Storytelling’s Power in Cancer Treatment
Authors: Susan Jenks
Journal: JNCI Journal of the National Cancer Institute (2014)

When his mother began chemotherapy for lung cancer, Brian Fies started sketching, realizing only later that he had captured the essence of her day in a cartoon.

For the next year and a half, he kept drawing. In 2005, he published Mom’s Cancer, a graphic novel that tells his mother’s story of fighting metastatic disease in 115 pages of comic illustrations.

Although she lost her battle, Fies, an artist and science writer who lives in Santa Rosa, Calif., sees his book as a road map for others facing a diagnosis of any life-altering illness, not just cancer. Despite having a nurse in the family and his own exhaustive research, “we kept getting surprised,” he said. “We were not prepared for many of our interactions with the medical community.”

Over the past several years, graphic novels, such as Mom’s Cancer or Miriam Engelberg’s Cancer Made Me a Shallower Person: A Memoir in Comics, have emerged as a powerful form of storytelling—or medical narrative—about cancer. Michael Green, M.D., a professor in the department of humanities and medicine at Penn State College of Medicine, chose this medium to depict a missed diagnosis that haunted him for years. The comic, published in the Annals of Internal Medicine (Ann. Intern. Med. 2013;158:357–61), is thought to be the first to appear in a mainstream medical journal. And many medical schools, including Penn, now include graphic novels as part of broader-based narrative approaches to improving doctor–patient communication in cancer and other diseases.

Gauging the effect of these efforts, however, largely centered around literature and the arts, is difficult, experts say, because no “empathy test” exists. But few dispute their therapeutic value or their potential to foster discussions about sensitive topics—no more so than in cancer. Most important, perhaps, these stories inject empathy and self-reflection into an increasingly technology-driven profession, they say, offering insight into patients’ and even doctors’ experiences.

Various other disciplines have grappled for years with improving the care of the sick, said Rita Charon, M.D., Ph.D., a professor of clinical medicine at the College of Physicians and Surgeons at Columbia University.

“But we have to keep coming up with ‘hearable’ means of addressing the most obvious concerns: patients’ sense of isolation and their fears when faced with disease.”

A pioneer in narrative medicine, Charon created a one-year master’s program in this discipline at Columbia in 2009 to teach medical students and others the skills to “shift the culture” in health care and “distract them from the technical part of what they do.” On the oncology side of the program, she said, the school brings artists into the pediatric clinic to, for example, help children deal with chemotherapy infusions.

“The artists let the kids create art as they’re getting their infusions,” Charon said, a visual storytelling technique that seems to not only change the climate of the clinic but also reduce children’s defensiveness and stress. The next step, she said, will be to have patients, families, and staff in both the adult and pediatric clinics write their own narratives, to address questions about hope and expectations concerning care.

So far, some 50 students have graduated from the program, many entering it immediately after college before starting medical school, whereas others are midcareer professionals seeking to add a narrative dimension to their practice, she said. A few are poets or writers who want to teach these skills in a clinical setting, according to Charon. To measure the program’s success, she said, “we have to look at what happens when they leave.”

An article by five former students touches on how the program contributed to their moral and personal growth. In “Five Voices, One Story” (JAMA 2013;310:2615–6), Christopher Salib, who is studying at Meharry Medical College in Nashville, cites how the William Carlos Williams short story “The Use of Force” captures a young girl’s “irrationality, unspoken fear, and determination” in resisting a throat culture for a diagnosis of diphtheria.

“We medical students need to learn how to recognize, manage, and approach the temperament of the sick,” Salib wrote. “Incorporating the use of story into medical education can help us do that. Narrative and medicine are codependent—words nurse the wounds medicine cannot describe.”



Paul Lyons, M.D.