50 Years of Cancer Progress - Survivorship > Podcasts

Transcript

00:00 --> 00:01Funding for Yale Cancer Answers
00:01 --> 00:03is provided by Smilow Cancer
00:03 --> 00:04Hospital.
00:06 --> 00:08Welcome to Yale Cancer Answers
00:08 --> 00:09with the director of
00:09 --> 00:10Yale Cancer Center, doctor Eric
00:10 --> 00:11Winer.
00:11 --> 00:13Yale Cancer Answers features conversations
00:14 --> 00:14with oncologists
00:15 --> 00:16and specialists who are on
00:16 --> 00:17the forefront of the battle
00:17 --> 00:18to fight cancer.
00:18 --> 00:20This week, it's a conversation
00:20 --> 00:22about survivorship with doctor Tara
00:22 --> 00:23Sanft. Doctor Sanft is an
00:23 --> 00:25associate professor of medicine and
00:25 --> 00:27medical oncology and hematology at
00:27 --> 00:29the Yale School of Medicine.
00:29 --> 00:30Here's doctor Winer.
00:33 --> 00:35Before we get into t
00:35 --> 00:36some of the
00:38 --> 00:40topics that we're
00:40 --> 00:41gonna be discussing, can you
00:41 --> 00:42just tell us a little
00:42 --> 00:43bit about yourself? How is
00:43 --> 00:45it that you
00:45 --> 00:46came to this field?
00:47 --> 00:49What made you become
00:49 --> 00:50an oncologist? And what drew
00:50 --> 00:52you to both this area
00:52 --> 00:54of patient experience and survivorship,
00:55 --> 00:56which I tend to think
00:56 --> 00:58are quite complimentary?
00:58 --> 01:00Thank you. Well,
01:00 --> 01:01I'm from a mid
01:01 --> 01:03sized town in Iowa.
01:03 --> 01:05I'm a very Midwestern girl,
01:06 --> 01:07through and through.
01:07 --> 01:08I have two siblings and
01:10 --> 01:11my parents now live in
01:11 --> 01:12Minnesota, which is where they're
01:12 --> 01:14originally from.
01:15 --> 01:16And when I was eleven,
01:16 --> 01:17my uncle,
01:18 --> 01:19who was thirty two,
01:19 --> 01:21passed away from pancreas cancer.
01:22 --> 01:23And he had two little
01:23 --> 01:25kids, and at that time,
01:25 --> 01:26there were very
01:28 --> 01:30few treatments to offer and
01:30 --> 01:31he tried some and they
01:31 --> 01:32didn't work and he
01:33 --> 01:34passed away within a year
01:34 --> 01:35of his diagnosis.
01:36 --> 01:38I'm so sorry.
01:38 --> 01:39Thank you, and he was
01:39 --> 01:41so young particularly for pancreatic
01:41 --> 01:43cancer. My heart
01:43 --> 01:45breaks for our patients and
01:46 --> 01:47at that time of my
01:47 --> 01:48life, I was eleven years
01:48 --> 01:50old. I didn't really understand
01:50 --> 01:51everything that was going on,
01:51 --> 01:52but I did know
01:53 --> 01:54that the medical team who
01:54 --> 01:55cared for him and then
01:55 --> 01:57eventually the home hospice
01:58 --> 01:59team where he passed away
01:59 --> 02:00at home,
02:00 --> 02:02really supported my
02:02 --> 02:02family
02:03 --> 02:05and there was something special
02:05 --> 02:06there. And
02:06 --> 02:08at that time, I decided
02:08 --> 02:08I wanted to become a
02:08 --> 02:09doctor. And I didn't know
02:09 --> 02:11in my mind that I
02:11 --> 02:11would end up in this
02:11 --> 02:13field, but looking back, it
02:15 --> 02:16was starting at a very
02:16 --> 02:17young age. I really
02:18 --> 02:19appreciated the relationships
02:20 --> 02:21that doctors and patients could
02:21 --> 02:24have and especially in really
02:24 --> 02:25difficult times.
02:27 --> 02:28Of course, you're not a
02:28 --> 02:30pancreatic cancer doctor. As it
02:30 --> 02:31turns out, you are a
02:31 --> 02:33breast cancer doctor. How did
02:33 --> 02:34you decide to do that?
02:35 --> 02:36Well, I did
02:36 --> 02:38training in oncology and palliative
02:39 --> 02:39medicine
02:40 --> 02:41at Northwestern in Chicago
02:42 --> 02:43and I
02:43 --> 02:44enjoy the
02:45 --> 02:46serious decisions
02:46 --> 02:47that patients have to make
02:47 --> 02:49and the end of life,
02:49 --> 02:51conversations, goals of care.
02:52 --> 02:53But I also had a
02:53 --> 02:54really good mentor there and
02:54 --> 02:56I started running marathons and
02:56 --> 02:58I wanted to understand
02:58 --> 02:59the benefits of
03:00 --> 03:00healthy
03:00 --> 03:02decisions, healthy lifestyles
03:02 --> 03:04as it relates to cancer
03:04 --> 03:04treatment.
03:05 --> 03:06And most of this work
03:06 --> 03:07was being done in breast
03:07 --> 03:09cancer patients. And my
03:09 --> 03:10mentor there happened to be
03:10 --> 03:11a breast cancer oncologist, and
03:12 --> 03:13I kept coming back to
03:13 --> 03:14his clinic and talking to
03:14 --> 03:16the patients there. And,
03:17 --> 03:18so while I still do
03:18 --> 03:20a lot of palliative care
03:20 --> 03:21type conversations when I'm on
03:21 --> 03:23the inpatient service and, of
03:23 --> 03:24course, all my patients,
03:25 --> 03:26we talk about goals of
03:26 --> 03:27care when needed,
03:28 --> 03:30I focused on my
03:30 --> 03:32research efforts, in terms of
03:32 --> 03:33healthy diet and exercise, and
03:33 --> 03:33that's
03:34 --> 03:35really what got me into
03:35 --> 03:37survivorship. That's where that
03:37 --> 03:38field started,
03:39 --> 03:40in the healthy diet and
03:40 --> 03:41exercise.
