A Priceless Connection

For pediatric oncologist Katie Janeway ’88, the importance of building strong relationships in caring for her young patients is incalculable.

Story by April White
Photographs by Jo Sittenfeld

The starting line of the Pan-Mass Challenge in Wellesley is a sea of brightly colored spandex and barely contained enthusiasm. Each August, thousands of cyclists gather there and in other locations around eastern Massachusetts for the two-day ride, all to benefit the Dana-Farber Cancer Institute. In 2024, nearly 7,000 riders raised a record $75 million to fund cancer research and treatment. Katie Janeway ’88, in her black-and-neon Team Precision for Kids bike jersey, was among them. She had trained to pedal 162 miles from Wellesley to Provincetown—a feat she had undertaken several previous years—but for her the most important moment came not at the end of the journey but here, at its beginning. “When you’re all lined up to get started and you look back or ahead, and you see all these people who have turned out, that’s really an amazing experience,” she says.

Janeway is a doctor at the Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, and the money raised by the Pan-Mass Challenge funds her work treating patients with pediatric cancer and the research she undertakes as director of a clinical genomics lab at Dana-Farber that bears her name. More than that though, the event is a show of support. She says: “I see parents of patients who survived; I see parents of patients who didn’t survive; I see patients who are riding after they complete their treatment. I see a ton of other physicians who ride it. And then there are people who have never been impacted by cancer who just think it a great thing to do.” Even before the riders cross the starting line, they’ve left an impression that’s important to Janeway: Patients are not alone in their cancer journeys.

Katie Janeway didn’t dream of becoming a doctor when she was at Milton. She came from a family of medical professionals, with six generations of physicians and researchers. Her father and stepmother were both immunologists who often discussed their scientific studies at the family dinner table in New Haven. “I’m never doing that,” teenage Katie thought. “So boring.”

She never felt pressured to go to medical school,” she recalls. “Actually, when I told my dad, he said, ‘Are you sure you want to do that? It’s really not the easiest job.’”

And of the specialties Janeway was introduced to while pursuing her degree at Harvard Medical School (where she is now an associate professor) and during her residency at Boston Children’s Hospital, pediatric oncology—and her eventual focus on osteosarcoma, a rare bone cancer with a mediocre survival rate—was among the hardest jobs. Cancers in teens and young adults, especially rare diagnoses, challenge doctors’ medical knowledge, requiring them to continually learn and grow, but the patients and their families need more than that. “You need to really work on communication and education and developing a trust relationship,” Janeway says.

That was a skill she first learned in restaurants. “I think of doctoring as a service profession,” Janeway says today. “When I enter any interaction with any patient, I enter it in the same way I did in the service industry. I’m trying to find out what somebody is looking for—What do they need? Why are they coming to me?—and deliver it. It’s much more complicated in medicine, of course, but the framework is no different.”

Young people and their caregivers typically arrive at the Jimmy Fund Clinic in Boston, where Janeway often sees patients, with a lump or a bump—an abnormality in an examination or a scan their pediatricians couldn’t explain. It’s a scary moment for everyone, and Janeway knows she won’t be able to soothe their worries or confirm their worst fears and offer a treatment plan quickly. In suspected cases of leukemia—a general term for cancer of the blood cells, the most common pediatric oncology diagnosis—a determination can come within 24 hours. But in solid-tumor cancers, or sarcomas, like those Janeway studies, it can take several weeks to complete the necessary medical tests.

For patients and their loved ones those long weeks can be an agonizing limbo, so Janeway and her team typically meet with the patient once a week to discuss the possible diagnoses and communicate even more frequently about the next steps in the process. It’s vital information, Janeway explains, but the relationship it fosters is even more important. For patients it’s the first opportunity to get to know their treatment team—which can include Janeway, a doctor-in-training, another specialist such as a surgeon, a social worker, and other support staff—and it serves a similar purpose for Janeway. “We’re trying to get to know patients as people, not just as their diagnoses and their treatment.”

