Roads to Meaning and Resilience With Cancer

Book Title: Roads to Meaning and Resilience With Cancer

Book Author: Morhaf Al Achkar

Publication Information: San Bernardino, CA, self-published, 2019, 221 pp., $14.99, paperback

Family physician, teacher, and researcher Morhaf Al Achkar, MD, PhD, describes this book as part of his mission to express as much of his experiences as a patient as he can to help others also dealing with a diagnosis of stage 4 lung cancer. Moreover, he reports writing the book as one answer to his existential struggle and to open a space for others to advance conversation around their own existential inquiries. This book includes insights from interviews with 40 individuals, including the author, who have advanced or metastatic non-small cell lung cancer with an oncogenic alteration (ALK, EGFR, ROSI) living in the United States. The author explains that those with this mutation are living for years due to recent advancements in medical treatment, which is different from the previous life expectancy of only a few months. The interviews aim to identify how these individuals make meaning, build resilience, and deal with the struggle of living with a metastatic cancer that is nevertheless a chronic condition.

In cancer literature, resilience has been described as a practice that occurs through constant recalibration through which individuals move on a resilience—distress continuum.1 Dr Al Achkar’s work parallels these findings. Interviewees describe building resilience and strength in several ways, such as learning more about the disease, as well as building a network of family and friends. Others report allowing themselves to be weak at times and accept that doing so is ok.

The coping strategies described in this book are varied and complex. This is consistent with previous work that highlights the need for contextualized and holistic approaches in the care of people with advanced lung cancer.2 Moreover, interviewees describe ways in which they have and have not changed in several health actions, such as diet and exercise. Dr Al Achkar offers no judgments of the opinions offered by those interviewed, though he does caution that alternative medicines should be pursued with caution and may be unwise to use as the only form of treatment. His nonjudgmental stance allows this book to be read by people with differing stances on many topics (eg, religion, support groups, holistic medicine) without feeling criticized.

The book addresses its goal to summarize 40 interviews of people with advanced lung cancer. This information is well condensed, though minimally synthesized for the reader beyond short summative and transitional statements. Additionally, the text could be enhanced with a table of contents and an index to help readers more easily find subsections. Going beyond typical qualitative work, the author reflects on his own answers to the questions he poses to the other interviewees. These portions are compelling and provide patients with a glimpse into how a physician grapples with the disease. This includes his reported struggle to accept being a patient and being vulnerable. Given Dr Al Achkar’s insight and the seeming congruence of these interviews with overall literature on resilience and coping in individuals with cancer, the book would be further improved by a conceptual model/framework for physicians to utilize when treating such patients. Nevertheless, Dr Al Achkar states his mission is to help others also dealing with a diagnosis of stage 4 lung cancer, and this text does that by providing many nonjudgmental perspectives on finding meaning, building resilience, and dealing with the disease.

Though not the target audience, medical providers, their patients, and their loved ones could benefit from the salient message of the book to avoid stereotyping, blaming, or making assumptions about individuals with lung cancer. This is emphasized as none of the individuals with stage 4 lung cancer interviewed ever reported smoking tobacco and many reported that although they may appear healthy, they could be very sick. Dr Al Achkar describes how people with lung cancer are misunderstood and the stigma with lung cancer’s relationship to smoking. He encourages that providers and the general public should not blame individuals for a disease that they did not create and how it is critical we do not withhold empathy for these individuals.

In a Final Remarks section, Dr Al Achkar provides a brief summary of the areas mentioned in the book. He reports that these interviews helped him learn to better listen to his patients with an open and curious mind. A moving sentiment is best encapsulated in his own words, “I am a person, and I have cancer. Now I can stand in solidarity with people in ways that were not attainable to me before.”