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View From the Other Side of the Stethoscope

As an internist and cancer survivor, Wendy S. Harpham, MD, FACP, offers a unique perspective on oncology practices.

Thursday, April 7, 2022

Office visits often begin with “How are you?" I recently experienced an unexpected dilemma of how best to answer. Exploring my little conundrum may expose opportunities for clinicians to offer healing words. Here's what happened.

I was waiting alone in an exam room, holding my index card of questions. The door opened. My pulse quickened. The nurse walked in and gently asked, “How are you?" I stammered, frozen with confusion about whether to reference my physical condition, how I was coping, or the imminent arrival of my sixth grandchild.

My stutter surprised me. Early in my survivorship I'd explored my dread of that question in social situations. Readings and discussions had led me to insights that helped me thereafter navigate all the “How are you?" queries from friends, family, colleagues, and acquaintances. (See “Surviving 'How ARE you?'" at tinyurl.com/wshhowareyou) Today, I respond without hesitation in whatever way works for me. I often take the question as a colloquial “hello" (no matter how intended) and answer, “Great!" (even if I'm anything but).

I could have simply answered the nurse with the same “Great!" and gotten on with the visit. Except I couldn't. Doctor visits are not social visits. To get good care, I must provide accurate information, no matter how uncomfortable doing so is for me.

What probably threw me off that day was that I'd not yet adjusted to my new diagnosis or the routines of the specialty clinic. Different sides of me competed to answer, jamming up my tongue. The responsible patient wanted to report succinctly, “Exertion exhausts me. I wake up in the middle of the night and cry." The Healthy Survivor in me wanted to exude confidence that I was working around my limits and making life the best it could be, an outlook that defines me. I squelched the snarky voice of the anxious patient who wanted to snap, “I have no idea how I am. I'm about to find out."

In the moment, I didn't consider answering, “Great." Don't for a second think I didn't want to. On occasion, I even daydream of doctor visits where I'm beaming brighter than the sun while answering: “I'm doing great." An obvious explanation for my fantasy is how unbelievably wonderful it would be if true. Hand me a magic wand and—swish—I'm on it. My reality is that my days are shaped by aftereffects.

Decades ago, I stopped hoping to feel great after realizing that my happiness depended on accepting and adjusting to my discomforts and limits. That's why I hope only to feel good enough to do things that bring meaning or joy. Good enough is good enough.

My theory for the source of my recurrent daydream hinges on my problem with gratitude. (See Thanks at tinyurl.com/WSHThanks) Back when I practiced medicine, a soul-filling reward was seeing a patient in follow-up, fully recovered after a long or high-risk illness. Now, as a patient grateful beyond words for my superb medical care, I yearn to give each of my doctors and nurses a success story. I want them to enjoy the gift of that same energizing satisfaction, instead of my prettily wrapped books and fancy chocolates.

A lesser explanation for my daydream has to do with my public persona. Perhaps more than I want my doctors and nurses to see me as thriving, I need to see myself that way. At doctor visits, the necessary focus on my symptoms often causes a brief bout of post-visit blues because my losses are sad and suggest I'm not doing great. Contrast that with social situations where my cheery, if automatic, “No complaints!" boosts my self-perception as a thriver.

What are my intended takeaways of these personal stories? Let me be clear: I see no need to analyze a patient's response to your “How are you?" greeting. Just be aware of possible subliminal bias. A patient's enthusiastically positive response may suggest that the symptoms you subsequently discuss are well-managed when, in fact, that patient would benefit from further evaluation or intervention. Conversely, a patient's negative or odd response may reflect momentary distress and not a need to sound the alarm.

Consider the possibility that your patients who answer, “Great!" may be…

  • Treating doctor visits as social visits. Patients may worry about disappointing you, or they don't realize how inaccurate reporting can jeopardize their care.
  • Encouraging you to keep treating their cancer. Patients may fear that reporting symptoms will lead you to lower their doses or stop treatment.
  • Putting on a good show. Patients may dress meticulously and sound energetic throughout the visit, for themselves as much as for you. Then they go home and collapse for hours.

Thanks to my experience as a clinician and my work exploring the patient side of getting good care, I know what sorts of things make it easier to care for patients. In my efforts to be an effective yet low-maintenance patient, I'm committed to candid reporting and complying with therapies. Despite my clarity of purpose, I still find patienthood uncomfortable. Without a doubt, the compassionate way my doctors and nurses validate both my difficulties and my efforts helps me live my best life between visits.

