“I can just flush It all out.”

“no one Is judgIng you. no one wIll ostracIze you.”

“I dIdn’t know where to go or who to talk to.”

“I have a $4,000-a-month pIll that I have to buy.”

“my prIorItIes have changed.”

“frIends and famIly don’t understand.”

are tImes when desperatIon takes“people are afraId to be around you because they don’t know what to say.”

“I’m not afraId to dIe.”

“I understand what you’re sayIng. I completely know where you’re at.”

DECIDED TO

“wow, thIs Is hopeful.”“I wonder what I would do If I were all by myself.” “she’s not afraId of her cancer returnIng, but I am.”

“I haven’t been fearful. I haven’t been angry.”

“can cancer

“all of my lIfe I’ve been able to solve problems. thIs one I can’t.”

“there Is a good way to dIe.”

Iris holliday figured she’d go to this support group just

to listen. maybe she’d gain some practical tips, then go

home and resume her private and isolating battle with

a rare and advanced cancer. yet when it came time to

introduce herself, months of pent-up feelings rose to the

surface. holliday began to talk.

like holliday, many members of this tuesday morning

support group at providence cancer center have metastatic

cancer, a stage of the disease in which cures are harder to

come by and support is all the more valuable.

with the help of facilitators katie hartnett, m.ed., l.p.c., and

a’lee wardwell, l.c.s.w., the members meet for two hours,

confiding the fears they’ve withheld from loved ones, venting

about friends who offer medical advice, and talking about

the muddled confusion of “chemo brain,” as a dozen heads

nod in agreement. It’s a group where jokes are swapped,

tears are shed and unlikely bonds are forged. In short, it’s

a place for healing as profound as any clinical treatment. > > >

by shirleen holtphotos by pete stone

cancer support groups give comfort, relief, and their own special kind of healing.

talk therapy

The singer: Iris Holliday

www.providence.org/together4 | PROVIDENCE TOGETHER

“ThaT was scary. ThaT was very scary.” “I spend a lot of tIme by myself, whIch Is oK.”

“people understand when you say chemo brain.”

“you get to say how you feel – how you really feel.”

“I want to be cancer-free. that’s my goal. that’s my prayer.”

www.providence.org/together PROVIDENCE TOGETHER | 5

www.providence.org/together6 | PROVIDENCE TOGETHER

“It’s a supportIve group. we hug each other.”“I can just flush It all out.”

“both the guys and the gals can cry very easIly.”

“I don’t want any pIty.” “death Isn’t the endIng, but the begInnIng.”

“we had an ImmedIate connectIon.”

“How you really feel”Four years ago, the supports of Holliday’s life gave way. A

singer whose voice could reach to the church rafters, she was rehearsing for a musical when she started having trouble swallowing and catching her breath.

“I was home when the doctor called,” recalls Holliday, who held a full-time job with Seattle’s Human Services Department. “She said, ‘I’m so sorry to tell you this, but you have a large tumor in the middle of your chest.’ ”

Holliday was diagnosed with thymoma, a rare cancer of the thymus gland that already had spread. Surgeons removed the grapefruit-sized tumor and parts of her left lung, diaphragm and pericardium sac that surrounds her heart.

She uprooted her life in Seattle, reluctantly quit her job, broke off with her fiancé and moved to Portland to be near her family. Although Holliday had overcome early-stage breast cancer several years earlier, the severity of this advanced cancer thrust her into an unfamiliar role. She’d always been the one to lift other people’s spirits, to comfort those who were vulnerable. And still when friends asked how she was doing, she gave her usual answer: “I’m OK.”

“I don’t always disclose how I’m really feeling,” she says softly. “I don’t want pity. And it does start a spiral of questions: ‘When’s your next treatment?’ ‘What’s going on?’ If I answer every one, I start sounding like a broken record. And I purposely don’t share a lot of my emotional stuff with my mother because I don’t want her to worry.”

Instead, she saves her confidences for Tuesday mornings and the group.

“You can say how you feel,” she says. “How you really feel.”

Healing tHe wHole personCancer support groups are hardly new; they date back to

the 1940s, when the American Cancer Society wanted to help patients stigmatized by disabling or disfiguring treatments, such as laryngectomy or mastectomy.

