Colorectal Cancer Awareness 2023

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 --> 00:12Yale Cancer Answers features the
00:12 --> 00:14latest information on cancer care
00:14 --> 00:15by welcoming oncologists and
00:15 --> 00:17specialists who are on the forefront
00:18 --> 00:19of the battle to fight cancer.
00:19 --> 00:22This week, it's a conversation about
00:22 --> 00:24colorectal cancer with Doctor Laura Baum.
00:24 --> 00:26Dr. Baum is an assistant professor
00:26 --> 00:28of medicine and medical oncology
00:28 --> 00:30at the Yale School of Medicine,
00:30 --> 00:32where Doctor Chagpar is a professor
00:32 --> 00:33of surgical oncology.
00:34 --> 00:36So Laura, maybe we can start off
00:36 --> 00:38by you telling us a little bit more
00:38 --> 00:40about yourself and what it is you do.
00:40 --> 00:43I'm a medical oncologist and
00:43 --> 00:47I'm also trained in palliative care.
00:47 --> 00:50That means that initially I did an
00:50 --> 00:52internal medicine residency and then I
00:52 --> 00:55did a fellowship in palliative care as
00:55 --> 00:58well as in medical oncology and hematology.
00:58 --> 01:03So I came here to Yale to serve in
01:03 --> 01:05the clinic taking care of patients
01:05 --> 01:08with gastrointestinal cancers,
01:08 --> 01:10which includes colorectal,
01:10 --> 01:13the most common gastrointestinal cancer.
01:13 --> 01:14In the clinic
01:14 --> 01:16I also see palliative
01:16 --> 01:18care consults in the hospital.
01:18 --> 01:22Let's look at both of
01:22 --> 01:24those kind of segments of your career.
01:24 --> 01:26But let's start with colorectal
01:26 --> 01:28cancer given that it is colorectal
01:28 --> 01:31Cancer Awareness Month.
01:31 --> 01:34Colorectal cancer is one of the most
01:34 --> 01:36common cancers that we see here in the
01:36 --> 01:39US, can you kind of give us a bit of
01:39 --> 01:41the landscape about how many patients
01:41 --> 01:44are diagnosed with colorectal cancer,
01:44 --> 01:46how many patients pass away and have
01:46 --> 01:48we seen any trends in improvement
01:48 --> 01:50in those statistics?
01:50 --> 01:54I would say that colorectal cancer,
01:54 --> 01:58I believe, is the 4th most common cancer in
01:58 --> 02:01the US maybe it's the third.
02:01 --> 02:03It's one of the most
02:03 --> 02:06common cancers we do see.
02:06 --> 02:08I think it's the fourth most common
02:08 --> 02:10cancer and the third most common
02:10 --> 02:12cancer death in the United States.
02:12 --> 02:16So the incidence meaning how many
02:16 --> 02:19people get colorectal cancer
02:19 --> 02:21has not significantly improved.
02:21 --> 02:22In fact, we're seeing more
02:22 --> 02:23younger people getting it,
02:23 --> 02:27but the treatments and how long people are
02:27 --> 02:30living with colorectal cancer has improved.
02:32 --> 02:35It's a complicated question.
02:35 --> 02:37It's going in both directions
02:37 --> 02:39all at the same time.
02:39 --> 02:40But you know,
02:40 --> 02:43it is definitely one of the
02:43 --> 02:44most common cancers,
02:44 --> 02:47one of the most common fatal
02:47 --> 02:49cancers both in the United States
02:49 --> 02:51just as far as numbers,
02:51 --> 02:54I think about 8% of all new
02:54 --> 02:58cancer cases in the United States
02:58 --> 03:00are colorectal and a similar
03:00 --> 03:02about 8% of all cancer deaths.
03:03 --> 03:06Yeah, I mean I think part of the reason
03:06 --> 03:10why colorectal cancer perhaps is seen
03:10 --> 03:14quite frequently is 2 pronged.
03:14 --> 03:17First, I think that there is general awareness
03:17 --> 03:20of colorectal cancer and the 2nd is
03:20 --> 03:23that we have screening modalities.
03:23 --> 03:25So let's talk about each of
03:25 --> 03:26those things in turn.
03:26 --> 03:29You know, in terms of colorectal cancer,
03:29 --> 03:32if people are going to be symptomatic,
03:32 --> 03:34if they're going to present
03:34 --> 03:34with symptoms,
03:34 --> 03:36can you talk a little bit about
03:36 --> 03:38what are the common symptoms that
03:38 --> 03:40patients may present with that
03:40 --> 03:43leads to people wondering about a
03:43 --> 03:44diagnosis of colorectal cancer?