You may comfort and inspire your patients going through rough times by….

  • Validating their experience of adversity. “I hear you that you feel…."
  • Sharing your perception of how they are coping. “It sounds like you are (or aren't) well enough to do things that matter to you."
  • Expressing gratitude for their reporting. “Your candid explanations help our evaluation and treatment decisions."

For patients, “How are you?" may be taken as a meaningless greeting, an invitation to summarize their medical condition, or a profound question about their whole life. The recognition that a variety of factors plays into a patient's answer may assist your assessment and open opportunities to offer healing words. ​

Friday, February 18, 2022

While waiting for test results, patients often wrestle with distressing mind games. As a 31-year cancer survivor, I've come to depend on my hope for accurate news to help me manage the uncertainty—a healing hope you can share with patients. To illustrate, here's my personal story.

My latest health venture began after routine bloodwork showed cytopenia that progressed. When my oncologist expressed concern and recommended a bone marrow biopsy, my reaction was probably atypical. I attribute that to having written a textbook chapter in 1998 on late effects (Principles and Practice of Supportive Oncology; Lippincott) and having befriended a few co-survivors who developed marrow diseases—most of whom died.

Knowing my risks in graphic detail made each day without major late effects feel like a gift. While driving home from the biopsy, as the lidocaine wore off, I murmured a prayer of thanks. If my diagnosis was ominous, how wonderful that it hadn't happened before now. Nobody could take away my good fortune: I'd raised my young children to adulthood, enjoyed a fulfilling writing career, and met my five grandchildren.

As expected, gratitude alone didn't dissipate the fog of grief and fear. The ability to keep functioning depended on a different emotion: hope. Not just vague hopefulness, but specific hopes that could decrease the anticipatory grief and build my confidence. To that end, I should hope for…what?

Naturally, I've been hoping for good news. Maybe the low blood counts are a fluke due to a virus or a transient Covid-booster effect. As each piece of information comes in, that hope swings like a screen door in a summer storm, slamming shut and then flying wide open, only to swing back again with a shudder.

Early in my survivorship, “hope for good news" occupied center stage whenever waiting for test results. Now I know better. The trick is to let that hope drift into the background while nurturing hope for something else: accurate news (i.e., evidence revealing the truth of what's wrong). To understand how that hope helps, let's first look at the distress I feel while hoping for good news.

Obviously, I want good news. That desire is echoed by family and friends asserting, “I'm hoping for good news for you!" They repeatedly encourage me to do the same—as if strong hope improves the outcome. Meanwhile, my primal desire for control pushes a little button in my brain. Now my mind is spinning all available information—from preliminary test results to dreams filled with symbolism—to predict the biopsy results, an impossible task. Between the exhausting mental chatter and the social pressure to hope for good news, my anxiety escalates (see Real Good News; 09/25/2011; https://bit.ly/3rFNAQQ).

In contrast, hope for accurate news comforts and inspires me, its power derived from a dispassionate fact: The news that can help me most is accurate news. Think about it: A false negative will make me happy while possibly delaying effective treatment. My “Aha" moment was realizing that more than I want good news I want accurate news. This desire for an outcome determined by technology and interpretive expertise renders my thoughts and feelings irrelevant. As when hoping for warm weather or light traffic, I accept the hoped-for biopsy results as out of my hands.

Soon they'll post the final biopsy report on my patient portal. My hope for accurate news is in full swing, helping me prepare emotionally for any news. I've surrendered to the uncertainty, which frees my energies to work on making today the best it can be. Each time the mental chatter starts up (and it does), reminding myself to hope for accurate news hits the Off button. It's quite amazing. Until I'd experienced the power of this hope, I had no idea how healing a hope could be.

Patients look to you not only for what's happening and what to do but also for guidance on healthy responses, including what to hope for. During evaluations, consider introducing the notion of hope for accurate news:

  • Share your desire. I want good news for you.
  • Mention hope. Naturally, we all hope for good news.
  • State your primary hope: What I'm hoping for most is accurate news…results that tell us what's going on, so we can know how to make things better.

That approach sends multiple healing messages. For starters, voicing your heartfelt desires and hopes affirms your emotional investment in their well-being. Whatever happens, they won't forget your compassion.

Also, you are acknowledging a natural hope most people want to feel, one promoted by a pervasive belief of the power of positive thinking. Without criticizing hope for good news, you are encouraging patients to foster a variety of hopes and specifying one that works well for you. What's key is that you are not telling them what to hope for. You are modeling an option they can now consider for themselves.

