Celebrating Cancer Survivors Month

Transcript

00:00 --> 00:03Funding for Yale Cancer Answers is
00:03 --> 00:06provided by Smilow Cancer Hospital.
00:06 --> 00:08Welcome to Yale Cancer Answers
00:08 --> 00:10with Doctor Anees Chagpar.
00:10 --> 00:11Yale Cancer Answers features the
00:11 --> 00:13latest information on cancer care
00:13 --> 00:15by welcoming oncologists and
00:15 --> 00:17specialists who are on the forefront
00:17 --> 00:19of the battle to fight cancer.
00:19 --> 00:21This week, it's a conversation about cancer
00:21 --> 00:23survivorship with Doctor Neal Fischbach.
00:23 --> 00:26Dr. Fischbach is an assistant professor
00:26 --> 00:27of medicine and medical oncology
00:27 --> 00:29at the Yale School of Medicine,
00:29 --> 00:31where Doctor Chagpar is a professor
00:31 --> 00:32of surgical oncology.
00:34 --> 00:36Neal, maybe we can start off
00:36 --> 00:38by you telling us a little bit more
00:38 --> 00:41about yourself and what it is you do.
00:41 --> 00:44I am a medical oncologist
00:44 --> 00:48and I specialize in breast cancer.
00:48 --> 00:50I came to Yale via Northern
00:50 --> 00:51California at UCSF,
00:51 --> 00:54where I started as a molecular
00:54 --> 00:57biologist involved in what makes
00:57 --> 01:00leukemia cells grow and morphed into
01:00 --> 01:02a general clinical oncologist and
01:02 --> 01:04ultimately into a breast oncologist.
01:04 --> 01:07So that's given me a pretty wide
01:07 --> 01:09spectrum for all the aspects of oncology.
01:11 --> 01:14And so at the top of the show,
01:14 --> 01:17you gave a shout out
01:17 --> 01:19to all thrivers out there.
01:21 --> 01:24We talk about survivorship.
01:25 --> 01:27Has the term survivor been
01:27 --> 01:28now replaced with thrivers?
01:28 --> 01:30Can you talk
01:30 --> 01:31a little bit about that?
01:34 --> 01:36I hear the word survivor,
01:36 --> 01:37it really implies a catastrophic
01:37 --> 01:40thing that occurred in your life
01:40 --> 01:42that you've managed to survive.
01:42 --> 01:44And I think we're moving more towards a
01:44 --> 01:47model that for many cancer is
01:47 --> 01:50a very profound thing that happens in life,
01:52 --> 01:55and from that profound thing,
01:55 --> 01:57a positive change can occur.
01:57 --> 02:01And I think what thrivership is about is
02:01 --> 02:04exploring tools to live your best life.
02:04 --> 02:06And that encompasses a very,
02:06 --> 02:08very wide breadth of
02:08 --> 02:10services and exploration.
02:11 --> 02:14Yeah, I agree with you.
02:14 --> 02:18I think that for many patients
02:18 --> 02:22after you get that diagnosis,
02:22 --> 02:25many patients actually find that it
02:25 --> 02:27was not something that they would
02:27 --> 02:29necessarily ever want to do again,
02:29 --> 02:32but something that gives them a reset and
02:32 --> 02:36a refresh and a new way to think about
02:36 --> 02:42life that really can be energetic
02:42 --> 02:44and a really positive thing.
02:44 --> 02:46Can you talk a little bit about that?
02:46 --> 02:48Have you seen that in your
02:48 --> 02:49patient population as well?
02:49 --> 02:52And can you maybe give us
02:52 --> 02:54some stories as to how
02:54 --> 02:56that's kind of played
02:56 --> 02:57out in your practice?
02:58 --> 03:00Absolutely.
03:00 --> 03:02I think this is one of the reasons
03:02 --> 03:05why many people choose to go into
03:05 --> 03:07medical oncology because this is not
03:07 --> 03:08a rare phenomenon.
03:08 --> 03:10And I think anyone who's
03:10 --> 03:12experienced something very profound
03:12 --> 03:14and difficult in their life,
03:14 --> 03:16whether that be confronting cancer,
03:16 --> 03:17another illness,
03:17 --> 03:21a major challenge growing up,
03:21 --> 03:23all find that it can change
03:23 --> 03:24us in some positive ways.
03:24 --> 03:25And in truth,
03:25 --> 03:27that's really what's drawn me to oncology,
03:27 --> 03:29because witnessing this
03:29 --> 03:32transition and transformation
03:32 --> 03:37is something that I gain a lot of energy
03:37 --> 03:38and joy from seeing.