03:45 --> 03:47Well, I think those questions really go
03:47 --> 03:50hand in hand because you know
03:50 --> 03:53ideally the goal of a screening
03:53 --> 03:58test is to find a cancer or a
03:58 --> 04:00problem early enough that finding
04:00 --> 04:01it earlier makes a difference,
04:01 --> 04:03meaning that finding it earlier
04:03 --> 04:04allows better treatment and
04:04 --> 04:06longer survival for something
04:06 --> 04:08that you would otherwise
04:08 --> 04:10not find symptomatically.
04:10 --> 04:12So many people with colorectal cancer
04:12 --> 04:15will not have symptoms they will
04:15 --> 04:18have a screening colonoscopy or
04:18 --> 04:20whatever it is and that would allow
04:20 --> 04:22diagnosis prior to having symptoms.
04:22 --> 04:25If colorectal cancer is diagnosed
04:25 --> 04:27based on symptoms,
04:27 --> 04:31the most common is bleeding in the stool,
04:31 --> 04:36so either red or black blood in the stool.
04:36 --> 04:38That can present as overt like
04:38 --> 04:41visible blood or as anemia.
04:41 --> 04:43That may be the primary care doctor
04:43 --> 04:45or somebody notices the patient has
04:45 --> 04:47iron deficiency anemia even though
04:47 --> 04:49they're not menstruating or they're
04:49 --> 04:52not bleeding from another known issue.
04:52 --> 04:53And I think that would be the
04:53 --> 04:55most common way it presents.
04:55 --> 04:56You know,
04:56 --> 04:58it can present in more serious ways upfront.
04:58 --> 05:01It can present as an obstruction
05:01 --> 05:02of the colon.
05:02 --> 05:06It can present with more advanced disease
05:06 --> 05:08as symptoms outside of the colon,
05:08 --> 05:09if it's spread,
05:09 --> 05:11it can present with weight loss.
05:12 --> 05:15If people are starting to lose
05:15 --> 05:17weight from their cancer diagnosis.
05:17 --> 05:19But ideally early colorectal cancer is
05:19 --> 05:22either asymptomatic or diagnosed with
05:22 --> 05:25a small amount of blood
05:25 --> 05:27found on some kind of screening exam
05:28 --> 05:30or noticed by the patient or a doctor.
05:30 --> 05:32So certainly if this is going to
05:32 --> 05:35be symptomatic, these are symptoms that a
05:35 --> 05:38lot of people are not going to ignore, right.
05:38 --> 05:40So if you certainly have blood in
05:40 --> 05:43your stool or you find that
05:43 --> 05:45you cannot pass stool, that you're
05:45 --> 05:47having some bloating and obstruction,
05:47 --> 05:51maybe you have weight loss or jaundice,
05:51 --> 05:53those are things that oftentimes will
05:53 --> 05:55prompt you to go and see a doctor.
05:55 --> 05:57But as you say, Laura,
05:57 --> 06:00it's ideal if colorectal cancer is picked
06:00 --> 06:03up early with a screening test and we
06:03 --> 06:07have so many screening tests now available.
06:07 --> 06:09But that brings me to the next question,
06:09 --> 06:11which is
06:11 --> 06:13in terms of colorectal screening,
06:13 --> 06:17given the fact that we have so many options,
06:17 --> 06:20fecal occult blood tests,
06:20 --> 06:23DNA tests like Cologuard, you know,
06:23 --> 06:25sigmoidoscopy, colonoscopy,
06:25 --> 06:28virtual colonoscopy, barium enema,
06:28 --> 06:30I mean we can go on and on.
06:30 --> 06:34There are so many options in terms of
06:34 --> 06:36colorectal screening and different intervals
06:36 --> 06:39at which these are each recommended.
06:39 --> 06:41It can get kind of confusing.
06:41 --> 06:44Can you layout kind
06:44 --> 06:46of the screening guidelines?
06:46 --> 06:48Who should get screened?
06:48 --> 06:50When should they start screening
06:50 --> 06:51with what and how frequently?
06:52 --> 06:54Sure. And I will just say to
06:54 --> 06:57your earlier point,
06:57 --> 06:59I think people are very capable
06:59 --> 07:02of ignoring even very serious
07:02 --> 07:04symptoms because they're afraid.
07:04 --> 07:07And so I would say that if you're
07:07 --> 07:10having symptoms
07:10 --> 07:11that you're worried about
07:11 --> 07:13think of it as being reassuring and
07:13 --> 07:15proactive to look into them rather than,
07:15 --> 07:18you know, letting them continue to develop
07:18 --> 07:20and presenting very late because of fear.
07:20 --> 07:21And I think that also can
07:21 --> 07:22hold true for screening tests.
07:22 --> 07:24Some people think that they
07:24 --> 07:25would rather not know.
07:25 --> 07:28But the truth is,
07:28 --> 07:30colorectal cancer screening
07:30 --> 07:32allows diagnosis while the cancer
07:32 --> 07:35is curable and manageable.