03:41 --> 03:43My research mostly started in cancer
03:43 --> 03:45survivors. And I came here
03:45 --> 03:46to work with Melinda Irwin,
03:46 --> 03:48who is a world renowned
03:48 --> 03:49researcher in that field, and
03:49 --> 03:50I still work with her
03:50 --> 03:51to this day.
03:52 --> 03:53That's great.
03:53 --> 03:54So let's
03:55 --> 03:56talk about survivorship.
03:57 --> 03:59Fifty years ago, nobody thought
03:59 --> 04:01about survivorship. They just wanted
04:01 --> 04:02people to survive.
04:03 --> 04:04And if you were so
04:04 --> 04:05lucky to survive, you were
04:05 --> 04:06really
04:06 --> 04:08totally on your own.
04:08 --> 04:09And any
04:10 --> 04:11scars
04:11 --> 04:14from treatment, any scars from
04:14 --> 04:15the illness itself, and, of
04:15 --> 04:17course, there there can be
04:17 --> 04:17many,
04:18 --> 04:19were just swept under the
04:19 --> 04:20rug, and you were supposed
04:20 --> 04:21to be back to your
04:21 --> 04:22normal self.
04:24 --> 04:25Tell us what's happened with
04:25 --> 04:27survivorship over these,
04:27 --> 04:29let's say, past
04:29 --> 04:30twenty, twenty five years where
04:30 --> 04:31it's become
04:31 --> 04:32so much more of
04:33 --> 04:34a focus of what we do.
04:36 --> 04:38Yeah. I think you're exactly
04:38 --> 04:39right, Eric. If you
04:39 --> 04:42happen to survive cancer when
04:42 --> 04:43treatments were evolving,
04:44 --> 04:46you were made to feel
04:46 --> 04:47very lucky about that and
04:47 --> 04:49many people did not survive.
04:49 --> 04:50So patients really did feel
04:50 --> 04:51grateful,
04:51 --> 04:52and they still do to
04:52 --> 04:53this day.
04:54 --> 04:55But because the advances have
04:55 --> 04:56gotten
04:56 --> 04:57so staggeringly
04:58 --> 05:00much better than they were,
05:00 --> 05:01they're not good enough, but
05:01 --> 05:01they're
05:02 --> 05:03much better. We have, you
05:03 --> 05:05know, something like eighteen million
05:05 --> 05:07survivors as of
05:07 --> 05:09twenty twenty two in the
05:09 --> 05:11United States alone. And if
05:11 --> 05:13you're diagnosed today,
05:13 --> 05:14fifty percent of patients diagnosed
05:14 --> 05:15are going to live at least
05:15 --> 05:16ten years.
05:17 --> 05:18So the number of survivors
05:18 --> 05:20is just projected to continue
05:20 --> 05:20to grow
05:21 --> 05:22and for longer and longer
05:22 --> 05:23periods of time.
05:25 --> 05:27With that,
05:27 --> 05:29people sort of finish their
05:29 --> 05:30treatments and they
05:30 --> 05:32have these moments of realization
05:32 --> 05:33that I've just been through
05:33 --> 05:34a lot and I'm not
05:35 --> 05:36what I used to be.
05:36 --> 05:37I don't feel
05:37 --> 05:38the way I used to
05:38 --> 05:39feel. I don't look the
05:39 --> 05:40way I used to look.
05:41 --> 05:42And we then sort of
05:43 --> 05:45evolved into really dealing with
05:45 --> 05:46things after
05:47 --> 05:48treatment was over. We call
05:48 --> 05:50it a new normal, which
05:50 --> 05:51kind of bothers me because
05:51 --> 05:51I think
05:52 --> 05:53our responsibility is to try
05:53 --> 05:55to mitigate that so that
05:55 --> 05:56you're just your normal self.
05:58 --> 06:00I've always thought of it
06:00 --> 06:00that
06:01 --> 06:03whether it's a medical issue
06:04 --> 06:06or some other major event
06:06 --> 06:07in your life, you go
06:07 --> 06:08through it.
06:08 --> 06:10For example, you know, the
06:10 --> 06:11birth of a child, a
06:11 --> 06:12divorce,
06:12 --> 06:14a huge job change.
06:15 --> 06:17And these things affect us.
06:18 --> 06:20We are, as people, the accumulation
06:20 --> 06:22of the events that occur
06:22 --> 06:23in our lives to some
06:23 --> 06:24degree.
06:24 --> 06:25And I think it
06:25 --> 06:27would be foolish to think
06:27 --> 06:28that someone could go through
06:28 --> 06:30three months, six months, a
06:30 --> 06:32year of cancer treatment and
06:32 --> 06:34just resume
06:34 --> 06:35where they were
06:36 --> 06:37a year earlier. And yet
06:37 --> 06:39people's families to this day
06:40 --> 06:42still sort of expect it.
06:43 --> 06:44They expect it. And I
06:44 --> 06:46think there's some patients who
06:48 --> 06:49it's a little blip in their radar
06:49 --> 06:50and as far as they're
06:50 --> 06:52concerned, they're not gonna even
06:52 --> 06:54acknowledge that was a
06:54 --> 06:55major event and they're just
06:55 --> 06:56gonna keep going forward.
