Dealing with Cancer During COVID

September 21, 2020

Information

September 20, 2020

Yale Cancer Center

visit: http://www.yalecancercenter.org

email: canceranswers@yale.edu

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00:00Support for Yale Cancer Answers
00:03comes from AstraZeneca dedicated
00:05to advancing options and providing
00:08hope for people living with
00:11cancer. More information at astrazeneca-us.com.
00:14Welcome to Yale Cancer
00:15Answers with your host
00:17Doctor Anees Chagpar.
00:19Yale Cancer Answers features the
00:20latest information on cancer care by
00:23welcoming oncologists and specialists
00:24who are on the forefront of the
00:27battle to fight cancer. This week,
00:29it's a conversation about Integrative
00:30Medicine and the challenges
00:32of dealing with cancer during
00:34the pandemic with Doctor Gary
00:35Soffer. Doctor Soffer is the director of
00:38the Integrative Medicine Program at
00:40Smilow Cancer Hospital and an assistant
00:42professor of clinical Pediatrics
00:44at the Yale School of Medicine
00:46where doctor Chagpar is a
00:48professor of surgical oncology.
00:51Gary, maybe we can start off by you telling
00:54us a little bit more about yourself and
00:56about what exactly you do.
00:58Sure, and it's funny,
00:59I always start my integrative medicine
01:02appointments with, tell me about
01:03yourself, and the patients tend to
01:05dive into their cancer diagnosis.
01:07So I correct them and
01:10I'm going to avoid that.
01:12I'm going to say I'm a father of two.
01:15I am happily married.
01:16We live in Connecticut and
01:18I enjoy things like yoga and
01:20meditation and I love my job.
01:22But I will talk about what people are
01:24probably a little more interested in,
01:27which is what I actually do.
01:29I specialize in something
01:31called Integrative Medicine,
01:32and I also specialize in something
01:34called allergy and immunology.
01:36I think for awhile people saw this
01:38as a strange combination,
01:40but as COVID was coming up I think
01:42the conversations about Integrative
01:44Medicine and immunology are
01:45becoming more and more prevalent,
01:47so it's giving me an interesting
01:50space to talk about these things.
01:53Maybe dive a little bit more into
01:54what exactly is integrative medicine.
01:57I think it's one of these terms
01:59that might be a little confusing to people.
02:02Yeah, it's a little confusing to
02:04me to be quite honest, and
02:07it really does depend on where you look,
02:10and I think each individual
02:12practitioner of Integrative Medicine,
02:13for better or for worse,
02:15sort of has their own take on it.
02:17But the way I see it is
02:20that integrative medicine just simply
02:22incorporates into conventional care
02:24and what kept people healthy before
02:26the advent of modern medicine and
02:28all these wonderful things that
02:30we have and bringing that in and
02:32reminding ourselves these things
02:34did have value and they had importance.
02:37And then
02:38the other thing that we really think
02:41about is what is the least invasive
02:43way to make a patient feel better?
02:47And sometimes it's about helping the cancer,
02:49but sometimes it's just also
02:51about changing the journey
02:53and changing how they feel about
02:55their disease and how they experience
02:58their disease day to day.
03:00I mean the least invasive way to make
03:04somebody feel better might be not to
03:07treat a cancer with things like surgery,
03:10radiation, or chemotherapy,
03:11but it sounds like that's not really
03:15where you're at?
03:18I'm speaking to the patient and
03:21respecting their autonomy and
03:23understanding where they're coming from.
03:25I'm on the side of conventional
03:28medicine in the sense that I
03:31believe in my heart that
03:33is the best cure for cancer,
03:35but sometimes that's not what the
03:37patient is looking for and we
03:38have to understand that and we
03:40have to have that conversation.
03:45And it's important
03:50to ask the question of why do patients
03:52seek out integrative medicine?
03:54What are they looking for?
03:56And it's easy to say, well,
03:58they're looking for more natural options,
04:00and that's true to a certain degree,
04:03but I think what we also have to understand
04:05is that they're looking for autonomy.
04:08They're looking for a way to
04:09participate in their care,
04:11and so if they do their research
04:13and they find some herb that their
04:15doctor didn't tell them about, well,
04:17that makes him feel empowered.