07:35 --> 07:37And the screening itself has really evolved.
07:38 --> 07:40So I'm going to confess a little
07:40 --> 07:42bit of ignorance about some
07:42 --> 07:44of the trends in screening.
07:44 --> 07:46Before I became an oncologist,
07:46 --> 07:48I was a primary care doctor.
07:48 --> 07:51And so that is really in their realm.
07:51 --> 07:54I think most oncologists have
07:54 --> 07:57a bias towards the colonoscopy.
07:57 --> 07:59I think most physicians that I
07:59 --> 08:01know use that as their sort of
08:01 --> 08:04what they would get for themselves.
08:04 --> 08:07It's the most evidence based
08:07 --> 08:09colorectal cancer screening.
08:10 --> 08:11If it's normal,
08:11 --> 08:14it's done approximately every 10 years.
08:14 --> 08:17But I think a lot of patients have some
08:17 --> 08:19fears about the bowel prep or having
08:19 --> 08:22the colonoscopy done and there's
08:22 --> 08:24been this development of other options.
08:24 --> 08:27So the most frequently discussed
08:27 --> 08:29is the high sensitivity
08:29 --> 08:32fecal occult blood testing.
08:32 --> 08:34That is a yearly test.
08:34 --> 08:36It's very similar to the fit test,
08:36 --> 08:39which is I think also done on the stool.
08:42 --> 08:44Those are both done annually
08:44 --> 08:47and the key I think is that
08:47 --> 08:49it has to be followed up,
08:49 --> 08:53you know if it's negative it has to be done
08:53 --> 08:55the next year again and if it's positive,
08:55 --> 08:57it has to be followed up with some
08:57 --> 08:59kind of more direct visualizing test.
08:59 --> 09:02So I don't remember the exact numbers,
09:02 --> 09:04but some very large percentage of
09:04 --> 09:06patients who get these fit tests or
09:06 --> 09:07these FBT mailed to their homes and
09:08 --> 09:09do them don't necessarily follow
09:09 --> 09:11through on having the colonoscopy afterwards.
09:11 --> 09:14So I think it's very important to
09:14 --> 09:16realize that the test only works
09:16 --> 09:18if you're going to react to the results.
09:20 --> 09:24So both of those direct stool tests are
09:24 --> 09:28annual and they require a colonoscopy if
09:28 --> 09:30they're positive for blood,
09:30 --> 09:31which also means if you have hemorrhoids
09:31 --> 09:33or some other kind of problem,
09:33 --> 09:37they're going to be less helpful as
09:37 --> 09:39far as the virtual colonoscopy.
09:40 --> 09:43I don't have a strong opinion.
09:43 --> 09:46I know it can be comforting to people
09:46 --> 09:49to not have the internal colonoscopy.
09:49 --> 09:53I think it has shown to be pretty effective.
09:53 --> 09:55But you know, obviously not the
09:55 --> 09:57same as the direct colonoscopy.
09:57 --> 09:59It doesn't allow for biopsy and
09:59 --> 10:01it doesn't allow for intervention.
10:01 --> 10:04So one goal of the colonoscopy is
10:04 --> 10:06early diagnosis, but another goal is
10:06 --> 10:09actually prevention, which is that
10:09 --> 10:12colon cancer usually develops from polyps.
10:12 --> 10:16So when a person has what's
10:16 --> 10:18called an adenoma, a colonoscopy,
10:18 --> 10:20if everything is normal,
10:20 --> 10:21they say everything looks normal and
10:21 --> 10:23you have another one in 10 years.
10:23 --> 10:24But oftentimes they'll say, oh,
10:24 --> 10:25we removed
10:25 --> 10:273 polyps, have another colonoscopy
10:27 --> 10:29in three years or five years or
10:29 --> 10:30whatever the gastroenterologist
10:30 --> 10:32thinks based on their appearance,
10:32 --> 10:35and then you're able to also remove those.
10:35 --> 10:37So it prevents and it's almost like
10:37 --> 10:39taking out a precancerous lesion,
10:39 --> 10:42like if you go for a skin check
10:42 --> 10:44and you did that virtually,
10:44 --> 10:46they wouldn't also be able to
10:46 --> 10:48biopsy what looks suspicious
10:48 --> 10:50or to remove a precancerous sort
10:50 --> 10:51of sun damage spot.
10:51 --> 10:53It's the same with the colon.
10:53 --> 10:56You want to be able to do the colonoscopy,
10:56 --> 10:59and also do whatever biopsies or
10:59 --> 11:01preventive removal of polyps is
11:01 --> 11:04needed depending on what they find.
11:05 --> 11:07I think that the benefit of
11:07 --> 11:09the stool testing is that it's easy,
11:09 --> 11:12it's at home, it's once a year.
