Cancer Care in the Community

Transcript

00:00 --> 00:02Support for Yale Cancer Answers
00:02 --> 00:04comes from AstraZeneca, dedicated
00:05 --> 00:07to advancing options and providing
00:07 --> 00:10hope for people living with cancer.
00:10 --> 00:14More information at astrazeneca-us.com.
00:14 --> 00:15Welcome to Yale Cancer Answers
00:15 --> 00:17with your host doctor Anees Chagpar.
00:17 --> 00:19Yale Cancer Answers
00:19 --> 00:21features the latest information on
00:21 --> 00:23cancer care by welcoming oncologists and
00:23 --> 00:25specialists who are on the forefront of
00:25 --> 00:27the battle to fight cancer. This week,
00:27 --> 00:29it's a conversation about cancer care
00:29 --> 00:31in the community with Doctor Anamika Katoch.
00:31 --> 00:34Dr Katoch is assistant professor
00:34 --> 00:35of clinical medicine and medical
00:35 --> 00:38oncology at the Yale School of Medicine,
00:38 --> 00:41where Doctor Chagpar is a
00:41 --> 00:43professor of surgical oncology.
00:43 --> 00:46Doctor Katoch, maybe you could start off by
00:46 --> 00:49telling us a little bit about yourself and
00:49 --> 00:51what it is that you do.
00:51 --> 00:53So I'm a hematologist oncologist,
00:53 --> 00:56and I work out of Smilow Waterbury.
00:56 --> 00:58It's a small community setting we
00:58 --> 01:01work out of a regional Cancer Center
01:01 --> 01:04called the Harold Leever Cancer Center.
01:04 --> 01:06So I'm a general community oncologist,
01:06 --> 01:09and I see all kinds of cancer.
01:09 --> 01:11The more common cancers,
01:11 --> 01:13of course, are more common,
01:13 --> 01:17so I tend to see those more than the others.
01:17 --> 01:20But breast, lung, colon, lymphoma,
01:20 --> 01:22and also some hematology patients.
01:22 --> 01:26And so how common is cancer in
01:26 --> 01:27the community?
01:27 --> 01:30I mean when we think about
01:30 --> 01:32cancers,
01:32 --> 01:34very often we think about
01:34 --> 01:37people going to large centers.
01:37 --> 01:38New York, Boston,
01:38 --> 01:40Houston, New Haven.
01:40 --> 01:42But you're in a
01:42 --> 01:43small Community Center.
01:43 --> 01:46So how often does cancer present
01:46 --> 01:48in those community centers?
01:48 --> 01:50So it is surprising
01:50 --> 01:54to see that cancer is very prevalent,
01:54 --> 01:56and especially in the Waterbury area.
01:56 --> 01:59I would say maybe because it
01:59 --> 02:02has been an industrial town.
02:02 --> 02:06And we do tend to see a lot of breast cancer.
02:06 --> 02:10A lot of bladder cancer in this area as well.
02:10 --> 02:12And yes,
02:12 --> 02:14the bigger centers actually have
02:14 --> 02:17the good fortune of having many
02:17 --> 02:19good bigger centers around us.
02:19 --> 02:21There's Memorial Sloan,
02:21 --> 02:22Dana Farber.
02:22 --> 02:25And certainly these are very useful and
02:25 --> 02:28helpful for us when we have particularly
02:28 --> 02:31tough situations where we need to
02:31 --> 02:33get another opinion or some help.
02:33 --> 02:37But I would say in the general Community,
02:37 --> 02:38cancer is fairly
02:38 --> 02:41prevalent and so many people,
02:41 --> 02:44because cancer really doesn't discriminate
02:44 --> 02:47based on where you live
02:47 --> 02:50and many people may wonder,
02:50 --> 02:53are there advantages and disadvantages
02:53 --> 02:55to being treated closer to home
02:55 --> 02:58versus going into a larger center?
02:58 --> 03:00What would you say to people
03:00 --> 03:02who are contemplating those
03:02 --> 03:04decisions?
03:06 --> 03:09It is important,
03:09 --> 03:11especially for certain rare cancers
03:11 --> 03:15to be seen at bigger centers that tend
03:15 --> 03:18to see a lot more of those cancers.
03:18 --> 03:20Sarcomas being one.
03:20 --> 03:22They require a real multi
03:22 --> 03:23disciplinary approach.
03:23 --> 03:26You have to have surgeons who've
03:26 --> 03:28done enough of those surgeries,
03:28 --> 03:31trained radiation oncology team,
03:31 --> 03:33trained chemotherapy
03:33 --> 03:35professionals who've dealt
03:35 --> 03:37enough of with that cancer.
03:37 --> 03:39It is always patients preference
03:39 --> 03:41to be treated close to home and
03:41 --> 03:44nobody wants to drive 2 hours to get
03:44 --> 03:46treatment because you know chemotherapy
03:46 --> 03:48treatment is not just about chemotherapy,
03:48 --> 03:50it's also about supportive
03:50 --> 03:51care that goes with it.
