Navigating Personality Disorders in Cancer Care

Cancer is never convenient, and it never arrives when a patient is truly prepared, according to Daniel C. McFarland, DO, who began the most recent episode of Oncology On the Go with this sentiment. When individuals enter the high-stakes, highly coordinated world of oncology, they do so under extreme duress, often presenting the versions of themselves that are most under stress. In this environment, clinical teams frequently encounter behaviors that get unfairly lumped into the vague and pejorative category of the “difficult patient.” What happens when these challenges stem from an underlying personality disorder rather than just temporary situational anxiety?

In this episode, McFarland was joined by psycho-oncology expert Kaleena Chilcote, MD, to unpack the inner workings of personality styles and disorders within oncologic science. Together, they explored the Diagnostic and Statistical Manual of Mental Health Disorders (DSM) diagnostic framework, spanning the eccentric, dramatic, and anxious categories. They discussed how these enduring, pervasive traits impact a patient’s health care journey.

Shifting the conversation away from the stigma of labels, McFarland and Chilcote delivered actionable, real-world advice for oncology teams. They discussed how to utilize objective, descriptive charting; initiate a pause to check your own provider emotions; and build highly consistent, structured boundaries. From managing frequent phone calls to intentionally scheduling short, high-frequency touchpoints, the pair provided a roadmap for turning interpersonal conflict into therapeutic collaboration, proving that underneath the defense mechanisms, every patient has a uniquely valuable strength to connect with.

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 a psycho-oncology editorial advisory board member for the journal ONCOLOGY®. Chilcote is director of Psycho-Oncology in the Department of Palliative and Supportive Care at the Taussig Cancer Center, part of the Cleveland Clinic.