Making Peace With Cancer
Authors: Christiane A. Voit, Alexander C.J. van Akkooi
Journal: Journal of Clinical Oncology (2015)

DOI: 10.1200/JCO.2015.63.1333 Dedicated to Christo, to my children Michael (with his girlfriend Helene), Lukas, and Christina Helena, and to Nina. Next to me sounds the buzzing of my Lympha Press machine, which substitutes for the constant visits of the physiotherapist who performs the lymph drainage. This gives me more freedom, and we have more privacy at home. I can use the machine whenever I need it, and my 5-year-old daughter Christina can be around me without problems. Today, the little one is at school. This gives me time to work a bit, but as I lie on the bed like a large insect in Michelin tire–like blow-up pants, with several liters of ascites in my abdomen, it is difficult to use the laptop. Thus I decide to get up to speed with reading my journals, which I have not done for months. As an oncologist, I read Journal of Clinical Oncology (JCO) with feelings of pride and empathy. I am proud of my own articles in JCO, but during the last few months, I have not been able to touch it. Why? If you change sides of the bed—moving from physician to patient—you begin to change your style of reading. I realized today that I was more interested in the Art of Oncology articles than in the Original Report articles. I realized that except for stories of pediatric oncologists who lose children to cancer, few if any of the Art of Oncology articles seemed to tell the story of an oncologist with cancer. Does this mean it is unprofessional to get cancer? Or that it is unprofessional to write about that experience? Original Reports seem to always follow the same template: an Introduction tells why a particular cancer is so horrible or that there is no effective treatment for a specific stage of that cancer. In the Results section, the focus is usually on rates of response and relapse-free survival, all of which are appropriate to read and write about when seen through the eyes of an oncologist. However, these topics are seen differently through the eyes of a patient: what does an increase in relapse-free survival from 1.5 to 5.5 months mean if overall survival is the same in the end? When I looked at my own malignant lymph node on a rainy Sunday in October 2012 on the screen of my own high-end ultrasound machine, I immediately assumed a certain professional detachment. I saw that all the criteria I had developed for determining whether lymph nodes are malignant could be applied to my own. The only logical next step was to perform an ultrasound-guided fineneedle aspiration on myself. To prevent any colleagues from finding my personal pictures in the ultrasound machine, I gave myself the fictive name of a character from a German children’s book I had always loved. I saved the pictures and film clips because they were exemplary, and I would be able to use them for my next presentations and courses. Unfortunately, the cytology revealed undifferentiated cancer. From that point until the time of this writing, I have wrestled with a number of issues: why did the doctors I visited 6 months before my self-diagnosis not pick up on my complaints of abdominal pain, fatigue, and a yellow complexion? Why did they not want to do genetic testing when I asked them to do so years ago, because seven relatives (all maternal side) had developed breast cancer? I was refused because my mother and sister did not have breast or ovarian cancer. Now, in the final stage of my ovarian cancer, I have made peace with all of this. After 12 hours of massive debulking surgery, weeks of parenteral nutrition on the intensive care unit as a result of vomiting, and courses of chemotherapy, I had again a small glimmer of hope. First results of several anti-cell death protein 1 (PD-1) and anti-cell death protein ligand 1 (PD-L1) treatments for different types of cancer were being presented and published, and they seemed encouraging. Perhaps as a result of my professional background, I was aware of these developments and was able to gain access to a clinical trial with anti-PD-1 in Paris with the help of my Dutch mentor who nowadays resides there. My tumor even expressed PD-L1, and I was allowed to be included in the study as one of the last patients. Despite all my efforts, my disease progressed on treatment. It might seem contradictory, but as I write this, it is now a happy time. My eldest two children, Michael and Lukas (26 and 21 years old), have been catapulted into adult roles as a result of my cancer diagnosis. They patiently wait with me at the doctor’s office, make fun of me when things get too serious, and give me good advice, like when I should cut my too-long hair. We are even able to talk about JOURNAL OF CLINICAL ONCOLOGY A R T O F O N C O L O G Y VOLUME 33 NUMBER 35 DECEMBER 1