Jimmie Holland, central founder of psycho-oncology

ABSTRACT: She wondered why no one asked the patients about how they felt

Jimmie C. Holland, MD, widely recognized as the founder of “psychooncology,” grew up in a rural part of Texas with fertile black soil, known as the Blackland Bible Belt. It was a time when cotton was king and little girls were named Bobbi and Jimmie. Back then, the gender line was clearly demarcated; girls became teachers and nurses and homemakers. Interested in medicine as a youngster, Jimmie thought about nursing, but decided instead to buck the old-boy tradition and become a doctor. Her family and teachers supported her dream, and she never looked back.

“I connected with our old family doctor. Although he clearly didn’t have all the resources, he took care of everyone and was an important part of all of our lives,” Dr. Holland told Oncology News International during a recent visit to her office at Memorial Sloan-Kettering Cancer Center in New York, where she served for many years as chair of the department of Psychiatry and Behavioral Sciences. She currently holds the Wayne E. Chapman Chair in Psychiatric Oncology.

“Here I was, a country girl wanting to become a doctor. I had ‘country’ and ‘girl’ against me. I don’t know which came first,” Dr. Holland said. During her high school years, she said, the countryside was desolate. WWII was raging, and all able-boded adults had gone overseas or to work in defense plants in the cities. “There were very few teachers around, but we survived,” she said.

Finding her way
While attending Baylor University in Waco, Tex., the war ended. By the time Jimmie Holland entered Baylor Medical School in Houston, the college was fi lled with older men, veterans returning from the war. “When I started medical school, I was one of only 3 women accepted into a class of more than 90 men. I did well, loved the experience,” she said.

After medical school, she said she expected to return to her little country town and practice pediatrics or general medicine. However, during her internship at St. Louis City Hospital, Dr. Holland’s career path In collaboration with Bristol-Myers Squibb Download and share this informative new podcast with your patients Addressing an Unmet Need for Patients With Advanced Breast Cancer veered from home-town doctoring. “It was the old days, and interns rotated monthly. I went from emergency medicine to surgery to OB-GYN. When I began the rotation in psychiatry, I immediately found it fascinating,” she said.

Dr. Holland’s interest in psychiatry bloomed during her residency training at Malcolm Bliss Psychiatric Hospital and Washington University in St. Louis, reaching career-shaping velocity toward the end of her residency at Boston’s Massachusetts General Hospital.

Boston was in the grip of a devastating polio epidemic. “A whole ward was cleared out and set up with row aft er row of iron lungs. People were healthy one day, then paralyzed from the neck down the next,” Dr. Holland said. This direct human drama sparked an interest in finding out how people cope with such a catastrophic illness.

But how do patients feel?
Shortly after her residency, Dr. Holland moved to Buffalo, New York, where she married James Holland, MD, who was chair of medicine at Roswell Park Memorial Institute.

“We had small children so my career was at a standstill for a few years. But I listened to my husband talk about his work with patients on the CALGB, and I used to say to him, ‘you guys do a battery of tests, but you never find out how the patients feel about what you’re doing to them.’ He told me they didn’t have time for that; they were too busy trying to save their lives,” Dr. Holland said.

Determined to gauge cancer patients’ quality of life, Dr. Holland succeeded in launching a psychosocial committee within the CALGB; her husband was the trial group’s chair at the time. She refers to using his pull within the CALGB as a form of benign nepotism. “I told Jim, if you’re really going to deliver multidisciplinary care, then you need to include psychiatric services as well. So we began the first quality-of-life studies ever conducted. That was over 25 years ago,” she said.

Dr. Holland stressed that when she began her work, the idea of patients’ self-report of subjective symptoms was not considered reliable or valid. “Cancer was still deep in the closet. There was a well-known woman who had a radical mastectomy, and she wanted to publicize her story in the New York Times, but the editor wouldn’t print the words breast and cancer. The editor suggested the story might be published if breast cancer were referred to as disease of the chest wall!” Dr. Holland said. She said it was during the social upheaval of the Vietnam War that the “illogical prudishness” that had stifled cancer dialogue started to dissipate. “We began developing scales to measure a patient’s level of emotional distress. By today’s standards, our methods were primitive. But we were starting a new field, and it was very exciting,” she said.

Psycho-oncology is born
After her children “got a little bigger,” the Hollands moved to New York City. It was there, in 1977, with just two fellows, that Dr. Holland started the Psychiatric Service at Memorial Sloan-Kettering Cancer Center. “What an opportunity it was, I could finally do my thing!” she said.

Dr. Holland’s fledging Psychiatry Service was housed in the department of neurology: a small room with a card table and some 3 × 5 index cards on which they gathered patient data. “Our work began to show, for instance, that psychotropic drugs eased cancer-associated depression. Before that, depression was viewed as an inevitable part of having cancer,” she said.

Over the years, Dr. Holland conducted some of the first epidemiologic studies of the psychological impact of cancer on patients and their families. Her work was largely responsible for putting psychosocial research on the agenda of the American Cancer Society in the early 1980s. Th e Society awarded her its Medal of Honor in 1993. She is also the founding president of the International Psycho-oncology Society (IPOS) and the American Society of Psychosocial Oncology (APOS).

A collective loud voice
“We’ve come a long way,” Dr. Holland said. “In 1996, the Psychiatry Service at Memorial achieved departmental status. It was then that our collective loud voice began to shape psychiatric services. We conducted randomized controlled studies that proved interventions do work. We now have more than 100 people working here.”

But making an attitudinal shift on a national level required attention from policy makers in Washington, DC. Dr. Holland pointed out that the opportunity finally came in 2005 by way of a $1 million grant to the Institute of Medicine to study the barriers to psychosocial care in cancer patients. Dr. Holland served on the study’s board.

The IOM committee concluded that “attending to psychosocial needs should be an integral part of quality cancer care. All components of the healthcare system that are involved in cancer care should explicitly incorporate attention to psychosocial needs into their policies, practices, and standards addressing clinical health care. These policies, practices, and standards should be aimed at ensuring the provision of psychosocial health services to all patients who need them.” “The IOM report, which came out in 2007, stated that providing appropriate psychosocial services to all cancer patients and their families should become a new standard of quality cancer care. Now that’s powerful stuff ,” she said, picking up the book based on the IOM report she helped author, Cancer Care for the Whole Patient.

Dr. Holland’s journey from small-town Texas to Memorial Sloan-Kettering is best described by an overused but, in her case, eminently appropriate word: pioneer. A box of tissues sits on a table in her office. It’s a small but poignant reminder that cancer patients suffering from emotional trauma sometimes need to cry. Jimmie Holland knew that 30 years ago, when she first began to look for ways to help patients cope with the psychological burden of cancer.