Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

A story that showed me how cancer is a social disease

Don S. Dizon, MD
Conditions
May 23, 2016
148 Shares
Share
Tweet
Share

asco-logo

Young women get gynecologic cancers, and I have had my share of conversations about ovarian cancers with women in their 20s and 30s. It rarely happens, but when it does, it is devastating. I make it a point to talk with them about their present and their future; although it is something I try to do with all of my patients regardless of age, it is somewhat more important that I do it when my patients are young. Yet, even with all of my experience gained through years of practice, I was not prepared for Lyn*.

I had read her chart before we met. I knew she was only 16, diagnosed with a rare ovarian germ cell tumor. She had had an ovary removed, but her surgeon had not taken the other ovary and had preserved her uterus. Her records stated she had a stage IC tumor: the kind that we would treat with chemotherapy for cure. I knew she was an only child and was in high school. I mentally prepared myself for the visit, knowing that she was a teenager facing a cancer diagnosis and the prospect of chemotherapy.

I walked through the door and stopped in my tracks. She looked so much younger than 16, and in her face, I could not help but see my own daughter. She was dressed in grey sweats, her long hair was gathered in a thick ponytail. I greeted her, and she shyly greeted me with a “hello.” I looked in her brown eyes, and it was that look: deer in the headlights, bloodshot, like she had been crying.

With her was her mother, obviously worried but trying so hard not to show it. Her hands were shaking at her sides, and as we shook, she squeezed hard. She had been gazing at me intently, as if trying to telepathically send me a message: “Please save her.”

We sat down, and I reviewed Lyn’s history; she had presented with sudden cramps that had brought her to a local emergency room. She was told her ovary had torsed, and surgery was performed the same evening. When she woke up, she was told she had cancer. Everything else was a blur, so I talked her through her pathology, defining tumor grade, going through her cancer stage. We talked of prognosis and then we talked of treatment. I had recommended chemotherapy and described the regimen: the drugs, schedule, and side effects. Throughout our discussion, she asked questions, and it struck me that she wanted to really understand what had been diagnosed and what could be done to cure her. Honestly, it was her mom I was worried about more: She cried silently, and I worried she might actually pass out.

As we concluded and made a plan, I asked Lyn’s mom to step outside. She was reluctant, but Lyn said it was OK, so she did. Once the door closed, I opened the door to other topics.

“Most women have concerns about cancer and its treatment, especially when it comes to how it might impact them romantically and sexually. I am wondering if this has been on your mind?”

“No,” she answered. “I don’t have a boyfriend, so it’s fine. I’m not really interested in talking about sex right now.”

“OK then,” I said. “I just want you to know that if you ever do, that door is open. I want you to see your future, even as you are dealing with this now. Just because you have cancer does not mean you have to give up on any of your dreams, like college, a career, or even becoming a mother someday if you want.”

As I uttered those last few words, Lyn started to cry uncontrollably. It turns out, even as she had not yet started dating, she had worried that she would not have the opportunity to be a mom. She worried that with one ovary removed, her chances of infertility had increased somehow, and that chemotherapy meant a near guarantee that she would be menopausal — at 16.

“I do want kids someday,” she told me. “I always saw myself as a mom. What happens if I can’t have kids? Who would want to marry me?”

With that, I discussed fertility options with her, such as egg freezing and even ovarian freezing. As we were talking, her mom knocked on the door.

“Come in,” I said.

“I heard Lyn crying and just wanted to know if everything was OK,” her mom said.

“It’s fine, mom,” Lyn said. “The doctor and I were just talking about my becoming a mom someday.”

Her mom looked at me then, shocked. “I think we need to concentrate on curing my daughter right now, not about her having her own children. I don’t even care about grandkids.”

“Well, Mom,” Lyn said. “What about me? I want kids someday, and it frightens me to think I will never have them.”

We spoke some more, me trying to normalize Lyn’s concerns, Lyn voicing them herself, and her mom fairly aghast that this is where the visit with the oncologist was going. Ultimately, we all agreed that Lyn had the right to see a fertility doctor and that a consult was in order. To be honest, I did not feel great about how this initial meeting went. I felt I had done my best as an oncologist, but placing myself in Lyn’s mom’s shoes, I wondered if I would be even more unnerved than she was.

A few days later I got a letter from Lyn’s mom. In it, she told me how angry she was that I had mentioned fertility and talked about sex with her 16-year-old daughter (apparently Lyn had mentioned our discussion to her). She felt I had overstepped boundaries, that my “job” was to talk about cancer, treatment, and prognosis, not about orgasms, avoiding painful intercourse, and babies. She also informed me they had opted to seek treatment closer to home. I later learned that Lyn never saw that fertility specialist.

Perhaps it was naïve of me to think that conversations about sex and fertility were absolutely appropriate for young women, and that such private conversations do not require parental notification. Perhaps I should have asked Lyn and Lyn’s mom if it would be OK to have a conversation about these topics before asking Lyn’s mom to step outside of the room. I believe women with cancer deserve a discussion about fertility preservation and the opportunity to discuss their concerns regarding sex, even if they are young. Whether it be in their teens, twenties, thirties, or forties, all women deserve the information and the conversation about cancer and treatment, and how it might impact their future selves. This screen for sexuality I have learned is a part of the essential psychosocial “review of systems” some adolescent medicine clinicians use, called HEEADSS (home environment, education and employment, eating, peer-related activities, drugs, sexuality, suicide/depression, and safety), and most interviews should be conducted without the parent present.

