Jamie H. Von Roenn, MD: What is Value in Cancer Treatment?
Jamie Von Roenn, MD talks about value in cancer treatment as it pertains to palliative care. Jamie H. Von Roenn, MD is the Co-Director of the Cancer Control Program at the Robert H. Lurie Cancer Center at Northwestern University in Chicago.
The Group Room at the 2011 American Association For Cancer Research Annual Meeting was made possible, in part, by:
VIDEO TRANSCRIPT
Selma R. Schimmel, Founder & CEO, Vital Options International:
This is Selma Schimmel at ASCO 2011, where our conversation continues with physicians about a variety of topics. But this one’s very, very special because it’s an area of medicine that we need to talk more about, and it has to do with how we confront later stage of disease, end-of-life issues, palliative care, hospice care; it’s all a part of life. We’re going to spend time with one of the leaders in the United States in this area of medicine, Dr. Jamie Von Roenn. Dr. Roenn is a medical oncologist, treats breast cancer, but is also the Medical Director of Northwestern’s Memorial Hospital’s Home Hospice programs, Professor of Medicine at Northwestern University Feinberg School of Medicine, Robert H Lurie Cancer Center right here in Chicago. When we talk about value in cancer treatment and we understand that the natural human inclination is ‘I want to live, pull something out of the hat, give me something, help me’. But at some point you have to begin to measure the value of treatment against the value of your quality of life, and being able to have, feeling the best you can to live your life and not be burdened by toxic treatments that really diminish your quality of life even if in your mind you think that maybe it’s going to buy you more time. But if it buys you time without quality, what is that worth?
Jamie H. Von Roenn, MD, Co-Director, Cancer Control Program, Lurie Cancer Center:
I think we have a responsibility to be honest with people so they can use that time in a meaningful way. And when I recommend no more chemotherapy I talk about, this isn’t a time to sit back and wait to die, that there are very important tasks at the end of one’s life. And I frame them as the five things, are you familiar with them? You say, in the broadest sense, ‘I forgive you, please forgive me – because none of us have done everything perfectly in our lives and our relationship – I love you, thank you, goodbye’. And it is an incredibly powerful message. And I thought I understood how powerful it was until my own husband was dying of cancer and we did this with our children before he died. And now, 4-and-a-half-years later my kids will say ‘oh, when I had that conversation with dad, this…’ and it’s created a bond that is so remarkable, and so confirming for them. It’s an amazing experience.
Selma R. Schimmel:
First of all, I want to thank you for sharing that personally because it changes, for our viewer, it just took you from being the clinician to being this clinician who has just shared her intimate human experience and that kind of empathy makes it safe.
Jamie H. Von Roenn:
Well also, I think if we don’t bring our human experience to the practice of medicine you’ve lost a lot.
Selma R. Schimmel:
But it takes a lot of courage for a physician to bring that human side, and also to be comfortable and engaging in a dialogue on a subject that they themselves may not have experience with or feel terribly intimidated by and scared by. Our culture here doesn’t seem… it’s like, for such a natural part of life, I don’t understand how it remains a taboo subject. No one’s going to escape it.
Jamie H. Von Roenn:
Right, but it’s more taboo than sex and drugs, and violence. I think some of it is the youth orientation of our culture, and medicine can change that by talking about what’s good about the different phases of life and what one has to offer, and to gain.
Selma R. Schimmel:
When I spoke with your colleague, Dr. Smith, one of the things I brought up is truly the difference between healing and curing, and that resolving these areas of your life, that’s the essence of healing. I’ve met cancer patients that have…their cancer’s been cured but because they’ve never really confronted their own issues they’re really not healed. And then I’ve met people that are dying of cancer, but yet they’re at peace. And to me, that’s healing.
Jamie H. Von Roenn:
As horrible as the experience of cancer can be and how frightening it is, there are some lessons that are good, like valuing life and the people you love. And the people who come through it and are able to feel the good things, move on in a healing kind of way. And we can help that by talking about some of it.
Selma R. Schimmel:
What goes on, from what you understand in dealing with patients, dealing with end-stage disease– what have you learned from their journey, and what have they taught you?
Jamie H. Von Roenn:
The importance of finding meaning in that time, and that’s what the five things are about. It’s why I tell people there are people they need to see, and I say it earlier. You know, see them now, and if you get to see them three times, great. But if you don’t, you’ll have done what matters by talking to the people you care about. It’s about leaving a legacy. Sometimes people write letters to their children for their anniversary, or their marriage, or whatever it is. And I talk to people about doing these things because I think it’s important for the people who are left behind, but also for those people to leave their voice in a way that they want it heard for special occasions or whatever.
Selma R. Schimmel:
What are the issues, and how do you deal differently in helping people? Because developmentally, people are in different places of their life based on age and experience.
Jamie H. Von Roenn:
I think you can talk about it in general terms. Legacy doesn’t have an age. Children are actually, in some ways better at this than we are. They take it at face value. Younger people are able to say ‘I know I’m dying’ and that’s the way it is’ – many of them. I think that talking about, what do you want people to remember, what are the things you still have to do that are reasonable. Very few people say ‘oh, I want to go on a cruise’. It isn’t what matters at the end of life. Whatever you had on your list, somehow when you’re that close, it isn’t what’s important. We are really all defined by the people we love and the meaning in our life is defined by that.
Selma R. Schimmel:
Your experience with people that have strong faith, do you find it is different when someone has a strong spiritual connection, or not?
Jamie H. Von Roenn:
So, I think it’s a different experience. When it’s a religious belief, sometimes, there’s confusion about what the religion is telling them to do versus what they as an individual might want to do, and there’s a struggle. When it’s a spiritual faith I actually think they do better because they trust that they’re going to be taken care of and that this is the right thing, things go forward. It can go either way, though.
Selma R. Schimmel:
Thank you, Dr. Jamie Von Roenn; such a privilege to have had this time with you. Congratulations again, recipient of the 2011 ASCO ACS Award and lecture for really pioneering work in palliative medicine and cancer pain management. You’re a medical oncologist, you treat breast cancer but you’re the Medical Director of Northwestern’s Memorial Hospital’s Home Hospice Programs, and Professor of Medicine at Northwestern University’s Feinberg School of Medicine, Robert H. Lurie Cancer Center right here in Chicago.
Jamie H. Von Roenn:
Thank you for inviting me. It’s been a pleasure.
END OF VIDEO