03:38 --> 03:41So in my profession,
03:41 --> 03:45I've seen people who have had cancer
03:45 --> 03:47enter their life and have decided as part
03:47 --> 03:49of their assessment that the job they're in,
03:49 --> 03:51they are not satisfied.
03:51 --> 03:53They want to go on to do something different.
03:54 --> 03:58And people have gone on to open their own
03:58 --> 04:02businesses or start a career in advocacy,
04:02 --> 04:04things which bring them in
04:04 --> 04:06their workplace a ton of joy.
04:06 --> 04:09And it's cliche that people might say,
04:09 --> 04:11I really lost tolerance for all the
04:11 --> 04:14BS and found what's important to me.
04:14 --> 04:17But I think that really does ring true.
04:17 --> 04:19And while that covers a lot of
04:19 --> 04:21professional life and in truth,
04:21 --> 04:23in personal life too,
04:23 --> 04:26I think that the healthy habits
04:26 --> 04:29that people can adopt,
04:29 --> 04:31just discovering the world of
04:31 --> 04:34mindfulness and how the brain
04:34 --> 04:36and being present can have
04:36 --> 04:38a really dramatic impact on
04:38 --> 04:42our mood and life is pretty remarkable.
04:42 --> 04:45In addition to the exercise,
04:45 --> 04:46nutrition,
04:46 --> 04:49and all of the services that we are
04:49 --> 04:51trying to make available to people.
04:51 --> 04:53So as they're going through this process,
04:53 --> 04:56they can have all the opportunities
04:56 --> 04:57to explore.
04:57 --> 04:57And I also,
04:57 --> 04:59want to make clear that
04:59 --> 05:01the term survivorship in survivor
05:01 --> 05:03does not apply only to people
05:03 --> 05:05who had cancer in their past.
05:05 --> 05:07This includes people living with
05:07 --> 05:08cancer during their treatment,
05:08 --> 05:10living with metastatic cancer,
05:10 --> 05:12and those have been some of
05:12 --> 05:13the most profound,
05:13 --> 05:14I think,
05:14 --> 05:16experiences that I've had with
05:16 --> 05:18people who find that
05:18 --> 05:20their life has changed in ways
05:20 --> 05:21that you've never imagined.
05:21 --> 05:23But there's positive even
05:23 --> 05:26when living with chronic cancer.
05:26 --> 05:28You know, I've seen the
05:28 --> 05:30same thing in my practice as well.
05:30 --> 05:32People with this diagnosis
05:32 --> 05:34all of a sudden start reassessing
05:34 --> 05:36not only their jobs,
05:36 --> 05:37but their relationships.
05:37 --> 05:39They get out of bad relationships
05:39 --> 05:41or into new good relationships.
05:43 --> 05:46They have never travelled in their life and
05:46 --> 05:49they end up going and getting a passport.
05:49 --> 05:51I had a patient who had always wanted
05:51 --> 05:54to go skydiving but never did.
05:54 --> 05:57She was always too afraid.
05:57 --> 06:00And then after she got her diagnosis
06:00 --> 06:03on her fifth year anniversary,
06:03 --> 06:07she went skydiving and had a blast.
06:07 --> 06:08So I agree with you.
06:08 --> 06:10I think it it can be so positive.
06:10 --> 06:15But if we take a step back,
06:15 --> 06:18I can only imagine that people
06:18 --> 06:20who are just newly diagnosed,
06:20 --> 06:23hearing us talk about
06:23 --> 06:25these wonderful, magical,
06:25 --> 06:29positive kind of reformations of
06:29 --> 06:31people and the journeys that
06:31 --> 06:34they've had might be thinking,
06:34 --> 06:35you know, jeez,
06:35 --> 06:37this is a really scary diagnosis
06:37 --> 06:40that I've just been handed.
06:40 --> 06:42And especially as you say,
06:42 --> 06:45for people who have had metastatic disease,
06:45 --> 06:48it can be particularly scary.
06:48 --> 06:49And they may not be thinking about how
06:49 --> 06:51this is a really positive experience.
06:51 --> 06:53They may be thinking like,
06:53 --> 06:55Oh my God, I'm going to die.
06:55 --> 06:58Can you talk a little bit about
06:58 --> 07:00how you hold patient's hands and
07:00 --> 07:03get them through that scary part
07:03 --> 07:06so that they can get to the
07:06 --> 07:08not so scary, positive part?
07:09 --> 07:11Well, I think that is the real art
07:11 --> 07:14of medicine and it takes a village.
07:14 --> 07:17As you said, I think that one of
07:17 --> 07:20the biggest issues that people face
07:20 --> 07:22when they're given a diagnosis of
07:22 --> 07:24cancer is simply fear of the unknown.
