Hi, Donna,

Sometimes it may seem as if loved ones care more about the treatment than the one who is going through it. My sister-in-law was diagnosed with lung cancer when she was 42 and died about two years later. She had been a heavy smoker for years and as it turns out- smoked throughout her entire treatment including after she appeared to go into remission. My brother has never smoked and he tried for years to get her to stop but gave up long before she was diagnosed with cancer. Her three children tried to get her to stop (pre-cancer) and were devastated when they "caught" her smoking during treatment. She smoked the last weeks of her life as well. I have thought about this so many times- how hurt and angry her family was because they felt that she valued/enjoyed smoking and her right to smoke over their concerns for her and her caring for them. She and I talked once about her smoking right after she was diagnosed and she said she expected cigarettes would likely shorten her life (e.g., heart attack but not cancer) but was thinking more in terms of dying at 80 instead of 85 (NEVER expected such dire consequences in her early 40's). Of course I sort of "get" all of the psychological and physical things that go with smoking - the routine, doing something one wants to do whether others agree or not, the soothing aspects it takes on which certainly all come out during times of stress and fear. But I have to say I often wondered why she continued to smoke once diagnosed and especially when she appeared to be in remission. I don't know the answer but I've gone back and forth between her never really believing that she was going to make it anyway and her believing that because she was so young and looked healthy she would beat the cancer regardless of whether she continued to smoke.

I think that whether it's about smoking or something else, the individual with the cancer needs to care about and believe in their treatment at least as much or more than their loved ones. There is only so much we can do as caregivers if we are trying to promote something that the patient doesn't want or doesn't think he or she can do. I don't mean on occasion that we don't push things but in an overall sense.