06:56 --> 06:58So the survivorship team
06:58 --> 06:59doesn't resonate with everyone,
07:00 --> 07:03but for a not insignificant
07:03 --> 07:05number, it does cause
07:05 --> 07:07lots of reflection and
07:09 --> 07:10side effects, unfortunately,
07:11 --> 07:12physical, mental,
07:12 --> 07:13spiritual,
07:13 --> 07:15emotional, and family and financial
07:15 --> 07:17side effects as well. And
07:17 --> 07:19that's where the
07:19 --> 07:19field of survivorship
07:20 --> 07:22recognizes the obligation to try to
07:23 --> 07:25make people feel whole again
07:25 --> 07:26or even thrive
07:27 --> 07:29after cancer and its treatment
07:30 --> 07:31so that they're able to
07:31 --> 07:31reprioritize
07:32 --> 07:33their life to live it
07:33 --> 07:33even better
07:34 --> 07:34than before.
07:35 --> 07:37So apart from
07:37 --> 07:39just giving it a name
07:39 --> 07:40and talking about survivorship
07:40 --> 07:42and recognizing the importance,
07:43 --> 07:44what are some of the
07:44 --> 07:45biggest advances in the field
07:46 --> 07:48over the past
07:48 --> 07:49ten years, twenty years?
07:53 --> 07:54To me, again,
07:54 --> 07:56in my world,
07:56 --> 07:59we've really advanced our knowledge
07:59 --> 08:00as it relates to
08:01 --> 08:03the role of health behaviors
08:03 --> 08:04in cancer survivorship.
08:05 --> 08:06So the
08:06 --> 08:08issue of exercise, for instance,
08:08 --> 08:09probably has got the
08:09 --> 08:12strongest evidence with it. And
08:12 --> 08:13like I said, a lot
08:13 --> 08:15of that started in survivorship
08:15 --> 08:16research.
08:17 --> 08:20What about patients who exercised
08:20 --> 08:21before cancer? Did they do
08:21 --> 08:23better after if they exercised
08:23 --> 08:24after cancer? Could they still
08:24 --> 08:26do really well? And the
08:26 --> 08:28answers are yes for many
08:28 --> 08:28things.
08:29 --> 08:30And those side effects that
08:30 --> 08:32we induce with our treatments
08:32 --> 08:33certainly,
08:33 --> 08:35are mitigated with exercise as
08:35 --> 08:36an example. But
08:37 --> 08:39we've gotten even better at
08:39 --> 08:40understanding
08:40 --> 08:42the role of exercise in
08:42 --> 08:44various side effects and
08:44 --> 08:46the dose intensity, if you
08:46 --> 08:47will, and the types of
08:47 --> 08:49exercises that can help. And
08:49 --> 08:51we're still refining all of
08:51 --> 08:52that, but to me,
08:52 --> 08:53what this all means is that
08:55 --> 08:56patients have some control
08:57 --> 08:57over
08:58 --> 09:00what their behaviors are and
09:00 --> 09:02that cancer is a teachable
09:02 --> 09:03moment. And as we
09:03 --> 09:04even move forward, we're gonna
09:04 --> 09:05move all of these
09:06 --> 09:09findings into the diagnostic period
09:09 --> 09:10to try to, again,
09:10 --> 09:12prevent loss of physical function
09:12 --> 09:14from happening and prevent cancer
09:14 --> 09:15related fatigue from happening in
09:15 --> 09:17the first place. So
09:17 --> 09:18that's where we are right
09:18 --> 09:19now. We still have
09:19 --> 09:20some ways to go, but
09:20 --> 09:21I see that as
09:21 --> 09:23a huge advancement for the
09:23 --> 09:24field and it's one that's
09:24 --> 09:24being
09:26 --> 09:28recognized. And hopefully, we
09:28 --> 09:30can even convince insurance to
09:30 --> 09:30cover
09:30 --> 09:33exercise programs for cancer patients
09:33 --> 09:34because we know how well
09:34 --> 09:35they do when they actually
09:35 --> 09:36exercise.
09:36 --> 09:38Well, you know, it does
09:38 --> 09:39seem to be
09:39 --> 09:40a bit absurd
09:41 --> 09:42that we, of course, have
09:42 --> 09:44insurance coverage for many
09:45 --> 09:45unbelievably
09:46 --> 09:47expensive new drugs,
09:48 --> 09:50new drugs that oftentimes are
09:50 --> 09:51quite beneficial,
09:52 --> 09:54sometimes are somewhat beneficial.
09:56 --> 09:58But approaches like exercise and
09:58 --> 10:00dietary counseling and
10:01 --> 10:03psychosocial interventions, which are far
10:03 --> 10:04less expensive,
10:04 --> 10:06it seems like we have
10:06 --> 10:07to go through,
10:08 --> 10:09many, many hoops to try
10:11 --> 10:12to get those kinds of
10:12 --> 10:13services reimbursed.
10:15 --> 10:16I do think the culture's gonna be
10:16 --> 10:18changing. It used to
10:18 --> 10:19be a nice to have,
10:19 --> 10:20and I think it needs
10:20 --> 10:21to be a must have.
10:21 --> 10:22And I think any
10:23 --> 10:25comprehensive cancer center understands that,
10:25 --> 10:27and we just need
10:27 --> 10:28the rest of the culture
10:28 --> 10:29to catch up.
10:30 --> 10:30Now
10:31 --> 10:32the term survivorship
10:33 --> 10:34has sort of
10:35 --> 10:37been adjusted over the years.
10:37 --> 10:38And at one time, we
10:38 --> 10:40thought about survivorship as people
10:40 --> 10:41who had
10:41 --> 10:44completed cancer treatment and
10:44 --> 10:45were presumably
10:46 --> 10:48pretty likely to be cured.
10:48 --> 10:49I think we think of
10:49 --> 10:51it a little differently now.
10:51 --> 10:52And could you comment on
10:52 --> 10:53that?
10:53 --> 10:54Yeah.