07:24 --> 07:27And that includes fear of the physical
07:27 --> 07:30aspects of cancer and its treatment.
07:30 --> 07:31What am I going to go through?
07:31 --> 07:32What's my body going to be like?
07:32 --> 07:33What am I going to lose?
07:33 --> 07:36How am I going to live with
07:36 --> 07:38those limitations, restrictions,
07:38 --> 07:41the emotional fear,
07:41 --> 07:44the emotional strain of diagnosis that
07:44 --> 07:47impacts not only the person with cancer,
07:48 --> 07:50but their family and their loved ones.
07:50 --> 07:51And lastly, of course,
07:51 --> 07:53one that's starting to garner more
07:53 --> 07:55attention is just the
07:55 --> 07:56fear of the financial unknown.
07:56 --> 07:59How's this gonna impact my finances
07:59 --> 08:01and my plan that I was to retire
08:01 --> 08:0410 years from now kind of thing.
08:04 --> 08:07And I think the best way to get
08:07 --> 08:09people through that is to name it,
08:09 --> 08:13to help people identify.
08:13 --> 08:13Yes,
08:13 --> 08:15we understand your concern that
08:15 --> 08:18you may lose your breasts or
08:18 --> 08:21you may lose part of your colon or
08:21 --> 08:22whatever cancer treatment may bring.
08:22 --> 08:24And this is exactly what that's going
08:24 --> 08:26to be like and this is how we're
08:26 --> 08:28going to help you live a full life.
08:28 --> 08:31I found back in the day when I was doing
08:31 --> 08:33general oncology and colon cancer,
08:33 --> 08:36just directing people to a site
08:36 --> 08:38for swimwear for those with
08:38 --> 08:39colostomies,
08:39 --> 08:40you can be swimming,
08:40 --> 08:41you can be scuba diving,
08:42 --> 08:43helping people realize that,
08:43 --> 08:45you know, they are not the first
08:45 --> 08:46to go through this problem.
08:46 --> 08:48There are resources available to
08:48 --> 08:50help them navigate these things.
08:50 --> 08:51And not only the physical,
08:51 --> 08:54but now one of the most wonderful
08:54 --> 08:56things about practicing at Yale and
08:56 --> 08:59Yale New Haven is we do have a really
08:59 --> 09:01broad range of services to help.
09:01 --> 09:03Once we have enumerated
09:03 --> 09:05the emotional and financial stuff,
09:05 --> 09:07direct people to the resources
09:07 --> 09:09that can help them with those things.
09:09 --> 09:10But again, I think
09:10 --> 09:13for me, I think fear of the unknown.
09:13 --> 09:14I think we're more scared
09:14 --> 09:15of what we don't know.
09:15 --> 09:17And once we know it and can name it,
09:17 --> 09:19we can overcome it.
09:20 --> 09:23And I think that's so important because
09:23 --> 09:26I think that when you're looking at this
09:26 --> 09:28diagnosis and you're thinking this is
09:28 --> 09:31going to really turn my life upside down,
09:31 --> 09:34it is not going to be the way it was.
09:34 --> 09:36But I think what you're saying is, OK.
09:36 --> 09:39So it might not be exactly how
09:39 --> 09:42it was because yes, you know,
09:42 --> 09:44we have to get through this,
09:44 --> 09:47this cancer diagnosis and the treatment,
09:47 --> 09:50but there are ways that we can make
09:50 --> 09:52this better and there are resources
09:52 --> 09:54available that
09:54 --> 09:56can make it such that you actually
09:56 --> 09:59can enjoy the things that you otherwise did.
09:59 --> 10:02I love the example of the
10:02 --> 10:04swimwear for colostomy patients.
10:04 --> 10:07You know, can you talk a little bit about
10:07 --> 10:12the fear factor of the existential?
10:12 --> 10:15You know, I think that especially for
10:15 --> 10:18patients who have metastatic disease,
10:18 --> 10:22it's in part OK,
10:22 --> 10:23am I going to lose my hair?
10:23 --> 10:25But I think it's more,
10:25 --> 10:27am I going to lose my life?
10:27 --> 10:28Or perhaps more pointedly,
10:28 --> 10:32when is that going to happen and how
10:32 --> 10:34is that going to impact my family?
10:34 --> 10:38And I think that those scary moments make
10:38 --> 10:43it really hard to kind of in the moment.
10:43 --> 10:46And when you're talking to those patients,
10:46 --> 10:49they may be kind of like, Doctor Fischbach,
10:50 --> 10:52I get the whole mindfulness thing,
10:52 --> 10:55but right now I'm just,
10:55 --> 10:58really scared about what's going
10:58 --> 11:01to happen to me and my family and my life.