04:19It makes him feel a part of their care,
04:23and part of integrated medicine is
04:24giving the patients those tools
04:26and techniques in a safe way.
04:28That they can participate in
04:29their care and they don't just
04:31have to sit back and
04:33get the chemotherapy treatment
04:34done to them.
04:37I totally get that.
04:39And I think the other thing is
04:42that when you talk to patients
04:44and you ask them why are
04:47they seeking out integrative care?
04:50A lot of times it's because
04:52conventional care is scary,
04:53because chemotherapy is scary.
04:55People don't want to feel sick.
04:59They don't want to feel nauseous
05:03and I think that oftentimes I
05:05find that integrative care can
05:07actually help people to get through
05:10conventional treatments and get over
05:13that fear that helps them to
05:16get through that journey.
05:20There's a concept in
05:22Tibetan Buddhism called Duhkha and Duhkha
05:25roughly translates into suffering,
05:27but I really hate that translation and
05:30what I think it really means is feeling
05:33unsettled and this feeling of just constant
05:36stimulation in our head and this chatter
05:39that keeps going and going and going.
05:41And am I going to feel horrible?
05:43Am I going to feel nauseous?
05:50And what I try to remind them
05:52is at the anticipation of getting a
05:55shot or getting a needle is just so
05:58much worse than the needle itself.
06:00And that's not to diminish the
06:02sensations or the experiences that
06:04people have while on chemotherapy.
06:08But integrative medicine
06:10really can help in changing how we
06:13sort of view it, how we experience it,
06:17and how we approach all of
06:20these experiences.
06:22And let's unpack a
06:24little bit about that.
06:26So you know cancer is a
06:28scary diagnosis for anybody,
06:30no matter how strong you think
06:32you are deep down inside,
06:34everybody is a little bit fearful
06:36of not only the diagnosis but
06:38the treatment and the prognosis.
06:41So how do you use integrative
06:43medicine to get people to
06:45settle that unsettled feeling?
06:48I mean, we have lots of different
06:50techniques and
06:52obviously the things that come to mind,
06:54are mindfulness and yoga,
06:56but every patient is different
06:57and every patient needs to find
06:59that thing that does it for them.
07:01So I have patients who knit and that's
07:03a mindfulness exercise,
07:06but we don't really think about it that way,
07:08or drawing or coloring,
07:10or just finding ways to be present.
07:14And that's so important,
07:17but what about people who kind
07:19of have difficulty with that?
07:21because I think that
07:23oftentimes in mindfulness practice,
07:25people tell you to kind of focus on
07:28the present and be present and focus
07:30on the breath and so on and so forth.
07:33But for many patients I can just imagine
07:36that you know their head is going to spin,
07:39I just was diagnosed with cancer,
07:41I've got a doctors appointment in three days.
07:44My test results are coming back.
07:47I have to think about
07:49my next chemotherapy and on
07:51top of all of that,
07:53especially now we're living
07:55in this crazy world of Covid,
07:57so I'm worried about my kids
07:59getting infected.
08:00I'm worried about home schooling or whether
08:03they should go to school and how that
08:07affects me and all of that chatter.
08:12It just might be difficult
08:14to be mindful.
08:16So what tips do you have
08:19for people to
08:21settle that unsettled feeling?
08:24First of all, anybody who
08:25tells you they're a good
08:27meditator is a liar. It's hard work,
08:32and it's called a practice for a reason.
08:34It's because we're constantly
08:36striving for a little bit better.
08:38There's a concept
08:40in mindfulness and meditation that I
08:42talk to a lot of my patients about.
08:44Which is we can't
08:46control the first thought.
08:47Whatever pops into your head is human.
08:50It's natural,
08:51whatever comes into your mind is there.
08:54What we have control over is the
08:56second thought, and that's where the
08:58practice of mindfulness comes in.
08:59That's where we learn to exercise
09:01our brains in a way that say,
09:03OK, the first thought came in,
09:05but where's the second thought
09:07going to take me?
09:08Where are we going to go with this?
09:10This isn't a band aid.
09:12It's not a quick and easy fix,
09:15it takes work
09:16and it takes practice and
09:18ideally
09:18all of my patients have been meditating
09:20for years before they get the diagnosis.