These groups, where patients could talk with others in similar circumstances, came to represent a new term in medicine: psychosocial care. The principle, now widely accepted, is that treating patients’ emotional and psychological condition is every bit as important as treating their disease, in part because patients in healthy emotional states are more likely to follow their treatment plans.

Despite this, doctors and hospitals have been slow to put understanding into practice. As recently as 2007, the Institute of Medicine reported that care providers weren’t referring patients to support groups or other social services designed to help them cope with the nonclinical aspects of their cancer. Likewise, a third of oncologists surveyed by the American Society of Clinical Oncology said they didn’t routinely screen their patients for emotional distress.

In helping patients’ emotional and psychological needs, however, Providence Health & Services has been far ahead of the curve. Its first support group – one for bereavement – began in 1982, followed the next year with a breast cancer support group. Since then, groups have blossomed and now cover a variety of niches. Providence hosts groups for prostate, breast and colon cancer; groups for men, women and families; groups for knitters, readers and writers. They’re all provided free of charge, supported entirely through donor contributions to Providence foundations.

“Healing occurs on many levels; it’s not only about the physical level,” says Diane Harris, M.S.W., L.C.S.W., regional clinical supervisor for Providence Cancer Support Services. “It’s the psychological, emotional, spiritual, social. We want patients to get the medical care from their physicians and western medicine, but someone has to address the psychosocial needs, and that’s what we do.”

tHe art and science of HealingResearchers have tried to quantify the medical benefits of

psychosocial care, but one answer remains tantalizingly out of reach: If support groups help improve the quality of life, can they help cancer patients actually live longer?

Experts have been divided on the subject since the 1980s, when Stanford University psychiatrist David Spiegel, M.D., released results of a study that rocked the medical establishment. Dr. Spiegel, a self-described skeptic at the time, set out to measure the effects of intensive group therapy on women with metastatic breast cancer. To his surprise, he found that the women who participated in a group survived on average 18 months longer than those who didn’t.

A later study of people with malignant melanoma, conducted by the University of California, Los Angeles, seemed to confirm theories about the power of support. It found that the death rate among patients involved with support groups was 60 percent lower than for those treated with standard medical care alone. > > >

“SHE’S A GOOD FRIEND, BUT SHE WANTS TO FIX ME.”

“I dIdn’t know where to go or who to talk to.”

“I WAS TRYING TO FIND A PLACE WHERE I COULD FIT IN.”

“I went to the mall on my own.”

www.providence.org/together PROVIDENCE TOGETHER | 7

The newlyweds: Jean and John Ingram

jean Ingram has one of the sturdiest supports a cancer patient could ask for: her husband, john. he drives her to her appointments at providence portland medical center from

their home in sandy. he built her a garden room so she could watch the birds without exposure to harmful sunlight. and when she was weak from chemotherapy and struggling to get into the bathtub, he built a custom tub that she could step into.

but even with their strong bond, the couple needed help to fight the financial, physical and mental strain of jean’s advanced lung cancer. they joined the tuesday morning group.

“the minute we walked in the door, they knew where we were coming from,” john says.

the couple met more than three years ago, when jean was 69 and living in montana. she came across john’s profile on match.com. he was 66, a widower, and living in oregon.

“something just drew me,” she says. e-mails progressed to phone calls, then to john flying to billings for their first coffee date. jean, a nurse’s assistant, was taken by his kindness. john, a retired profitability analyst, was impressed by her stable practicality.

“we realized we didn’t have 10 years for courting,” he says. “that’s not even sensible.” so three weeks after they met, john proposed.

shortly before their wedding, a routine ct scan revealed that jean’s lung cancer, which had been in remission, had returned, and this time it was inoperable.

“I said to john before we got married, ‘you don’t have to do this,’ ” jean recalls. “ ‘I can’t guarantee a year.’ ”

“when I asked you to marry me,” john responded, “I meant for life.”

the couple wed oct. 7, 2007, on the columbia gorge sternwheeler, with jean’s wheelchair nearby in case she needed to sit during the ceremony.

friends offer advice on nutrition, vitamins and miracle cures. they also instruct jean to think positively – a common bit of wisdom, but one that chafes with repetition.

the friends are well meaning, jean says, but they don’t understand. so the couple looks forward to tuesdays. at the support group they learn about a special heated blanket that’s just the size of a chair; about where one doctor’s role ends and another’s begins; and how to find financial help for drugs that cost more than $4,000 a month.

then there are the deeper matters – the kind that rarely come up in daily conversation but rise to the surface on tuesday mornings. one member worried out loud that her cancer might be too much for her partner to bear.