11:01 --> 11:02What do you say to those patients?
11:03 --> 11:07Well, I think the first thing to
11:07 --> 11:10recognize is that everybody is different.
11:10 --> 11:14Everybody has their own coping mechanisms
11:14 --> 11:17for dealing with this kind of fear.
11:17 --> 11:19I think this is where family and
11:19 --> 11:22caregivers are really important to help
11:22 --> 11:24understand what's best for one person.
11:24 --> 11:27I think for some people having a
11:27 --> 11:29very quantitative discussion about
11:29 --> 11:31statistics and what we expect in the
11:31 --> 11:34future is helpful and reassuring.
11:34 --> 11:37And for other people that can
11:37 --> 11:38be really distressing.
11:38 --> 11:41But with that in mind,
11:41 --> 11:45I think that what I try and stress
11:45 --> 11:49is that the brain is a amazing thing
11:49 --> 11:54and it handles big world shifting
11:54 --> 11:58information like this in small bites.
11:58 --> 11:59It's sort of like the aphorism
11:59 --> 12:00of how to eat an elephant,
12:01 --> 12:02you know, one bite at a time.
12:02 --> 12:04That's the way the brain works.
12:04 --> 12:08And so starting with just
12:08 --> 12:10a small broad overview about
12:10 --> 12:11what concerns you the most,
12:11 --> 12:14thinking about what is now as opposed
12:14 --> 12:18to what may be in the future and
12:18 --> 12:21trying to bring it back to what is now.
12:21 --> 12:22I think that is one of
12:22 --> 12:25the real strengths of mindfulness
12:25 --> 12:30and getting people to open up.
12:30 --> 12:35I think cancer and in some respects
12:35 --> 12:39suffering and worry about outcome
12:39 --> 12:42and treatment side effects is a
12:42 --> 12:45very internal kind of process.
12:45 --> 12:49And we can sometimes spend too much
12:49 --> 12:51time internally and helping people
12:51 --> 12:53start thinking again about opening
12:53 --> 12:55up and exploring the external,
12:55 --> 12:58whether that's via, you know,
12:58 --> 12:59exercise or getting involved in advocacy,
12:59 --> 13:01that type of thing.
13:01 --> 13:04I think it's a pretty extraordinary
13:04 --> 13:05transformation.
13:06 --> 13:08And I think the other piece that
13:08 --> 13:10makes things a little less scary,
13:10 --> 13:12at least for me,
13:12 --> 13:15is the whole idea that, you know,
13:15 --> 13:17cancer treatment has changed a
13:17 --> 13:20lot and it continues to move and
13:20 --> 13:22develop and get better and better.
13:22 --> 13:25So the side effects that your Aunt Mary
13:25 --> 13:27may have faced may be very different
13:27 --> 13:30than what you're going to face.
13:30 --> 13:32We'll talk about all of that.
13:32 --> 13:34But first, we do need to take a
13:34 --> 13:36short break for a medical minute.
13:36 --> 13:39So please stay tuned to learn more
13:39 --> 13:41about survivorship in honor of Cancer
13:41 --> 13:43Survivors Month with my guest,
13:43 --> 13:44doctor Neal Fischbach.
13:44 --> 13:46Funding for Yale Cancer Answers
13:46 --> 13:49comes from Smilow Cancer Hospital,
13:49 --> 13:50where their survivorship clinic is
13:50 --> 13:52a resource for cancer survivors
13:52 --> 13:54and provides patients and their
13:54 --> 13:55families with information on
13:55 --> 13:57cancer prevention, wellness,
13:57 --> 13:59supportive services and health research.
14:02 --> 14:02smilocancerhospital.org.
14:04 --> 14:06Genetic testing can be useful for
14:06 --> 14:08people with certain types of cancer
14:08 --> 14:10that seem to run in their families.
14:10 --> 14:12Genetic counseling is a process
14:12 --> 14:14that includes collecting a detailed
14:14 --> 14:15personal and family history,
14:15 --> 14:17a risk assessment,
14:17 --> 14:20and a discussion of genetic testing options.
14:20 --> 14:22Only about 5 to 10% of all cancers
14:22 --> 14:24are inherited and genetic testing
14:24 --> 14:26is not recommended for everyone.
14:26 --> 14:28Individuals who have a personal
14:28 --> 14:31and or family history that includes
14:31 --> 14:33cancer at unusually early ages,
14:33 --> 14:35multiple relatives on the same side
14:35 --> 14:37of the family with the same cancer,
14:38 --> 14:40more than one diagnosis of cancer
14:40 --> 14:41in the same individual,
14:41 --> 14:42rare cancers,
14:42 --> 14:45or family history of a known altered
14:45 --> 14:47cancer predisposing gene could be
14:47 --> 14:49candidates for genetic testing.