09:23But let's be honest,
09:24the moment that they start to
09:26explore these ideas and think about
09:28them and see the value in them is
09:29truly is when they're struggling and
09:31when they're suffering and so we
09:32have to meet them there.
09:35And I can just imagine that
09:37it may be difficult,
09:39especially when you're thinking
09:41about everything else that's
09:42going on in the world now,
09:44to try to practice mindfulness.
09:46I mean, it's just one more
09:48thing and that might not be your
09:50thing, and that's sort of
09:52the beauty of Integrative Medicine
09:54is we have so many different tools
09:56in our toolbox to bring patients to
09:58that place and it may just not be
10:01about sitting cross legged some place.
10:03It may just be simply about going
10:05for a walk without your cell phone.
10:07That's a pretty mindful activity,
10:09but people don't think about it like that,
10:12So it's about
10:14looking at your patients,
10:16seeing what their value system is,
10:18seeing what's important to them
10:20and reminding them of that because
10:22it gets so lost all of a sudden you
10:25get a diagnosis and your medical record
10:27number and you're the next patient on
10:29the doctors schedule and you have 15
10:32minutes to ask whatever you want to
10:34ask your doctor and you forgot 12 of
10:37the questions you wanted to ask and
10:39then you leave and then you show up
10:42the next day and you get your chemotherapy.
10:44And nobody knows your name and nobody
10:47knows who you are and it can be a
10:51very depersonalizing experience when
10:53your entire experience is unique,
10:56what you're feeling is so unique
10:59and so independent.
11:02And you treat patients with breast cancer
11:05and you know every patient with breast
11:08cancer experiences it differently, their
11:10pathology, their genetics,
11:12everything might be identical on paper,
11:15but who they are,
11:16how they experience their disease
11:18is completely unique,
11:19and so I'm not going to prescribe
11:21mindfulness to everybody.
11:22I certainly don't,
11:24I think it's the wrong decision for people,
11:27but there are certain patients who it
11:29works well with and the reason why we
11:32like it so much is going back to
11:36this original concept of is
11:37this invasive?
11:38It's not really that invasive.
11:40Is this safe?
11:41It is safe,
11:43it's generally not a harmful
11:45practice for patients,
11:46and so it's a really
11:48helpful tool in the toolbox,
11:50but it's not the only one
11:53and the integrative
11:56medicine, as you say,
11:59has got so many tools in the toolbox,
12:03some of which are really
12:06kind of mindfulness based.
12:08But others are things that may
12:11stem from other ancient practices.
12:17So I can imagine things
12:20like complementary
12:22therapies with herbal supplements
12:25or acupuncture or acupressure.
12:27How do all of these other modalities play
12:31into a cancer patients journey as well?
12:35So again, it's about meeting
12:37patients where they are and what they are.
12:41Their hopes and expectations and
12:44what they want out of this.
12:46We have a lot of success with
12:49certain patients with acupuncture.
12:51Neuropathic patients who haven't been
12:54able to find anything else to help
12:56treat that pain or that discomfort.
12:58That's really helpful.
12:59I also find that
13:01finding a patients tradition and
13:03where they come from and their roots
13:06is also really meaningful.
13:07So oftentimes I will talk to patients
13:10of Indian descent and talk about
13:12Ayurveda because that's what their
13:14grandmother did and that grounds them.
13:17It roots them in something
13:19and on top of that,
13:21there are certainly certain herbs that
13:23come from Ayurveda that have been shown
13:26to be helpful in certain patients.
13:28Boswellia, for example,
13:30is a pretty safe
13:31herb to give patients and it can
13:33be helpful and they're looking
13:35for something like that.
13:40I think that concept of
13:42really meeting people where they
13:43are and letting them experience
13:45their journey and participate in
13:48their journey is so important.
13:49We're going to learn a lot more from
13:52about how to deal with cancer,
13:55particularly during these Covid times,
13:57right after we take a short
13:59break for a medical minute.
14:01Support for Yale Cancer Answers
14:03comes from AstraZeneca.
14:04A science led biopharmaceutical company
14:07dedicated to partnering across the
14:10oncology community to improve outcomes
14:13across various stages of cancer.