11:12 --> 11:14The benefit of the colonoscopy
11:14 --> 11:16is that it's more thorough,
11:16 --> 11:18and it really depends on what you
11:18 --> 11:19feel you're capable of doing,
11:19 --> 11:22and I think both are very useful.
11:22 --> 11:26As far as timing, the old recommendations
11:26 --> 11:29were starting at age 50.
11:29 --> 11:30The new recommendations from
11:30 --> 11:32the US Preventive Task Force,
11:34 --> 11:38have recently gone down to age 45,
11:38 --> 11:40and that's based on the new trends
11:40 --> 11:43in colon cancer occurring earlier.
11:43 --> 11:45So colorectal cancer screening is
11:45 --> 11:48recommended for adults beginning at age 45.
11:48 --> 11:52Some guidelines say continuing until age 75,
11:52 --> 11:55but really the idea is that
11:55 --> 11:59it should continue until
11:59 --> 12:03somebody has like a life expectancy
12:03 --> 12:04let's say of 10 years.
12:04 --> 12:06Because you're looking to catch these
12:06 --> 12:08adenomas or these polyps early enough and
12:08 --> 12:10they take supposedly about
12:10 --> 12:1210 years to develop into cancer and
12:12 --> 12:14that's why they do it every 10 years.
12:14 --> 12:15So you're looking to have
12:15 --> 12:17for the screening test,
12:17 --> 12:18not for a diagnostic colonoscopy,
12:18 --> 12:20but for a screening test without
12:20 --> 12:22symptoms to do this for somebody
12:22 --> 12:24who has a 10 year life expectancy.
12:24 --> 12:26So we're not looking for colonoscopies
12:26 --> 12:28in the very, very elderly,
12:28 --> 12:30and we're trying to start around
12:30 --> 12:32the time that colorectal cancer
12:32 --> 12:34incidence is beginning, preempting it.
12:34 --> 12:36So starting around age 45,
12:36 --> 12:38I will say that people who have a
12:38 --> 12:40family history of colon cancer or
12:40 --> 12:42some kind of hereditary syndrome do
12:42 --> 12:44need to start earlier than age 45.
12:44 --> 12:46They need to start 10 years prior
12:46 --> 12:47to their youngest
12:47 --> 12:49family member. So if there's a
12:49 --> 12:51family history or a syndrome,
12:51 --> 12:52you know, of cancer,
12:52 --> 12:54colon cancer at age 37,
12:54 --> 12:57then you would start at age
12:57 --> 13:0127 and that's sort of the idea of screening
13:01 --> 13:04is that you're catching something early.
13:04 --> 13:05You're allowing early intervention
13:05 --> 13:07to make a difference in both,
13:07 --> 13:10in this case in both prevention
13:10 --> 13:12and treatment and prognosis.
13:12 --> 13:14Yeah, such good information.
13:14 --> 13:17We are going to take a short
13:17 --> 13:19break for a medical minute.
13:19 --> 13:21When we come back, we'll learn more
13:21 --> 13:23about colorectal cancer with my guest,
13:23 --> 13:24doctor Laura Baum.
13:25 --> 13:27Funding for Yale Cancer Answers
13:27 --> 13:29comes from Smilow Cancer Hospital,
13:29 --> 13:31where their cancer genetics and
13:31 --> 13:33prevention program includes a colon cancer
13:33 --> 13:35genetics and prevention program that
13:35 --> 13:37provides comprehensive risk assessment,
13:37 --> 13:40education, and screening.
13:40 --> 13:43Smilowcancerhospital.org.
13:43 --> 13:45It's estimated that over 240,000
13:45 --> 13:47men in the US will be diagnosed
13:47 --> 13:50with prostate cancer this year.
13:50 --> 13:52With over 3000 new cases being identified
13:52 --> 13:53here in Connecticut,
13:53 --> 13:55one in eight American men
13:55 --> 13:57will develop prostate cancer
13:57 --> 13:59in the course of his lifetime.
13:59 --> 14:01Major advances in the detection and
14:01 --> 14:03treatment of prostate cancer have
14:03 --> 14:04dramatically decreased the number
14:04 --> 14:06of men who die from the disease.
14:06 --> 14:08Screening can be performed quickly
14:08 --> 14:10and easily in a physician's
14:10 --> 14:12office using two simple tests,
14:12 --> 14:14a physical exam and a blood test.
14:14 --> 14:17Clinical trials are currently underway
14:17 --> 14:18at federally designated Comprehensive
14:18 --> 14:21cancer centers such as Yale Cancer
14:21 --> 14:23Center and Smilow Cancer Hospital,
14:23 --> 14:25where doctors are also using
14:25 --> 14:26the Artemis machine,
14:26 --> 14:28which enables targeted biopsies
14:28 --> 14:29to be performed.
14:29 --> 14:32More information is available
14:32 --> 14:33at yalecancercenter.org.
14:33 --> 14:35You're listening to Connecticut public radio.
