Are Oncologists Better at Facing Their Own Deaths?

An oncologist at St. Elizabeth Healthcare, Douglas Flora, considers himself deeply empathetic. That is even one reason he became an oncologist.

But when he was diagnosed in 2017 with kidney cancer, he was astonished by where his thoughts took him. His mind raced in anguish over treatment options, statistical probabilities, and his wife and children.

Flora said, “It is a very surreal experience.” He added, “Within 20 seconds of the diagnosis, I began thinking, 'What videos will I need to make for my babies?'”

He might be having a wonderful evening surrounded by friends, music and beer. Then he would go to the bathroom, and the realization of what was lurking inside his body would hit him like a brick.

“It is like the scene in the Harry Potter films when the Dementors fly overhead,” he explained. “Everything feels dark. There is no hope. Everything you thought was good is gone.”

Oncologists counsel patients every day through life-threatening diagnoses and frightening decisions, so one might think they would be better prepared than anyone else to face their own diagnosis, treatment and mortality. But that is not always the case.

What Happens When White Coats Are Replaced by Patient Gowns?

So, what happens when oncology doctors exchange their white coats for patient gowns? Does their expertise help them navigate diagnosis and treatment better than their patients? How does the emotional burden of their personal cancer journey change the way they interact with patients?

Navigating the Process of Diagnosis and Treatment

In January 2017, breast cancer surgeon Karen Hendershott felt a lump under her arm while showering. With sharp insight, she anticipated her fate: it was almost certainly locally advanced breast cancer that had spread to the lymph nodes and would require surgery, radiotherapy and chemotherapy.

Taylor Riall also suspected cancer. Last December, Riall, a general surgeon and surgical oncologist at the University of Arizona Cancer Center, developed a persistent cough. An X-ray revealed a mass in her lung. Initially, she was diagnosed with a fungal infection and given a medication that caused skin side effects.

Doctors advised Riall to monitor her condition for another 6 months. But her oncology knowledge led her to think it was cancer, so she insisted on further testing. In June 2021, a biopsy confirmed that she had lung cancer.

Oncology expertise helped Riall and Hendershott recognize cancer symptoms and reach a diagnosis. But being too well informed also has disadvantages, Hendershott said.

“I think sometimes it is harder to know everything all at once than to give yourself time to get your head around it and take baby steps.” She said, “There were no baby steps in my process.”

Still, oncologists diagnosed with cancer navigate a familiar landscape and are often supported by a network of expert colleagues. A pharmacy technician at North Florida Cancer Center who was diagnosed with breast cancer in July, Shenitha Edwards, explained that this made a major psychological difference.

Edwards said, “I felt stronger and a little more ready to fight because I had resources that my patients sometimes do not have.” She said, “I was connected with many people who could help me make informed decisions, so I did not have to walk in as much fear.”

Being informed can prepare doctors to make bold treatment choices. In Riall's case, surgeons were reluctant to remove the tumor because they would have to remove the entire upper lobe of her lung. She is also a marathon runner. Nevertheless, her surgical oncology experience meant Riall was not frightened by the prospect of major surgery.

“I was like, 'Look, just take it out.' I am less afraid of that than of having cancer, not knowing and letting it grow” Riall said.

Similarly, Hendershott's experience gave her the confidence to pursue a more intensive strategy. “Having a really intimate understanding of what the risks and probabilities looked like helped me feel more comfortable with a more aggressive approach. Especially because I had a 10-year-old child, there was no doubt in my mind that I wanted to do everything I could, including a few things still in clinical trials.” she said.

Almost paradoxically, Mark Lewis found that his oncology training gave him the courage to take the risk of watching and waiting after discovering a slow-growing tumor in his pancreas. Lewis monitored the tumors accumulating in his pancreas for 8 years. When some grew as far as his liver, he underwent Whipple surgery to remove the head of the pancreas, part of the small intestine and the gallbladder.

Lewis, a gastrointestinal oncologist at Intermountain Healthcare, said, “It was a bit of a gamble, but one that paid off and allowed me to reset my career and have another child.” Treating patients for about a decade had also shown him how fortunate he was to have a slow-growing, operable cancer. He said that gratitude gave him the mental strength to endure the ordeal.

Whether they took a more aggressive or minimalist approach to their own care, each doctor's decision was deeply personal and informed by extensive oncology expertise.

Although research into oncologists' experiences of having cancer is limited, studies suggest there may be differences in end-of-life care. According to a 2016 study published in JAMA, physicians choose significantly less intensive end-of-life care than the general US population in three of five categories: having surgery, being admitted to an intensive care unit (ICU), and dying in a hospital. The reason proposed by the researchers is that doctors know these end-stage interventions are typically harsh and futile.

But these differences were quite small, and a 2019 study published in JAMA Open Network found the opposite: Doctors with cancer were more likely to die in intensive care and receive chemotherapy in the last 6 months of life.

