Jamie Von Roenn Honored as Palliative Pioneer

Fran Lowry

May 17, 2011

May 17, 2011 — Jamie H. Von Roenn, MD, has been named recipient of the 2011 American Society of Clinical Oncology (ASCO)–American Cancer Society Award and Lecture in recognition of her pioneering work in palliative medicine and her contributions to cancer care and cancer pain management.

The award will be bestowed at the annual ASCO meeting in June.

Dr. Von Roenn is professor of medicine at the Northwestern University Feinberg School of Medicine and codirector of the cancer control program at the Robert H. Lurie Comprehensive Cancer Center in Chicago, Illinois, and has been involved in palliative medicine since the 1980s.

"Very early — before any other academic institution, actually — Northwestern had a hospice program. I started to refer patients. They needed a medical director and they recruited me. That is how I got involved in palliative medicine as part of my oncology work," she told Medscape Medical News.

Dr. Von Roenn chose oncology as her specialty because she figured the science would always remain interesting and intellectually stimulating, and because she recognized the importance of relationships with patients.

"It was both the science and the people. Oncology seemed a very good field to combine those interests, and that has turned out to be true," she said.

Early Interest in Special Ed

Dr. Jamie Von Roenn

Originally, Dr. Von Roenn thought she would go into special education, but a stint as a counselor at a camp for severely disturbed children dissuaded her from that idea.

"I started out in special ed. I had a psychiatrist as a mentor who asked me to work at a camp he ran for severely disturbed children," she said. "The first summer, I ran the swimming program; the second summer, I worked as the head counselor for the camp. These were very disturbed children — kids who were setting trees on fire — and they had a lot of emotional angst."

"It was an 8-week away camp and the kids would actually get better," she added. "But then at about 6 weeks, their families would come to visit and all the children went back to day one."

What became too painfully clear was that their home environment was the source of their pain, Dr. Von Roenn noted, "and they were all going back there. So no matter what we did, we wouldn't have a big enough impact."

She felt as though she was hitting her head against a wall. "So, in talking with this psychiatrist and thinking about other ways in which I might be stimulated and contribute, and fields where relationships with people made a difference, I ended up going into medicine," she recalled. But definitely not psychiatry.

"The idea that medicine had nothing to offer these children was very depressing and disturbing, so I wasn't drawn to psychiatry," she said.

Integration of Care Needed

Instead, she feels that palliative medicine and working to improve the management of cancer pain have given her the chance to make a real difference in the lives of her patients.

However, despite recent advances, she feels that cancer pain is not as well managed as it could be.

"If I had a magic wand, I would sweep it much more broadly, because what I would choose is to really integrate personalized care with aggressive medical care," she said.

Before all the modern advances of medicine — before the advent of penicillin and all the effective treatments for various diseases including cancer — what physicians and healthcare providers did was to provide comfort, she pointed out.

"Personalized care is now this buzzword for targeted therapy, and targeted therapy refers to taking advantage of the molecular characteristics of the tumor to improve therapy and outcomes," Dr. Von Roenn told Medscape Medical News. "In my view, personalized medicine consists of very specific disease-oriented therapies that target molecular findings, combined with care that's focused on the individual's personal agenda. It's that marriage I would make happen again."

"After we learned so much and made so many advances in treating disease, somehow the assumption arose that if you treat the disease you'll provide comfort, but it takes more than that, I think," she continued. "Whether people have curable or incurable disease — cancer or otherwise — there is suffering involved. We could all treat that better — me, everybody. It takes a team; I don't think any of us can do it alone."

Much of her career has focused on integrating palliative medicine into oncology care. "I'd like to see symptom management in palliative care — not as end-of-life care, but as relief of suffering integrated across the trajectory of cancer," she said.

Palliative medicine should be part of oncology training, she added. "Oncologists already do a lot of it, but there is so much more. We also need to build effective healthcare structures to help us with it. I don't think we can reasonably expect oncologists, who are already totally overloaded with work, to do all this themselves. The system needs to have teams so that the psychosocial issues of our patients get addressed on a regular basis."

Condolence Letters

Dr. Von Roenn sees her patients through the continuum of their care. Her practice now is focused on breast cancer and her patients include those with curable disease and those who are dying. She stays involved with them to the end.

"I make house calls on my advanced-disease patients, and no, it's not depressing at all," she said. "I see the spectrum of disease, I don't just see end of life. But even at the end of life, you always have something to offer."

Dr. Von Roenn has not faced burn out, and still loves taking care of her patients. She attributes this to the "feeling that I do everything that I can as a physician, everything that I can as a person, and that's all there is. I walk away without regrets."

"Also, I'm rewarded by whatever differences we make, if not in survival, then in quality of life and support of the family. My patients are grateful for that, and I'm grateful for that. I learn so much from every patient I care for," she added.

Dr. Von Roenn is also a believer in condolence letters and writes them when appropriate.

"I think every doctor should write condolence letters," she explained. "If you've cared for someone from early in their course onward, there's a sense of a bond with that patient and their family, and the loop kind of needs to be closed. The condolence letter helps me close, too."

Remarkable Advocate

"Jaime has been a remarkable advocate for the integration of palliative care into oncology practice," Judith Paice, RN, PhD, a colleague of Dr. Von Roenn who has worked with her for the past 10 years, told Medscape Medical News.

"She truly practices what she teaches, providing extraordinary oncology care while attending to the patient's emotional and social concerns with the greatest empathy," said Dr. Paice.

Dr. Paice, director of the cancer pain program in the division of hematology oncology at Northwestern, noted that writing condolence letters is not something that is generally done by physicians.

"It's one of many examples of Jaime's compassion that she takes the time to send condolence letters or cards to families after the death of a patient," she said. "That's pretty unique to Jamie. Many times nurses on different units might get together as a group project and do that, but for physicians to do it, that's unique."

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