14:37 --> 14:39Welcome back to Yale Cancer Answers.
14:39 --> 14:40This is doctor Anees Chagpar
14:40 --> 14:42and I'm joined tonight by my guest,
14:42 --> 14:44doctor Laura Baum.
14:44 --> 14:47We're talking about the care of patients
14:47 --> 14:49with colorectal cancer in honor of
14:49 --> 14:51Colorectal Cancer Awareness Month.
14:51 --> 14:52And right before the break,
14:52 --> 14:54Laura, you started talking about,
14:54 --> 14:55we were talking about screening
14:55 --> 14:57and the whole plethora of screening
14:57 --> 14:59tests that are out there.
14:59 --> 15:02You had mentioned that the USPSTF has
15:02 --> 15:06moved the age down to 45 to start
15:06 --> 15:08screening and certainly that can be
15:08 --> 15:11even earlier if you have a family
15:11 --> 15:13history of a colorectal cancer syndrome.
15:13 --> 15:16So you want to start screening 10
15:16 --> 15:18years younger than the youngest
15:18 --> 15:21person in your family got diagnosed.
15:21 --> 15:23Which leads us to the next question,
15:23 --> 15:24which is,
15:24 --> 15:26are there other risk factors aside
15:26 --> 15:29from family history that put you at
15:29 --> 15:30increased risk of colorectal cancer?
15:30 --> 15:33So often I find that patients are
15:33 --> 15:34always asking, what did I do,
15:35 --> 15:39is this caused by smoking or alcohol,
15:39 --> 15:43red meat, smoked meats, fats,
15:43 --> 15:44all of those kinds of things.
15:44 --> 15:46Can you talk a little bit about risk factors?
15:47 --> 15:49Sure. So I think the answer
15:49 --> 15:51to that question is yes.
15:51 --> 15:54It's caused by everything you said,
15:54 --> 15:55but the more important thing,
15:55 --> 15:56I think is that
15:56 --> 15:58so often when people are facing cancer
15:58 --> 16:01and they're asking what did I do?
16:01 --> 16:04To me that's like an
16:04 --> 16:06existential distress question, you know,
16:06 --> 16:08a feeling of guilt and stigma,
16:08 --> 16:11a sense of the unfairness of it all.
16:11 --> 16:13And I will say that it is
16:13 --> 16:15very unfair and unpredictable.
16:15 --> 16:19There are many people who eat high fat,
16:19 --> 16:20smoked meat,
16:20 --> 16:23red meat diets and drink a lot
16:23 --> 16:27of alcohol and are sedentary and
16:27 --> 16:29don't develop colorectal cancer.
16:29 --> 16:31So I think it's very important
16:31 --> 16:33to sort of think of this as once
16:33 --> 16:34you're facing the disease to
16:34 --> 16:36think of this as something
16:38 --> 16:39that's not your fault.
16:39 --> 16:41That's not stigmatized in that sense.
16:41 --> 16:44As far as preventing colorectal cancer,
16:44 --> 16:48though, it is aside from family syndromes,
16:48 --> 16:51it is also associated with a lot
16:51 --> 16:52of those things we just mentioned,
16:52 --> 16:55particularly alcohol and obesity
16:55 --> 16:58contribute to colorectal cancer.
17:01 --> 17:04As does you know, the concept
17:04 --> 17:06of a low fiber diet sort of
17:06 --> 17:09having a less healthy gut Biome,
17:09 --> 17:11interestingly, and this isn't super
17:11 --> 17:14relevant to a lot of our younger patients,
17:14 --> 17:16but long histories of starvation
17:16 --> 17:17and deprivation also contribute
17:17 --> 17:19to colorectal cancer.
17:19 --> 17:22For example, survivors of the
17:22 --> 17:25Holocaust in Nazi Germany have very
17:25 --> 17:27high rates of colorectal cancer.
17:27 --> 17:29You know, the other thing that you had
17:29 --> 17:31mentioned right at the top of the show,
17:31 --> 17:35though, was that while the incidence
17:35 --> 17:38of colorectal cancer is quite high.
17:38 --> 17:41we're making strides in
17:41 --> 17:44terms of increasing longevity after
17:44 --> 17:46a colorectal cancer diagnosis.
17:46 --> 17:49So can you talk to us a little
17:49 --> 17:51bit more about why that is?
17:51 --> 17:54I mean part of it might be that we're
17:54 --> 17:56catching more colorectal cancers earlier
17:56 --> 17:58with screening like we talked about,
17:58 --> 18:02but another might be advances in treatment.
18:02 --> 18:04So can you talk to us a little bit about
18:04 --> 18:06where the state of the science is there?
18:07 --> 18:09Yeah, it's definitely both. So catching
18:09 --> 18:12cancer earlier allows for curative intent
18:12 --> 18:14treatment and the state of the science
18:14 --> 18:16has significantly improved there as well.
