When Jimmie C. Holland, MD, first began to work in oncology in the 1970s, patients usually were not told their diagnosis of cancer, making it nearly impossible to talk with them about how they were coping with illness.
Photo courtesy of Memorial Sloan-Kettering Cancer Center
An Interview With Jimmie C. Holland, MD
Times have changed a lot since thenâŽ¯thanks in no small measure to the efforts of the pioneering oncologic psychiatrist.
In 1997, the National Comprehensive Cancer Network wrote guidelines for distress management, and more recently, two leading medical organizations asserted in their own guidelines that quality routine cancer care should include attention to patients’ psychosocial needs.
“We’ve seen an overall humanizing of medicine,” said Holland, 85, who founded the nation’s first full-time psychiatric program in an oncology center at Memorial Sloan-Kettering Cancer Center (MSKCC) in New York City in the 1970s. She is still treating patients and conducting research at the institution, where she has held the Wayne E. Chapman Chair in Psychiatric Oncology since 1989.
“The humanist aspects are much more respected now,” she said. “We call it patient-centered medicine. Doctors are being taught how to talk to patients, how to give bad news, how to communicate about illness, and how to better understand patients’ responses, which they were not taught for so long before that. So, it’s coming.”
It was the Institute of Medicine that, after a year of research funded through a million-dollar government grant, for the first time declared that the psychosocial domain should be integrated into routine cancer care. Holland, a fellow of the Institute, served on the panel that reviewed data from clinical trials and found in 2007 that there was convincing evidence in the literature to support a range of psychotherapeutic and psychotropic drugs, but that many patients who needed them weren’t getting them. The panel released its findings in a report titled “Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs.”
“It was a big move forward,” Holland said, “because it was the first national health policy organization that had endorsed the fact that the psychosocial domain must be integrated into routine cancer care.”
Since then, she said, the Commission on Cancer of the American College of Surgeons—which regularly reviews and accredits more than 1500 American cancer centers—has passed a similar mandate: that, by 2015, accreditation will require a center to have in place a program to identify patients experiencing distress and refer them, when appropriate, for psychosocial care (tinyurl.com/bpo45rv
“This is big stuff,” Holland said. “We’re very pleased this is happening, because now there’s a stick, as well as a carrot, for doing this kind of work. It will make a difference.”
Identifying a Need
Holland’s interest in the way patients dealt with the range of responses to illness developed during her medical training.
“When I started my internship [at St. Louis City Hospital in Missouri],” she recalled, “I began to realize that I really liked the psychological aspects of patients: how they were coping with their illness or how they managed to deal with an acute heart attack or with polio, resulting in being paralyzed from the neck down.”
So Holland switched her focus to psychiatry, and kept it there through her training as a resident and research fellow at the Malcolm Bliss Mental Health Center and Washington University School of Medicine, both in St. Louis, and then a residency and fellowship at Massachusetts General Hospital in Boston.
But it wasn’t until she met her husband— James F. Holland, MD, a pioneer in the treatment of childhood acute lymphoblastic leukemia who is now Distinguished Professor of Neoplastic Diseases at Mount Sinai Medical Center in New York—that she realized that attention to psychosocial care was largely missing from routine cancer care. It wasn’t adequately considered in patients, and it wasn’t being studied. Social workers carried the front line, with the nurse and oncologist in second place.
“I thought, ‘I’d like to work with patients with cancer to see if we can understand how to help them cope with their disease, and get them through it,’ ” Holland said.
She saw an opportunity in the 1970s, when the stigma associated with cancer started to fade. Both Betty Ford and Happy Rockefeller had gone public about surviving breast cancer, and patients were no longer being kept in the dark about their diagnoses.