Beyond The Cancer Diagnosis: Dialogue with Dr. William Breitbart, Hosted By Adrian Pogacian

And I am the Jimmy C. Howland Chair in Psychiatric Oncology. I am trained both in internal medicine and psychiatry.

And I went to do a special fellowship, a two-year fellowship in the subspecialty of psychiatry called Consultation Liaison Psychiatry or psychosomatic medicine. But at Memorial Sloan Kettering, the fellowship was specifically in psycho-oncology. That was in 1984 through 1986.

In 1984, when I came to Sloan Kettering to do my training, this was the 100th anniversary of Memorial Sloan Kettering. And so Memorial Sloan Kettering is now 140 years old. It was established 140 years ago as a small hospital in Manhattan called the New York Cancer Hospital.

And it evolved to the point where in 1964, it became Memorial Sloan Kettering Cancer Center, which was a corporation that involved two entities, Memorial Hospital and the Sloan Kettering Research Institute. And we are the first freestanding cancer center in the world, I believe.

And we have a very long history of making innovations in cancer diagnosis and treatment through innovations in surgery, radiation therapy, and chemotherapy, including recent advances, obviously, in precision medicine, genomics and precision medicine and immunotherapies, et cetera.

Dr. Allison, who won his Nobel Prize in immunotherapy, spent most of his career and did most of his research at Memorial Sloan Kettering before leaving to MD Anderson and then eventually getting his Nobel Prize. So a lot of that Nobel Prize money were a lot of very famous people in the world of oncology from Karnofsky to Blaylock, famous surgeons. It’s a place of firsts.

And when it comes to the field of psycho-oncology, it’s the place of firsts. It’s actually the birthplace of the field of psycho-oncology or psychiatric oncology, or as some people call it, psychosocial oncology, to acknowledge the fact that it is a multidisciplinary field that involves not only psychiatrists, but psychologists and nurses and social workers, et cetera.

He was a master diagnostician as well. He decided that we needed to have a psychiatric service within Sloan Kettering to deal with patients who were struggling with problems of anxiety, depression, delirium, coping throughout the course of cancer, from diagnosis through cancer treatment, through end-of-life care, through survivorship, et cetera.

In 1977, he started two services. One was the psychiatry service. The other was the first cancer pain service ever established in a cancer center.

He recruited Dr. Jimmy Holland, who is the wife of a psychiatrist in psychosomatic medicine, who actually was the wife of a rather famous oncologist named James Holland, who edited a major textbook of oncology for many, many years, and he’s one of the pioneers, along with Mel Farber and others, of combination chemotherapy.

And then they added a few psychologists who were starting to do research on various aspects of cancer, both in adults and pediatrics, oncology. In 1978, he established a fellowship, a clinical fellowship, which was the one that I entered.

And we now just graduated our 46th class of psycho-oncologists, psychiatrists and psycho-oncologists. We also, for the last 40 years, have had a post-doctoral research fellowship training program, training six post-doctoral fellows, mainly PhDs, in research aspects of psycho-oncology. And so there’ve been a number of developments.

In 1984, Dr. Holland helped found the International Psycho-Oncology Society, and I was lucky enough to become a founding member of the board of directors. About two years later, we founded the American Psychosocial Oncology Society. And then in 1989, we put out the first textbook called The Handbook of Psycho-Oncology, which is different than this

It was a predecessor of the series of the textbook of psycho-oncology, which I had the privilege of being the senior editor of the fourth edition in 2021. It was produced during COVID, the height of COVID. That’s how I spent most of COVID.

A hundred-plus chapters really outlining the depth and breadth of our field. And so in 1996, we became a department, an independent department, and that department had two services, a psychiatry service. I became the chief of the psychiatry service, and a behavioral science service, which Dr. Jamie Ostroff became the chief of.

And when I became chair in 2011, we added a third service, Cancer Disparities and Immigrant Health Service, focusing on issues like cancer disparities, access to healthcare, access to cancer care, access to clinical trials, financial insecurity, financial toxicity, food insecurity, cultural and linguistic adaptations of many of the interventions that we developed in our research in the department. We have about eight or nine research laboratories within the department.

I headed up the psychopharmacology and symptom control lab. We did a series of studies looking at different treatments of delirium, treatment of psychostimulants for fatigue in both cancer and AIDS patients, studies of desire for haste and death, studies of inflammation and depression in pancreatic cancer patients, most recent studies that we’ve done. I also head up the psychotherapy lab in which we’ve developed a number of novel, unique psychotherapies targeted toward cancer patients.

I think probably our most well-known intervention, psychotherapy intervention that my colleagues and I developed is meaning-centered psychotherapy, which originated- Another question that I want to ask you to tell us about.

And I think the adaptations are endless. And then there were other trials of ACT, acceptance commitments of therapy, CBT, other kinds of psychotherapies that were specifically adapted for interpersonal therapy, adapted for cancer populations.

