The day that Deborah Przekop was diagnosed with non-Hodgkin’s lymphoma in 2010, her head started spinning. It didn’t stop until she met Dr. Jesse Fann, a psychiatrist at Seattle Cancer Care Alliance (SCCA).
Przekop had heard her oncologist tell her that she had stage 4 cancer for which there was no cure. She doesn’t recall much after that but her daughter tells her she asked two questions:
“Do I have five years left?”
“Probably, with treatment,” her oncologist said.
“Do I have 10??
“Possibly,” he said.
Przekop was 68 and she saw her life contract before her eyes.
She knew she needed help processing next steps, so she made an appointment with Dr. Fann, medical director of psychosocial oncology at SCCA. “From the first five minutes in his office, he calmed me down,” says Przekop, who has been in remission since 2013 after three years of chemotherapy. “He wouldn’t tell me what to do, but he would make suggestions and give me options to consider. It broadened my perspective about being sick and going through chemo all those years.”
Dr. Fann, named one of Seattle Magazine’s Top Doctors in its 19th annual list, has spent more than two decades acknowledging that cancers attack not just a person’s body but that person’s psychological, social and spiritual bedrock. He is one of 56 SCCA physicians on the Top Doctors list, which will be posted online April 15.
A cancer diagnosis is typically accompanied by an overwhelming amount of information — type of cancer, how much it’s progressed, options for treatment. The focus of both doctors and patients is often on deciding the best way to attack the cancer and less on the emotional toll that cancer can take.
But Dr. Fann knows that this disease has both physical and emotional components. “There is still stigma, and some people unfortunately think it’s a sign of weakness if they feel depressed or they’re not being positive enough,” he says. “Addressing emotional needs is an important part of getting through cancer care. Our services are no different than any other service here. They're designed to help people get through their cancer diagnosis and treatment as smoothly as possible so they can get back to doing the things they want to be doing."
Helping people through difficult times
When he was in medical school, Dr. Fann chose to become a psychiatrist, attracted by the opportunity to get to know his patients in depth and by the immense scientific potential in the field. He decided to focus on oncology because he wanted to work in a medical setting, unlike many psychiatrists who choose the specialty in part because they are not interested in or comfortable treating physically ill patients. “To be able to help people going through such a difficult time in their lives was something I found extremely gratifying,” he says.
Fann, who has been named a “Top Doctor” six times by Seattle Magazine, says that up to a third of patients experience significant depression or anxiety during the course of cancer treatment.
The Integrated Psychosocial Oncology Program at SCCA (IPOP) is unique among cancer centers in its goal to incorporate psychosocial care into routine cancer care. While other cancer centers also acknowledge the importance of psychosocial care, they typically refer patients to outside providers. The IPOP program has been so successful that the American Psychosocial Oncology Society has asked Dr. Fann to develop training to help other cancer centers implement a similar program.
“One challenge and barrier to people receiving psychosocial care is that it tends to be fragmented and separate from other aspects of oncology care,” says Dr. Fann.
At SCCA, IPOP represents a team-based, collaborative care approach that includes social workers who can help deliver and coordinate care and are key members of each clinic’s oncology team, as well as specially trained psychiatrists and psychologists, all of whom provide treatment on site at SCCA to make accessing psychosocial care convenient for patients who are visiting the clinic for treatment.
All SCCA patients — not just those who are referred by their oncologists or those who self-refer — are screened for signs and symptoms of distress early on in their care at SCCA and are followed throughout treatment to ensure that their needs are adequately addressed, though counseling, medications or a combination of both. This helps the psychosocial oncology team identify patients who may need support but may not have sought it out. “Usually it’s the squeaky wheel that gets the grease,” says Dr. Fann. “It’s often people suffering in silence who don’t get enough attention.”
The screening questionnaire helped identify a need for treatment for one of Dr. Fann’s current patients, who has survived two different cancers. “One of the questions asked if I was suicidal,” says the patient, who requested anonymity. “I tried to answer very honestly because I knew hiding something was not good for me. My response was yes.”
Dr. Fann helped the patient understand that his depression was both common and treatable. Today, the patient feels much better, thanks to Dr. Fann’s treatment and “excellent” bedside manner, enhanced by their shared background. The two swap engineering jokes (apparently, they exist): Dr. Fann has a B.S. in electrical engineering from Stanford University; his patient is a retired engineer.
Another patient, Ron Robbecke, worked with Dr. Fann to trial several different medications to help him sleep and calm his anxiety before landing on the right one. “He was always willing to try something different,” says Robbecke, who began seeing Dr. Fann after his chronic myeloid leukemia diagnosis. Robbecke was in active treatment for 13 years. “I knew I needed help and I was hoping that someone like Dr. Fann would be behind the door. He really changed my life.”
Cultivating an attitude of gratitude and acceptance
Like those patients, Przekop credits her time with Dr. Fann to reshaping her outlook on life. He showed her how to accept that life, in and of itself, is a gamble, a crapshoot, a series of events that often can’t be controlled. “After seeing him for a while, my life was so happy. I would go to chemo and I would be so happy,” says Przekop. "I had never been so happy in my whole life. Is that the craziest thing you’ve ever heard?”
Despite her sunny outlook, Przekop realizes that her cancer is likely to return. “Since they can’t cure me, I am waiting for the other shoe to drop. I never know if this blood test will show it’s back or that scan will show something,” she says. "Dr. Fann helped me accept that life can change in an instant, on a dime, and it does all the time. He helped me make it a part of my life to accept change and to appreciate what I have. It’s not what happens in your life; it’s how you cope with it."
Przekop found her time with Dr. Fann so helpful that she keeps in touch with him even after her treatment has ended. “He became part of my life and who I was,” she says. Although oncology is traditionally associated with treating physical disease, Przekop thinks that addressing mental and emotional health is even more important. “It’s so valuable because whether you’re going to live or die, you have to be emotionally able to cope with that.”
That sentiment reinforces for Dr. Fann why he chose psychosocial oncology as a specialty. “A lot of people ask me if it’s depressing to work in the cancer field,” he says. "I don’t find it depressing at all. I find it really inspirational to see how strong and courageous people can be in the face of adversity. Sometimes they just need a little help along the way."