How To Discuss Death? A Conversation of Mortality in Cancer Care

In the recent episode of Oncology-on-the-Go, in collaboration with the American Psychosocial Oncology Society (APOS), Daniel C. McFarland, DO, welcomes William S. Breitbart, MD, to discuss how clinicians can address patients’ existential concerns. While oncologists often focus on treatment and the drive for life, the core concern for many patients remains mortality. Breitbart’s work in meaning-centered therapy provides a framework for these difficult conversations.

Breitbart emphasizes that patients grappling with fear, uncertainty, and depression may not always express it directly. The goal of meaning-centered therapy is to help patients find a sense of purpose and peace, even as they face a terminal illness. This approach is not about eliminating suffering, but about helping patients find meaning in their experiences. The conversation covers the practical application of these principles, including how to bring up topics of death and dying, and the importance of validating a patient's fears without resorting to platitudes.

The discussion also touches on the concept of “existential guilt,” which Breitbart links to the human awareness of one’s own existence and mortality. He notes that many clinicians are drawn to oncology or psycho-oncology because of their own personal experiences with death and illness. Overall, the episode is a reminder for oncologists and their multidisciplinary team members to look beyond the treatment and its clinical outcomes, and engage in human conversations that can significantly improve a patient’s quality of life, emotional support, and overall well-being.

McFarland is the director of the Psycho-Oncology Program at Wilmot Cancer Center and a medical oncologist who specializes in head, neck, and lung cancer, in addition to being the psycho-oncology editorial advisory board member for the journal ONCOLOGY^®; Breitbart is an attending physician and the Jimmie C. Holland Chair in Psycho-Oncology at Memorial Sloan Kettering Cancer Center.