18:16 --> 18:18For colon cancer
18:18 --> 18:22that means surgery and likely chemotherapy
18:22 --> 18:24subsequently afterward in order to make
18:24 --> 18:26sure that there's a higher rate of cure.
18:26 --> 18:27For rectal cancer,
18:27 --> 18:30it means chemotherapy and radiation,
18:30 --> 18:32sometimes even without surgery,
18:32 --> 18:34but generally, you know,
18:34 --> 18:35with the surgery as well and
18:35 --> 18:37that has improved, right?
18:37 --> 18:39Those cure rates of early stage
18:39 --> 18:41colon and rectal cancer,
18:41 --> 18:43the long term cure is improving.
18:43 --> 18:44We're really perfecting the science
18:44 --> 18:46thereof even now starting to think
18:46 --> 18:48how do we not overtreat people?
18:48 --> 18:50How do we treat somebody with an
18:50 --> 18:52earlier stage colon or rectal cancer
18:52 --> 18:54in a way where they're going to
18:54 --> 18:56have the best long term survivorship
18:56 --> 18:58with the least complications and
18:58 --> 18:59the least surgical complications,
18:59 --> 19:02the least radiation complications,
19:02 --> 19:04the least chemotherapy complications.
19:04 --> 19:06So that has improved significantly
19:06 --> 19:09and then for patients who are being
19:09 --> 19:11diagnosed with advanced disease,
19:11 --> 19:12there's the NCI that says
19:15 --> 19:18survivorship starts from diagnosis.
19:18 --> 19:20There's this concept of metastatic
19:20 --> 19:20survivorship,
19:20 --> 19:22which some people find controversial.
19:22 --> 19:23I don't love it,
19:23 --> 19:26having followed a lot of patients with
19:26 --> 19:28metastatic disease on social media,
19:28 --> 19:29I think some people like it,
19:29 --> 19:30some people don't.
19:30 --> 19:32But the idea is that you can
19:32 --> 19:34be living with advanced cancer
19:34 --> 19:35for some amount of years,
19:35 --> 19:38and that's certainly true in colon cancer.
19:38 --> 19:40Unlike a lot of other gastrointestinal
19:40 --> 19:41cancers, pancreas cancer,
19:41 --> 19:43and so on,
19:43 --> 19:45colon cancer is becoming a disease that
19:45 --> 19:48even diagnosed in stage 4 metastatic without.
19:48 --> 19:49surgical options,
19:49 --> 19:52people are living for several years
19:52 --> 19:55making it through initial chemotherapy,
19:55 --> 19:57second line chemotherapy,
19:57 --> 19:59third line chemotherapy.
19:59 --> 20:01Just yesterday,
20:01 --> 20:02for example,
20:02 --> 20:05here we were reviewing the results of
20:05 --> 20:07the gastrointestinal Annual Society
20:07 --> 20:10of Clinical Oncology Abstracts,
20:10 --> 20:13which showed some real movement even in
20:13 --> 20:16the third and fourth line treatments,
20:17 --> 20:20patients living several
20:20 --> 20:22years after diagnosis.
20:23 --> 20:25So just a quick question,
20:25 --> 20:27why don't you like the term
20:27 --> 20:29survivorship?
20:29 --> 20:31I personally know
20:31 --> 20:33it's very controversial this idea
20:33 --> 20:36of calling yourself a a metastatic
20:36 --> 20:38survivor or an advanced cancer survivor.
20:38 --> 20:40Some people love this they
20:40 --> 20:41find it empowering.
20:41 --> 20:43The idea that survivorship starts
20:43 --> 20:46from diagnosis and even though they
20:46 --> 20:48have a terminal diagnosis they are
20:48 --> 20:50living with advanced disease and
20:50 --> 20:52they are a cancer survivor that
20:52 --> 20:53they're surviving cancer for the
20:53 --> 20:55two or three or however many years
20:55 --> 20:57they're with us and I think
20:57 --> 20:59some people and a lot of this is
20:59 --> 21:00coming out of the breast cancer
21:00 --> 21:04Twitter world feel that it's a
21:04 --> 21:07completely different experience to
21:07 --> 21:09have a terminal diagnosis regardless
21:09 --> 21:13of the fact that you're living longer
21:13 --> 21:16with it and that it minimizes or
21:16 --> 21:18doesn't fully encompass their experience.
21:18 --> 21:21Because even though they have quality of
21:21 --> 21:24life and they're living with advanced cancer,
21:24 --> 21:26they know that they are going to
21:26 --> 21:28die from that cancer and they find
21:28 --> 21:30it disingenuous to call themselves
21:30 --> 21:31a cancer survivor.
21:31 --> 21:34So I think both perspectives
21:34 --> 21:35are really valid.
