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Saying goodbye
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I will shortly be leaving Utah to take up a new position at Harold C. Simmons Comprehensive Cancer Center at UT Southwestern in Dallas.
Anyone who knows me well will probably not be surprised I am moving again. It is true I have had a very “mobile” career in oncology — it has been a source of bewilderment, amusement and some teasing over the years from friends and colleagues.
Although there are definite downsides to moving, I have found the changes to be invigorating and enriching; working in several centers has given me a mix of experiences and insights that have been invaluable.
Time for reflection
As I work through the process of leaving my current position, it has been a time of excitement for the future and reflection on the last few years.
From a big-picture perspective, the 6 years I have spent in Utah have seen transformative changes in oncology.
Checkpoint inhibitors now have a firmly established role in multiple tumor types; chimeric antigen receptor T-cell therapy is growing, based on remarkable responses in particularly refractory diseases; the treatment of B-cell malignancies has shifted dramatically with the advent of small molecule inhibitors of B-cell signaling (and other) pathways; and frontline, chemotherapy-free regimens are being used in multiple settings. Awareness of patient-centered issues, such as financial toxicity of therapy and the importance of patient-reported outcomes, is now mainstream, as is awareness of issues related to oncology provider wellness and burnout.
At a more individual level, I have met some extraordinarily talented colleagues, learned from some remarkable leaders and observed a broad spectrum of behaviors as the institution went through turbulent times.
Throughout this time, (as I mentioned in my Feb. 10, 2018, editorial) my clinical practice, although relatively small now, has been a refuge from the sometimes crazy and mystifying world of academic oncology. Moving on can be difficult for many reasons, but leaving the care of individual patients when the story of their cancer is only partially complete gives me a sense of unfinished business.
Of course, I also understand that referring them to a colleague can give a fresh perspective and new thoughts about their management, which can certainly be a positive change for some patients.
‘Awesome responsibility’
That said, I wonder if we underestimate the impact our actions can have on our patients and how enduring our effects on their lives can be.
As I have gone through the process of transition, I have had several reminders of this.
A couple of weeks ago, I sent out a letter to my patients letting them know of my departure and the plans for transitioning their care. During the first clinic after the letter went out, I was humbled by the heartwarming good wishes and gratitude I received.
I also was humbled by one man who told me that he shed tears when he read my letter. He went on to explain that he felt a special bond because I had seen him from diagnosis through his treatment and into what has, thankfully, been a very durable remission. He was fearful of what might happen in the future. This brought home to me the incredible trust some of our patients place in us and the awesome responsibility that comes with it.
I have also been reminded twice in the last month of the enduring nature of the friendships and bonds that can form.
Two former patients from the U.K. have contacted me after more than 20 years to update me on their progress or to seek advice. One is a young man with lymphoblastic lymphoma who I treated in the mid-1990s who reached out to let me know he had just celebrated his 25th wedding anniversary, and that he has two wonderful daughters and is in excellent health.
The other is a man who had an autologous stem cell transplant for relapsed Hodgkin lymphoma 24 years ago, has now been diagnosed with multiple myeloma and was looking for guidance about next steps.
Knowing that these relationships can be very long-lasting and that our decisions as providers can have such a profound impact, I was curious to know if there is literature regarding the effect on patients when an oncologist either leaves a practice or retires from it.
My attempts at literature searches on this subject drew a complete blank. There are some interesting articles on the administrative adjustments associated with physician retirement and some very insightful articles from individual physicians reflecting on their retirement and the effect it has on them. However, I wasn’t able to find anything that addressed this issue from a patient perspective.
My assumption is that, although our patients may wish us well and be happy for us in our new roles, some may feel a sense of loss, especially those in the early phase of their care or during active treatment.
It would be interesting to know what I can do, as a departing physician, to make this transition as smooth as possible for my patients. Fortunately, ensuring that they have the best ongoing cancer care is not a problem when you are surrounded by excellent colleagues. Managing the emotional attachment, which can, of course, be bidirectional, is more challenging — I have no idea whether maintaining intermittent contact with patients is helpful or detrimental.
My transition has reminded me once again of what an extraordinary privilege and responsibility we have as oncologists.
We may not be fully aware of the impact we are having on other people’s lives, or how strong the emotional attachments can be. But that’s what makes cancer care so rewarding, and why it can be so difficult to say goodbye.
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John Sweetenham, MD, FRCP, FACP, is HemOnc Today’s Chief Medical Editor for Hematology. He also is senior director of clinical affairs and executive medical director of Huntsman Cancer Institute at The University of Utah. He can be reached at john.sweetenham@hci.utah.edu. He begins his position at Harold C. Simmons Comprehensive Cancer Center at UT Southwestern on April 15.
Disclosure: Sweetenham reports no relevant financial disclosures.