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January 2017

Taking Care of Our Friends and Neighbors DeVita’s The Death of Cancer and the Challenge of Letting Go

Author Affiliations
  • 1Knight Cancer Institute, Oregon Health and Science University, Portland
  • 2Division of Hematology Oncology, Knight Cancer Institute, Portland, Oregon
  • 3Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland
  • 4Center for Ethics in Health Care, Oregon Health and Science University, Portland
JAMA Oncol. 2017;3(1):16-17. doi:10.1001/jamaoncol.2016.3076

Cancer affects the lives of many individuals, and some are friends, neighbors, or colleagues of an oncology professional. Naturally, when faced with a diagnosis of cancer, in addition to formal medical consultation, many people seek the counsel of trusted friends. Thus, every practicing oncologist from time to time is asked to provide advice in the care of a friend, neighbor, loved one, or associate.

This happens to the most celebrated among us. Vincent T. DeVita Jr, MD, describes, in detail, his involvement in the care of a family friend, “Lee,” in his fascinating book The Death of Cancer.1 At the age of 60 years, after an episode of hematuria, Lee was found to have an elevated blood level of the prostate-specific antigen (PSA), results of a biopsy confirmed adenocarcinoma of the prostate with a Gleason score of 5 + 5, and imaging findings suggested pelvic nodal involvement. Like so many patients with cancer, Lee sought the second opinion of an oncologist he knew. Ultimately, DeVita uses Lee’s story to highlight his view that modern oncologists fail to fully embrace innovative cancer care and to indict oncology research and practice. On closer examination, however, we believe that the case highlights missed opportunities when the recommendations are measured against the best available knowledge at the time and the broader challenges with informal consultation. Ultimately, Lee’s story suggests that even the best of us must approach such queries with humility.

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