14:16More at astrazeneca-us.com.
14:20This is a medical minute about genetic
14:23testing which can be useful for
14:25people with certain types of cancer
14:27that seem to run in their families.
14:30Patients that are considered at risk
14:33receive genetic counseling and testing so
14:35informed medical decisions can be based
14:38on their own personal risk assessment.
14:40Resources for genetic counseling and
14:42testing are available at federally
14:44designated comprehensive cancer centers.
14:46Interdisciplinary teams include geneticists,
14:48genetic counselors, physicians,
14:49and nurses
14:50who work together to provide risk assessment
14:53and steps to prevent the development
14:55of cancer.
14:56More information is available
14:58at yalecancercenter.org.
14:59You're listening to Connecticut public radio.
15:04Welcome back to Yale Cancer Answers.
15:06This is doctor Anees Chagpar.
15:09I'm joined tonight by my guest doctor Gary
15:12Soffer. We are talking
15:14about dealing with cancer,
15:15particularly during the times of
15:17Covid and how integrative medicine
15:19can really help with that.
15:21Gary, before the break we
15:23were talking about cancer in general,
15:26being a really scary diagnosis and how
15:29integrative medicine can really help to
15:31meet patients where they are in that journey,
15:34and make it just a little bit more tolerable.
15:37But I can imagine that particularly
15:39now during Covid it's worse.
15:41What are you seeing from patients in terms
15:44of how they are coping with this?
15:48They might not be able to see
15:50their doctor face to face without
15:52a computer screen in between them.
15:55They may have had their therapies delayed.
15:57I can imagine that what is normally
16:00a stressful experience
16:01just got a whole lot more stressful.
16:05You know, it's interesting.
16:07I mentioned to you before that I see
16:10pediatric allergy and immunology patients
16:12in addition to my work at Smilow
16:15in integrative medicine.
16:16Cancer patients
16:18are really in a
16:20unique struggle right now and there is
16:22very real and practical concerns about
16:24their immune system being
16:27suppressed from their chemotherapy.
16:29The added loneliness that
16:30we talked about with
16:32cancer can be isolating.
16:34There's an added loneliness because now
16:36you're socially
16:38isolating from people,
16:39but I also find that many of my
16:42allergy immunology patients are doing
16:44worse because they haven't quite
16:46explored these greater esoteric
16:49questions that our cancer patients
16:51have. They haven't
16:54been forced to explore
16:57with the unknown and the unexpected.
17:00They haven't been forced to understand
17:02what it means when you're
17:05body isn't working in your favor.
17:08And sure they have
17:09their own conditions and their own diseases,
17:12but for the most part,
17:14the quality of life that they are
17:17experiencing is very, very different.
17:19You know our cancer patients have been
17:22through that journey to a certain degree,
17:25so sometimes it's just simply
17:27reminding them of what they've
17:29already persevered through and that
17:32this is simply a part of that journey.
17:36It's a mixed bag and there's no
17:38good answer.
17:41I will say this, we've started
17:43doing things almost completely
17:45virtually in integrative medicine.
17:47I was pretty reluctant at
17:49the beginning to do that.
17:51I figured,
17:52Integrative medicine is about touch
17:54and it's about this human connection,
17:59but I've been having really,
18:01really meaningful interactions with
18:03patients just over the Internet,
18:05and I think part of that is
18:07patients are in their environment,
18:10their comfortable they are at home
18:12that they love the most.
18:17I've really come to hate the term
18:19social distancing because I'm
18:21continuing to have very meaningful
18:23human social interactions with people.
18:26And yes, I'm physically distancing,
18:28that's for sure.
18:29But I'm certainly
18:31not socially
18:32distancing.
18:35I like to think of it as healthy distancing
18:38as opposed to social distancing.
18:41And something that you
18:44said really struck a chord with me,
18:47which is that you know,
18:49cancer patients often have gone
18:51through some of that mental journey
18:54of what's life about
18:57and what's meaningful and what matters.
18:59And I think that for others
19:03that this may be a whole new
19:07kind of concept to grapple with,
19:10and I find that so often many of my cancer
19:14patients really use this diagnosis as
19:19a teachable or
19:21a life changing moment.
19:23A chance to nurture relationships.