14:49 --> 14:52Resources for genetic counseling and
14:52 --> 14:54testing are available at federally
14:54 --> 14:55designated comprehensive Cancer
14:55 --> 14:57Centers such as Yale Cancer Center
14:57 --> 14:59and Smilow Cancer Hospital.
14:59 --> 15:02More information is available
15:02 --> 15:03at yalecancercenter.org.
15:03 --> 15:05You're listening to Connecticut Public Radio.
15:06 --> 15:08Welcome back to Yale Cancer Answers.
15:08 --> 15:10This is doctor in Anees Chagpar.
15:10 --> 15:12And I'm joined tonight by my guest,
15:12 --> 15:13doctor Neal Fishbach.
15:13 --> 15:16We're discussing the care of patients with
15:16 --> 15:18cancer in honor of Cancer Survivors Month.
15:18 --> 15:20And right before the break,
15:20 --> 15:24we were talking about how, you know,
15:24 --> 15:27sometimes we as clinicians see
15:27 --> 15:29these absolutely beautiful,
15:29 --> 15:31wonderful transformations of patients
15:31 --> 15:34into the best versions of themselves.
15:34 --> 15:37And while we can try to
15:37 --> 15:40intimate that to patients,
15:40 --> 15:42sometimes it's still really scary
15:42 --> 15:44when you're faced with a new
15:44 --> 15:46diagnosis of cancer and you think,
15:46 --> 15:48perhaps rightly in part,
15:48 --> 15:51that your world is falling apart.
15:51 --> 15:53But it doesn't have to be that way.
15:53 --> 15:57And I think part of it has
15:57 --> 15:59changed in terms of cancer therapies.
15:59 --> 16:01We're moving forward at
16:02 --> 16:05rocket speed in terms of finding
16:05 --> 16:06new therapies,
16:06 --> 16:08better therapies that have fewer
16:08 --> 16:09side effects.
16:09 --> 16:12And so sometimes the fear that many
16:12 --> 16:15patients have is based on information
16:15 --> 16:17that they've seen from friends,
16:17 --> 16:18from family members.
16:18 --> 16:19And so,
16:19 --> 16:22can you talk a little bit more
16:22 --> 16:24about this concept that your
16:24 --> 16:26cancer isn't your grandmother's
16:26 --> 16:28cancer and how things are changing
16:28 --> 16:30in terms of cancer therapies
16:30 --> 16:33today that might make things a
16:33 --> 16:35little less scary for people who
16:35 --> 16:37are newly diagnosed with cancer?
16:38 --> 16:40I think that is such an
16:40 --> 16:42important point Anees.
16:42 --> 16:45I think that conveying to people that
16:46 --> 16:50one of the biggest sources or areas of
16:50 --> 16:52investigation over the last 10 years anyway,
16:52 --> 16:54in my experience in breast cancer,
16:54 --> 16:56somewhat other breast cancers is how
16:56 --> 16:59can we achieve the same spectacular
16:59 --> 17:01outcomes with less toxicity.
17:01 --> 17:03And that includes even in the
17:03 --> 17:05case of metastatic breast cancer,
17:05 --> 17:07how do we help people live longer
17:07 --> 17:09and live better at the same time?
17:09 --> 17:10And, fortunately,
17:10 --> 17:13we are more and more able to realize
17:13 --> 17:16both those goals at the same time.
17:16 --> 17:19And so that's just again an
17:19 --> 17:21exercise in trying to evoke what
17:21 --> 17:23worries you about the treatment,
17:23 --> 17:26what have your past experiences been?
17:26 --> 17:30And then trying to convey what
17:30 --> 17:33the modern approaches are.
17:33 --> 17:34And again, emphasizing
17:34 --> 17:34in my mind,
17:34 --> 17:35one of the most wonderful
17:35 --> 17:36things that's happened
17:36 --> 17:39in medical oncology is deciding who
17:39 --> 17:41needs treatment and who doesn't,
17:41 --> 17:44who may safely be observed after
17:44 --> 17:46a curative cancer surgery without
17:46 --> 17:48needing any systemic treatment.
17:48 --> 17:51And in the breast cancer world,
17:51 --> 17:52who with breast cancer,
17:52 --> 17:54which may have occurred and
17:54 --> 17:56be spread throughout the body,
17:56 --> 17:58who can be managed now with
17:58 --> 18:00pills only very gentle endocrine
18:00 --> 18:03and targeted therapies and the
18:03 --> 18:04era of personalized medicine,
18:04 --> 18:08which we may discuss in more depth later.
18:08 --> 18:10I think that's something that
18:10 --> 18:11has really transformed oncology.
