It is hard to realize that an elderly patient's visit to you is likely the only trip outside his or her apartment for the week and the only contact with someone other than family or an aide. Doctor visits sometimes become the elderly's primary contact with the larger world.
Jimmie C. Holland, MD
A simple intervention addressing the emotional impact of cancer can help put the "care" back in caregiving
As a midcareer academic medical oncologist, I have found that some books are especially useful as a pocket reference. Some books are small enough for a briefcase, but not ideal for a coat pocket. Others are best sequestered on a bookshelf. Where a book is placed often influences how one will (or won't) use it or read it.
Oncologists grapple with an element of psychological stress that relates
to the suffering their patients experience. Although this stress may
not be unique to oncology, it is profound. When these stresses become
overwhelming, they lead to physician burnout. It is important to understand
what makes an oncologist feel successful, what coping strategies
help combat burnout, and what adds to the process of renewal. The
doctor-patient relationship plays an important role for many oncologists
in this regard, and communication skills are increasingly recognized
for their importance in this arena. We outline several clinical scenarios
that pose particular challenges to oncologists. These include breaking
bad news and the patient’s response to hearing bad news, transitions in
care and offering end-of-life care, participation in investigational studies,
error disclosure, complementary and alternative medicine, spirituality,
family discussions, and cross-cultural issues. By highlighting the
relevant psychosocial issues, we offer insight into, and tools for, an
enriched dialogue between patient and oncologist. The doctor-patient
relationship can be viewed as the ultimate buffer for dealing with the
hassles encountered in clinical oncology.
Written by Jimmie C. Holland, MD, and Sheldon Lewis, this book focuses on the "human effects" as opposed to the
This article identifies the professional stressors experienced by nurses, house staff, and medical oncologists and examines the effect of stress and personality attributes on burnout scores. A survey was conducted of 261 house
A 43-year-old married man was referred to Memorial Sloan-Kettering Cancer Center in June, 1995, for further management of a malignant brain tumor. He was asymptomatic until April, 1994, when he suffered a generalized seizure and was admitted to a local hospital. An MRI revealed a right parietal lobe lesion. The tumor was resected and found to be a glioblastoma multiforme.
Dr. Bernard Fox has served as the mentor and unbiased monitor of psychological, social, and behavioral research in cancer as it has evolved over the past 20 years. The thoughtful review in this issue of the current status of this research is extremely valuable for oncologists who must deal with patients' concerns as to whether their personality, emotions, or recent stresses caused their cancer or its progression. Media reports of psychological studies proposing new evidence of mind-body relationships and cancer are read by frightened patients who are trying to make some meaning out of their plight. The physician who has read Dr. Fox's article can provide a strong antidote to patients' inappropriate assumptions that they have somehow caused their cancer.