19:26They get even better.
19:29Prune some relationships that
19:31may not have been so healthy.
19:33Grab hold of experiences that
19:36they really want to savor.
19:38And that whole concept of gratitude
19:41and sucking the
19:44marrow out of life and knowing
19:47how vital it is to really
19:50experience all that life has to offer
19:53is something that cancer patients
19:56really often have come to.
20:02I think back about the moments
20:04that I really fell in love with the
20:06practice of Integrative Medicine.
20:08And I had done acupuncture
20:10when I was 13 and I had meditated
20:12a little older and I traveled
20:14around the world and saw
20:16different cultures that
20:17practice different ways.
20:18But one of the moments that I really,
20:20really knew this was something that was
20:23important to me was when I was reading
20:25the integrative medicine textbook.
20:27And it said the benefits of ADHD are.
20:30And I was like wow.
20:33The benefits of ADHD.
20:35I mean, I've been taught my entire life,
20:37this is a pathology.
20:39This is a disease, it is a problem.
20:41This needs to be medicated and
20:43it shifted my perspective and I
20:45brought that up to one patient at
20:47one point and they
20:50broke down in front of me and they said,
20:53You know
20:54this isn't how I
20:56would have wanted it,
20:58but I've strengthened my relationships.
21:00I've been reading more.
21:02I've been doing the things that I enjoy more.
21:05In some ways, I'm happier.
21:08And that is really what integrative
21:10medicine is about.
21:12I think that
21:14especially with this pandemic
21:15so many of us are going through
21:18that same sort of process.
21:20On the one hand,
21:25who knew everybody loved
21:26making sourdough bread?
21:29On the one hand we've had this
21:31virus and I don't want to diminish
21:34its effects at all.
21:36I mean, it certainly has caused
21:38so many people their lives.
21:40It has
21:42turned our economy upside down.
21:44It has
21:46really changed how we do so many things,
21:49but there's so much now
21:51that we're able to do that
21:53we didn't think that we could
21:55before and there are so many things
21:58that I'm now so grateful for.
22:00that I think I used to take for granted.
22:05This is what we were talking about before,
22:07right? The first thought is
22:09this is a horrible thing.
22:10Covid is a horrible thing.
22:12So what do we do with that thought?
22:14And this is where
22:15mindfulness practice comes in.
22:17What do we do with that thought?
22:19Do we continue down that path?
22:21This is horrible.
22:22I feel horrible.
22:22I can't stand this.
22:24Or do we say this is horrible,
22:27I'm going to go make my sourdough bread.
22:30I'm going to go take that course
22:32that I never took before online.
22:34This is horrible.
22:35I'm going to play my guitar for
22:37the first time in a very long time,
22:41Even though we're not diminishing what
22:43this means on a greater level,
22:46but there are so many opportunities here
22:48to better yourself
22:50and better your being and
22:51better your experience.
22:54I never thought that
22:56what I was doing in terms of
22:58being grateful or seeing
23:00the positives in a pandemic was
23:03really a mindfulness practice.
23:04But when you put it that way,
23:07I guess it kind of is.
23:10I like to think so.
23:12I want to dig into
23:15some of the the things that are
23:18really tragic about this pandemic,
23:21though because you know there are people
23:24who have been diagnosed with cancer.
23:26There are people who have been
23:29diagnosed with cancer during Covid.
23:31There are people who have lost
23:33their lives or their loved ones
23:36with one or both of those diagnosis.
23:39And sadly even in these times
23:41when you talk about human
23:44connection and not being able to
23:46be there to touch your patients.
23:47I can imagine what it feels like
23:49to be a family member who can't
23:51go to a funeral because of
23:54regulations regarding the
23:55number of people who can attend.
23:58How do you get people through that?
24:02You know, sometimes you don't.
24:03Sometimes you just let them be present.
24:06You know we have such a tendency
24:08to try to make people feel better.
24:10You know this will all be OK.
24:13This will all go away.
24:14This will all be better.
24:16Sometimes it's just a matter of letting them
24:19be in that moment and experience that moment
24:22because you know you can pardon my French,
24:25but it sucks.
24:29It's tough.
