“Il Prof” and I

EDUARDO BRUERA

Professor and Chair, Department of Palliative care, Rehabilitation and Integrated Medicine The University of Texas MD Anderson Cancer Center, Houston, Texas, United States

Received on October 2, 2026




In the early 80s I completed my fellowship in medical oncology in Buenos Aires. The hospital and oncology service were among the best in the country and cancer treatments were state of the art. There was impeccable attention to the stage of the cancer and the treatment strategy with no focus on the patient physical, psychosocial or spiritual distress and no expertise on communication. I felt quite disappointed by the way we approached patient care. A young mother told us during rounds that she was sad since she could not pick up her baby due to severe metastatic bone pain, and our response was that “this is normal due to the metastases”. I felt that as oncologists we were focused on the tumor more than the patient. I learned that a Professor from Italy was coming to the faculty of medicine to give a lecture about something called “palliative care”. I asked a fellow colleague to take care of my patients that morning and took the bus listen to the lecture. I arrived to a huge, dark, very cold auditorium. There were only 4-5 of us in the audience there. Not even those who had invited Prof. Vittorio Ventafridda were there to listen to his talk. I was sure it would be cancelled, but when the time came he went to the podium and delivered for a few of us an amazing lecture full knowledge, wisdom, and emotional commitment to the care of the whole person suffering from cancer. I left that room with 3 lessons: 1. This is what I want to do for the rest of my professional career; 2. No matter if there are 4,000 or 4 persons in the audience, we should always teach with the same passion, since we never know if someone there will be impacted by our talk as I was; 3. Traveling to teach is an ethical mandate for those of us who can do it, since it will greatly help patients and clinicians in other places, as I experienced hearing in person Prof. Ventafridda in Argentina (that as Pope Francis used to say “ is at the end of the world”).

When I asked my boss if I could do this type of work the response that this field just did not exist and there were no job or career opportunities. I wrote (pre- internet) 52 letters expressing my interest to the main cancer centers. I received only 2 responses: one from Lyon, France inviting me to do a fellowship in phase I chemotherapy, and one from Edmonton, Canada, where the cancer center director, Dr Neil MacDonald was interested in developing a program in palliative care. Unbeknown to me Neil and “il Prof” (as we all called Ventafridda) both knew each other and shared the same passion and commitment to person-centered care.

I relocated to Edmonton and “il Prof” visited us there. Those were hard times for those of us working in palliative care. There were almost no clinical or academic programs in most hospitals and universities. There was no specialty, no professional associations, and no journals. Neil and “il Prof” were tireless pioneers who lived by the Gandhi principle: “Be the change you want”. They both abandoned areas of safe, well paid and recognized practice (medical oncology for Neil, Interventional Pain for “il Prof”).

“Il Prof” understood that pain expression by a cancer patient is never a simple result of nociceptive input. There are many dimensions that amplify the patient’s expression, and lack of attention to those was the main limitation of interventional pain. He faced criticism by the pain establishment and lack of support by the oncology establishment. But his talent, passion and persistence allowed him to establish the initial and most successful palliative care program in Italy and Europe at the Milan NCI. He trained the first generation of leaders and made education and research major priorities for our embryonal field. He understood better than anyone I know the importance of having a society such as the SICP, he was one of the few a founders of the EAPC (and faced major resistance from leaders from many countries, who feared that the creation of a body of knowledge and specialist field might reduce the compassionate approach to care), and his teachings always emphasized the importance of being present where medicine was taught and investigated (even though this was not existent in Italy at that time). He also understood that money was required and was able to attract numerous foundations from Italy and Europe to support the mission of better end of life for adults and children.

I had the opportunity to meet “il Prof” many times over the years. His mentoring on all his values and beliefs was instrumental in my career progress. One advice he gave me all the time was: “Eduardo you have to go to the US”. He believed that progress for our field globally depended on being accepted at the leading academic medical centers and universities, that were (and largely still are) in the US. When I received the phone call from MD Anderson inviting me to establish a palliative care program, the first thought in my mind was “this is what “il Prof” wanted me to do” and I took the job.

