"The language reflects society and culture," Lerner said. "If you're not paying close attention, you might feel obligated to behave in a way that makes you a fighter and some people don't want to do that. Different people deal with cancer in different ways."
Dorene Williams thinks battle is the perfect word to describe her experience: In 2003, she was diagnosed with metastatic breast cancer, two years after she thought she had beaten the disease in 2001. Although she said she doesn't think words like "win" or "lose" apply in war, she said she's "battling cancer seven days a week, 24 hours a day" for her two sons, Cody, 16, and Lucas, 11.
Part of that is keeping up appearances, both for her sons' sake and her own. Much like the celebrities coping with cancer in the media, Williams chooses the attitude she wants to portray. She has decided she doesn't want anyone to know how sick she really is, so she makes a point of getting out of bed, taking a shower, fixing her hair and putting on nice clothes and make-up.
"I make sure that when I go out in public, no matter how sick I am, no matter how much pain I'm in, that I look presentable so no one says, 'Oh my God, what's wrong with her?'" Williams said. "I don't want pity. Ted Kennedy doesn't want pity. No one wants pity."