For patients who've never thought about “accurate news," you are introducing a hope that's different from the usual ones because fulfilling it depends on science and technology. Patients who focus on it may benefit from an uplifting feeling linked to letting go of responsibility and accepting the uncertainty.

As for faith and other hopes, my experience has been that hope for accurate news co-exists nicely with my faith in a loving God by my side and my many other hopes, such as to make the most of today.

Healing words that take seconds to say may echo in a patient's mind between visits. Help patients through the distress of waiting for test results by reminding them, “The best news is accurate news." That's the news that enables you to help them and that helps them move forward in healing ways (Healing Hope; page 13; Curant House, 2018). ​

Tuesday, August 24, 2021

My sister's experience with her music therapist surprised me, and not because of how much the music helped her manage her cancer pain. Witnessing the therapist's work up-close, I discovered how little I knew as a physician about the variety of ways these professionals can help patients throughout survivorship, whatever the prognosis. The biggest surprise was how my sister's music therapist helped me. Here's our story.

A few years ago, a cardinal perched on a bare branch, announcing the imminent arrival of winter. My 65-year-old sister opened the door to welcome a music-therapy intern into her spacious bedroom, warm and bright from the morning sun. The youthful Danielle set down her guitar and introduced herself while scanning the room, with its two acoustic guitars, three djembes (tall, goblet-shaped drums played with bare hands), and stacks of sheet music. She assessed my sister's movements with a clinical eye, making a mental list of potential interventions, and asked, “How are you feeling today?"

Debra's answer informed Danielle that low-dose narcotics were controlling the physical pain but not the surreality and sadness of settling into hospice—something she sensed Debra didn't want to talk about. All my sister wanted was to learn drumming patterns for songs from her childhood. For the rest of the hour, Danielle taught her “music student." They sang traditional Jewish melodies in unison, accompanied by drumbeats and chords. The only talk was of notes or rhythms. Not pain or cancer. Each song ended with a coda of smiles and Debra's eager, “Okay, what's next?"

Unlike the passivity of receiving radiation and chemotherapy, Debra ran the show for this therapy, deciding where they sat and what they played. If a song felt too challenging or stirred sadness, she simply stopped mid-phrase and turned the page. When time was up, before saying their first goodbye and opening the door to the cold, Debra assured Danielle she'd practice.

At least once a day throughout the subsequent week, between nurses' visits and managing all her pills and trying to eat or sleep, Debra took out her djembes. The music transported her like a magic carpet to joyful spaces where she escaped her pain and grief.

In anticipation of Danielle's second visit, Debra readied the chairs and music stand. She couldn't wait to show off her progress and learn new techniques and harmonies. Again, Danielle first asked “How are you feeling?" to gauge the best therapies for the day. For the rest of the hour the bedroom vibrated with music and laughter—celebrations of life.

Visit after visit, the two women became increasingly in sync. Danielle rejoiced in Debra's expanding musical repertoire and improving technique while noting Debra's weakening muscles and increasing abdominal distension. Conversation remained limited to notes and rhythms. Danielle knew to wait until Debra was ready to let her in.

The end of winter brought the end of their musical give-and-take. Leaving her drums untouched in the corner, Debra asked if she could lie down and just listen. Danielle played familiar melodies she knew would help. Once the creases in Debra's forehead relaxed, Danielle used guided visualization to serenade Debra on a moonlit boat ride a world away from the army of pill bottles on the nightstand.

Outside, a few daffodils defied the chill, heralding the hope of new beginnings. Inside, hope waned. The usual “How are you?" prompted Debra to start talking about what was happening to her…and to her family. Danielle asked, “Would you like to leave them a song?" Without hesitation, Debra welcomed the chance to preserve her voice, answering, “Let's do it!" Danielle scribed, catching all she could as Debra poured herself into a jumble of verses that sent a message: “I want my family to keep love in their hearts regardless of the hardships they face."

By their next session, Debra's somnolence made talking difficult. Danielle performed music that enabled her patient to escape the pain. Suddenly, with tears streaming, Debra turned to Danielle, took her hand, and said clear as day: “Thank you for the amazing work we've done…for bringing music, laughter, positivity and joy to these months." Her last words to Danielle.

A few weeks later, Debra's family, two nurses, and I surrounded Debra's bed. Danielle quietly entered the room with her guitar. By now, Debra was non-verbal but obviously still aware of her surroundings. We propped her up with pillows. Her daughters kept stroking her back and Danielle kept strumming two chords over and over as we waited for Debra's pain to quiet down enough for her to hear her musical debut.

