A conversation about modern oncology and the human side of cancer care
Before we begin, could you tell us a bit about yourself and your role at Ichilov?
Dr. Irina Stefanskiy:
My name is Irina Stefanskiy. I am a medical oncologist with more than twenty years of clinical experience. Most of my professional life has been closely connected to Ichilov Medical Center, where I serve as the head of the oncology day-care unit. It is a role that combines high medical responsibility with a very strong human dimension. Every day I work with patients facing complex diagnoses, difficult decisions, and intense emotional moments — alongside moments of remarkable strength.
In my daily clinical practice, I treat patients with a wide range of oncological conditions, from relatively straightforward cases to very complex ones. For me, it has always been essential not only to treat the tumor, but to see the person as a whole — their life, fears, inner resources, and personal limits.
In addition to my hospital work, I also consult patients in private practice at Tel Aviv Medical Clinic, where there is more time for conversation, explanation, and questions. I say this sincerely: sometimes time itself — and being truly listened to — becomes part of the treatment, no less important than the medication.
1. How do patients cope emotionally with a cancer diagnosis?
This is often the hardest part, even before we begin talking about scans or treatment plans. The moment of diagnosis usually comes as a shock. No one is ever truly prepared for it. Even patients who suspected something was wrong often react physically before they can process the information intellectually when they hear the words, “You have cancer.”
I see this almost every day. A patient sits across from me, and from their posture, breathing, and eye contact, it’s clear how tense everything is inside. Sometimes I intentionally do not start with medical explanations right away. Sometimes the first thing that’s needed is silence — simply allowing the moment to exist. Many patients need to feel that they are seen before they are treated.
A sentence I hear very often is: “I feel like I’ve lost control.”
And that, in many ways, is the core experience. Cancer brings uncertainty, and human beings naturally seek stability and predictability. When that disappears, anxiety grows. One of the most important goals at the beginning is to help patients regain at least part of that control. It doesn’t have to be something big. Sometimes it’s understanding what the diagnosis actually means, what the first step will be, or what comes next. Sometimes it’s deciding who to bring to the appointment, who to tell, or how to organize the coming days.
I also see many patients withdraw emotionally. They don’t want to worry their families, they don’t want to be a burden, they don’t want to appear weak. In reality, this often increases anxiety for everyone involved. When communication opens — even briefly — tension tends to decrease. I often suggest that patients bring a family member to a follow-up visit, once the initial shock has settled. It creates a sense that “we are in this together.”
Routine also matters more than people expect. Even when life has been disrupted, small anchors help — regular meals, a short walk, a simple conversation. These details remind patients that they are not defined only by the illness. And paradoxically, many people discover inner strength during this period that they never knew they had.
There is one thing I always emphasize: fear is normal. Sadness, confusion, exhaustion — all of these are human reactions, not weakness. Part of my role is to help patients not be afraid of their own emotions. When emotions are acknowledged rather than avoided, they lose much of their power.
If patients ask me what matters most in the first days after diagnosis, my answer is always the same: don’t rush. Don’t make life-changing decisions on the first day. Allow yourself time to absorb the information. Find a physician who is willing to explain things clearly and move step by step. When there is a clear first step — even a small one — the fog begins to lift.
The emotional process after a cancer diagnosis comes in waves. Fear and calm alternate. But when someone is not alone in holding that wave — when there is a plan and a trusted professional — patients often discover resilience they never imagined they possessed. I see this constantly. And I can say honestly: being alone with uncertainty is the hardest part. Once the conversation begins, some sense of stability returns. Not everything disappears — but a point of balance emerges. And that is where the journey truly starts.
2. Many patients feel confused by the terminology. Chemotherapy, biological therapy, immunotherapy — what is the real difference between them?
Dr. Irina Stefanskiy:
This is a question I hear very often, and I’m always glad when patients ask it, because confusion usually comes from fear. People hear different names and start assuming that one treatment is “stronger” or “better” than another. In reality, these are simply different approaches that work in very different ways — and the choice between them is never random.
Chemotherapy is the oldest of these treatments, and it still has an important role. It works by targeting rapidly dividing cells, which includes cancer cells but also some healthy cells. That’s why we see the classic side effects people are familiar with. But it’s important to understand that chemotherapy today is not what it was twenty or thirty years ago. Doses are more precise, treatment schedules are better designed, and supportive care has improved dramatically.
Biological therapy is a completely different concept. Here, we are no longer treating “broadly.” We first study the tumor at a molecular level, looking for specific mutations or pathways that drive its growth. If we find one, we can sometimes use a targeted drug that acts directly on that mechanism. For many patients, this means fewer side effects and, in some cases, very long and stable responses.
Immunotherapy works on yet another level. Instead of attacking the tumor directly, we help the patient’s own immune system recognize and fight it. This treatment is not suitable for everyone, and it doesn’t work in every situation, but when it does work, the results can be remarkable. In some patients, the disease remains stable for years.