10:55 --> 10:57I will say that my
10:57 --> 10:58understanding is way back in
10:58 --> 10:59the seventies,
11:00 --> 11:02patients were labeled as cancer
11:02 --> 11:03victims.
11:04 --> 11:06So the term
11:06 --> 11:08cancer survivor was meant to
11:08 --> 11:10combat that idea.
11:11 --> 11:11And,
11:13 --> 11:14there was a famous physician
11:14 --> 11:16named Fitzhugh Mullan who published
11:16 --> 11:18in the New England Journal
11:18 --> 11:19in nineteen eighty five, the
11:19 --> 11:20seasons of survival, and he
11:20 --> 11:22was a survivor himself. And
11:22 --> 11:24he said survivorship starts
11:24 --> 11:25at diagnosis.
11:25 --> 11:26And he
11:27 --> 11:28delegated it into certain phases,
11:28 --> 11:30so it's different when you're
11:30 --> 11:31in treatment versus right when
11:31 --> 11:33you finish treatment and you're
11:33 --> 11:34realizing you have a lot
11:34 --> 11:36of things to deal with.
11:36 --> 11:38And then long term survivorship,
11:38 --> 11:39you know,
11:40 --> 11:41probably that's a better label
11:41 --> 11:44for people who've survived many
11:44 --> 11:45years without a recurrence and
11:45 --> 11:47they enter into long
11:47 --> 11:48term surveillance. So
11:49 --> 11:50I think survivors are meant
11:50 --> 11:51to encompass
11:52 --> 11:53anyone with a diagnosis of
11:53 --> 11:54cancer.
11:55 --> 11:56It's really meant to be
11:56 --> 11:58from the diagnosis through the
11:58 --> 11:59span of life.
12:00 --> 12:02And, you know, again, recognizing
12:02 --> 12:03that this is not a
12:03 --> 12:05term that resonates with everyone,
12:07 --> 12:08not everybody agrees with it,
12:08 --> 12:10but it is some
12:10 --> 12:10way to
12:11 --> 12:13describe this population that deserves
12:13 --> 12:16these services especially to try
12:16 --> 12:17to make themselves feel better,
12:17 --> 12:18you know, during and after
12:18 --> 12:19cancer treatment.
12:21 --> 12:23Now in terms of the
12:23 --> 12:24trajectory of survivorship,
12:26 --> 12:26oftentimes,
12:27 --> 12:28patients
12:28 --> 12:30will be going through
12:31 --> 12:32treatment
12:33 --> 12:34for three months, six months,
12:34 --> 12:36a year, what have you.
12:36 --> 12:38Oftentimes, there may side effects
12:38 --> 12:38with that treatment.
12:39 --> 12:41They finish it, and they
12:41 --> 12:41think,
12:42 --> 12:43I'm home free.
12:44 --> 12:45Life is gonna be great
12:45 --> 12:46again.
12:46 --> 12:47And
12:47 --> 12:49surprisingly to many of our
12:49 --> 12:50patients,
12:50 --> 12:52they find that transition time
12:52 --> 12:53when they're done with treatment
12:54 --> 12:55to be a pretty scary
12:55 --> 12:57moment, one that at times
12:57 --> 12:58they get depressed
12:58 --> 13:00and anxious.
13:00 --> 13:02What's going on there?
13:04 --> 13:05Well, I think that
13:06 --> 13:08the post treatment phase and
13:08 --> 13:10entering into, you know, this
13:10 --> 13:11what we call extended survival,
13:13 --> 13:15regardless of your diagnosis, there's
13:15 --> 13:17several unifying themes. And
13:17 --> 13:17a lot of it can
13:17 --> 13:19be a fear of recurrence
13:20 --> 13:22and also some anxiety and
13:22 --> 13:23depression over
13:23 --> 13:24having
13:24 --> 13:25a lot of changes in
13:25 --> 13:26life.
13:27 --> 13:29We at Yale, I'll just
13:29 --> 13:30mention, have a multidisciplinary
13:31 --> 13:32clinic that's meant to see
13:32 --> 13:33patients in this
13:34 --> 13:36time between visits, right after
13:36 --> 13:38treatment ends and maybe in
13:38 --> 13:39the first three, six,
13:39 --> 13:41nine, or twelve months to
13:41 --> 13:41really
13:42 --> 13:44realize how we can optimize
13:44 --> 13:45health going forward.
13:45 --> 13:47So I think that it's
13:47 --> 13:48a real phenomenon and
13:48 --> 13:49at least almost
13:49 --> 13:51forty percent of patients suffer
13:51 --> 13:52from depression, anxiety,
13:53 --> 13:55cancer related fatigue,
13:55 --> 13:57loss of physical performance, insomnia,
13:58 --> 13:59and that's where
13:59 --> 13:59a multidisciplinary
14:00 --> 14:02clinic or specialists within a
14:02 --> 14:03cancer center can really help
14:04 --> 14:06get patients back on track.
14:07 --> 14:09That's very helpful.
14:09 --> 14:10We're gonna take just a
14:10 --> 14:11minute now,
14:12 --> 14:12and,
14:13 --> 14:15we'll be back
14:16 --> 14:17shortly. And we'll continue our
14:17 --> 14:18conversation
14:18 --> 14:20with Tara Sanft,
14:20 --> 14:22chief patient experience officer,
14:22 --> 14:24director of survivorship
14:24 --> 14:26at Yale
14:26 --> 14:27Cancer Center.
14:28 --> 14:29Support for Yale Cancer Answers
14:29 --> 14:31comes from Smilow Cancer Hospital,
14:32 --> 14:33where all patients have access
14:33 --> 14:35to cutting edge clinical trials
14:35 --> 14:37at several convenient locations throughout
14:37 --> 14:39the region. To learn more,
14:39 --> 14:41visit smilow cancer hospital dot
14:41 --> 14:41org.
