Seeing Both Sides of Cancer: Talking with Sandra Horning, MD

A renowned cancer leader, oncologist, and researcher talks about suddenly seeing cancer from the other side-as a cancer survivor. 

Editor's Note: This article first appeared in the Winter 2006 issue of the Caring4Cancer magazine.

Dr. Sandra J. Horning has been confronting the challenges of cancer most of her personal and professional life. While a young medical student, she lost her father to the disease, and around the same time grappled with the death from lymphoma of a 16-year-old patient.

Dr. Horning says that "it was the combination of being really mad at cancer and intrigued from a purely medical point of view by a disease so complex, so truly challenging," that led her to focus her talents as a physician and researcher on the quest for a cure and on a crusade to improve the quality of patients' lives. She has never lost sight of that combined mission.

Today, after almost three decades in the field, Dr. Horning is a world-renowned oncologist practicing at the Stanford Comprehensive Cancer Center, a professor of medicine at Stanford University School of Medicine, and a leading expert in lymphoma research. The recent past president of the American Society of Clinical Oncology (ASCO), the largest professional organization of oncology practitioners, she is a highly regarded leader in the oncology community. She is also recognized as an exceptional practitioner, and her name has appeared on several "Best Doctors in America" rosters, including Better Homes and Gardens' annual list.

Dr. Horning also knows the other side of the physician-patient relationship. Ten years ago she was diagnosed with breast cancer. Today, at age 57, she is healthy and cancer-free.

Her experience of what she calls "the Full Monty of cancer"--as a survivor of the disease, caregiver to a family member with it, and as an oncologist and cancer researcher--has, she says, made her even more sensitive to the issues that patients and their families confront. 

When Dr. Horning Got Her Diagnosis

In a recent interview during a break at a conference for oncologists in New York, Dr. Horning recalled the "emotional roller coaster" she experienced when she was first diagnosed, and talked about how she and her family got through those early days as well as the months of treatment that followed. 

It took Dr. Horning about 6 months after she initially started having symptoms to get her cancer diagnosis. She had been experiencing a persistent pain in her breast, but a mammogram didn't show anything abnormal. When the pain persisted, however, she knew she had to listen to her body and get to the source. Ultimately, three doctors missed the diagnosis before she found one who had enough suspicions to take a tissue sample and test it for cancer.  
 
Even though she had dealt with cancer in her immediate family and by that time had many years of experience as an oncologist, Dr. Horning says she found it was "very different to be on the other side," and to suddenly be a cancer patient. 

"When it happens to you, it's like the world stops. The first thing you think about is your mortality. You're scared. You feel very vulnerable." One of her first thoughts was that, with 14- and 12-year-old sons, she had to be strong and survive. 

Dr. Horning asked a lot of questions and she got a second opinion as well before partnering with her doctor to come up with the best treatment plan.

"There's a natural tendency to want to rush ahead and get rid of the cancer as soon as you receive the diagnosis, but I think it's important to take as measured an approach as possible, not to rush into anything. Except in rare, life-threatening situations, there's time for this," Dr. Horning says.

"Just as you would if you were purchasing a service, you want to know the cost and whether there are alternatives. Really what you're asking is, 'What's the cost to me?'" Dr. Horning believes there is a core set of questions every newly diagnosed patient should ask. (Read Dr. Horning's "Questions Every Newly Diagnosed Patient Should Ask.")   

Fortunately for Dr. Horning, the prognosis for her particular type of cancer was very good. She checked herself into the hospital and had breast surgery. She spent a couple of weeks recovering, and then began chemotherapy. 

Her Decision to Continue Working

Many people going through cancer treatment have to decide whether going back to work is appropriate for them. Dr. Horning says that having a strong support system, including a "great husband," and living within close proximity of her job, made it possible for her to return to work. She stresses though that returning to work isn't for everybody. "You really need to consider your own special circumstances."  

Dr. Horning worked during her 6 months of chemotherapy treatment. She recalls that there were some days when she was so tired she couldn't keep her head up and had to shut her office door and take a rest. "I learned how important it is to respect how you're feeling, and to talk with your doctor about what you're experiencing and get supportive care." 

The first days back at work were awkward, she recalls, but mostly she found that her colleagues and patients were tremendously supportive. Rather than hide her illness, she decided to "have fun with it." A blond before she lost her hair, she bought a red wig with long hair. "It was really funny how some people reacted. I'd have to say that a good sense of humor goes a long way." There were still self-esteem issues she had to work through. "Cancer is like being stamped, you know, stamped as a person who is not healthy, and you can feel very self-conscious."  

How She Talked with Her Children

"My husband and I made a point of explaining to our children what was going on.   One of them was actually away at camp when all of this was happening--my diagnosis and surgery, that is--so that was a little bit hard. But both of our sons were very mature about the whole thing, and we encouraged them to ask questions." 

One thing that helped her children, Dr. Horning believes, was that she and her husband laid out a plan: "I think they needed to know or wanted to know, as do most children, how things would be at home, that there was a plan. I think it also helped that my prognosis was good. We were able to share that with them. Obviously, we were very fortunate in that regard. In homes where the situation is more challenging, parents really need to reach out for help. There are many excellent resources available."

Her Life as an Oncologist and Cancer Survivor Now

Dr. Horning's presidency of ASCO last year coincided with her 10th year anniversary as a cancer survivor. (ASCO presidents' terms are limited to 1 year.)  She doesn't regard the two events as wholly coincidental. In preparing her ASCO presidential address, she had an opportunity to stop and take stock of many things. "It was really in some ways almost an epiphany to see the gains we've made not only in survival rates but also in the quality of life of patients who survive cancer. It was such a reward, though we have a long way to go still, of course." 

Dr. Horning's chief focus as ASCO's president, she says, was to steer the 42-year-old society more in the direction of increased support for cancer research-research not only to improve cure rates but research aimed at improving the quality of life during and after treatment. Another priority of hers was a major ASCO initiative to improve follow-up and ongoing care for cancer survivors by training oncologists to write "survivorship prescriptions" for their patients--a critical component of the overall care package, she and other leaders in the field believe.

Dr. Horning recalls that there was once a time when she wondered if there would ever come a day when she would wake up and not ask herself, "Am I going to die of cancer?" She says it took awhile but, thankfully, that day did come.