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There are lessons that are not taught in medical school. Students and trainees learn how to classify tumors according to their stage, their histology, their margins, the number of lymph nodes they’ve colonized, and now, even by their genomic profiles.

“But they don’t tell you what to do when a patient looks you in the eye and says: I deserve this cancer,” Amitabh Ray, MD, professor and radiation oncologist at the Chittaranjan National Cancer Institute in India, said during an ASCO Voices session at the American Society of Clinical Oncology (ASCO) 2026 annual meeting in Chicago.

During the session, Ray told the story of why this patient initially refused treatment and how he convinced her that she was worthy of survival.

“When we think about ASCO, we think about science, survival rates, and adverse effects,” said session moderator Erika Ruiz-Garcia, MD, a medical oncologist at the National Cancer Institute in Mexico. “But we need to turn the page. We need to think in a different manner. It’s not because science doesn’t matter, but we need to think more in a humanistic way. We need to be more empathetic with our patients, with caregivers, and with ourselves.”

A Patient Overcome by Guilt

For a long time as an oncologist, Ray also focused on the science, the technology, and the evidence base. Then, one day, a woman came to see him. She had traveled with her son-in-law to New Town, where Ray practices. This woman “changed my thought process forever,” he said. 

The son-in-law was anxious and exhausted, the kind of tired that comes from carrying too much for too long, Ray said. The woman had advanced oral cancer and had recently had a stroke. “Medically, this case was formidable. But the real weight emerged only after [the woman’s son-in-law] started telling me his family’s story.”

A few weeks earlier, the patient and her daughter had traveled to Mumbai to seek cancer treatment at Tata Memorial Hospital. While in Mumbai, the daughter suddenly contracted dengue and died. “The shock of that loss triggered a debilitating stroke in the mother,” Ray said.

Back home, hearing this news, her son rushed to the airport to be with his mother, only to be killed in a car crash on the way. “I remember very well sitting in that small consultation room and feeling the air change around me,” Ray said. 

The woman refused all treatment. 

There are many reasons why patients decline therapy, including toxicity concerns, functional deficits, and unreasonable goals of care. “But this was none of that,” Ray said. The patient was convinced it was all her fault. “ ‘I killed them; I deserve to die.’ These were her exact words.” 

Resistance to treatment is nothing new for oncologists. There are patients who don’t believe in treatment, others who distrust the system, and “second opinions that become third opinions that become no opinions at all,” Ray said. Healthcare providers have several tools to respond, including toolkits, motivational frameworks, and patient education brochures. 

“But there is no brochure for guilt of this magnitude.” 

Lessons from Ray’s Experience 

Ray shared his story at ASCO 2026 to try to inspire other oncologists to explore the many reasons why patients refuse treatment. He also expressed hope that he would encourage his peers to not automatically default to making clinical arguments aimed at convincing patients to accept medical care.

Here’s what he did.

Ray tried reasoning with the woman, presenting evidence and statistics. He gently explained that there was no causal relationship between her existence and the deaths in her family. “I was evidence-based and thorough, and I was completely and utterly useless.”

Then he realized something no journal article had ever taught him. “I was trying to treat a tumor in a body when her soul had already given up. So I stopped. I put down my clipboard. I sat down with her to listen to her grief, and not with an agenda or a solution waiting in the wings.

“So we spoke about her daughter. We spoke about her son. We spoke about grief. We spoke about this incalculable arithmetic, the way the mind reaches for blame when the alternative, pure random loss is too terrifying to accept,” Ray said. 

“Slowly, she began to untie this knot that she had around herself. She probably began to realize that survival was not a betrayal of the people she had lost, but perhaps in some way a continuation of them,” he said. Eventually, she accepted treatment.

This one patient taught Ray something he carries with him to this day when counseling patients: that the greatest barrier to care is not always the biology of the tumor; sometimes it’s the weight of their human story. 

“We have impeccable science and extraordinary instruments, but we must never forget that we are not treating lesions on a scan. We are treating human beings,” Ray added. “We train for years to become experts in disease, but our truest vocation, the one that was probably not listed on any curriculum anywhere, is to see the person beyond the pathology. We must learn not only to treat — we must learn to heal.”

Ruiz-Garcia disclosed she is a consultant for Amgen, Astellas Pharma, AstraZeneca, BMS, Johnson & Johnson/Janssen, Merck Serono, SERVIER, and Takeda. Ray reported no relevant financial relationships. 

Damian McNamara is a freelance contributor to Medscape Medical News. He worked full-time for Medscape and WebMD from 2018 to 2024. Damian has a BA in chemistry and an MA in science, health and environmental reporting/journalism.