Janeway usually first meets her patients when they are between the ages of 10 and 20, often a time of big dreams and big changes. She wants to know if they love to cuddle with their dogs or ride their bikes through the neighborhood; if they aspire to be video-game developers or to join the military. Other seemingly typical questions—such as,“Have you had people with cancer in your family?”—are not solely about collecting a medical history but about developing an emotional understanding of how the disease and its treatment will change a young person’s life at a pivotal moment. And it’s not just about the patient. “In pediatric oncology, it’s the patient-family unit,” Janeway says. She wants to know what the family’s support systems look like and what challenges they might be facing beyond the cancer diagnosis. “Getting to understand who they are and what really matters to them impacts how you think about the treatment and explaining the treatment,” she says.

The science of treating sarcomas has not advanced as quickly as in some other cancer specialties. Targeted therapy and immunotherapy, which have proved effective against other cancers, have not yet shown the same results in many types of sarcomas—Janeway’s research is working to change that—which means that most patients will undergo chemotherapy and surgery. “They’re getting treatment that removes them from their day-to-day school life. They’re getting surgeries that really impact their physical function or how they appear at a very crucial time in their developmental life,” Janeway says, her voice wavering. “I feel a ton of compassion for them.”

Forming a bond with her patients and their caregivers is key to navigating this treatment process, Janeway says. She relies on patients and those around them to provide vital feedback on the side effects of chemotherapy and other treatments. “It’s really important that people know when to call you and feel comfortable calling you,” she says. That information can shape the course of individual treatment and ultimately advance the medical understanding more broadly. Among her other research interests, Janeway is involved in a patient-partnered research program called Count Me In that works to develop community among osteosarcoma patients and caregivers and to build a dataset of patient experiences, treatment information, and test results to spur advances in treatment.

Though Janeway is unaware of any research that has tried to directly measure the impact of relationship building on cancer prognosis, “I think it’s essential for a good outcome,” she says. “I don’t think you can actually treat cancer without building those relationships.” And in the best-case scenarios, the relationships that start in those anxious moments before diagnosis can last years, well beyond the typical six to 12 months of treatment and five years of regular monitoring. Janeway treated her first osteosarcoma patient more than two decades ago. This past winter, she received an email from the woman, announcing the birth of her baby.

“Some people ask me, Why do you do this job?” Janeway says. “It’s so hard. Even the parents of some of the patients I took care of have asked me that.” Her answer: “You see these young people going through this incredible challenge and coming out the other side often—although not always—and going on to do amazing things.”

When Janeway heads to the starting line of the Pan-Mass Challenge this year, she will again be riding for her patients—past, present, and future—and for her fellow physicians and herself. Eleven years ago, she was diagnosed with acute myeloid leukemia, a rare and aggressive cancer. She underwent chemotherapy and a bone-marrow transplant at Dana-Farber, which sent the disease into remission. At the time of her diagnosis, in 2014, she had been training for the Boston Marathon as part of the Dana-Farber team. Four years after treatment, in the spring of 2018, she was ready to run 26.2 miles, and the next year she began riding the Pan-Mass Challenge. It was a chance to show herself—and others—that recovery is possible.

Janeway is quick to add that her own experience with cancer is not a shortcut to understanding her patients better. “Every cancer journey is different, every treatment is different,” she says. Instead, her diagnosis reinforced her career-long dedication to relationship building and turned her professional passion into a personal one—an evolution that has helped her develop more genuine bonds with her patients. “Earlier in my career I felt the need to have more boundaries between who I am as a person and my work,” Janeway says. “Over time that has changed quite a bit for me. I show up a little bit more as who I am as a person, not so much as doctor me.”

“The foundation of any relationship is about honesty,” Janeway says, noting the echoes of Milton Academy’s motto, “Dare to be true.” “And there is no more important setting in which to be honest and straightforward than when somebody is trusting you with the care of their child.”

April White is the author of The Divorce Colony: How Women Revolutionized Marriage and Found Freedom on the American Frontier. Her work has also appeared in publications such as Smithsonian Magazine, The Washington Post, and The Atavist Magazine.