What I always emphasize is this: there is no “best” treatment in general. There is only the treatment that is most appropriate for a specific patient and a specific tumor. Sometimes it’s one approach, sometimes a combination, and often a sequence that changes over time.
When patients understand the reasoning behind the choice, their anxiety decreases. Treatment stops feeling like something mysterious or frightening and becomes a logical step forward.
3. The term “personalized treatment” is used a lot today. What does it actually mean in real life?
Dr. Irina Stefanskiy:
Personalized treatment is not a slogan. It’s the reality of modern oncology.
In practice, it means that we no longer treat just a diagnosis — we treat a person with a very specific disease profile.
When I meet a patient for the first time, I don’t look only at scans. I consider age, other medical conditions, daily functioning, personal priorities, emotional state. At the same time, we analyze the tumor itself — its genetics, its behavior, and its sensitivity to different therapies.
Two patients with the same diagnosis on paper may receive very different treatments, and that is completely appropriate. Tumors behave differently, and people live differently.
Personalized treatment is also a dynamic process. We don’t make a single decision and close the book. We observe how the body responds, we reassess, and we adjust when needed. It’s an ongoing dialogue between the physician, the patient, and the disease.
And one important point: personalization doesn’t always mean “the newest drug.” Sometimes the most personalized decision is a well-established treatment, used at the right moment and in the right context. That, to me, is the maturity of modern oncology.
4. Side effects are a major concern for many patients. How well can they be managed today?
Dr. Irina Stefanskiy:
Fear of side effects is completely understandable. Many people carry stories from friends or family members who were treated many years ago. But the reality today is very different.
We are much better at preventing and managing side effects. We have highly effective anti-nausea medications, better ways to support blood counts, and close monitoring that allows us to intervene early. Many complications that once required hospitalization are now preventable.
Equally important is treatment selection. If I see that a particular regimen is likely to be too difficult for a patient, I won’t choose it just because it appears in a guideline. Guidelines are a foundation, but the patient always comes first.
I also tell patients very clearly: side effects are not a test of endurance. If something feels wrong, you should say so. The earlier we know, the easier it is to help. In oncology, there is no prize for suffering in silence.
5. Clinical trials often sound frightening to patients. Many think of them as experiments. How do you explain them?
Dr. Irina Stefanskiy:
I understand this fear very well. The word “trial” often creates an image of uncertainty or risk. My role is to clarify what clinical trials in oncology actually are.
A clinical trial is not treatment “by chance.” It follows a very strict protocol that has gone through multiple levels of safety evaluation. Patients are never left without treatment. They receive either the current standard therapy or the standard therapy plus something new.
Participation is always voluntary. Patients can ask questions, consult their families, and withdraw at any point. There is no pressure. The key question is not whether a trial sounds scary — the real question is whether it is medically appropriate for that specific patient.
In some situations, a clinical trial provides access to treatments that are not yet widely available. In others, standard therapy remains the best choice. My responsibility is to be honest about both.
6. Do you feel that patients today are more informed? Does that help or complicate things?
Dr. Irina Stefanskiy:
Patients today are definitely more informed — sometimes even overwhelmed by information. The internet offers an enormous amount of content, but it is rarely personalized and often outdated or misleading.
When patients come with questions and curiosity, that’s wonderful. It allows for meaningful discussion and shared decision-making.
When they come with fixed conclusions based on forums or anecdotal stories, my job becomes helping them reframe the information without dismissing their effort.
Information is powerful when it is interpreted correctly. Oncology is not an area where reading alone is enough — there are too many variables. That’s why I encourage questions but also try to serve as a filter between useful knowledge and unnecessary fear.
7. What role does the patient’s family play during cancer treatment?
Dr. Irina Stefanskiy:
The role of the family is enormous — and sometimes it’s decisive. Cancer almost never affects just one person. It affects an entire system around them.
I often see patients trying to “protect” their loved ones by holding everything inside — not sharing fears, not asking for help, not showing weakness. But in reality, this usually increases anxiety on all sides. Family members feel that something is wrong but don’t understand what’s happening, and that uncertainty becomes very heavy.
When family involvement is balanced — not controlling, not overwhelming, but simply present — treatment tends to be easier. Patients feel supported rather than alone. Sometimes it’s expressed in very simple ways: someone reminding them about medication, accompanying them to treatment, or just sitting quietly during a difficult day.
At the same time, families often need guidance themselves. Relatives are afraid to ask questions. They are afraid of the answers. In those moments, my role expands — I’m not only a physician for the patient, but also a source of clarity and reassurance for the people around them.
Good cancer care is not only about choosing the right drugs. It’s also about creating a stable, supportive environment in which the patient can function emotionally and physically.
8. Many patients feel that once treatment begins, their life is essentially “over.” How do you address that fear?
Dr. Irina Stefanskiy:
This feeling is very common, and it usually comes from imagination rather than experience. Before treatment starts, people tend to picture the worst possible scenario — pain, weakness, loss of independence. In reality, treatment rarely looks the way patients imagine it will.