14:43 --> 14:46The American Cancer Society estimates
14:46 --> 14:47that more than sixty five
14:47 --> 14:49thousand Americans will be diagnosed
14:49 --> 14:49with cancer.
15:01 --> 15:03Clinical trials are currently underway
15:03 --> 15:06at federally designated comprehensive cancer
15:06 --> 15:06centers,
15:06 --> 15:08such as Yale Cancer Center
15:08 --> 15:10and at Smilow Cancer Hospital,
15:10 --> 15:12to test innovative new treatments
15:12 --> 15:13for head and neck cancers.
15:14 --> 15:16Yale Cancer Center was recently
15:16 --> 15:18awarded grants from the National
15:18 --> 15:19Institutes of Health to fund
15:19 --> 15:21the Yale Head and Neck
15:21 --> 15:22Cancer Specialized
15:22 --> 15:24Program of Research Excellence,
15:24 --> 15:25or SPORE,
15:26 --> 15:27to address critical barriers to
15:27 --> 15:29treatment of head and neck
15:29 --> 15:31squamous cell carcinoma due to
15:31 --> 15:33resistance to immune DNA damaging
15:33 --> 15:35and targeted therapy.
15:35 --> 15:37More information is available at
15:37 --> 15:39yale cancer center dot org.
15:39 --> 15:41You're listening to Connecticut Public
15:41 --> 15:41Radio.
15:43 --> 15:45Welcome back. This is Eric
15:45 --> 15:46Winer with the second half of
15:46 --> 15:48Yale Cancer Answers for this
15:48 --> 15:49evening. I'm here with my
15:49 --> 15:52guest, doctor Tara Sanft, associate
15:52 --> 15:52professor
15:53 --> 15:55of medicine at Yale School
15:55 --> 15:56of Medicine and
15:57 --> 15:59chief patient experience officer.
16:00 --> 16:02So, Tara, could you
16:02 --> 16:04just expand a little further
16:04 --> 16:06in this conversation about survivorship,
16:07 --> 16:08about what kinds of services
16:09 --> 16:10are available to survivors,
16:11 --> 16:12not just
16:12 --> 16:14at major medical centers, but
16:14 --> 16:15in the community?
16:16 --> 16:18Yes. I will say that
16:18 --> 16:20again, because of
16:20 --> 16:21the issues we talked about
16:21 --> 16:23before regarding insurance reimbursement,
16:24 --> 16:25a lot of these programs
16:27 --> 16:28can be
16:28 --> 16:30inaccessible to people. And
16:30 --> 16:31again, that's one of the
16:31 --> 16:32things that I think we
16:32 --> 16:33hope to change with our
16:33 --> 16:34efforts at Yale.
16:35 --> 16:38But within institutions, there's often
16:39 --> 16:40programs that cancer survivors have
16:40 --> 16:42direct access to because they're
16:42 --> 16:43patients there.
16:43 --> 16:44So those include
16:45 --> 16:46oncology rehab
16:46 --> 16:48services, physical therapy,
16:49 --> 16:49dietitians,
16:50 --> 16:51social workers,
16:52 --> 16:53who can oftentimes provide counseling
16:54 --> 16:56and provide recommendations
16:56 --> 16:58for further treatments of depression
16:59 --> 16:59and anxiety.
17:01 --> 17:02In the communities,
17:03 --> 17:04there are organizations
17:05 --> 17:06like LiveStrong at
17:06 --> 17:07the Y program, which is
17:07 --> 17:09a really creative,
17:11 --> 17:13excellent program. If your local
17:13 --> 17:13YMCA
17:13 --> 17:14offers this and you're a
17:14 --> 17:16cancer survivor, I highly suggest
17:16 --> 17:18that you look into it.
17:18 --> 17:19And it is
17:19 --> 17:21a pretty comprehensive program
17:21 --> 17:23for some number of weeks.
17:23 --> 17:24I think it's twelve weeks
17:24 --> 17:24and it's
17:25 --> 17:27geared towards cancer survivors to
17:27 --> 17:29optimize their health. And as
17:29 --> 17:30we've talked about before, a
17:30 --> 17:31lot of that includes things
17:31 --> 17:32like diet and exercise.
17:33 --> 17:34But there's also a community
17:35 --> 17:37there of survivors that naturally
17:37 --> 17:38forms when people participate.
17:40 --> 17:42And there's also places like
17:42 --> 17:44Gilda's Club or in Connecticut,
17:44 --> 17:46we have a wonderful resource
17:46 --> 17:47called Anne's Place,
17:48 --> 17:50that can help patients get
17:50 --> 17:52connected with various services and
17:52 --> 17:53and support groups.
17:54 --> 17:55So I'm gonna ask you
17:55 --> 17:56to do what is almost
17:56 --> 17:56the impossible.
17:58 --> 17:59There's a a certain negative
17:59 --> 18:02connotation associated with elevator pitches,
18:02 --> 18:03but
18:03 --> 18:04I would actually like
18:04 --> 18:06you to give me the
18:06 --> 18:07elevator pitch to the cancer
18:08 --> 18:10survivor, to the person who's
18:10 --> 18:10had cancer,
18:11 --> 18:12is either living with it
18:12 --> 18:14or is past that diagnosis
18:15 --> 18:15and is
18:16 --> 18:17hoping to do well the
18:17 --> 18:18rest of their life,
18:18 --> 18:20still struggling with
18:21 --> 18:22some of the
18:22 --> 18:24aftermath of the diagnosis.
18:25 --> 18:26And what would you tell
18:26 --> 18:27them in terms of
18:28 --> 18:29leading the best life they
18:29 --> 18:30can at that moment?
18:31 --> 18:33Well, I'm gonna pretend
18:33 --> 18:34you're one of my patients.
18:36 --> 18:37Please, please do.