MD Anderson and the American establishment were not friendly to our field and myself. I applied the important knowledge had learned from “il Prof” over the years regarding strategies, but perhaps more important, I felt totally confident in a hostile environment: I was never alone, I was part of a movement led by people I greatly admired.

“Il Prof” was generous with his time and advice, even with colleagues who were completely unknown and had nothing to show such as myself in those years. We shared many meals, and even an aqua aerobics session in Hawaii. I made the error of buying tickets for him to the Tosca of the Edmonton opera, and he kindly reminded me in Milan he had the Teatro “Alla Scala”.

His photo is on my desk, and also at the conference room of our Department at MD Anderson, and whenever I have to make difficult decisions, I look at the photo and ask myself “what would ‘il Prof’ do about this?”.

“Il Prof” had enormous impact on my professional and personal life, and when he retired and died many of us felt lonelier in this field that is still not fully accepted in medicine.

Structures, processes and outcomes in palliative care are much better than they were before “il Prof”. Having so many Italians in my family, including my sister, I can only feel proud of the way Italian patients and families receive so much better care than only one generation ago.

One thing I have learned over time is that the heroes in this process are not those of us who had the blessing of being part of the initiation of palliative care around the world. The real heroes are to me the second and third generation of palliative care clinicians who every day come to work in very difficult, less well paid, and in uncertain or still hostile conditions from universities and hospitals, who keep our dream and our field alive and growing.

My gratitude is to all of you for what you do every day, and hopefully you will feel inspiration and energy from a small group of very unreasonable people who wanted better care by better clinicians.

Godspeed, my dear Prof.

Biography

Dr. Bruera obtained his medical degree from the University of Rosario, in Argentina. He trained in Medical Oncology and in 1984 he relocated to the University of Alberta in Edmonton, Canada where he directed the clinical and academic palliative care programs until 1999. In 1999 Dr. Bruera joined The University of Texas MD Anderson Cancer Center where he currently holds the F.T. McGraw Chair in the Treatment of Cancer and is the Chair of the Department of Palliative Rehabilitation and Integrative Medicine. He was medical director of the outpatient Supportive Care center for 15 years until 2018.

His main clinical interest is the care of the physical and psychosocial distress of patients with advanced cancer and the support of their families. He established and led, for the first five years of operations, the Edmonton Regional and Palliative Care program. He later established and currently leads the Department of Palliative, Rehabilitation and Integrative Medicine at The University of Texas MD Anderson Cancer Center since 1999.

Dr. Bruera has been interested in the development of palliative care programs internationally and helped in the establishment of numerous palliative care programs in Latin America, India, and different areas of Europe. He has held leadership roles with the World Health Organization, the Multinational Association of Supportive Care in Cancer, the International Association of Hospice and Palliative Care and Cicely Saunders International.

Bruera has trained hundreds of physicians, nurses, and other health care professionals in the different aspects of the clinical delivery of palliative care. He established the first academic fellowship program in palliative care at the University of Alberta in Canada and one of the first academic palliative care fellowships in the United States at The University of Texas MD Anderson Cancer Center.

He has more than 1400 peer reviewed publications (h- index 121, D-index 147) and has edited 40 books. He has given more than 1000 major invited lectures. He has received multiple Federal research grants in the US and Canada.

Dr. Bruera has received a number of national and international awards from the American Cancer Society (Lane Adams), the American Society of Clinical Oncology (Supportive care), the American Academy of Hospice and Palliative Medicine Lifetime Achievement Award. He was awarded the Sigillum Magnum (most prestigious award) by the University of Bologna (2023). He was awarded the 2022 Balfour Mount professorship by the Royal College of Physicians of Canada.

He has been named a Fellow of the American College of Physicians, American Academy of Hospice and Palliative Medicine, the American Society of Clinical Oncology, King’s College London, and the Multinational Association of Supportive Care in Cancer . He has received honorary doctorate degrees from the University of Montreal (2017) and Universitat Internacional de Catalunya (2023), and distinguished visitor of the Catholic University of Cordoba, In 2024 he was inducted Master of the American College of Physicians ( MACP).

The Canadian Society of Palliative Care Physicians has established the “Eduardo Bruera Award” as a career award for palliative care specialists. The Latin American Association for Palliative Care has established the “Eduardo Bruera” career award for research.