I try to ground the conversation in reality. Not to dismiss fear, but to give it boundaries. We talk in detail about what the first phase of treatment will actually look like — how long it lasts, what sensations are normal, what should raise a question. When fear has structure and explanation, it becomes manageable.
I also emphasize something very important: starting treatment is not losing control — it is regaining it.
Before treatment, the disease feels like it’s dictating everything. Once treatment begins, there is a plan, a framework, a team. Psychologically, that shift is profound.
Another point I stress is this: patients do not need to “live the entire journey” in their heads from day one. Today, you only need to live today’s step. Today’s appointment. Today’s treatment. Today’s rest. When people stop seeing the process as an endless tunnel and start seeing it as a sequence of steps, breathing becomes easier.
9. Are there common mistakes patients make at the beginning of their cancer journey?
Dr. Irina Stefanskiy:
Yes — and most of them are human, not medical.
The most common mistake is trying to be strong alone. Patients think that if they don’t complain, don’t ask too many questions, and don’t “burden” anyone, they’ll cope better. In reality, tension builds, fear grows, and problems surface later in a more complicated way.
Another common mistake is trying to get answers to everything immediately. People read endlessly online, compare themselves to others, and become overwhelmed. Oncology is not a field where someone else’s story can simply be applied to your own situation.
And perhaps the most important mistake is staying silent about symptoms.
Patients sometimes notice changes or side effects but don’t mention them because they don’t want to “disturb” the doctor. I always say: in oncology, it’s far better to ask one question too many than to stay quiet. Almost everything is easier to manage when addressed early.
10. How does your role as an oncologist change over the course of treatment?
Dr. Irina Stefanskiy:
At the beginning, the physician is primarily a source of information and stability. Patients arrive confused and frightened, and they need someone to help organize the situation and outline the next steps.
Over time, that role evolves. The relationship becomes more of a partnership. We assess responses together, adjust plans together, and make decisions collaboratively. It becomes a dialogue rather than a one-sided explanation.
In longer treatment journeys, I often feel that I become a point of continuity for the patient. Treatments may change, scans fluctuate, emotions rise and fall — but knowing that someone understands the entire story and sees the full picture creates a sense of safety.
To me, a good oncologist is not only someone who knows protocols. It’s someone who can stay present over time, tolerate difficult conversations, and remain honest — even when answers are not simple.
11. This is an emotionally demanding profession. How do you personally maintain balance?
Dr. Irina Stefanskiy:
It’s a question that isn’t asked often enough. Oncology is emotionally intense. Every day you encounter fear, pain, uncertainty — and if you don’t create internal boundaries, burnout becomes inevitable.
What helps me is remembering that I don’t need to carry everything for my patients. I can support, explain, guide, and treat — but I cannot live their emotions for them. Finding that balance takes time and experience.
Meaning also matters. I see how treatment changes lives, how patients discover resilience they never imagined. Even when the road is difficult, there are moments of deep humanity that give the work purpose.
And, like everyone else, I need life outside medicine. Family, rest, quiet moments. That’s not a luxury — it’s what allows me to remain a human physician rather than a function.
12. If you had to summarize this conversation — what would you want listeners to take with them?
Dr. Irina Stefanskiy:
Most of all, I would want people to understand that oncology today looks very different from what many imagine.
It is no longer a path without options, and it is not something a person must face alone. It is a complex but manageable process — with medicine, with people, and with time.
For anyone listening who may be at the beginning of this journey: questions are normal, fear is normal, uncertainty is part of the process. But there are professionals who are ready to walk step by step, explain, support, and make decisions together with you.
And if there is one place to start — it is conversation.
Conversation brings clarity. And clarity almost always brings a measure of calm.
“Before we close, I want to say one final thing that I believe often gets lost in medical conversations. A cancer diagnosis can make everything feel overwhelming, and it’s natural to feel as though the ground has shifted beneath you. But uncertainty does not have to mean being alone with it.
Good care doesn’t begin with a treatment protocol — it begins with understanding. With having the space to ask questions, to talk through options, and to make sense of what is happening in your own body. When there is clarity, even in a complex situation, something changes. Decisions become more grounded, and the process becomes more manageable.
If this conversation has helped even slightly — by making things feel clearer or less intimidating — then it has already served its purpose. And if you feel that you need guidance, another perspective, or simply a professional conversation about your situation, don’t carry that weight by yourself. A thoughtful discussion with a physician is often the first step toward regaining balance.”
Patients who are seeking an oncological consultation, treatment clarification, or a second medical opinion may consult with Dr. Irina Stefanskiy at Tel Aviv Medical Clinic.
These consultations are designed to provide clear medical explanations, thoughtful discussion of options, and professional guidance in a calm, unhurried setting.