18:12 --> 18:13Yeah, I agree with you.
18:13 --> 18:16But, you know, I think for some people,
18:16 --> 18:19they may be under the impression that,
18:19 --> 18:23you know, cancer being such a scary
18:23 --> 18:26diagnosis, they may approach the whole
18:26 --> 18:28conversation of watchful waiting or
18:29 --> 18:31being treated with less aggressive
18:31 --> 18:34therapies as scary in and of itself.
18:34 --> 18:36Like, what do you mean you're
18:36 --> 18:38not going to treat me with like
18:38 --> 18:39the most aggressive chemotherapy?
18:39 --> 18:42We want to fight this cancer, don't we?
18:42 --> 18:44How do you approach
18:44 --> 18:45those conversations?
18:46 --> 18:49First, it depends a bit on the situation.
18:49 --> 18:52So in one instance, if we are dealing
18:52 --> 18:55with a cancer that we cannot cure
18:55 --> 18:56with currently available tools,
18:56 --> 19:00but we try and have the marathon
19:00 --> 19:03approach, our goal is to keep you
19:03 --> 19:05healthy and living well in a joyful
19:05 --> 19:08life until we have a cure or an
19:08 --> 19:10indefinite way to control your cancer.
19:10 --> 19:15And doing more upfront in fact
19:15 --> 19:17is counterproductive for those who
19:17 --> 19:20have early cancer for whom we are
19:21 --> 19:23quite confident that less is more.
19:23 --> 19:26I think focusing on some of the
19:26 --> 19:28toxicities of late toxicities of
19:28 --> 19:30treatment which we've identified
19:30 --> 19:33and the confidence we have with our
19:33 --> 19:35new molecular techniques in risk
19:35 --> 19:37stratifying people and deciding
19:37 --> 19:39who needs more treatment and who
19:39 --> 19:42needs less is really one of the
19:42 --> 19:45main tasks of the physician helping
19:45 --> 19:48recognize what is the person sitting
19:48 --> 19:50across from you healthcare values.
19:50 --> 19:53Are they maximizing risk reduction
19:53 --> 19:55over short term toxicity?
19:55 --> 19:59Do they maximize avoiding a toxicity
19:59 --> 20:02medicine and then helping meld
20:02 --> 20:04their own healthcare values with the
20:04 --> 20:06treatments we have available and
20:06 --> 20:08that's really the fun of oncology.
20:08 --> 20:10Can you talk a little
20:10 --> 20:12bit more about some of the advances
20:12 --> 20:14that we've made? I think that
20:14 --> 20:16you mentioned several of them.
20:16 --> 20:19So one is limiting toxicities, 2 is
20:19 --> 20:21potentially, you know,
20:21 --> 20:24figuring out who needs treatment versus not.
20:24 --> 20:26A lot of that work has not
20:26 --> 20:27been done in a vacuum.
20:27 --> 20:30A lot of that work has actually
20:30 --> 20:33been done on the back of really
20:33 --> 20:35rigorous robust clinical trials.
20:35 --> 20:38So this of course
20:38 --> 20:40is one of my passions.
20:40 --> 20:43And what I try to impress upon
20:43 --> 20:47people is we are walking a well trod
20:47 --> 20:50path and all of the recommendations
20:50 --> 20:53that we make for standard care are
20:53 --> 20:55based on this extraordinary altruism
20:55 --> 20:58of people who have come before
20:58 --> 21:00and who have decided, you know,
21:00 --> 21:02I also want to help those behind me.
21:02 --> 21:05And so if there's uncertainty as to what
21:05 --> 21:09is the best course of treatment for me,
21:09 --> 21:12I want to be part of finding out.
21:12 --> 21:14And that's the selfless part
21:14 --> 21:17of participating in a clinical
21:17 --> 21:20trial that you are helping the next
21:20 --> 21:22generation of people coming behind.
21:22 --> 21:26There's also a real self immediate
21:26 --> 21:29interest part of participating in
21:29 --> 21:32clinical trials in that many of our
21:32 --> 21:34studies these days are standard of
21:34 --> 21:37care plus a treatment which we have
21:37 --> 21:40reason to suspect may really improve
21:40 --> 21:43efficacy or standard of care versus
21:43 --> 21:46something a little bit less which we
21:46 --> 21:49suspect is safe to do and less toxic.
21:49 --> 21:52And that can translate into real benefits
21:52 --> 21:55for the individual themselves as well
21:55 --> 21:58as for those coming down the path after.