We also have a communication skills research training laboratory. We have a neurocognitive laboratory that looks at the cognitive effects of cancer and cancer treatment and interventions for that, often involving exercise or neurostimulation. We have a geriatric oncology therapy lab, which develops interventions for older cancer patients, psychotherapy interventions for older cancer patients, and also screening tools to diagnose.

Every time you develop an intervention and you don’t have a good tool to use to measure what you want to measure, we’re forced to create new tools. So, we’ve developed a number of, over the years, I developed a new measure of delirium, the Memorial Delirium Assessment Scale, a new measure of hopelessness, a measure of desire for haste and death called SAD. We’ve had to develop a measure.

We also have a decision-making and biogenomics laboratory, a cancer prevention control laboratory, which focuses on things like smoking cessation. A lot of our labs have taken interventions and worked with industry to develop digital apps, therapeutic apps. We have a pediatric psycho-oncology program.

We have a neuropsychology, pediatric and adult neuropsychology program. So, there are a number, and then we have an immigrant health cancer disparities research lab, which focuses. So, there’s a lot of research that goes on.

And this research is intended, obviously, to change the practice of psycho-oncology to benefit cancer patients in all stages of disease and disease prevention and survivorship.

And that is the nature of living with cancer. And that is the nature of the struggle of to maintain hope and to live a human life with meaning throughout any stage of life, throughout any stage of illness. Life is a struggle and the struggle is to maintain our authentic selves, a life with meaning.

And there are many external events that buffer our lives, like war in Europe or in the Middle East, and many internal dangers, illnesses, cancers, tumors, things like that. And the struggle is to maintain the essence of, to retain who we are as individuals.

And that, to quote Viktor Frankl, even when we’re facing suffering, we have the choice to choose our attitude towards suffering and to find meaning even in suffering. And so the realization that we have the choice in creating our lives in the face of suffering, Carl Jaspers defined suffering as any encounter with limitations. And I would say that death might be the ultimate limitation, but going through cancer illness, even survivorship, we’re encountering lots of limitations, it’s causing lots of suffering.

We can choose our attitudes towards the suffering. We can make choices that will allow us to regain the essence of who we are. So the choices that we make are driven by the attitude that we have towards suffering.

And if the attitude we have towards suffering is that we are going to make every effort to preserve the sense of who we are and to preserve the sense of who we are, having meaning, then you can even drive meaning out of a suffering experience.

And we’ve undertaken for the last 20 years trying to train as many clinicians as possible in meaning-centered psychotherapy through conferences at meetings, but in the last 10 years, we’ve been funded by our National Cancer Institute in the United States to do what’s called R25 training grant. So for the last nine years, we’re going into our 10th year starting this fall, we’ve trained about 700, close to 800 clinicians from around the country, including some international people.

The two-day workshop using actors as patients, we’ve actually have treatment manuals, obviously, for all the various forms of meaning-centered psychotherapy that have been developed. So there are treatment manuals that are available for people to, for therapists to buy, but we’ve also been actively training people and trying to provide a cadre of providers for this kind of therapy. That’s just one specific kind of therapy.

If you take a place like Sloan Kettering, Memorial Sloan Kettering, we, I don’t know, we see 900,000 people a year, a million people a year. You take all of the cancer patients and every other cancer hospital. At Memorial Sloan Kettering, we have about 20, 21 psychiatrists and about 14 psychologists who do clinical work.

And then another 10 or 12 folks who do primarily research and a small amount of clinical work. MD Anderson basically has six psychiatrists and psychologists, and they treat more patients than us. So it’s vitally important that we find a way for patients to have access to our therapies when they can’t get it face-to-face or even through tele-psych from a trained individual.

So moving to a digital therapeutic platform for the delivery of all sorts of interventions is critically important. And artificial intelligence is one of the most helpful ways in which to transform a structured manual, like our therapy, like Meaning-Centered Psychotherapy, into a digitally delivered psychotherapy because of the, you know, a patient says something to a therapist, there are a thousand answers.

Actually in Meaning-Centered Psychotherapy, there are only about 10 different answers, but artificial intelligence will help us develop digital therapeutics of all sorts of types of interventions and artificial intelligence will play a great role in that.

In research, it will be an enormous boom in order to be able to take large data sets of patients and look at outcomes, disparities in outcomes, looking at issues like inflammation and depression, and all sorts of research questions that artificial intelligence will help us with.

Previous editions of “Beyond The Cancer Diagnosis”

Edition 1: Beyond The Cancer Diagnosis: Psycho-Oncological Aspects Of Kate Middleton’s Diagnosis

Edition 2: Beyond The Cancer Diagnosis with Sonia Amin Thomas – Survivorship

Edition 3: Beyond The Cancer Diagnosis: Dialogue with Wendy Lam, Hosted By Adrian Pogacian

Edition 4: Beyond The Cancer Diagnosis: Dialogue with Camille Moses, Hosted By Adrian Pogacian

Edition 5: Beyond The Cancer Diagnosis: Dialogue with Tihana Gašpert, Hosted By Adrian Pogacian

Edition 6: Beyond The Cancer Diagnosis: Dialogue with Amanda Balakirsky, Hosted By Adrian Pogacian