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When we hear about people with cancer, the stories often end when the treatments end -- either the battle has been won and the cancer cured, or in more tragic circumstances, the cancer takes the patient's life. But for patients who survive, that's not where the story ends.
Cancer has fundamentally transformed their lives. How are they to make sense of the existentially threatening experience they have gone through? That's where cancer survivorship comes in.
Joining Henry Bair and Tyler Johnson, MD, in this episode is , director of the Survivorship Clinic at Yale Cancer Center in New Haven, Connecticut, where she helps patients thrive after cancer. Sanft is also a breast oncologist and the chief patient experience officer at .
In this episode, we discuss the importance of cancer survivorship, how Sanft navigates the emotional challenges of her work, and what all clinicians can do to better support patients through difficult times.
In this episode, you will hear about:
- 2:04 How the death of a family member influenced Sanft's decision to go into medicine
- 6:02 Why Sanft decided to focus on palliative care
- 14:20 Reflections on how communication and building relationships are key to palliative care
- 19:53 A discussion of cultivating sacred moments in medicine
- 26:02 The purpose of a cancer survivorship clinic
- 33:35 A discussion of the most challenging aspects of Sanft's practice
- 36:30 How she shoulders the emotional toll of her work
- 40:25 Sanft's duties as the chief patient experience officer at her hospital
- 43:17 How to create culture change in medicine
- 48:18 Sanft's advice to clinicians on how to better foster self-compassion and create effective healthcare teams
The following is a partial transcript (note errors are possible):
Johnson: Can you start out by just telling us your origin story? How did you get into medicine? What did your path look like?
Sanft: I grew up in Iowa and my father worked for Winnebago Industries and my mother was a psychiatric nurse in the outpatient setting. Sort of functioned like a nurse practitioner back in the day, and she really found her job very fulfilling. So she would talk to me as a child that you could do anything you want. And she felt that practicing medicine was really special.
And so in her generation, she was not encouraged to pursue a career in medicine as a medical doctor, but instead through a nursing school. And she suggested, though, that I could be anything, even a doctor. And so that seed was planted very early.
And then when I was 11, her brother died of pancreas cancer -- so my uncle; he was 32 at the time, and I was 11. And I realized now that that had a profound impact, not just on my family, but on me and my connection to oncology, to palliative care, and to supporting people during really serious illness.
Johnson: And so, tell us a little bit about that. You know, it's so interesting. We've talked with a number of people on the program over time who have some experience in their young life that has a really formative impact in terms of leading them to become a doctor. But it's also so interesting that what I imagine was, you know, especially when your uncle was so young at the time of diagnosis, had to be a tragic and very difficult -- and I imagine as a child, very confusing -- event in your life. How was it that that operated to make you then want to go into medicine?
Sanft: It's interesting, because what I remember is just snippets from like back seats of a car, you know, of conversation happening in the front. And I remember profoundly that there was just great sadness that at this time there wasn't great treatments. There was nothing much that could be done.
He had two little kids, and my uncle was the life of the party. He was the comedian at the barbecue who was always having us laughing with funny stories, with the kids included. And so there was this profound sadness that this was coming.
And yet when he passed away in his home in hospice, everyone felt like that was very beautiful. And I remember being drawn to that, to that ability to support a family in their most serious time of suffering and giving them comfort through something that's inevitable, and I didn't know all of this at 11. All I knew is I could be anything, including a doctor.
And so, fast forwarded, I loved school. I loved science. And I went into medical school. And it probably wasn't until my intern year when I rotated on oncology and was on call in the middle of the night having to talk to patients about either transferring to the ICU [intensive care unit] or focusing on their comfort on the floor, that it all kind of clicked for me.
And I felt that deep connection to these patients at their toughest times of deciding what to do next. And I finally felt like I was finding my calling and that it made me feel very fulfilled to be a part of that, regardless of what they chose, whether to go to the ICU or to stay on the floor and focus on comfort, I felt always fulfilled after being a part and bearing witness to that and helping to facilitate those decisions.
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