Hope as a Strategy

Ernest Rosenbaum, M.D. and David Spiegel, M.D. 

The Philosophy of Hope

Hope is one of the greatest allies supporting quality of life.

Hope can be a major tool of empowerment and an element for sustaining life and the will to live. We hope for better times. We hope for remission.

We hope to prolong life by averting death through medical treatment and supportive care. Or, if disease progresses, we hope to control pain, side effects, and suffering.  We hope for treatments that can cure or palliate and make the disease stable.

“Hope is the most beautiful of all the affections, and doth much to the prolongation of life, if it be not too often frustrated, but entertaineth fancy with an expectation of good.” Francis Bacon

The Oxford Dictionary defines hope as “to entertain expectations of something desired.” Hope embodies an emotional component beyond expectation that is an important part of human experience. Plants and trees often bend toward the warmth of the sun, which is comparable to a person's hope for improved survival.

Hope is a precious commodity that is often hard to define but is very important to keep alive. It often gives a person a glimpse of the future and is supported by enduring fortitude, courage, and ingenuity, often in the face of adversity. Hope is synonymous with a positive will to live and affects a positive outcome, whatever that might be.

Hope can be a part of one’s upbringing from childhood. It can also be developed through life experiences, passed on from friends, from spiritual or religious philosophy, or from examples in life.

A lot depends on development of one’s personality and how one has dealt with crises during life. The better one copes with crises, the better chance one has of being more hopeful. In contrast, requesting euthanasia at the end of life reflects a feeling of severe hopelessness, a wish only for peace, and an end to suffering. If a patient strives for quality and purpose in this final period of life, then the goal of the medical and social professions is to promote hope, compassion, comfort, and optimal care.

An interesting example is that of Viktor Frankl, a survivor of a German concentration camp during World War II. Facing death, he found that many of his fellow captives continued to maintain a reason and purpose for living. They often fared better than those who found the concentration camp experience nothing but dreadful and overwhelming. At Buchenwald, he saw that prisoners who were physicians kept hope alive by preparing and presenting medical papers, often late at night when fellow prisoners were asleep. They even put together a working X-ray machine. They believed that hopelessness had a significant effect on the human response to illness. This lack of optimism in the form of hopelessness has been shown to predict poorer survival among breast cancer patients

Dr. Karl Menninger was one of the first health professionals to address the concept of hope relating to the treatment of patients with psychiatric disorders. He believed that hope was an important element of humanizing medicine that, in the 20th century, had become more involved with technological therapies. He believed that hope could promote the humanitarian goals that were in danger of being destroyed.

But hope has not always been viewed as a virtue.  The story of Pandora’s box from ancient Greek mythology relates that, when the box was opened, all the evils were dispersed throughout the world and hope was concealed. The Greeks placed hope in a category with other miseries, and felt that was the reason hope was concealed within Pandora’s box.   Buddhists teach that desire is an affliction, tying us to the worldly life rather than allowing us to seek release from it.  Friedrich Nietzsche, in his discussions in Human, All Too Human, stated: “Hope is the worst of evils, for it prolongs the torment of man.”

The Judeo-Christian belief, in contrast, is that hope is related to the congenial spirit of goodness, as conveyed in the saying, “Where there is life, there is hope.” But a fragmentation of hope often glimmers when one is watching, with humility, the prolonged dying of a loved one.

A serious illness is a reminder that life is not infinite.

“You can be told you have a 90 percent, or a one percent chance to survive. But as long as you take that chance, and believe in yourself and are a brave person, and then want to be better than before. ... I’m living proof that you get a second chance, and the second time around is better than the first.”Lance Armstrong, cancer survivor

Plato said that courage is knowing when to be afraid.   Many people have faced serious illness, managed and were not overwhelmed by it. Although they became ill, they did not give up. Their bodies may have suffered, but their spirits remained strong. Indeed, serious illness is a reminder that we are not immortal. Those who respond creatively to a life-threatening illness hear it as a wake-up call; a reminder of how short time is and that life is precious. They do what matters most while they can, experience the joys of living and loving, and let the people around them know how much they are loved and appreciated. They trivialize the trivial, drop useless commitments, eliminate relationships that are taxing and not worth the trouble, and “just say no” to what they think they should do rather than what they want to. Many stories abound of courageous people, who became very ill or faced some other crisis, yet count themselves fortunate.  In the face of a dismal diagnosis or harsh circumstances, they can take stock of their resources and find strength and love.

No matter what stage one’s cancer is, setting short-term and long-term goals will help define and achieve life’s purposes.  Survivors are well advised to hope for the best but prepare for the worst.  They can live with hope for a cure, a remission, or stable cancer without suffering and enjoy high quality of life with family and friends for as long as possible.

