I co-direct a medical student elective at Harvard Medical School called the “Care of the Gynecologic Oncology Patient" (ME525M.3), alongside Dr. Marcela del Carmen. Our students rotate through various clinics in surgical and medical gynecologic oncology, radiation oncology, and pathology, and when they rotate with me, the oncology sexual health clinic. We do this to demonstrate how quality cancer care is often interdisciplinary.
Our student in July 2014 was Katherine Hicks-Courant, a senior medical student from the University of Massachusetts. A published researcher in her own right (she was a co-author on a study showing that there was little consensus in how oncologists approach tumor genomic testing), both Marcela and I were impressed with how easily she assimilated into each clinic.
After a morning spent with my patients with gynecologic cancer, I put away my oncologist’s “white coat” and began my afternoon session in the sexual health clinic. Some patients were in their 40s, others older, and they all came to discuss issues about intimacy and sexuality--how different things were after cancer, the side effects on the vaginal health due to treatments administered. Most wanted to know why something so natural (e.g., attraction, sexual interest, and pleasure) was so different now; how some things that came to them so easily, were all of a sudden hard. I would listen to their stories, ask questions. I did my best to explain what cancer has done and what we can do to get “it” back. Ultimately, I wanted each patient to know that indeed, she was not alone and that issues regarding sexual health are among the top concerns after (and during) treatment for cancer.
After clinic, I asked Katherine what she thought.“It’s been incredible to see how providers can artfully shift from significant conversations about health to talks about summer trips, vacations planned or taken, and family and friends visited. It’s even more heartening to see that, despite what was discussed, most of the time, appointments ended with a hug. 'We are here if you need anything at all,' was a commonly expressed parting thought from the team, and it was often met with smiles that were sometimes radiant, but more often weary and resigned, from women and their families as they aim to return to their lives, forever changed by cancer.
"I remember you turned to me and said, 'Now I take off my oncologist hat and put on my sexual health counselor hat.' Suddenly, I had the sense that I was about to see a very different side of oncology. After clinic, my eyes were opened to the enormity of what our patients go through. Beyond the goal and fact-oriented objectives of oncology follow-up ('What are my blood levels?'; 'What did my scan show?'; 'What can I take to move my bowels?') there were other issues brought about by cancer, and the questions asked and answers available were less black and white: 'Why don’t I feel like myself?'; 'How do I take care of my children when I just want to stay in my room?'; 'How can I make love with my husband if it hurts?')."
Katherine had intimated that the sexual health clinic was an “unexpected” experience. She had not seen anyone talk about sexuality and intimacy with a patient diagnosed with (and after) cancer over an entire session. And, yes, I do recall her saying it was an eye-opening experience, and she had asked why I did it.
I admit that I had never really given much thought about it. I had become a sexual health clinician because I believed there were so few resources for our patients to access information about, let alone discuss, the sexual health complications that often follow a diagnosis and treatment for cancer. I wanted to advocate for its importance in the lives of our patients, and to make sure that every person who saw me knew that the field of oncology embraced their concerns as well.
But after speaking with Katherine, I realized that becoming a sexual health specialist has done something positive for me—it has taught me to persevere. After all, oncology can be a very hard profession—cancer is scary and even today, can be deadly. Talks about death and dying are still necessary, even as we have more discussions about precision therapy, genomics, and targeted treatments. With time, even the best clinician can grow weary of the psychological toll of cancer.
Embracing a cause in after-cancer care has given me the remarkable opportunity to help our patients live beyond and despite cancer. It is helping them navigate their new normal, validating that their experiences are real, and, in my clinic, educating them (and their partners) about the sexual dysfunction that can accompany cancer and its treatment.
Maybe, just maybe, I stumbled on a secret to longevity in our profession and that more oncologists need to embrace survivorship. I’ve found a way to make a difference in the lives of our patients, beyond the more “traditional” roles of a medical oncologist. It not only helps our patients see their future, but also might help sustain the energy and enthusiasm needed as a cancer clinician.