For three sacred minutes, Debra's Song filled the room with the love of my sister's heart.

Danielle quietly packed up her guitar and leaned over her patient to whisper a final goodbye. She then made the rounds, giving each of us a hug and a promise to email an mp3 version of the song. With a wave, Danielle was gone. Before sundown the next day, Debra was gone, too.

After the funeral, the promised email arrived. I plugged in my earbuds and adjusted the media settings to auto replay. When my fingers froze, my grief counselors' wise words echoed in my head: “You have to feel it to heal." Taking a deep breath, I pressed “play." 

Danielle's sweet rendition of Debra's Song ushered me through the painful transition to life without my sister. That first month, the song helped me accept my loss as real…and forever. A few months later, I played Debra's Song for my new granddaughter while holding a photo of my sister in front of her face. Delighted cooing assuaged my pain of knowing they'd never meet on earth. For the rest of my life, I can play Debra's Song whenever I miss my sister or want to feel inspired by her message, such as right now.

In today's world of high-tech medicine, let's remember the ancient healing art of music therapy. From baroque to Broadway hits to bawdy rap, music therapists use rhythms and tunes to help patients through tough times.

Minimally, music may offer patients respite—a few bars of cheer or a memory-filled return to happier times and places. At best, music helps them live fully in the moment. If conversation fails, music may give voice to patients' thoughts and feelings that desperately need sharing. If illness threatens all happiness, music may offer patients a way to regain a sense of control, obtain pain relief, calm anxiety, or find hope. And if patients die, their loved ones' memories of music-therapy sessions may make it easier to let go of painful memories and remember their loved one with joy. Music can be like a medicine for patients and for their loved ones. ​

Wednesday, August 11, 2021

The demands of modern medicine leave little room for history lessons. Nevertheless, I will try to persuade you to read From Shadows to Life—A Biography of the Cancer Survivorship Movement. The historical perspective may energize your efforts to optimize your patients' care.

Journalist Judith Pearson felt compelled to tackle this topic in 2017, six years after feeling blindsided by her own post-cancer challenges. Coming across work by the National Coalition for Cancer Survivorship (NCCS), she reacted to the notion of survivorship with shock. “OMG! How could I have not known about this?" For the next year, she scoured newsletters, memos, articles, and diary entries about the organization that had introduced the label “survivor" in 1986. Failing to find a comprehensive history of either the NCCS or the movement it advanced, she did what she does best: She used her investigative and storytelling talents to fill a gap.

From Shadows to Life offers readers a bird's eye view of the history of “survivorship," by which I mean the science and art of making life the best it can be after a cancer diagnosis. Her overarching goals are increasing awareness among cancer survivors and facilitating dialogue among all the stakeholders in cancer care, especially between patients and caregivers. Pearson reasons that awareness of “how the survivorship movement has changed our collective lives" may encourage patients to advocate for themselves and, if they choose, join advocacy efforts that help others. For clinicians, reflecting on how cancer care got to today may feed your hope of facilitating a better tomorrow for your patients and for public health.

The 275 pages are divided into 16 chapters, organized chronologically from 1965 to 2021. As with any social movement, the story is complex. The pace of progress in survivorship has been impacted by the relentless work of individuals and the interplay of a variety of forces—scientific, political, social, economic, and cultural. Of necessity, Pearson backtracks each time she picks up a new theme to braid it into an understandable history. For example, in the chapters about the 1970s, she backtracks to the 1950s and 1960s to explain the impact of the Viet Nam War and the space race with Russia on advocates' efforts to generate public demand for increased government funding for cancer research. To keep readers oriented in time, epigraphs introduce chapters with a specific year and statistic (usually the corresponding number of Americans newly diagnosed with and/or surviving cancer).

No history book includes every detail, let alone tells all the narratives perfectly. Success is measured by a book's ability to engage readers, fill in blanks in their knowledge, and help them know in useful new ways what they already knew. To those ends, Pearson succeeds by weaving together multiple concurrent storylines, zooming in for the personal stories and zooming out for the milestones that drove the history of cancer survivorship.

Her timeline includes a huge cast of characters and organizations impacting the ebb and flow of the survivorship movement. The strength of the book is Pearson's unique blend of fact and story. Footnotes in other histories of medicine are described as if by a fly on the wall, making readers vicarious witnesses to the traumas, courage, and persistence at the heart of the movement. A young man received meals on paper plates because his mother feared catching his cancer. Oncology nurses were “charged with mixing the new, highly toxic chemicals…while relatively unprotected."

