Jimmie C. Holland, MD
Cancer has been around for centuries, but talking about it is something relatively new. As recently as the early 1970s, cancer remained an illness cloaked behind whispers and closed doors—as Jimmie C. Holland, MD, found when she began working in oncology. While the young doctor’s goal was to help patients cope with their cancer, she discovered that was nearly impossible, since most were never even told they had the disease.
Forty years later, physicians and others who treat patients with cancer are not just encouraged, but in some cases required to speak with patients about how the disease is affecting their lives—thanks in no small measure to the efforts of the pioneering oncologic psychiatrist described as the “mother of psycho-oncology” in a 2004 interview published in the Journal of the National Cancer Institute
Holland played a vital role in the transformation by founding the nation’s first full-time psychiatric program in an oncology center at Memorial Sloan Kettering Cancer Center (MSK) in New York City in the 1970s. Now 87, 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. Along the way, she helped create the first quality-of-life questionnaires used to monitor the distress level of cancer patients, and founded two societies—still in existence—dedicated to the support of her field.
For her contributions, Holland was chosen by an advisory board of her colleagues to receive OncLive’s 2014 Giants of Cancer Care® Award in the Supportive Care category. “I’m honored,” she said, “and honored to be the first [to receive the award in the Supportive Care category], which is very nice.”
Witnessing an Evolution
It was 1997 when Holland first saw solid evidence that psychosocial medicine had become a widely recognized part of cancer care. That was when the National Comprehensive Cancer Network wrote its first treatment guidelines for distress management. 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,” Holland said. “The humanist aspects are much more respected now. 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 2007 when the Institute of Medicine, after a year of research funded through a million-dollar government grant, declared for the first time 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 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.”
After that, she said, the Commission on Cancer of the American College of Surgeons —which regularly reviews and accredits more than 1500 American cancer centers—passed a mandate stating that, by 2015, any center that wants to be accredited will need to have a program in place to identify patients experiencing distress and refer them, when appropriate, for psychosocial care. “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.”
As a whole, Holland hopes, her work over the years has not only helped individual patients, but also banished myths that have made life more difficult for cancer patients as a group. “There’s a myth that you have to be positive to fight cancer,” she said. “I call it the tyranny of positive thinking. There’s no such thing as making cancer worse if you’re depressed. We just want patients to say when they are distressed and need help.”
Focusing on Older Cancer Patients
Holland’s efforts to spread that message haven’t slowed, despite her many years in the field. The doctor works a 12-hour day, devoting about a quarter of her time to seeing patients. Her only nod to her age is her interest in working with people of her generation.