21:58 --> 22:01And I think that's so important that
22:01 --> 22:03patients know that because that way NOTE Confidence: 0.858897474285714
22:03 --> 22:06the whole idea of participating in
22:06 --> 22:08clinical trials might be a little
22:08 --> 22:10less scary because I think there are
22:10 --> 22:12still some who feel like clinical
22:12 --> 22:15trials are only for those who have no
22:15 --> 22:18other option or clinical trials are,
22:18 --> 22:21you know, really human experimentation
22:21 --> 22:24and being a human Guinea pig.
22:25 --> 22:27And I think that the way you phrased it kind
22:27 --> 22:30of alleviate some of the fears.
22:30 --> 22:33Do you find that patients are
22:33 --> 22:34more receptive now
22:34 --> 22:37to participating in clinical trials?
22:37 --> 22:40Yes, and I think there still is a
22:40 --> 22:43lot of prevalent belief that clinical
22:43 --> 22:46trials are experimentation and that
22:46 --> 22:49they they involve a lot of uncertainty.
22:49 --> 22:52And here this is the most
22:52 --> 22:55fertile ground for me in helping people
22:55 --> 22:58understand that just the opposite is true.
22:58 --> 23:01So there was a time where we reached
23:01 --> 23:03for clinical trials when people were
23:03 --> 23:06resistant to all of the currently available
23:06 --> 23:09treatments and we had a new chemotherapy,
23:09 --> 23:10which we were trying to test.
23:10 --> 23:12And not surprisingly,
23:12 --> 23:14when giving a new chemotherapy to someone
23:14 --> 23:17who'd been through a lot of chemotherapy,
23:17 --> 23:19the success rates were low
23:19 --> 23:20and the toxicities were high.
23:20 --> 23:22Well, things have transformed
23:22 --> 23:24in clinical trials.
23:24 --> 23:27Now where we're actually using targeted
23:27 --> 23:29treatments based on our understanding
23:29 --> 23:33of what's driving that person's cancer,
23:33 --> 23:35often unique to just the molecular
23:35 --> 23:37abnormalities in their own cancer
23:37 --> 23:38as an individual.
23:38 --> 23:42And we've developed rationally designed
23:42 --> 23:45treatments for those abnormalities.
23:45 --> 23:47And so we've seen a kind of flip flop in
23:47 --> 23:49our developmental therapeutics where now
23:49 --> 23:52those getting these experimental treatments,
23:52 --> 23:54the response rates are higher
23:54 --> 23:56and the toxicities are lower.
23:56 --> 24:00And this not only applies to people
24:00 --> 24:03who've been through a lot of therapies.
24:03 --> 24:05My greatest joy at the end of this week,
24:05 --> 24:08I'm seeing a woman who is 6 years out from
24:08 --> 24:11her diagnosis with metastatic breast cancer,
24:11 --> 24:15has no evidence of cancer in her body 'cause
24:15 --> 24:18she went on a first line trial with a
24:18 --> 24:19at the time,
24:19 --> 24:21a newer kind of medicine called
24:21 --> 24:23a PARP inhibitor for her breast
24:23 --> 24:26cancer with immune therapy.
24:26 --> 24:27And instead of getting
24:27 --> 24:28the standard treatment,
24:28 --> 24:30she got this treatment with which her
24:30 --> 24:32cancer has really responded beautifully.
24:32 --> 24:33Will it ever come back?
24:33 --> 24:35We don't know.
24:35 --> 24:38But even for those just
24:38 --> 24:40diagnosed with advanced cancer,
24:40 --> 24:41I think considering clinical
24:41 --> 24:43trials is important to do.
24:43 --> 24:45And when we do in that setting,
24:45 --> 24:47we recognize we're in the driver's seat.
24:47 --> 24:49We don't have to do a clinical trial.
24:49 --> 24:51There's something really compelling
24:51 --> 24:53and exciting that's available.
24:53 --> 24:54We're going to do it.
24:54 --> 24:55But we have these great
24:55 --> 24:56standard of care therapies,
24:56 --> 24:57which we can also do.
25:00 --> 25:02I think the other point that you
25:02 --> 25:04just made that I think is really
25:04 --> 25:06important for patients to understand,
25:06 --> 25:08especially when they're diagnosed
25:08 --> 25:10with metastatic disease.
25:10 --> 25:12I think so many patients when
25:12 --> 25:13they hear metastatic disease,
25:13 --> 25:15they think cancer has spread
25:15 --> 25:16all over my body,
25:16 --> 25:19which might in fact be true.
25:19 --> 25:22But the leap that they then make
25:22 --> 25:25is I'm going to die tomorrow,
25:25 --> 25:28but tomorrow might not be tomorrow.
25:28 --> 25:31Tomorrow might be six years down the line,
25:31 --> 25:34it might be 20 years down the line.