21:35 --> 21:38It really depends on the person and the
21:38 --> 21:41patient sort of centered perspective on that.
21:41 --> 21:43I have personally been using the
21:43 --> 21:45term living with advanced disease.
21:45 --> 21:47More than saying somebody is
21:47 --> 21:49a metastatic survivor.
21:49 --> 21:52There's a bunch of different terminology
21:52 --> 21:55for it for people who are sort of
21:55 --> 21:57on chemotherapy for the rest
21:57 --> 21:59of their life and going to die
21:59 --> 22:00of their cancer eventually.
22:00 --> 22:02Which brings me to
22:02 --> 22:05the next kind of topic,
22:05 --> 22:08which is you are also trained
22:08 --> 22:11as a palliative care physician,
22:11 --> 22:15and I find so often that
22:15 --> 22:17for some people,
22:17 --> 22:20that concept of palliative care is
22:20 --> 22:23really scary because they equate it with
22:23 --> 22:25I'm going to die
22:25 --> 22:30and my care team has given up hope on me.
22:30 --> 22:32Can you kind of speak to that?
22:32 --> 22:35I think a lot of people don't
22:35 --> 22:38understand what palliative care is.
22:38 --> 22:41And what we're trying to tell people is that
22:41 --> 22:44when you are living with advanced disease,
22:44 --> 22:46you have a lot of good years left,
22:46 --> 22:49let's say you may still need extra support
22:49 --> 22:52so palliative care can start early on
22:52 --> 22:55in a cancer diagnosis to help with
22:55 --> 22:57prognostics, understanding their
22:57 --> 22:58prognosis with treatment,
22:58 --> 23:01decision making with an added layer
23:01 --> 23:03of support, with spiritual support,
23:03 --> 23:05with pain and symptom management or
23:05 --> 23:07palliative care can come in later and
23:07 --> 23:10really be helping with end of life questions.
23:10 --> 23:12Palliative care is very much a spectrum
23:12 --> 23:15it's given with cancer treatment,
23:15 --> 23:17it's given you know,
23:17 --> 23:20while curative intent therapies are being
23:20 --> 23:24pursued if there's a lot of needs.
23:24 --> 23:25So I think it's
23:25 --> 23:26really a spectrum.
23:26 --> 23:28It includes Hospice,
23:29 --> 23:32Hospice is part of palliative care,
23:32 --> 23:34but it's not the same.
23:34 --> 23:36And I think a lot of patients
23:36 --> 23:38think when they hear palliative
23:38 --> 23:41care that it's like a bridge to
23:41 --> 23:43Hospice and that can be intimidating.
23:43 --> 23:46A lot of national surveys on
23:46 --> 23:48perception have shown that,
23:48 --> 23:49for example,
23:49 --> 23:50with Hospice,
23:50 --> 23:52it's very popular and has a very
23:52 --> 23:52good reputation.
23:52 --> 23:54People think very favorably of
23:54 --> 23:56Hospice for other people.
23:56 --> 23:59So they have a very positive idea of it,
23:59 --> 24:01but they don't think that it should
24:01 --> 24:02be for them.
24:02 --> 24:03And so I think the idea of palliative
24:03 --> 24:05care is that it's not just end of life,
24:05 --> 24:07it's not just Hospice.
24:07 --> 24:10And using palliative care only as sort
24:10 --> 24:12of a bridge or a mini Hospice does
24:12 --> 24:15a disservice to patients who might
24:15 --> 24:18benefit from it earlier on in their
24:18 --> 24:21treatment or with support issues,
24:22 --> 24:23that kind of thing.
24:26 --> 24:29So for many cancer centers,
24:29 --> 24:32there's this kind of move to
24:32 --> 24:35integrating palliative care into the
24:35 --> 24:38curative treatment realm, right.
24:38 --> 24:41So this idea that palliative
24:41 --> 24:45care can actually start at
24:45 --> 24:47diagnosis perhaps as
24:47 --> 24:49that extra layer of support
24:49 --> 24:51maybe in a more secondary role
24:51 --> 24:55to the curative oncologist that
24:55 --> 24:57kind of can grow over time.
24:57 --> 25:00With you having
25:00 --> 25:03two hats in the same person,
25:03 --> 25:06do you find that is a more seamless
25:06 --> 25:09transition for you with your patients?
25:10 --> 25:13Well first
25:13 --> 25:15of all I would separate palliative
25:15 --> 25:16care from diagnosis from palliative
25:16 --> 25:18care with curative intent.
25:18 --> 25:20I think a lot of times when we talk
25:20 --> 25:22about palliative care from diagnosis,
25:22 --> 25:24we do really mean for patients
25:24 --> 25:25diagnosed with advanced disease
25:25 --> 25:27and to allow that gradual
25:27 --> 25:28transition where the cancer
25:28 --> 25:30doctors play a larger role and
25:30 --> 25:32eventually the palliative care
25:32 --> 25:34doctor will play the larger role with
25:34 --> 25:36palliative care and curative intent.