While I am comforted because I believe that I did the right thing by addressing issues with Lyn, and provided information for her on sensitive issues regarding sexuality and fertility, I see now that I perhaps could have done at least one thing better: preparing Lyn’s mom for the conversation I was about to have with her. I saw Lyn as my patient, not her mom, and perhaps that is the biggest mistake I made. The HEEADSS system does not sanction ignoring the parent. Rather, it stresses the importance of eliciting their own concerns, explaining the purpose of the private interview, and assuring them that their child will be followed for medical and other issues that might arise. I think, in this way, I failed Lyn and her mom.

Ultimately, Lyn and her mom showed me once again that cancer is indeed a social disease, and that Lyn might be the one with cancer, but there are others who love and care about her who have been affected as well. They taught me too that I am perhaps doing my best when I am cognizant of their concerns: all of theirs.

* Name and identifying information changed to protect patient privacy.

Don S. Dizon is an oncologist who blogs at ASCO Connection.  This article originally appeared in the Oncologist.

Image credit: Shutterstock.com

Prev

Don't lose weight the Biggest Loser way. Here's why.

May 23, 2016 Kevin 25
…
Next

The enemy is not death. The enemy is needless suffering.

May 24, 2016 Kevin 4
…

Tagged as: Oncology/Hematology

Post navigation

< Previous Post
Don't lose weight the Biggest Loser way. Here's why.
Next Post >
The enemy is not death. The enemy is needless suffering.

More by Don S. Dizon, MD

  • As an oncologist, this is the hardest role I play

    Don S. Dizon, MD
  • Why physicians should acknowledge the validity of second opinions

    Don S. Dizon, MD
  • A patient who taught an important lesson in doctoring

    Don S. Dizon, MD

Related Posts

  • Is social media a friend or foe of science?

    Michael Joyce, MD
  • Why social media may be causing real emotional harm

    Edwin Leap, MD
  • A physician’s addiction to social media

    Amanda Xi, MD
  • Are negative news cycles and social media injurious to our health?

    Rabia Jalal, MD
  • How I used social media to get promoted to professor

    David R. Stukus, MD
  • How social media leads to a loss of creativity

    Edwin Leap, MD

More in Conditions

  • The beauty of a patient’s gratitude

    Dr. Damane Zehra
  • From clocking in to clocking out: the transition to retirement

    Debbie Moore-Black, RN
  • Overcoming Parkinson’s: a journey of laughter and resilience

    Cynthia Poire Mathews, FNP
  • The untold struggles patients face with resident doctors

    Denise Reich
  • Maximize sleep efficiency with stimulus control

    Pedram Navab, DO
  • The endless waves of chronic illness

    Michele Luckenbaugh
  • Most Popular

  • Past Week

    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Beyond pizza and pens: National Doctors’ Day should be about saving lives

      James Young, MD | Physician
    • Physicians are a finite resource we need to protect

      Jack Resneck, Jr., MD | Physician
    • From clocking in to clocking out: the transition to retirement

      Debbie Moore-Black, RN | Conditions
    • Unlearning our habits: a journey from intelligence to wisdom

      Brian Sayers, MD | Physician
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
  • Recent Posts

    • Unlearning our habits: a journey from intelligence to wisdom

      Brian Sayers, MD | Physician
    • Lessons from an orthopedic surgery journey [PODCAST]

      The Podcast by KevinMD | Podcast
    • Beyond pizza and pens: National Doctors’ Day should be about saving lives

      James Young, MD | Physician
    • Maximizing physician potential: How coaching can aid in conflict resolution, enhance health care leadership and build stronger teams

      Asha Padmanabhan, MD | Physician
    • The future of education: AI empowerment, YouTube college credits, and the impact on traditional colleges

      Harvey Castro, MD, MBA | Tech
    • The beauty of a patient’s gratitude

      Dr. Damane Zehra | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Moderna's Steep COVID Vaccine Price: Corporate Greed or Capitalism?
  • House Republican Argues Against FDA Budget Increase
  • Prescriptions for Stimulants Jumped During the Pandemic
  • Federal Judge Strikes Down ACA's Preventive Care Coverage Requirements
  • Pandemic Jump in ED Visits for Firearm Injuries Continued Into 2022

Meeting Coverage

  • VTE Risk in Recurrent Ovarian Cancer Increases With More Lines of Chemotherapy
  • Obesity's Impact on Uterine Cancer Risk Greater in Younger Age Groups
  • Oral Roflumilast Effective in the Treatment of Plaque Psoriasis
  • Phase III Trials 'Hit a Home Run' in Advanced Endometrial Cancer
  • Cannabis Use Common in Post-Surgery Patients on Opioid Tapering
  • Most Popular

  • Past Week

    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Beyond pizza and pens: National Doctors’ Day should be about saving lives

      James Young, MD | Physician
    • Physicians are a finite resource we need to protect

      Jack Resneck, Jr., MD | Physician
    • From clocking in to clocking out: the transition to retirement

      Debbie Moore-Black, RN | Conditions
    • Unlearning our habits: a journey from intelligence to wisdom

      Brian Sayers, MD | Physician
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
  • Recent Posts

    • Unlearning our habits: a journey from intelligence to wisdom

      Brian Sayers, MD | Physician
    • Lessons from an orthopedic surgery journey [PODCAST]

      The Podcast by KevinMD | Podcast
    • Beyond pizza and pens: National Doctors’ Day should be about saving lives

      James Young, MD | Physician
    • Maximizing physician potential: How coaching can aid in conflict resolution, enhance health care leadership and build stronger teams

      Asha Padmanabhan, MD | Physician
    • The future of education: AI empowerment, YouTube college credits, and the impact on traditional colleges

      Harvey Castro, MD, MBA | Tech
    • The beauty of a patient’s gratitude

      Dr. Damane Zehra | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

A story that showed me how cancer is a social disease
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...