25:34 --> 25:38And we have made a great deal of progress
25:38 --> 25:40in terms of the therapies that we have.
25:40 --> 25:42Can you talk a little bit about
25:42 --> 25:45that in terms of the longevity that
25:45 --> 25:47people can have with metastatic disease?
25:48 --> 25:49Absolutely,
25:49 --> 25:53and this is really true almost across
25:53 --> 25:57the board in oncology these days.
25:57 --> 26:01There are so many new
26:01 --> 26:03compelling classes of medications.
26:03 --> 26:05I'll just list a couple off
26:05 --> 26:07the top of my head.
26:07 --> 26:09One is a whole family of drugs
26:09 --> 26:11called the antibody drug conjugates,
26:11 --> 26:14ways to bring cancer killing
26:14 --> 26:16medicines directly to the the cancer
26:16 --> 26:18cells themselves while limiting
26:18 --> 26:21exposure to the rest of your body.
26:21 --> 26:23And this has really transformed
26:23 --> 26:25the treatment of certain types
26:25 --> 26:26of metastatic breast cancer.
26:26 --> 26:28And it's the same technologies being
26:28 --> 26:31employed in a wide variety of cancers.
26:31 --> 26:33We have new and different ways
26:33 --> 26:35to harness the immune system.
26:35 --> 26:38The bioengineering that is going
26:38 --> 26:41into how to engage our immune
26:41 --> 26:43system is mind blowing and it's
26:43 --> 26:46happening on a molecular scale.
26:46 --> 26:49Ways to tether your immune cells to
26:49 --> 26:52your tumor and turn the tumors on which
26:52 --> 26:55are leading to dramatic responses in
26:55 --> 26:58now largely lymphomas and leukemia.
26:58 --> 27:00But this technology is now being
27:00 --> 27:02expanded to solid tumors and taking
27:02 --> 27:05our own immune cells and reprogramming
27:05 --> 27:08them to fight our cancers is again
27:08 --> 27:10something that has transformed
27:10 --> 27:14leukemia and lymphoma and now is making
27:14 --> 27:16serious inroads into solid tumors
27:16 --> 27:19we never thought would be immune
27:19 --> 27:21responsive like pancreas cancer.
27:21 --> 27:24So this is a really extraordinary time.
27:25 --> 27:26And the vignette
27:26 --> 27:29I share with people just on a personal level,
27:29 --> 27:31I'd like to think I'm not so, so old.
27:31 --> 27:33I will share with the audience.
27:33 --> 27:35I've been practicing for 20 years,
27:35 --> 27:37but just at the tender age of 56,
27:37 --> 27:40I have lived already through
27:40 --> 27:41two transformations,
27:41 --> 27:44the era of targeted pill treatments
27:44 --> 27:47for cancers like chronic myelogenous
27:47 --> 27:49leukemia and lung cancer,
27:49 --> 27:51which have completely altered the
27:51 --> 27:53Natural History of those cancer
27:53 --> 27:55and people are living for decades
27:55 --> 27:56or indefinitely.
27:56 --> 27:59And a second quantum leap,
27:59 --> 28:01the early days of our immune
28:01 --> 28:03therapy where now some people even
28:03 --> 28:05with metastatic lung cancer,
28:05 --> 28:07we're saying have been cured.
28:07 --> 28:11So these changes are coming fast and furious.
28:11 --> 28:13The way these changes happen is
28:13 --> 28:15via access to clinical trials.
28:15 --> 28:17And I would urge people to
28:17 --> 28:19think of your medical oncologist,
28:19 --> 28:21your treating team as your concierge.
28:21 --> 28:25Their job is to help you find
28:25 --> 28:27the best treatment,
28:27 --> 28:29including thinking about are
28:29 --> 28:31there clinical trials available,
28:31 --> 28:32which you might want to consider
28:32 --> 28:33at all phases
28:33 --> 28:34of your treatment.
28:34 --> 28:36Doctor Neal Fischbach is an assistant
28:36 --> 28:38professor of medicine and medical
28:38 --> 28:41oncology at the Yale School of Medicine.
28:41 --> 28:43If you have questions,
28:43 --> 28:44the address is canceranswers@yale.edu,
28:44 --> 28:47and past editions of the program
28:47 --> 28:49are available in audio and written
28:49 --> 28:50form at yalecancercenter.org.
28:50 --> 28:53We hope you'll join us next time to learn
28:53 --> 28:55more about the fight against cancer.
28:55 --> 28:57Funding for Yale Cancer Answers is
28:57 --> 29:00provided by Smilow Cancer Hospital.

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Celebrating Cancer Survivors Month with guests Neal Fischbach June 16, 2024

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Neal Fischbach, MD

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