24:32And you want to be there and
24:34you can't be there and how you've
24:37been conditioned to experience
24:39humanity has been completely
24:40turned on its head and we have
24:43to give people permission to
24:45experience that and to be there.
24:52It really is difficult.
24:54And I can imagine how you know,
24:58talking to somebody like yourself,
25:00somebody who specializes
25:01in integrative medicine,
25:02somebody who has been practicing mindfulness
25:05for a long time can really give people
25:08that space to kind of explore.
25:10I want to get back into
25:13some of the other
25:16alternative therapies to that.
25:17Our listeners might be thinking
25:19about or wondering about.
25:21And I really loved that concept of
25:25trying to explore people's own cultures and
25:28what might resonate for them.
25:30But for people who are just kind of,
25:33you know, on the periphery of this,
25:36they may have heard about
25:38some of these things.
25:40Maybe some of their friends have told them,
25:45you really ought to try turmeric
25:47or vitamin C cleanses,
25:50or acupressure or whatever.
25:52Are there data
25:56that these practices can help?
26:00And is there a difference between
26:03using them as an alternative form of therapy?
26:08Or are they better positioned
26:10potentially to help with some of the
26:13side effects of standard therapy?
26:16Talk a little bit about how
26:18people who may be new to the whole
26:21space of complementary and alternative
26:24medicine might find out more?
26:27Yeah, so there's a lot to unpack.
26:30First and foremost,
26:34is an alternative option better.
26:35I don't believe so,
26:37and I don't think the research shows that.
26:40But what we provide is a space
26:42for you to ask those questions.
26:45So if we have patients on
26:46tons and tons of supplements,
26:49we work with the pharmacist to
26:51go over to see if they're safe
26:53and to see if they're beneficial.
26:56You know the state of research in
26:58Integrative Medicine
26:58certainly lacks,
26:59but that's why the questions of
27:02is this a burden to the patient,
27:05or is this safe for the patient becomes
27:09so important because sometimes
27:11things that are safe for the
27:14patient may also be effective.
27:17I think in conventional medicine
27:20our biggest issue is that we see
27:23medical treatment as a group of
27:261000 or 10,000 and out of 10,000 people
27:28this worked for 8000.
27:30That's a good number, right?
27:32That's a really good number,
27:34but we're ignoring the 2000 and then
27:38on the other side,
27:39we might look at this and say
27:42this only worked for 10 people out of 100.
27:45Well, if you're one of those 10 people,
27:49this could be really life changing.
27:51This could be really helpful,
27:53and so in Integrative Medicine it's
27:56important to give space for that while not
27:58coming against the wall or
28:00hurting the conventional treatment,
28:02which is probably the safest bet for you,
28:05which is probably the smartest
28:06decision for you, so with
28:08herbs and supplements,
28:09it takes more work diving in because
28:12there can be interactions but with other
28:14practices such as acupuncture,
28:15Massage Therapy,
28:16Reiki,
28:17these are practices that certainly
28:20data exists for some of them,
28:22but we also have to put it in
28:25the perspective of if it's safe
28:26and if it makes that patient,
28:29that individual that one person feel better,
28:31then it works,
28:32then
28:33it's meaningful and it's important to
28:35honor that patient and their individuality.
28:37And the great news is
28:39that you can do both.
28:41You know it isn't a one or the other.
28:45It frequently is both and so I think one
28:48of the critical things is to really,
28:51talk to your doctor,
28:53talk to your team and have that space
28:56to have that conversation so that you
28:59can take care of all of you.
29:03There are things that don't get talked about in that
29:0615 minutes that you're with your doctor.
29:09And that's things like sleep or
29:12nutrition or exercise and coming to
29:14Integrative Medicine and being given
29:17that space is so important to the care
29:20of the patient. NOTE Confidence: 0.865415930747986
29:22Dr. Gary Soffer is an assistant professor of
29:24clinical Pediatrics and director
29:26of the Integrative Medicine
29:28Program at Smilow Cancer Hospital,
29:30if you have questions,
29:32the address is canceranswers@yale.edu
29:33and past editions of the program
29:36are available in audio and written
29:38form at Yalecancercenter.org.
29:40We hope you'll join us next week to
29:42learn more about the fight against
29:44cancer here on Connecticut public radio.