Dr. Provencher

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Dr. Provencher is a surgeon-oncologist at the CHU de Québec-Laval University, a clinical researcher at the Research Center of the CHU de Québec-Laval University, and a clinical professor at the Laval University School of Medicine. Dr. Provencher also participates in several Canadian advisory committees on breast cancer.

Finding Purpose in Medicine
I am a surgeon first, then an oncologist. The surgeon in me likes to solve problems and treat disease. When I was a student, I quickly realized that all diseases are not equal: some are limited in time (called ‘acute’), while others sometimes become chronic diseases. Breast cancer is one of those diseases that is not only difficult for patients, but also for healthcare providers. This cancer requires ongoing personal and professional commitment, forcing us to excel in our knowledge and our attitudes because patients teach us incredible life lessons! Going down this road also means working as a team, an aspect which really attracted me.

Without a doubt, the most satisfying part is contact with patients and their families. Our diagnosis of breast cancer changes the lives of our patients and their loved ones. The examples of resilience and adjustment that they show inspire us. They rouse my admiration. The more we find out about this disease, the humbler we become there is so much to learn, so many aspects! Over my 30 years of practice, treatments have changed a great deal, from mutilating surgeries to smaller surgeries, then to more precise, more targeted treatments, aimed at several subtypes of breast cancer. Even so, sometimes the disease wins and metastases occur.

Relaying a Diagnosis
How do you give a patient a diagnosis of metastatic breast cancer? My automatic answer is that there is no right or wrong way but when I really think about it, there are two distinct situations.

First, there is the patient that we have known since the onset of her disease, who we have encouraged all the way through her treatments which were given as a cure, such as surgery, chemotherapy, and radiation therapy. The contact is already there, established, and then, a few months or a few years later, we have to tell her that the cancer was stronger than our treatments, than our knowledge. It is felt like a failure for the healthcare provider, but we have to get over it to support this patient, not abandon her, do everything for her to feel supported, to encourage her to continue her journey, her battle, and convince her that it is worth it.

On the other hand, there is the new patient, whom we do not know, and who has metastatic cancer as soon as she is diagnosed. It is difficult to find the right way to tell them, giving understandable answers, suited to their knowledge about the disease, often acquired through the scanty information conveyed by television or in newspapers.

Explicit questions are the ones that are the hardest to answer: ‘Am I going to die, doctor?’ Our responsibility as attending physicians is to tell the truth and then qualify it, explain the aspects of treatments, describe the journey ahead which, nowadays, in a great many cases, continues for several years. For the healthcare professional, however, one patient dying of breast cancer is one too many. We all hope that clinical and basic research will help us find the drugs or treatments that will put an end to this condition.

Some patients have impressed me with their fighting spirit and determination, while others have earned my admiration by the care that they took to ensure their loved ones would lack nothing after they are gone, or simply by their love of life. They have all impressed me by their ability to adjust to their situation. When we are healthy, we sometimes say to ourselves: ‘If I had metastatic breast cancer, I would not have that chemotherapy,’ or ‘In that situation, I would not agree to any more treatment.’ The quality of life that a patient consents to during treatment depends on her life goals. I remember one grandmother who wanted to have one more chemotherapy in the hope of seeing her second granddaughter born, or another woman who wanted to go to her son’s wedding. Who am I to judge my patient’s quality of life and what she accepts, when I’m the healthy one? My job is to inform and support her and give her appropriate treatment to the best of my knowledge.

The future of mBC and patient care
It is difficult to separate our professional life from our personal life; it’s a constant challenge. Separating these two sides of ourselves completely is almost impossible. Ours is an exciting profession, full of altruism and emotions. Discussing a patient that I’m worried about with my life partner does me good and helps my spouse understand some of my moods! This then allows me to take full advantage of the present moment, to put the small annoyances of life in perspective. I have learned this from my patients.

Not many people talk about metastatic breast cancer, because it makes them face the precariousness of life, and it worries everyone. Today’s lifestyle focuses on success, performance, attainment of objectives, not failure. Everything is compartmentalized too: a ‘patient’ is in hospital, an elderly person in a nursing home. In short, we only coexist with chronic disease for short periods, and we do not know how to react or what to say. We are afraid to ask how this woman with cancer lives day-to-day, to the point of forgetting that she has a day-to-day life and that, sometimes it is good for her just to talk about it! Sometimes, during an interview with a patient, I think about her journey and realize that it has been eight to ten years since metastases were diagnosed. She tells me about the happy times in those ten years, how happy she is to have had this reprieve… and how she wants to keep going. We carry on, as a team, hoping we have another ten years!
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