At NYU Langone Health’s Perlmutter Cancer Center, Jane L. Rosenthal, MD, medical director of psychosocial services, provides supportive and compassionate care for people who are struggling with cancer diagnoses and treatment.
Dr. Rosenthal has joint appointments in the Department of Psychiatry and the Department of Population Health as a clinical associate professor and is an affiliate faculty member in the Division of Medical Ethics. She sits on the Tisch Hospital Ethics Committee and previously served as its chair for three years. She currently oversees an elective in psycho-oncology for the rotating consultation liaison fellows, teaches and supervises medical students and residents, teaches in NYU Grossman School of Medicine’s bioethics track on death and dying, and is a facilitator for the Humanistic Aspects of Medical Education for medicine clerks.
She discusses why psychiatric care can help alleviate symptoms for patients with cancer, how advances in treatments have changed her work with patients, overcoming the stigmas associated with psychiatric care, and more.
Tell us about your role as medical director of psychosocial services at Perlmutter Cancer Center.
My aim is to help mitigate the symptoms that every patient who walks through the front door of Perlmutter Cancer Center experiences: anxiety, depression, demoralization, insomnia, hot flashes, nausea, and lack of appetite.
For patients who can benefit from different psychotherapies, such as cognitive behavioral therapy to learn skills or ongoing supportive psychotherapy to help them process the experience they are going through, I work with social workers to find appropriate referrals.
In addition to patients, I sometimes see families. Family members often accompany their loved ones in the infusion suites, so I meet them there. I occasionally suggest that a patient and their spouse or partner speak with me specifically about helping them to communicate openly with each other without hiding their feelings in an effort to protect each other. This is very common. Also, younger patients frequently have questions about how to talk to their children about their diagnosis and treatment; this is part of the territory we discuss as well.
Why is your work important for patients who are treated at Perlmutter Cancer Center?
Whatever one’s age, the diagnosis of cancer or its recurrence raises profound personal and identity issues. It’s a confusing and distressing time with the frequent “why me?” question. But it’s also a moment when patients can consider what’s most important to them. My explicit goal is to help patients with symptom management, but my implicit goal is to help my patients feel like they can live with cancer, rather than having cancer be front and center relentlessly.
I like to help patients contemplate what the next chapter in their life could look like. If it’s the last chapter, for people who are in the end stages of the disease, I help them identify their goals for whatever time remains and try to help them to live the best that they can.
In my view, and from what I hear from patients and colleagues at other medical centers, Perlmutter Cancer Center is singularly devoted to the provision of, and easy access to, a full menu of services, including integrative health, nutritional health, and financial and legal consultation. Leadership is invested in it, and I believe it makes a huge difference for our patients and their families.
You have practiced at Perlmutter Cancer Center since 2015. What changes have you seen in treatments, and how have those changes affected your work with patients?
In the time since I’ve arrived at Perlmutter Cancer Center, there have been enormous strides in treatment and outcomes. Stage IV lung cancer, for instance, had a six-month prognosis when I first started here. Now many of these patients are living far longer than that with immunotherapy. I just saw a patient in my office who had breast cancer that was originally diagnosed 12 years ago; last year she was found to have a recurrence with metastatic disease in her bones, lungs, and liver. Understandably, that was extraordinarily terrifying for my patient. But now, after treatment, the patient is thriving, with no evidence of disease. I initially put her on medication to help improve her mood, relieve her anxiety, help with her sleep, and stimulate her appetite. Now she’s gotten back to her life and is exercising, seeing friends and family, cooking, and planning ahead. The specter of recurrence is always there for patients with metastatic disease, but science is marching steadily ahead.
As patients are surviving longer, I am able to have continuity with them over time, which is very gratifying because I get to know them, and sometimes their families, pretty well. Likewise, it is so satisfying when a former patient, at the cancer center for routine follow-up and now with a full head of hair and glowing skin, stops by my office to say hello. Working in an outpatient setting with people who have cancer is a luxury. People come here and they feel well taken care of by the whole team.
For a long time, there’s been a stigma surrounding mental health problems or the need for mental health services. How do patients react to the services you provide?
That’s a very good question. There certainly are times when the social workers suggest to a patient that they could benefit from psychiatry. For those who have never been to a psychiatrist, or who view it as a sign of weakness, or who feel that they should be able to just pull themselves “up by the bootstraps,” it is a challenge to get them to see me, and they will occasionally decline our services. The social workers, however, do a good job of suggesting that there is little downside by meeting with me and hearing my recommendations.
When I do have an opportunity to see these stoic patients, I might joke with them a little and say: “Look, for anybody who walks through the front door of the cancer center and doesn’t feel anxiety or distress, I would want to see if they have a pulse and a beating heart.” I try to normalize these symptoms as something that anybody in their position would experience, and to de-stigmatize it. Once I explain how I have helped others, these patients are often more willing to accept my recommendations for medication and might be even more willing to reveal their feelings.