03:51 --> 03:53So we don't just see patients
03:53 --> 03:55on day one and say OK,
03:55 --> 03:58now we'll see you in three weeks.
03:58 --> 03:59It doesn't work like that.
03:59 --> 04:02So we see patients on day one,
04:02 --> 04:04we're always available by phone.
04:04 --> 04:06We are seeing them sometimes the very
04:06 --> 04:08next day, sometimes within a week.
04:08 --> 04:10Sometimes they need transfusion support.
04:10 --> 04:11So it is a
04:11 --> 04:14complicated and complex process,
04:14 --> 04:16so patients preference is always
04:16 --> 04:20to be treated in your home and I
04:20 --> 04:22would say that we have very robust
04:22 --> 04:24multidisciplinary teams for almost
04:24 --> 04:27all cancers and we also recognize that
04:27 --> 04:30some cancers do better when they are
04:30 --> 04:32referred out to tertiary centers,
04:32 --> 04:34one major example being acute leukemia.
04:36 --> 04:39It is a cancer that requires
04:39 --> 04:40a lot of resources.
04:40 --> 04:41A lot of support,
04:41 --> 04:44a lot of experience and
04:44 --> 04:45people who have acute leukemias
04:45 --> 04:48tend to do better when they're
04:48 --> 04:50treated at tertiary care centers,
04:50 --> 04:52so this is also recognizing
04:52 --> 04:54what are your limitations.
04:54 --> 04:56And what are the patients that
04:56 --> 04:58you can best serve and which
04:58 --> 05:01patients will do better if they are
05:01 --> 05:04referred out? And so I guess the
05:04 --> 05:07take home message there is that if
05:07 --> 05:10a patient has a cancer that they can
05:10 --> 05:13be seen at a Cancer Center in their
05:13 --> 05:15community and that Community Center
05:15 --> 05:17will have no hesitation about referring
05:17 --> 05:19them out to a larger center if that's
05:19 --> 05:21in the patients best interest.
05:21 --> 05:24That is absolutely correct and a
05:24 --> 05:26lot of times it is driven by physicians.
05:26 --> 05:28Sometimes it's driven by patients,
05:28 --> 05:30but I have to say that patients
05:30 --> 05:31often feel uncomfortable telling
05:31 --> 05:33their physicians that they
05:33 --> 05:36want to get a second opinion and
05:36 --> 05:38part of it will also depend upon
05:38 --> 05:40your approach to the patient,
05:40 --> 05:43and we're sort of very open about it.
05:43 --> 05:44We understand
05:44 --> 05:45that this is cancer.
05:45 --> 05:48It can be a life changing diagnosis.
05:48 --> 05:51So we we will often say to our patients,
05:51 --> 05:53if you would like another opinion,
05:53 --> 05:55please let me know
05:55 --> 05:57and I will help you get one.
05:57 --> 06:00So sometimes people do elect to get
06:00 --> 06:01another opinion and lots of times
06:01 --> 06:03people say no,
06:03 --> 06:05what you're saying makes sense if
06:05 --> 06:07they've already developed a
06:07 --> 06:10sense of trust and confidence in you
06:10 --> 06:12they will stay with you
06:12 --> 06:14and be treated close to where they
06:14 --> 06:17live and so are there particular
06:17 --> 06:18cancers that are particularly amenable
06:18 --> 06:20to being treated closer to home.
06:20 --> 06:23So you mentioned that the rare cancers
06:23 --> 06:26might be ones where you want to seek
06:26 --> 06:28a second opinion, but are there
06:28 --> 06:30certain cancers that
06:30 --> 06:33you think, if you have
06:33 --> 06:35for example, breast cancer or colon
06:35 --> 06:38cancer that that those really can
06:38 --> 06:40be treated closer to where you
06:40 --> 06:42live that you don't necessarily
06:42 --> 06:44need to go to a larger center.
06:45 --> 06:47That is absolutely true.
06:47 --> 06:49It of course depends upon
06:49 --> 06:51the strength of your surgical
06:51 --> 06:53staff and your surgical support,
06:53 --> 06:55because a lot of these
06:55 --> 06:57cancers do need surgery.
06:57 --> 06:59So if you have a trained
06:59 --> 07:02oncological surgeon on staff who
07:02 --> 07:05is equipped to do these surgeries,
07:05 --> 07:07then I think these cancers can
07:07 --> 07:10be very well handled in the community.
07:11 --> 07:13And what questions should
07:13 --> 07:15patients be asking of their
07:15 --> 07:17team of doctors if they are
07:17 --> 07:19seen by a Community cancer program,
07:19 --> 07:21what questions should they be asking in
07:21 --> 07:24order to make the best informed decision
07:24 --> 07:26as to where they should be treated?
07:27 --> 07:29That's a good question,
07:29 --> 07:31but can be a little bit tricky.
07:31 --> 07:33I don't know if patients
07:33 --> 07:35would entirely feel comfortable
07:35 --> 07:36sometimes asking their physicians
07:36 --> 07:38what their experiences
07:38 --> 07:39in treating this cancer are.
