Now that I’ve been through cancer, my life seems to be full of clichés. What doesn’t kill you makes you stronger. There’s no time like the present. And especially pertinent for me, never judge another until you walk a mile in his shoes. I know now that these aren’t just clever sayings ― they’re wonderfully true and full of life lessons.
But, let me back up. I practiced outpatient and inpatient medicine at a community hospital for nine years. As I prepared to make the switch in the late 2000s to Cancer Treatment Centers of America (CTCA) — where I would focus solely on oncology patients by running their hospitalist program — I felt as close to being an expert as one can get in terms of my knowledge and practice of internal medicine and confident that I had a strong understanding of applying my expertise in the cancer arena. I had the roadmap for bettering the outcomes of cancer patients through a focused, strategic and clinically driven treatment plan. Little did I know that my medical expertise alone wouldn’t determine my career path and my ability to serve patients. What happened three weeks before I started at CTCA, and the experiences that stemmed from it, has also played a huge role in who I am today.
In 2007 at age 38, the irony of ironies fell upon me. I was diagnosed with cancer — Hodgkin’s Lymphoma. The road ahead included chemo, radiation and a compromised immune system. Because I am a doctor, I thought I knew everything to expect. And, on the medical/physical side of things — I was pretty spot on. But there was a whole other aspect to surviving cancer that I was nearly clueless about: the extensive range of emotion I’d experience, plus the psychological toll. The things that came into play long after the final treatment. The things I now consider to be some of the biggest challenges to survivorship … to living life as fully as possible after cancer.
I realized that cancer wasn’t all about the physical and clinical. When treating cancer patients in my practice, I took care to recognize they needed support beyond what medically could heal them. But, until I personally experienced cancer, I really didn’t comprehend just how much that physical and emotional support went hand-in-hand in the life of someone battling this disease.
One of my favorite examples is when a patient at CTCA gets to ring the “end-of-treatment” bell. Most patients on their last day of chemo or radiation are surrounded by nurses as they ring a celebratory bell outside the infusion room. I’d heard this bell ring dozens of times and always thought, What a happy moment; that patient’s ordeal is done. For eight weeks, I counted down my treatments, crossing each date off my calendar as I completed another round of chemo. As I moved from what I initially thought would be “a piece of cake” into the world of accumulating side effects such as fatigue, I couldn’t wait to get to the end.
I thought I knew everything to expect. And, on the medical/physical side of things — I was pretty spot on. But there was a whole other aspect to surviving cancer that I was nearly clueless about: the extensive range of emotion I’d experience plus the psychological toll.
Finally! The last day had arrived and it was my turn to ring the bell. But I didn’t feel the elation I expected. Yes, I was relieved, but I remember feeling a little panicky and anxious between that moment and getting the results of my final scans. What if the treatments don’t work? I wondered. And believe me, these feelings didn’t go away after the scans gave me the all clear. There was always a voice in the back of my head whispering, you’re fine now, but it can come back, you know. Moreover, I experienced what I’d call separation anxiety from my oncology care team. All during treatment, I was under a microscope, everyone was on the lookout for the cancer and firing on all cylinders to send it packing. But what now? Who’s looking out for me? Who is ready to attack if the cancer returns?
Despite being a physician in a cancer hospital, I wasn’t superman through all this. I experienced all of what you hear about if you are close to someone with cancer. I remember the anxiety that hit a few days before a PET scan and needing my wife to help “talk me down.” My anxiety about recurrence was so real and strong that I sought the support of a health coach to help me work through my emotions, develop personal coping strategies and stay focused on the progress I’d made. Her training in cognitive behavioral therapy and overall support was especially helpful around test time. I was frustrated with the fatigue, months after I thought I should have been over it. And I learned the meaning of what has been termed “survivor’s guilt” — I’d survived cancer, but the quality of life I wanted just wasn’t there yet. Everyone was saying to me, with the best of intentions, “You made it, you’re cancer-free. You must be so happy.” And, while, of course I was grateful, I felt very guilty for not being completely satisfied … yet.