25:36 --> 25:39I think usually the goal is like a bridge,
25:39 --> 25:41you know, a bridge to the cure
25:41 --> 25:43or dealing with uncertainty,
25:43 --> 25:44dealing with what it means to
25:44 --> 25:45have a life threatening illness
25:45 --> 25:47even if it's not life limiting.
25:47 --> 25:48But to your question,
25:48 --> 25:50I think with those patients who are
25:50 --> 25:53getting curative intent treatment, when it
25:53 --> 25:55doesn't go well,
25:55 --> 25:56which happens occasionally,
25:56 --> 25:57you know,
25:57 --> 25:59when there's a recurrence or relapse
25:59 --> 26:01some time after the presumed cure
26:01 --> 26:04or when the treatment
26:04 --> 26:06isn't going well.
26:06 --> 26:09I think that's just very hard for people.
26:09 --> 26:11It's a big disappointment.
26:11 --> 26:15It's a change in expectations.
26:15 --> 26:18Uncertainty is very hard for people.
26:18 --> 26:21I try to make it a more seamless
26:21 --> 26:23transition and to really be
26:23 --> 26:24there for people through that.
26:24 --> 26:29But it's not for everybody and
26:33 --> 26:34understanding that,
26:35 --> 26:38that is part of being human with
26:38 --> 26:40them and realizing that it's not
26:40 --> 26:42easy for anybody to think that
26:42 --> 26:44they're achieving a cure and then
26:44 --> 26:46find out that they didn't.
26:49 --> 26:51I think having those difficult
26:51 --> 26:54conversations is by definition difficult.
26:54 --> 26:57And and so,
26:57 --> 26:59in palliative care teams,
26:59 --> 27:01there's often multiple people who
27:01 --> 27:03are well trained to have those
27:03 --> 27:06conversations and deal with
27:06 --> 27:08various issues that come up whether
27:08 --> 27:11it's physical symptoms or you know
27:11 --> 27:14the emotional burden or the financial
27:14 --> 27:17burden or the existential spiritual
27:17 --> 27:20crises that people are having.
27:20 --> 27:23Can you talk a little bit
27:23 --> 27:26more about how that team aspect really
27:26 --> 27:28helps in terms of palliative care?
27:28 --> 27:31I mean you are a palliative care physician,
27:31 --> 27:32but you're one person.
27:32 --> 27:34I can imagine that sometimes you
27:34 --> 27:36also benefit from having
27:36 --> 27:37a palliative care team behind you?
27:37 --> 27:38Definitely.
27:38 --> 27:40And since I'm also working in
27:40 --> 27:42the outpatient setting primarily
27:42 --> 27:44as the medical oncologist,
27:44 --> 27:46I will often consult my palliative
27:46 --> 27:48care colleague whose
27:48 --> 27:49focus that is because I think sometimes
27:49 --> 27:52even when I have the skill set,
27:52 --> 27:54it's helpful to have him involved.
27:54 --> 27:57He's our GI palliative care oncologist.
27:57 --> 27:58Just because he has that
27:59 --> 28:01You sometimes see the different set of
28:01 --> 28:03eyes and ears in the room and somebody
28:03 --> 28:05to have a different kind of time frame
28:05 --> 28:06of what they're going to talk about.
28:06 --> 28:09So not only do I use my own palliative
28:09 --> 28:11care consult in the outpatient setting,
28:11 --> 28:13when I am working with
28:13 --> 28:14the palliative care team,
28:14 --> 28:16I find it very helpful that
28:16 --> 28:17there's a social worker,
28:17 --> 28:19that there's a chaplain
28:19 --> 28:21for spiritual distress.
28:21 --> 28:23At other institutions,
28:23 --> 28:24I think they'll have sometimes
28:24 --> 28:27an art therapist or various
28:27 --> 28:29different people can be a part
28:29 --> 28:31of the palliative care team.
28:31 --> 28:33Doctor Laura Baum is an assistant
28:33 --> 28:35professor of medicine and medical
28:35 --> 28:38oncology at the Yale School of Medicine.
28:38 --> 28:40If you have questions,
28:40 --> 28:42the address is canceranswers@yale.edu
28:42 --> 28:45and past editions of the program
28:45 --> 28:47are available in audio and written
28:47 --> 28:48form at yalecancercenter.org.
28:48 --> 28:50We hope you'll join us next week to
28:50 --> 28:52learn more about the fight against
28:52 --> 28:54cancer here on Connecticut Public Radio.
28:54 --> 28:57Funding for Yale Cancer Answers is
28:57 --> 29:00provided by Smilow Cancer Hospital.

Information

Colorectal Cancer Awareness 2023 with guest Dr. Laura Baum March 12, 2023 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095