18:37 --> 18:37I would say,
18:37 --> 18:39listen, if you're struggling after
18:39 --> 18:41cancer treatment, you are not
18:41 --> 18:41alone.
18:42 --> 18:43This is very
18:44 --> 18:46normal for patients to feel
18:46 --> 18:48completely untethered after cancer treatment.
18:49 --> 18:51And there's lots of issues
18:51 --> 18:52that can happen,
18:53 --> 18:55and there's lots of people
18:55 --> 18:56who wanna help.
18:56 --> 18:57And I will say
18:57 --> 18:59one size doesn't fit all.
18:59 --> 19:00So this is not,
19:01 --> 19:02there's not one thing that
19:02 --> 19:03you can do that's gonna
19:05 --> 19:06be right for everyone. So
19:06 --> 19:07why don't we talk about
19:07 --> 19:09what all is bothering you
19:09 --> 19:10and try to get you
19:10 --> 19:11into the most personalized
19:12 --> 19:14response that we can and
19:14 --> 19:15into a place of recovery
19:15 --> 19:17so that you
19:17 --> 19:19start to feel better. I'll
19:19 --> 19:20also say out of experience
19:21 --> 19:21that
19:22 --> 19:23these feelings and all
19:23 --> 19:25of this doesn't last forever.
19:25 --> 19:26There's a period of time
19:26 --> 19:27and after which,
19:28 --> 19:30cancer won't be on the
19:30 --> 19:31top of your mind every
19:31 --> 19:32day. But if we can
19:32 --> 19:34get that sooner, that relief
19:35 --> 19:36of having to deal with
19:37 --> 19:38the burden of being treated
19:38 --> 19:40and the side effects,
19:40 --> 19:41if we can get you
19:41 --> 19:42relief sooner, let's do that
19:42 --> 19:44and let's take advantage of
19:44 --> 19:45everything that we have. That's
19:45 --> 19:47great. And I think importantly,
19:47 --> 19:48you know, some of our
19:48 --> 19:50patients will say, oh, I
19:50 --> 19:52don't need help. I have
19:52 --> 19:53three very close friends, or
19:53 --> 19:55my family is very supportive.
19:55 --> 19:57And I think one of
19:57 --> 19:58the messages we sometimes have
19:58 --> 20:00to communicate is,
20:00 --> 20:01that's great that you have
20:01 --> 20:03these people, but sometimes there's
20:03 --> 20:04a real role
20:04 --> 20:06for some professional
20:06 --> 20:06assistance
20:07 --> 20:08and
20:09 --> 20:10assistance from people who are
20:10 --> 20:11not necessarily
20:12 --> 20:14so intimately involved in your life.
20:16 --> 20:17Yeah. And, you know, I'll
20:17 --> 20:17just say that,
20:18 --> 20:20experts in cancer care, whatever
20:20 --> 20:21field it is,
20:22 --> 20:23they understand
20:24 --> 20:26a broader landscape than
20:26 --> 20:28arguably a few good friends,
20:28 --> 20:29right? So they can really
20:29 --> 20:30help,
20:31 --> 20:33share strategies that work for
20:33 --> 20:35patients in similar situations because
20:35 --> 20:37they are the experts in
20:37 --> 20:37that field.
20:38 --> 20:39You know, for instance, a
20:39 --> 20:40really good friend can help
20:40 --> 20:42you feel better, but do
20:42 --> 20:43they know about meaning centered
20:43 --> 20:45therapy and making sense of
20:45 --> 20:46what you've just been
20:46 --> 20:47through as it relates to
20:47 --> 20:48the context and the story
20:48 --> 20:49of your life?
20:50 --> 20:51Our social workers know
20:51 --> 20:53that, and they can help
20:53 --> 20:55counsel patients on how to
20:55 --> 20:56make meaning out of what
20:56 --> 20:57just happened. And so
20:57 --> 20:59that's just one small example
20:59 --> 21:00of how the expertise,
21:01 --> 21:02I think, is invaluable. And
21:02 --> 21:03if you have access to
21:03 --> 21:04it,
21:04 --> 21:05why not help
21:05 --> 21:06yourself?
21:07 --> 21:08Well, your other role, of
21:08 --> 21:10course, is chief patient experience
21:10 --> 21:11officer at Smilow.
21:12 --> 21:14Patient experience is such a
21:14 --> 21:15huge topic
21:15 --> 21:16that I'd actually like to
21:16 --> 21:19focus down on one specific
21:19 --> 21:20area at least to begin
21:20 --> 21:21with,
21:21 --> 21:23although we may spend most
21:23 --> 21:24of the rest of the
21:24 --> 21:26time talking about that. And
21:26 --> 21:28that is the area of,
21:28 --> 21:29I won't say physician, I'm
21:29 --> 21:31gonna specifically say clinician
21:32 --> 21:32patient
21:33 --> 21:33communication.
21:34 --> 21:35And
21:35 --> 21:36I often
21:36 --> 21:37tell people
21:38 --> 21:40that when you're totally healthy,
21:40 --> 21:42the part of your quality
21:42 --> 21:43of life that is made
21:43 --> 21:45up by your relationship with
21:45 --> 21:47your medical team is tiny.
21:47 --> 21:49Doesn't matter for many people
21:49 --> 21:51who their primary care doctor
21:51 --> 21:52is exactly,
21:53 --> 21:54and they're just not having
21:54 --> 21:55enough contact.
21:56 --> 21:57But the minute you enter
21:58 --> 21:58an illness
21:59 --> 21:59situation,
22:00 --> 22:02it becomes really important that
22:02 --> 22:04that relationship with
22:04 --> 22:05the health care team
22:05 --> 22:06be right.
22:07 --> 22:07And a lot of that
22:07 --> 22:08is about communication.
