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When Joan was in last week and told me she had just completed chemotherapy for breast cancer, I assumed congratulations were in order. When I smiled and offered them, she suddenly became forlorn and began to cry. And these were not tears of joy.

I asked Joan to help me understand her feelings, as I was struggling to understand how finishing chemotherapy could be anything other than wonderful. What I heard was as  enlightening as it was surprising.

Joan explained how, over the course of her treatment, she felt nurtured and cared for by her oncology team. Although she was happy to be finished with chemo, she was also grieving a loss: the absence of regular visits with a familiar caring team.

Cancer patients can experience a myriad of emotions during and after treatment, and they may not always be concordant with prognosis or treatment success. In retrospect, I wish I had simply asked my patient, "How do you feel now that you have completed your chemotherapy?"

Jeffrey Millstein

Woodbury Heights, New Jersey