The meaning of cancer therapy: bone marrow transplantation as an exemplar of therapy.

Cancer touches all dimensions of life and consequently all realms of personal meaning including people's beliefs in an orderly and controllable world. Regaining a belief in a comprehensible world often begins with the confirmation of a definitive diagnosis and the initiation of therapy. The meaning of therapy will vary depending on the availability of viable treatment options, the natural history of cancer, the daily challenges of living with cancer, and the outcome of treatment. This article reviews the literature on the meaning of cancer therapy, explanatory models of therapy, and the meaning of personal control during treatment. A qualitative study of 23 adults with leukemia who were waiting to undergo a bone marrow transplantation (BMT) was conducted to describe the personal meaning of leukemia and BMT. The findings indicate that seeking confirmation for the diagnosis of leukemia is often impersonal, fraught with uncertainty, and surrounded by an unexplained sense of urgency. When making the decision to undergo BMT, people transformed the biomedical estimates of survival into personal terms to humanize the odds and to inflate their perceived chances of survival. Before undergoing BMT, individuals recalled their previous experiences with cancer therapy in an effort to make the unknown future more predictable. Ways to self-monitor daily progress and suggestions for mitigating the devastating effects of bad news were identified. Physicians were identified as controlling the BMT treatment regimen, whereas nurses were perceived as controlling the daily care routines. Implications include the need to give patients preparatory information about what to expect in therapy as well as the need to help them identify how they can cope effectively.(ABSTRACT TRUNCATED AT 250 WORDS)