THE PERSONAL SIDE

The preceding several paragraphs are what you will read in every other obituary, memorial tribute, or announcement of the life and death of Jimmie Coker Holland. But this memorial tribute is different, because each and every member of the Editorial Board of Palliative & Supportive Care, every associate editor, and the editor in chief, has had a personal and life altering relationship with this remarkable woman of strength. With the real, flesh and blood and heart of a woman who, with the occasion of her death, has become an icon, a legend, a myth, a historical figure for the ages, a “miracle.” Jimmie was very real to many of us, and our tribute to her is to that very real woman who we loved and who loved us.

I am personally so grateful to Jimmie for 34 years of mentoring: as a fellow, a faculty member, her service chief, and, more recently, the honor of being the incumbent of the Jimmie C. Holland Chair in Psychiatric Oncology. I would refer to Dr. Holland in public as Jimmie, but even as her chair, whenever I sought out solace or private advice, I would always call her “boss.” As with many of us who knew Jimmie and worked alongside her for decades, I truly believed that Jimmie would live forever. That she was invincible. Although many referred to her as the mother of psycho-oncology, Jimmie preferred the title of “the oldest living psycho-oncologist on the planet.” In a recent interview I conducted for IPOS on “Pioneers in Psycho-oncology” (https://www.youtube.com/watch?v=t5UkEAY754M&feature=youtu.be), we joked that given that this was true “we better get this interview done while we had the chance.” And now the unimaginable has happened, and we are here 7 months later, mourning her death, but more importantly celebrating her life; and grateful, so very grateful, for the privilege of the many wonderful years of inspiration, guidance, and support she gave us. On behalf of all of us connected to Palliative & Supportive Care, our deepest condolences go out to James Holland and the entire Holland family. Thank you for sharing Jimmie with us and the world for these past 40 years!

HOW IT ALL STARTED

Jimmie Holland changed the world! She changed the world with an IDEA. The IDEA was that “understanding the experience of the human being with cancer was as important as understanding the biology of the cancer itself.” An IDEA cannot change the world by itself. It has to be communicated effectively and it has to inspire others to take up the idea and create a movement. Jimmie was a great communicator, and soon a group of fellow believers were drawn to MSKCC and to Jimmie, to hear her words, to breathe the same air as her, to join her mission, and make this idea a reality.

Jimmie created the field of psycho-oncology, but she'd be the first to admit that she didn't do it alone. It took a visionary leader, Jerry Posner, to support the establishment at MSKCC of the first psychiatry service in any cancer center anywhere in the world. It took the early fellow pioneers who joined her faculty and training programs at MSKCC (Paul Jacobsen, David Cella, Bill Redd, Jamie Ostroff, Sharon Manne, Alice Kornblith, Kathy Kash, Jennifer Hay, Tim Ahles, David Kissane, Susan Tross, Harvey Chochinov, Andy Roth, Christian Nelson, William Pirl, Matt Loscalzo, Lori Wiener, Jon Levenson, and so many others too numerous to count: more than 50 faculty over the past 40 years and more 400 clinical and research fellows), and international colleagues such as Lea Baider, Maggie Watson, Barry Bultz, Luigi Grassi. Maria Die Trill, Luzia Travado, Uwe Koch, Christopher Johansen, and so many others. And then there was Jimmie's “secret weapon:” James Holland! As James, a cancer pioneer himself, said to me, they were “joined at the heart.”

Dr. Jimmie Holland was born in the small farming community of Nevada, Texas, in 1928. She credits the local family physician in that community with her interest in medicine and caring for those who were suffering. Jimmie was one of only three women in her class at Baylor College of Medicine. In 1956, she married the renowned oncology pioneer James Holland, MD, who was then chief of medicine at Roswell Park in Buffalo, New York. Jimmie recently described her early collaborations with James in the video interview with IPOS. “I started the Special Medical Clinic to provide psychiatric care to cancer patients. They didn't balk at being seen by a psychiatrist because it was, after all, special.” In the early days of collaborative oncology group research, Jimmie would chide James and complain that cancer patients were asked every conceivable question about their physical functioning, but no one ever asked them “how do you feel emotionally?” Jimmie subsequently chaired the Cancer and Leukemia Group B Quality of Life Committee for many years, pioneering the inclusion of psychological and emotional well-being patient-reported outcomes in quality of life measures and as a component of clinical outcomes in clinical trials.

At MSKCC, Dr. Holland conducted groundbreaking clinical research examining the course and treatment of anxiety in cancer patients, examining the relationship of depression to pancreatic cancer and most significant demonstrating the utility of screening for distress in cancer patients. As chair of the National Cancer Center Network Distress Management Guidelines since 1997, Jimmie's advocacy work led to the National Cancer Center Network Distress Screening Guidelines being adopted in all National Cancer Institute–designated cancer centers. “Screening for Distress” became a practice that was a requirement for accreditation of cancer centers by the American College of Surgeons. Psycho-oncology programs became mandatory in all National Cancer Institute–designated cancer centers.

In addition to her pioneering research at MSKCC, Dr. Holland established the largest clinical and research training post-doctoral training fellowship programs for psychiatrists and psychologists in the world. The clinical programs and innovations created at MSKCC during the past 40 years helped establish Jimmie's department as the “Center of Excellence” in psycho-oncology and supportive oncology worldwide.

Jimmie the mentor was “unique.” Jimmie was not the type of mentor who sat down and wrote out that research project with you, or worked out the details of that innovative clinical program with you. Instead, Jimmie was the kind of mentor who taught you that you had the strength and the ability to create your own ideas and to make your passion and mission a reality. She stood as the example. If she could create her dreams and make them a reality, you could. And once you did it, she'd say “terrific, just terrific!” I remember, in 1984, being Jimmie's clinical fellow and going on supervision rounds in the hospital. I remarked to her that I had encountered many patients with brain tumors on high-dose corticosteroids who developed depressions, manias, or delirium. I asked Jimmie what the underlying pathophysiology of theses steroid-induced disorders could be and what the best treatments were. She stopped and there was silence for a moment. And then in her Texas twang, she said, “Well, Bill, I really don't know. I guess you'll have to just go out and figure that one out for yourself!” Not the answer I expected! But it was the answer that launched a 34-year career of clinical research spent trying to answer clinical questions that Jimmie Holland did not have the answers for. She essentially said to me that she had full confidence in my ability to discover the answers to the questions about clinical care and ultimately the existential questions we humans have in confronting our mortality. Four years after that conversation, Jimmie and Julia Rowland were editing the first Handbook of Psychooncology. It would be the first textbook in a new field that we were virtually naming with the publication of this text. Jimmie asked me to write six chapters. I knew something about the topics of three of the chapters that I would be writing, but nothing about the three others. I stopped by Jimmie's office to discuss my trepidation. “Jimmie, I don't know anything about these three other topics that I am assigned to write chapters for. I'm not an expert on the psychosocial aspects of head and neck cancer!” Jimmie calmly responded, “Well, Bill, frankly no one is, so after you review all the clinical and research literature and write the chapter, I suppose you will be the world's expert!” And then I was.

Dr. Holland stepped down as chair of the MSKCC Department of Psychiatry and Behavioral Sciences in 2003; however, she kept working full time, seeing patients, conducting research, training and supervising fellows, traveling the world lecturing and teaching, establishing a geriatric psycho-oncology program in the department, and committing her attention and energies to bring psycho-oncology to Africa through her work with the African Organization for Cancer Research & Training in Cancer. Jimmie was seeing patients up until 2 days before her death. We've lost a pioneer, a remarkable woman, a once-in-a-generation influencer. Her death is a profound loss for all of us.