“that has helped me understand that this could be an underlying thought,” john says. so he reassures jean in gestures small and large. “we are in this together.”

fIrst love,then cancer

“we are In thIs together.”

www.providence.org/together8 | PROVIDENCE TOGETHER

“hEalIng OCCurs On many lEvEls; IT’s nOT Only

abOuT ThE physICal lEvEl.”“medIcIne Is an art and a scIence.”

– Eric Bernstein, M.D., Providence Cancer Center

Yet for every study showing that psychosocial therapy can prolong life for cancer patients, another comes along to negate the idea. This includes a subsequent study by Dr. Spiegel himself, which found that survival rates were the same regardless of whether the members attended group therapy.

For now, health care professionals rely on what is scientifically known: support can help lift depression, a crippling side effect that saps motivation, deepens isolation and increases stress. Depression is known to release stress hormones such as cortisol and adrenaline that over time can harm the immune system and even worsen cancers.

One study linked lowered stress and anxiety with improved immune system markers among patients with melanoma. That study, conducted by UCLA, also found that patients involved with support groups were less depressed, fatigued and confused than those who didn’t receive support therapy.

Without direct evidence that emotional and psychological well-being can slow the spread of cancer, however, physicians are cautious not to make scientific claims to their patients.

“Medicine is an art and a science,” says Eric Bernstein, M.D., an oncologist with Providence Cancer Center. He advocates “whole patient” care, tailoring his treatment plans to each patient’s physical, mental and emotional well-being. “I think mind/body medicine is incredibly important, but that’s the art.”

counselor becomes patientKatie Hartnett, co-leader of the Tuesday morning group,

considers herself a statistical outlier, but her story is a symbol of hope for anyone with metastatic cancer. In 1999, she had been helping cancer patients for 25 years when back pain sent her to the doctor.

Tests led to a devastating diagnosis: inoperable stage IV metastatic cancer. She had a football-size tumor on her spine and others on her ribs and in her lungs. Doctors couldn’t find the cancer’s origin, but the type was so aggressive they feared she wouldn’t survive six months.

Suddenly, Hartnett was going through the same experiences she’d helped others through: enduring chemotherapy and radiation; coping with the pain, fatigue, fear, loss, isolation,

grief; and adjusting to a new identity that she worried could overwhelm her – cancer patient.

Just as support group members had drawn strength and support from each other, Hartnett found herself drawing from her clients, past and present.

“I knew if they could do it, I could do it,” she says. “I knew that if I could still be Katie during my worst days, then I would be bigger than the cancer.”

Then something unusual happened. After her treatment ended, tests showed that her cancer had stopped growing. There was no evidence of further disease, and there hasn’t been any for 10 years.

Hartnett doesn’t know why she overcame the medical odds, and she doesn’t speculate.

“I think it was grace and great medical care,” she says. “I didn’t want to live more badly than anybody else. My physicians did exactly the same thing for me as they do for their other patients. I didn’t do one thing that made me deserve to be here more than anyone else.”

“tHat’s my prayer”After a brief remission, Iris Holliday’s thymoma returned in

full force. Inoperable tumors are growing in her lungs and heart, leaving her to battle the disease with chemotherapy, radiation, and with emotional support from her family, her church and her fellow cancer survivors.

For awhile she was still able to make it to the Tuesday morning meetings. “The group is definitely part of the healing process,” she said on a rainy afternoon in November 2009. “It’s very safe, even when your news for the day is not so great.”

But by the spring of 2010, Holliday had grown too weak to travel back and forth to the weekly support group. A couple from her church invited her to live in their home in Camas, Wash., where she waits to learn if intensive radiation treatments have shrunk a tumor threatening her heart.

Her friends from the support group now send well wishes through Hartnett and Wardwell, and they can follow her progress through a blog she started to chronicle her journey.

“I want to be cancer-free,” she says. “That’s my goal. That’s my prayer.” n

The facilitators: A’lee Wardwell, L.C.S.W. (left), and Katie Hartnett, M.Ed., L.P.C.

www.providence.org/together PROVIDENCE TOGETHER | 9