22:09 --> 22:09So
22:10 --> 22:11talk to us a little
22:11 --> 22:12bit about
22:13 --> 22:14what you think
22:15 --> 22:17patients want in terms of,
22:17 --> 22:19communication with their team
22:20 --> 22:21and how we can get
22:21 --> 22:22better at it because, of
22:22 --> 22:23course,
22:23 --> 22:24not all
22:24 --> 22:26clinicians are created equally.
22:26 --> 22:28Yeah. So I think that,
22:28 --> 22:29you know, you're touching on
22:29 --> 22:30something that when you become
22:30 --> 22:31ill,
22:31 --> 22:33that's a time of vulnerability.
22:34 --> 22:35And so it's fine if
22:35 --> 22:36everything's
22:37 --> 22:38working well and you just
22:38 --> 22:39need,
22:39 --> 22:40you know, a little checkup,
22:40 --> 22:42it doesn't feel as heavy.
22:42 --> 22:43But when you're very vulnerable,
22:43 --> 22:44and I would argue that
22:44 --> 22:45cancer is one of the
22:45 --> 22:47most vulnerable positions to be
22:47 --> 22:48put into,
22:49 --> 22:51you wanna feel and we
22:51 --> 22:52know this from data that,
22:53 --> 22:55patients want to feel seen,
22:55 --> 22:56heard, and understood.
22:57 --> 22:58They want to be known
22:58 --> 23:00as a human, not just
23:00 --> 23:01the patient with breast cancer
23:01 --> 23:02down the hall.
23:04 --> 23:05I think that
23:06 --> 23:07physicians and clinicians
23:08 --> 23:10battling high burnout rates as
23:10 --> 23:11a culture in
23:11 --> 23:12medicine,
23:13 --> 23:14you know, that is the
23:14 --> 23:15point that's why they
23:15 --> 23:16got into the field that
23:16 --> 23:18they want to help
23:18 --> 23:18people.
23:20 --> 23:21And they understand
23:21 --> 23:23that these patients are very
23:23 --> 23:25vulnerable and they want to
23:25 --> 23:26make them feel seen, heard,
23:26 --> 23:28and understood. Now I would
23:28 --> 23:29say that we didn't all
23:29 --> 23:29learn
23:30 --> 23:32communication skills the same way.
23:33 --> 23:33And
23:33 --> 23:34people say, yeah, but I'm
23:34 --> 23:36really good at talking.
23:37 --> 23:38But there's actual skills that
23:38 --> 23:40we can practice
23:40 --> 23:42and that we can employ
23:42 --> 23:44with all patients that are
23:44 --> 23:45much more likely to lead
23:45 --> 23:47to better outcomes and better
23:47 --> 23:49relationships if we just repeat
23:49 --> 23:50those over and over again.
23:50 --> 23:51And I'm happy to talk
23:51 --> 23:52about some of those details.
23:53 --> 23:55Sure. I think hearing some
23:55 --> 23:56of those details would
23:56 --> 23:57be great.
23:58 --> 24:00When I see patients who
24:00 --> 24:00have
24:01 --> 24:04come from some other facility,
24:04 --> 24:05there are
24:05 --> 24:08oftentimes people with cancer who,
24:08 --> 24:09you know, adore
24:09 --> 24:10their health care team and
24:10 --> 24:12feel completely in sync and
24:12 --> 24:13have had great communication.
24:14 --> 24:15And there are times when
24:15 --> 24:17it's just not as good.
24:18 --> 24:20And I often wonder what
24:20 --> 24:21in those situations where it
24:21 --> 24:22hasn't been as good, what's
24:22 --> 24:23gone wrong?
24:24 --> 24:26I think there's, again, a few
24:26 --> 24:27things that we can do
24:28 --> 24:30with every patient that sets
24:30 --> 24:31us up for success.
24:32 --> 24:33And, you know, it sounds,
24:34 --> 24:35simple, but you really do
24:35 --> 24:36need to be mindful about
24:36 --> 24:37these things. So the first
24:37 --> 24:39thing is to build rapport
24:39 --> 24:40with a patient. And there's
24:40 --> 24:41no better time to do
24:41 --> 24:42that than right at the
24:42 --> 24:44beginning of meeting them,
24:44 --> 24:46which really means understanding
24:47 --> 24:48who they are. And it
24:48 --> 24:49can be a few go
24:49 --> 24:50to things like where they
24:50 --> 24:52live, who they live with,
24:52 --> 24:53what they do.
24:53 --> 24:55Those are very simple. But
24:55 --> 24:57also things like what's most
24:57 --> 24:59important to them or how
24:59 --> 24:59have they handled,
25:00 --> 25:01you know, vulnerabilities
25:02 --> 25:03or medical illnesses in
25:03 --> 25:04the past.
25:05 --> 25:06Building rapport
25:06 --> 25:07builds trust.
25:08 --> 25:09And it starts to change
25:09 --> 25:11the relationship because I think
25:11 --> 25:12the clinicians also start to
25:12 --> 25:13see that person as not
25:13 --> 25:14just a new breast cancer
25:14 --> 25:16patient, but, you know, a
25:16 --> 25:17teacher who came an hour
25:17 --> 25:19away and is missing work,
25:20 --> 25:21and has a couple of
25:21 --> 25:22kids at home. Right? So
25:22 --> 25:23those are very valuable things.
25:25 --> 25:27And the second skill that
25:27 --> 25:28we need to employ every
25:28 --> 25:29time
25:29 --> 25:30is listening
25:31 --> 25:32without interruption.
25:33 --> 25:34So,
25:35 --> 25:36we might think that we're
25:36 --> 25:37good at this, but this
25:37 --> 25:38is a skill that we
25:38 --> 25:39need to practice and, you
25:39 --> 25:40know, research has shown
25:41 --> 25:41that
25:41 --> 25:43doctors in particular,
25:44 --> 25:46interrupt their patients around eleven
25:46 --> 25:46seconds,
25:48 --> 25:50which means that patients barely
25:50 --> 25:51get their story out before
25:51 --> 25:52I'm sorry. You're done with
25:52 --> 25:53that.
