I’ve learned a lot about medicine over the years, but one thing I wasn’t taught was how to guide someone through the existential weight of dying. My education centered on diagnosing, curing, or at least managing disease—not on the delicate art of helping people and their loved ones cope with what cannot be cured. Now, several years into my career as an oncologist, primarily caring for older adults, I recognize that providing cancer care for the whole patient requires deep attention to their psychosocial health needs.1
Dame Cicely Saunders, the founder of modern palliative care, once said: “You matter because you are you, and you matter to the last moment of your life.” Her words form the backbone of compassionate, dignified care—a reminder that for patients who may feel helpless or burdensome, we must affirm their worth, not just for who they are but for all they were and will continue to be in the lives of those they leave behind.2 It’s a philosophy lost in health-care delivery, especially for older patients such as John, an 80-year-old man with advanced, incurable cancer who reminded me what it means to truly care.
Ramy Sedhom, MD
Spiritual Dimensions of Illness
Each visit with John revealed his deep fear—not of dying but of leaving his wife, Nora, after nearly 60 years together. His pain wasn’t physical; it presented as the quiet heartbreak of anticipatory grief. Together, he and Nora had raised two children, seen eight grandchildren grow, and found comfort in the rhythms of daily life. He was grappling with something that medicine alone could not address.
Like many older adults, John held his worries close, not wanting to burden his family. It would be easy to see this stoicism as resilience, a quality often attributed to those who have lived long lives. But this would overlook the depth of his suffering. When we assume older adults are somehow “ready” for death, we fail to recognize the very real spiritual and emotional toll of dying.
For John, his supportive care needs went beyond symptom control; he struggled to find a sense of meaning and hoped to preserve his dignity while undergoing chemotherapy for metastatic pancreatic cancer. However, with its relentless focus on productivity and revenue, our health-care system seldom prioritizes this type of care. The spiritual dimensions of illness—the questions of meaning, connection, and transcendence that so often emerge with terminal illness—are too frequently overshadowed by the quantifiable.3 Our current system values treatments, procedures, and short visits over the more complex human needs at the heart of compassionate care.
Focusing on Empathy Not Spreadsheets
Psycho-oncology, the field that could help patients such as John navigate these moments, is often marginalized, financially undervalued, and accessible through only intermittent funding or the rare visionary who understands that supporting patients emotionally and spiritually is as essential as treating their bodies.4 Administrators who rarely see patients and do not fully grasp the depth of their suffering are increasingly making decisions about the allocation of resources, the investment in supportive care teams, and the presence of staff who could support patients like John through this phase of their lives. These decisions are driven by spreadsheets, not by empathy, and such intensive care is rarely provided.5
For John, the role of psycho-oncology and spiritual care was more important than the chemotherapy he received. Gemcitabine and nab-paclitaxel were readily available, yet psychosocial oncology teams are rare to find in a community setting. Chemotherapy itself would not help him cope with his cancer nor find meaning and peace. Over time, with the support of our psychosocial care team, John and Nora were able to discuss their fears and plan for the reality of when she would be navigating life without him.
This approach to care recognizes what Daniel Sulmasy, MD, PhD, has described as the spiritual dimensions of illness, which concern not only our physical selves but our souls—our sense of meaning, dignity, and relationship with those we hold dear. They are the dimensions of the human spirit and cannot be measured but can profoundly affect a person’s well-being. Whether one is religious or spiritual, it is not difficult to appreciate the value in what Dr. Sulmasy calls the “soulfulness” of all patients’ experience6—their hopes, fears, and connections to others.
This approach faces profound challenges in an increasingly business-oriented health-care system. Health-care administration is trending toward efficiency and financial benchmarks, often at the expense of the spiritual and relational aspects of care. Physicians are asked to manage patients with advanced cancers in 20-minute slots, listen, diagnose, and provide comfort. But the kind of presence needed to honor a patient’s dignity and meaning is something no billing code can capture, something no metric can measure.7
Although we were fortunate to partner with psychosocial oncology in John’s care, the service exists thanks to philanthropy. Most centers lack such support, making psychosocial expertise inaccessible mainly because of its poor reimbursement. As more of health care becomes directed by those removed from the reality of patient care, we risk losing sight of what makes care compassionate and complete.
Looking Beyond Survival
In the end, we couldn’t change John’s diagnosis, but we could help him shape his last days, honoring the life he had lived and the love he was leaving behind. To support this, we need to transform our care structures—to integrate psycho-oncology, embrace the spiritual dimensions of care, and acknowledge that patients are more than their diagnoses.
If there’s one thing I’ve learned from patients such as John, it’s that aging and cancer are not merely about survival; they’re about dignity, purpose, and the courage to face the inevitable with grace. Recognizing the spiritual dimensions of illness offers us a way to walk with patients through their final days, treating their diseases and helping them find meaning, comfort, and peace. This is the care that matters most for John and so many others like him.
Dr. Sedhom is Medical Director of Oncology and Palliative Care at Penn Medicine, Princeton Health, and Assistant Professor of Clinical Medicine at the University of Pennsylvania.
DISCLOSURE: Dr. Sedhom reported no conflicts of interest.
REFERENCES
1. Holland JC: Distress screening and the integration of psychosocial care into routine oncologic care. J Natl Compr Canc Netw 11(5 suppl):687-689, 2013.
2. Chochinov HM: Intensive caring: Reminding patients they matter. J Clin Oncol 41:2884-2887, 2023.
3. Sedhom R, Bates-Pappas GE, Feldman J, et al: Tumor is not the only target: Ensuring equitable person-centered supportive care in the era of precision medicine. Am Soc Clin Oncol Educ Book 44:e434026, 2024.
4. Holland J, Weiss T: The new standard of quality cancer care: Integrating the psychosocial aspects in routine cancer from diagnosis through survivorship. Cancer J 14:425-428, 2008.
5. Bruera E: Relieving physical and psychosocial pain in patients with cancer: The search for enlightened academic medical leaders. JAMA Oncol 5:1401-1402, 2019.
6. Sulmasy DP: Physicians, spirituality, and compassionate patient care. N Engl J Med 390:1061-1063, 2024.
7. Sedhom R, Kamal AH: Is improving the penetration rate of palliative care the right measure? JCO Oncol Pract 18:e1388-e1391, 2022.