Hope can be reduced by loss of empathy and compassion and by withdrawing oneself from reality, from family and friends, and from the medical support team. Patients may experience psychologically depressing or destructive medical or social processes if they feel that life is disappointing and unsatisfactory.  They may involve others in this destructive pattern that has grave psychological implications and indicates a process of utter despair.  So to feel embedded in a network of caring at a time of serious illness is deeply reassuring. The will to live is not the denial of death, but the intensification of a life experience, which comes with the realization of how finite life truly is.

Health professionals believe that a combination of medical therapy, adoption of healthy lifestyles, medical prevention and supportive care offers the best chance to maintain a patient’s quality of life. Such comprehensive care addresses a wide range of needs, from relieving the physical symptoms of cancer and cancer therapy to satisfying the craving for intellectual, creative, and spiritual sustenance. Satisfaction of these diverse needs demonstrates the powerful connection between mind and body. Obtaining relief from pain, nausea, or fatigue, for example, restores a sense of calm. Sufficient sleep, appropriate exercise, and good nutrition are energizing. Discussing one’s negative feelings candidly with others can diminish their effect. Learning to control blood pressure and heart rate through such means as biofeedback and self-hypnosis can foster a sense of personal power. Exploring one’s creative potential can lead to joy and transcendence.

Positive Thinking

When diagnosed with cancer, maintaining a positive attitude can be difficult. Individuals must confront many obstacles, including the side effects of the illness and treatment, as well as feelings of fear, anger, depression, and loneliness. All of this can impact even the most buoyant of personalities. One way to maintain a positive attitude is by setting reasonable, achievable goals. Another helpful hint is to put energy into activities that bring satisfaction. Doing one’s best to maintain a positive attitude helps to cope with illness.


For patients with cancer, the future is often unknown, and hope is what keeps them alive to endure treatments and social and personal adversities. Hope is supported by the positive attitudes of the medical team, but can also be very fragile.  Anything that demoralizes a person can negate the feeling of hope, which can make a difference in accepting or denying the next set of treatments if failure occurs. The feeling of hope and will to live will vary daily depending on one’s current physical status, psychological outlook (depression or elation), and treatment success or failure. The hope is to be kept alive, to live, and to recover through a resilient attitude rather than a feeling of despair. Hope is often a shared feeling with one’s personal team of family and friends because the future is often nebulous.  Hope keeps one alive to fight for another day, a month, a year, and a return to better health. It affords another opportunity to respond to therapy and to live.

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Ernest H. Rosenbaum, M.D.

Clinical Professor of Medicine, University of California, San Francisco, Comprehensive Cancer Center; Adjunct Clinical Professor, Department of Medicine, Stanford University Medical Center; Director, Stanford Cancer Supportive Care Programs National/International, Stanford Complementary Medicine Clinic, Stanford University Medical Center, Stanford, California. More 

Ernest H. Rosenbaum’s career has included a fellowship at the Blood Research Laboratory of Tufts University School of Medicine (New England Center Hospital) and MIT. He teaches at the University of California, San Francisco, Comprehensive Cancer Center, was the cofounder of the Northern California Academy of Clinical Oncology, and founded the Better Health Foundation and the Cancer Supportive Care Program at the Stanford Complementary Medicine Clinic, Stanford University Medical Center.

His passionate interest in clinical research and developing ways to improve patient care and communication with patients and colleagues has resulted in over fifty articles on cancer and hematology in various medical journals. He has also participated in many radio and television programs and frequently lectures to medical and public groups.

He has written numerous books, including Living with Cancer: A Home Care Training Program for Cancer Patients; Decisions for Life: You Can Live Ten Years Longer with Better Health; Cancer Supportive Care: A Comprehensive Guide for Cancer Patients and Their Families; Nutrition for the Cancer Patient; Everyone’s Guide to Cancer Therapy; and Everyone’s Guide to Cancer Survivorship. For Everyone’s Guide to Cancer Therapy, Ernest Rosenbaum, M.D., Malin Dollinger, M.D., and Greg Cable received and Honorable Mention in 1991 from the American Medical Writers Association for Excellence in Medical Publications. Ernest and Isadora Rosenbaum received the same award in 1982 for their book, A Comprehensive Guide for Cancer Patients and Their Families.


David Spiegel, M.D.

Dr. David Spiegel is Willson Professor and Associate Chair of Psychiatry & Behavioral Sciences, Director of the Center on Stress and Health, and Medical Director of the Center for Integrative Medicine at Stanford University School of Medicine, where he has been a member of the academic faculty since 1975.  More He is Past President of the American College of Psychiatrists, and Past President of the Society for Clinical and Experimental Hypnosis, and a member of the Institute of Medicine of the National Academies. He has published ten books, 368 scientific journal articles, and 156 book chapters on hypnosis, psychosocial oncology, stress physiology, trauma, and psychotherapy. His research has been supported by the National Institute of Mental Health, the National Cancer Institute, the National Institute on Aging, the National Center for Complementary and Alternative Medicine, the John D. and Catherine T. MacArthur Foundation, the Fetzer Institute, the Dana Foundation for Brain Sciences, and the Nathan S. Cummings Foundation.