25:54 --> 25:55And even if it's something
25:55 --> 25:57simple like, wait. When was
25:57 --> 25:58that? Right? Like, I'm engaged.
25:58 --> 25:59I wanna know.
26:00 --> 26:01Now you've just sent a
26:01 --> 26:02signal.
26:03 --> 26:04I'm in charge. I
26:04 --> 26:05wanna know an answer to
26:05 --> 26:06a question. And, also,
26:06 --> 26:07we know that eighty percent
26:07 --> 26:08of patients never get back
26:08 --> 26:09to their train of thought
26:09 --> 26:11once they're interrupted. So it's
26:11 --> 26:11really
26:12 --> 26:13important to let them tell
26:13 --> 26:14their story.
26:14 --> 26:16And I'll say one last
26:16 --> 26:16fact.
26:17 --> 26:18You know,
26:18 --> 26:20the vast majority of patients
26:20 --> 26:20finish
26:21 --> 26:22the bulk of their story
26:22 --> 26:23and they
26:23 --> 26:25do a natural pause by
26:25 --> 26:26ninety seconds.
26:26 --> 26:27So I know we all
26:27 --> 26:29remember the big talkers
26:29 --> 26:30who need to be
26:30 --> 26:31interrupted at five minutes, but
26:31 --> 26:33they're a small segment of
26:33 --> 26:34the population.
26:35 --> 26:36Sure. And,
26:37 --> 26:38you know, I would argue
26:38 --> 26:38that
26:39 --> 26:41cancer in particular, but many
26:41 --> 26:42other health care fields
26:43 --> 26:44are areas where
26:45 --> 26:47if as a clinician,
26:47 --> 26:48if as a physician,
26:49 --> 26:50you don't like talking to
26:50 --> 26:52people and hearing their stories,
26:53 --> 26:53then
26:54 --> 26:55maybe it's not quite the
26:55 --> 26:56right role for you.
26:59 --> 27:00I agree with you,
27:00 --> 27:01and I think that we try
27:03 --> 27:05to squeeze everybody into these
27:06 --> 27:07round holes. And if you're
27:07 --> 27:08a square peg,
27:08 --> 27:10there's value in all the
27:10 --> 27:11cancer work that you're doing.
27:11 --> 27:12It just might not be
27:12 --> 27:13in the frontline
27:14 --> 27:14relationship.
27:15 --> 27:16Or it might be with
27:16 --> 27:18some coaching from somebody
27:19 --> 27:20who can help that person
27:21 --> 27:22reevaluate
27:22 --> 27:23their approach and
27:24 --> 27:26learn some of these communication
27:26 --> 27:28skills.
27:28 --> 27:30I'm curious about
27:30 --> 27:31this. Have you found that
27:31 --> 27:32you have worked with
27:34 --> 27:34physicians
27:35 --> 27:35around communication
27:36 --> 27:37and
27:37 --> 27:39that as a result of
27:39 --> 27:40that work, they have come
27:40 --> 27:41to
27:42 --> 27:44enjoy their work and value
27:44 --> 27:45it in a way that
27:45 --> 27:46they didn't in the past?
27:47 --> 27:48Yeah. Actually, I just you
27:48 --> 27:49know, just a few weeks
27:49 --> 27:51ago, I had a physician
27:51 --> 27:52in our group
27:53 --> 27:54mention to me that he
27:54 --> 27:56changed his behavior after he
27:56 --> 27:58went through a communication skills
27:58 --> 27:58workshop.
27:58 --> 28:00Again, we teach some pretty
28:00 --> 28:01basic skills, but to him,
28:01 --> 28:03it was life changing.
28:03 --> 28:04And it was the
28:04 --> 28:05listening without interruption.
28:06 --> 28:07He's a wonderful physician. He's
28:07 --> 28:09always been well regarded. But
28:09 --> 28:10to him,
28:10 --> 28:11he would interrupt
28:12 --> 28:14frequently, and he didn't realize
28:14 --> 28:15that until he took the
28:15 --> 28:17workshop and practiced the skills.
28:17 --> 28:18And afterwards,
28:19 --> 28:20it really changed his
28:20 --> 28:22outlook, and I think
28:22 --> 28:24that's not the only example.
28:24 --> 28:25There's lots of people who
28:25 --> 28:27say that it's really changed
28:28 --> 28:30how they perceive their relationships
28:30 --> 28:32with patients that strengthened them,
28:32 --> 28:33which makes us enjoy our
28:33 --> 28:35work even more.
28:35 --> 28:36Dr. Tara Sanft is an associate professor
28:36 --> 28:38of medicine and medical oncology
28:38 --> 28:40and hematology at the Yale
28:40 --> 28:41School of Medicine.
28:41 --> 28:42If you have questions, the
28:42 --> 28:44address is cancer answers at
28:44 --> 28:45yale dot e d u,
28:45 --> 28:46and past editions of the
28:46 --> 28:48program are available in audio
28:48 --> 28:49and written form at yale
28:49 --> 28:51cancer center dot
28:51 --> 28:52org. We hope you'll join
28:52 --> 28:53us next time to learn
28:53 --> 28:54more about the fight against
28:54 --> 28:55cancer.
28:55 --> 28:57Funding for Yale Cancer Answers
28:57 --> 28:58is provided by Smilow Cancer
28:58 --> 28:59Hospital.

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50 Years of Cancer Progress - Survivorship with guest Dr. Tara Sanft February 2, 2025

Yale Cancer Center

visit: http://www.yalecancercenter.org

email: canceranswers@yale.edu

call: 203-785-4095