Even for clinicians working in survivorship who are history buffs, some stories surely will be new. Pearson's description of the NCCS founders' inaugural meeting deepened my appreciation for a gathering in Albuquerque I had heard about repeatedly over the years. Fascinating new details reshaped my vivid memories of NCCS events I had participated in and enriched what I knew about key players who are longtime personal friends or mentors.

Most chapters include material on the life and work of Susie Leigh, one of America's first oncology nurses and a nearly 50-year survivor. Shining a spotlight on Susie throughout the book helps keep “the patient" center stage, reminding readers how far survivorship has come and how many challenges persist. The power and limits of advocacy remain apparent while reading of Susie's professional triumphs, ongoing medical problems, heartbreaking disappointments, and enduring hope of advancing survivorship.

While some details are crucial to understanding the history, others simply make for enjoyable reading. Patient care will not be affected by learning when and why a hyphen was added to “psycho-oncology." Still, it is fun to imagine luminaries Jimmie Holland and Julia Rowland realizing that the word looked “bizarre" after receiving the first printed copies of the groundbreaking 1989 Handbook of Psychooncology.

My only criticism is that in later chapters Pearson uses the term “survivorship" a few times to mean “post-treatment consequences." While a commonly used definition, that usage in this book strikes a nerve. Why? After reading about the movement's struggles, I see today's multiple definitions of “survivorship" as more than an inconvenience or annoyance. Such ambiguous language is an obstacle to progress in cancer care. Pearson's history ignited in me a sense of urgency to bring clarity to “survivorship" (OT; 05/05/2021). With heightened appreciation for the sacrifices and tireless efforts of the advocates who came before me, I feel a sense of obligation to promote universal adoption of a single definition for “survivor" and another for “survivorship," both capturing the ideal of “whole-person care across the continuum."
            If nothing else, Pearson's big-picture perspective makes a convincing case that…

  • Survivors are an essential source of information and insight about cancer care.
  • Transparency and collaboration speed progress in survivorship.
  • The cornerstone of survivorship is hope.  

Since its inception, the survivorship movement has been a mission of hope. May “the unforgettable voice of these survivorship pioneers" inspire you with a sense of your place in history and your ability to carry on their work, advancing the movement while helping each of your patients live his or her best life.​

Friday, June 4, 2021

By Wendy S. Harpham, MD, FACP

When you see “Survivorship" in a headline, do you envision all your patients or only those who've completed therapy? Do you expect to read about medical interventions, quality-of-life issues, or advocacy? These days, any answers are reasonable—and that's a problem.

As a physician-survivor I've grappled for decades with the ambiguity surrounding “survivorship." Only recently did I see an urgent need to bring clarity to the term. Here's my story, with a vision of how both clinicians and patients would benefit from universal adoption of a single, specific definition.

The word “survivorship" has troubled me since the first time I heard it in 1990, the week of my cancer diagnosis. Decades later, my discomfort grew when the term was adopted as shorthand for “post-treatment survivorship." Like a vitreous floater, the annoyance wasn't preventing me from writing about challenges in oncology care, so I kept working around it.

Then I read Judith Pearson's From Shadows to Life—a Biography of the Cancer Survivorship Movement. Her stories took me back to an era before rainbow-colored rubber bracelets and digital communications, when patients were “victims" in an information desert. Recalling my own challenges with treatments and recoveries back then, I fantasized high-fiving—and thanking profusely—the founders of the National Coalition for Cancer Survivorship (NCCS). Today, inputting “cancer support" in a search bar yields pages of links to high-quality education and support resources. Robust data-gathering of adverse consequences of cancer therapies now impacts routine cancer care.

My stroll down memory lane wasn't all congratulatory. Many hopes prompting the survivorship movement remain unfulfilled. That disheartening realization compelled me to think about what “survivorship" means today and ask whether we need to update the definition. My exploration began with revisiting the origins of the NCCS.

I scrutinized Pearson's recounting of the inaugural NCCS meeting. Twenty-three people from different backgrounds bonded over a shared mission: To change the culture of cancer. Two key elements of their agenda were (1) helping patients move away from the hopelessness and powerlessness of “victimhood" and (2) making it routine for clinicians to address the “range of issues separate from the biology."