This was a time when I also learned what survivorship is all about. For me, survivorship meant taking a step back and asking myself why I went through treatment in the first place. I wanted to be able to continue to do the things I enjoy in life and to discover more pleasures. I chose to see my diagnosis as a temporary roadblock to planning my life, not as the inability to ever make another plan. I realized these things were possible as long as I didn’t let my fear and anxiety get in the way. I just had to ask for and accept the support from my wife, family and friends. I started to embrace the positives that my cancer journey gave me and realized that life is too short to allow over-thinking to get in the way of doing.
Experiencing all that comes with a cancer diagnosis has — perhaps surprisingly — actually been an amazing opportunity in many ways. Chief among them is that it has made me a much better doctor. Today, I picture myself in the same position at CTCA, doing the same things I would have done if I had never had cancer. I see my “then self” as a fine doctor with tons of medical school knowledge. But in that vision, there was a vast component missing: the ability to anticipate and discuss important issues with patients; issues even they may not be aware of, or that that they feel aren’t relevant to treatment. Questions they might be having like “Will I have to quit my job?” and “Why have my relationships changed?” and “I haven’t had a drop of chemo yet, so where is this nausea coming from (anticipatory nausea was a big factor in my own journey)?” and “My last scan was clear, so why all this anxiety?”
We aren’t taught about addressing these personal and emotional concerns in med school. But, because I experienced them — because I am keenly aware of the impact they have on stress, strength and healing — when I see patients today, I can broach these subjects with knowledge, compassion and empathy. I can validate their feelings. While no two cancer journeys are alike, I can relate and provide assurance that my patient is not alone. And, ultimately, because of all of this, I can help improve that patient’s quality of life.
Thanks to my personal experiences with cancer, I’ve had the opportunity to immerse myself in survivorship concerns and helped establish protocols of care for the post-treatment survivor. I’ve been very involved in our hospital’s survivorship program and consider myself fortunate to be able to take the lead on survivorship visits for many patients completing treatment. I have had the opportunity to bring my professional and personal passions together for the good of others. Not many people can say that about their “job.” I am extremely lucky to have experienced something life-changing which ultimately brought me closer to being the “expert” I’ve always aspired to be.
I think about where I started, the journey I’ve taken and where I am now. I love my job and the opportunities it gives me to leverage my cancer experience to provide my patients with greater comfort, hope and the power to heal. As physicians, we should all appreciate and strive to be excellent clinicians. However, for a patient to be made whole, they require their emotional, psychological and spiritual needs to be met as well as their physical ones. It’s a challenge because empathy is innate and not something that can be taught. However, as a cancer survivor, I’ve learned the importance of asking and learning why. Why does a person decide to fight his or her cancer? Knowing this is just as important as focusing on the disease and treatment — and it can give physicians powerful insights.
As a cancer survivor, I’ve learned the importance of asking and learning why. Why does a person decide to fight his or her cancer? Knowing this is just as important as focusing on the disease and treatment — and it can give physicians powerful insights.
In the past few years I have seen a greater effort by physicians to ask this critical question of why and gain a deeper understanding into their patients. They are taking more time to talk to patients and families not just about their physical needs, symptoms and side effects, but about their psychological needs, emotional ups and downs, and visions for the future. By engaging in these dialogues, physicians can develop insights which allow them to be more proactive in response to a patient’s needs, wants, fears and hopes. Moreover, administrators are fostering this type of interaction and quest for understanding, and we’re seeing it become an increasing part of hospital cultures. As a physician and a cancer survivor, it is a trend for which I am grateful — and one I am confident will make a huge impact on anyone touched by cancer.
Dr. Anthony Perre is Chief of the Division of Outpatient Medicine at Cancer Treatment Centers of America (CTCA) and Director of New Patient Intake and Vice Chief of Staff at CTCA in Philadelphia. Prior to joining CTCA in 2007, Dr. Perre practiced both outpatient and inpatient hospital medicine for nine years. A native of Philadelphia, Dr. Perre graduated from medical school at the Medical College of Pennsylvania (now known as Drexel University’s College of Medicine) and belongs to several professional organizations, including the Pennsylvania Medical Society, the American College of Physicians and the Alpha Omega Alpha Honor Medical Society.