When it comes to their own long-term or curative cancer care, oncologists generally do not approach treatment differently from their patients. In a 2015 study, researchers compared two groups of patients with early breast cancer — 46 physicians and 230 well-educated, qualified nonphysician patients — and found no difference between the groups' choices regarding mastectomy, chemotherapy, radiotherapy or breast treatment.

Ultimately, being an oncology specialist cannot fully prepare a person for the emotional challenge of cancer.

An Extremely Surreal Experience

Although fear may become less intense and more manageable over time, it may never truly disappear.

Dr. Douglas Flora, who initially felt hopeless, experienced emotional ups and downs for a while. Four years have now passed, and he is living cancer-free, but the fear of recurrence remains.

Dr. Karen Hendershott cried every time she got into her car and thought about her prognosis (the course of her disease). Now 47, she has about a 60% chance of being alive in 15 years, and fear still affects her.

“I think it is hard to understand the moments of sheer terror you experience when confronting your own mortality at 2 in the morning.” She said, “The implications are not just for you, but more importantly for the people you love and want to protect. It washes over you in waves over which you have little control.”

Dr. Taylor Riall felt cancer had ruined her life, but she found a way to cope. Severe blood loss, chest tubes, tests and needles, and nausea left Riall unbearably exhausted after surgery and delayed her return to work. At the same time, she missed academic promotions. Feeling frustrated and grief-stricken, she found comfort in the memory of doing Kintsugi with surgical residents. Kintsugi is a Japanese art of repairing broken pottery with resin that is powdered or mixed with powdered gold, silver or platinum. As a philosophy, it treats breakage and repair as part of an object's history.

“As a surgical oncologist, my instinct is to pick up those pieces and put them back together so no one sees that they were broken. But as a patient, I learned that an important part of healing is allowing yourself to sit in a broken state and feel angry, miserable and betrayed by your body. Then examine your shattered priorities and think about how you want to put them back together.”

For the gynecologic oncologist at Cancer Treatment Centers of America in Chicago, Illinois, Barbara Buttin, cancer did not ruin her life. On the contrary, a near-death experience and a life-threatening diagnosis made her a better, more empathetic oncologist. Facing her own mortality clarified what matters in life. She uses this understanding to make sure she knows what matters to her patients — what they care about most, their greatest fears, and what will keep them awake at night.

We Are in the Same Boat

Ultimately, when oncology doctors become patients, they strike a balance between control and vulnerability, rationality and emotion.

In the fall of 2020, oncology nurse Jenn Adams turned 40 and had her first mammogram. Unexpectedly, it revealed early-stage breast cancer requiring a double mastectomy, chemotherapy and a year of immunotherapy. She was due to start a new job at the Cancer Clinic in Texas a week after diagnosis. So she asked her manager whether she could be both a patient and an employee.

Adams worked 5 days a week, but every Thursday at 14:00 she sat beside her patients as her colleagues became her nurses. She had a chemo port implanted, lost her hair and felt terrible alongside her patients. Jenn, a mother of three, said, “It was an incredible experience that strengthened our bonds.”

Flora said having cancer “was completely different from what I imagined. When I thought I was walking deep into my patients' minds, I was not even visiting them. Yet we are in the same boat. When I share that with them, you can see their body language change. They almost relax, as if to say, 'Oh, this person understands me.' They understand how frightened I was. And I truly understand them.”

When Flora's patients have tests, he gives them their results immediately because he knows what it is like to wait on tenterhooks. He tells patients to text him when they are afraid or depressed, acknowledging that this is not great for his own mental health but believing it is worth it.

Similarly, Hendershott can hold out her shoulder-length curls to reassure a crying patient that her hair grew back after chemotherapy. She can describe her experience with hormone-blocking pills to ease the fears of people who have doubts about taking the medication.

Balancing these roles fosters so much empathy that doctors sometimes find their patients helping them. When one of Flora's patients heard that he had cancer, the patient sent Flora an email beginning, “A wise doctor once told me...” and repeated advice Flora had given years earlier.

Lewis has a special bond with his patients because people with pancreatic neuroendocrine tumors seek him out for treatment. “On some level, I will be caring for people with a mindset similar to mine” he said. “So I see their coping mechanisms and how they manage.”

Edwards told some patients about her breast cancer diagnosis, and now they give each other high fives and share words of encouragement. “I have made a point of relating to my patients as family” she said. “If you have learned to embrace love and love people, there is nothing you would not do for them. I have chosen that as my strategy in caring for all my patients.”

Adams has a similar mission. She joined a group of mothers with cancer to receive guidance and then guide others. “I feel this is what I want to be in my cancer practice” she said, “because my patients have someone who will say, 'I will walk with you because I have been there.'”

Adams said this transformation was worth all the heartbreaking moments. “I love the oncology nurse I am now because of my diagnosis. I do not love the diagnosis. But I love the way it has changed what I do.”