To jump-start their movement, the founders set out to “build an entirely new lexicon." Animated discussions about which label should replace “victim" concluded with the group settling on “survivor." Wisely, Pearson barely mentions the persistent controversy among patients over that choice because the NCCS wasn't looking for a branding opportunity. They'd succeeded whenever a patient's self-assigned label—thriver, patient active, or whatever—reflected hope and empowerment.

In contrast, success in the medical community required universal adoption of “survivor." To increase the term's impact, the founders gave it a revolutionary definition: “From the time of discovery and for the balance of life, an individual diagnosed with cancer is a survivor." Until then, “survivors" in the cancer world were grieving loved ones left behind and, only recently, patients still alive after five years.

While definitions don't necessarily prevent or solve problems, they play a vital role in communications, especially if trying to change a culture. The founders' definition promoted the perception of life before-during-after cancer treatment as a continuum. It also encouraged clinicians prescribing therapies and offering advice to consider the rest of that patient's life—where “rest" refers to both “life other than the malignancy" and “the weeks, months, or years ahead." On the other side of the stethoscope, it helped patients discuss their concerns beyond the status of their cancer.

What about the origins of “survivorship"? According to Pearson, it was first used in oncology when NCCS published its charter, which defined “survivor" and referred to “survivorship" (without a definition). Unfortunately, the noun modifier “-ship" can be interpreted a variety of ways. I mistakenly took it to mean “the state of or condition of," as in “friendship." That interpretation tripped me up by making my survivorship a fact of my disease without saying anything about my quality of life or role in my recovery.

Goal-oriented and needing more, I asked myself, “What kind of survivor do I want to be?" The qualifier “healthy" popped into my mind, with its connotation of “activity conducive to achieving the desired outcome," as in “healthy parenting" or “healthy financial planning."

To avoid confusion with “healthy" as “not displaying signs of disease," I defined “Healthy Survivors" as survivors who (1) obtain quality care in keeping with their values and (2) live as fully as possible. “Those two criteria inspire excellence without demanding perfection. They do so seamlessly over time as new challenges arise and the ability to respond in healthy ways evolves." (Healing Hope; 2018). For the corresponding word, “Healthy Survivorship," I tacked on “-ship" for its other meaning: “the art or skill of," as with “horsemanship" or “musicianship." It was a wraparound term for the work of obtaining quality care and living as fully as possible.

In retrospect, I now see that the NCCS founders had intended that same meaning of “-ship." I know this from a 1987 letter by Fitzhugh Mullan, MD, who wrote of “survivorship, the art and science of living after the cancer diagnosis." His adjectival phrase indicates a state of doing, not being, that supports the NCCS mission “to communicate that there can be vibrant, productive life following the diagnosis of cancer…."

Teasing apart the distinctions between “survivorship" and “Healthy Survivorship" is a discussion for another time and place. My concern here is the urgency of addressing the current ambiguity surrounding “survivorship." Any temporary confusion—"What is this 'Survivorship' presentation about?"—poses only minor inconveniences. My concerns revolve around the unintended consequences of appropriating “survivorship" as shorthand for “post-treatment survivorship."

The idea that “survivorship" begins after completing treatment hampers cancer care for many by disrupting the notion of a continuum “from the moment of diagnosis." That linguistic divide makes it easier for everyone to approach the active-treatment phase with complete focus on the immediate threats, leaving post-treatment and quality-of-life issues for later—or for others on the healthcare team to address. It forsakes those living with chronic, remitting-relapsing, and advanced or metastatic disease.

Looking back can help us move forward. Let's advance cancer care for all patients by using “survivorship" always—and only—to mean whole-person care from the moment of discovery and across the continuum. I propose this definition:

Survivorship: the science and art of making life the best it can be after a cancer diagnosis.

Researchers, clinicians, and advocates huddled together under one umbrella of “survivorship" positions them for meaningful connections that spark new research, funding, and education efforts based on mutual understanding. The synergy of cross-disciplinary interchange can help all stakeholders address problems of access, equity, and advocacy at all levels—from patients' self-advocacy at checkups to representatives' advocacy on Capitol Hill.

Meanwhile, it encourages everyone to keep in mind all spheres of each patient's life (physical, emotional, psychological, spiritual, social, financial), even while addressing only one aspect of care. As for a shorthand for post-treatment survivorship, "post-T survivorship" has a nice ring.

Definitions matter. As clinicians, you play a major role in optimizing patients' survivorship by defining “survivorship" for patients as a hopeful, active, and ongoing process. Then you can guide and support their efforts to make their life the best it can be today, tomorrow, and every day.