07:39 --> 07:41And I do get that question,
07:42 --> 07:42but very occasionally,
07:42 --> 07:45but I think it is important for
07:45 --> 07:47patients to get involved in their
07:47 --> 07:49care and ask these questions,
07:49 --> 07:52and I think a lot of times people don't
07:52 --> 07:54ask this question because they feel that
07:54 --> 07:57they are going to offend the physician.
07:57 --> 08:00Which sometimes may be true,
08:00 --> 08:03but most times is not.
08:03 --> 08:05So I think it's fair enough
08:05 --> 08:07to say, Doctor,
08:07 --> 08:10do you treat a lot of these cancers and
08:10 --> 08:13it's sort of a ubiquitous question.
08:15 --> 08:17How do patients generally do?
08:17 --> 08:19Do you think I need a second opinion?
08:19 --> 08:22So I think these are all fair
08:22 --> 08:24questions to ask and say,
08:24 --> 08:26do you work with the surgeon closely?
08:26 --> 08:29Do you know if he's done many surgeries?
08:29 --> 08:31Is it possible for me to speak
08:31 --> 08:33to someone who has
08:33 --> 08:35gone through this process?
08:35 --> 08:39Also, just basic questions that might help
08:39 --> 08:41keep patients well informed.
08:41 --> 08:44And I think that that's so important
08:44 --> 08:46that patients really do advocate
08:46 --> 08:49for themselves and truthfully,
08:49 --> 08:51many Community programs actually
08:51 --> 08:54do have the infrastructure to be
08:54 --> 08:56able to provide good quality care
08:56 --> 08:59for the more common cancers.
08:59 --> 09:01So you mentioned, for example,
09:01 --> 09:03that you have a multidisciplinary
09:03 --> 09:06team tell us more about how
09:06 --> 09:08that works in the Community
09:08 --> 09:09setting?
09:09 --> 09:12I would say that our our care,
09:12 --> 09:14even if I say so myself,
09:16 --> 09:18We bring most of our cases to a
09:18 --> 09:19multidisciplinary tumor conference.
09:19 --> 09:21So if I were to pick, let's say,
09:21 --> 09:24the most common cancer that we see in women,
09:24 --> 09:27which is breast cancer.
09:27 --> 09:31So once a woman gets a mammogram,
09:31 --> 09:34gets a biopsy, or sees a surgeon,
09:34 --> 09:37she is presented at a
09:37 --> 09:39multidisciplinary tumor conference.
09:40 --> 09:44For people who don't know what that is,
09:44 --> 09:46it is basically a collection
09:46 --> 09:49of many oncologists or any
09:49 --> 09:51oncologists in the community.
09:51 --> 09:54Radiation oncology, radiology, the breast
09:54 --> 09:55surgeons themselves,
09:55 --> 09:57social worker, nutritionists.
09:57 --> 10:00So we all get together as a team
10:00 --> 10:02and discuss the presentation of
10:02 --> 10:05each sort of person's cancer,
10:05 --> 10:08and then we decide
10:11 --> 10:13to dealing with that situation.
10:13 --> 10:16Being most of the time, it's standard,
10:16 --> 10:18but things are changing.
10:18 --> 10:21You know we were used to using,
10:21 --> 10:22for example,
10:22 --> 10:24chemotherapy in always the
10:24 --> 10:25post surgical setting.
10:25 --> 10:28But now we're moving to using
10:28 --> 10:29treatment sometimes upfront
10:29 --> 10:31before surgery so not everybody
10:31 --> 10:34is a good candidate for that.
10:34 --> 10:36We talk about
10:36 --> 10:38the things like that.
10:38 --> 10:41Other things that come up are genetics.
10:41 --> 10:43This has also become a very
10:43 --> 10:46important part of management for patients.
10:46 --> 10:49You know 10% of the cancers
10:49 --> 10:50that are diagnosed,
10:50 --> 10:52especially breast cancer I'm
10:52 --> 10:54talking about can be genetic,
10:54 --> 10:56so we always talk about that.
10:56 --> 10:58We have a genetic counselor
10:58 --> 11:01as a part of the team who will
11:01 --> 11:03be there and say, OK,
11:03 --> 11:05I think this person needs to meet with me.
11:05 --> 11:06We need to
11:06 --> 11:09check her or family members.
11:09 --> 11:12If there are
11:12 --> 11:13financial issues.
11:13 --> 11:14Social issues.
11:14 --> 11:16We have a social worker who is
11:16 --> 11:20present who can help
11:20 --> 11:22guide patients through that process.
11:22 --> 11:25We have a licensed nutritionist who can
11:25 --> 11:27provide support as to healthy diets.
11:27 --> 11:30Because this really becomes a very
11:30 --> 11:32important part of what people feel
11:32 --> 11:35that they have some control over it
11:35 --> 11:37and it empowers them.
11:37 --> 11:40And of course we know that obesity
11:40 --> 11:43and cancer have a direct link so
11:43 --> 11:46we always want to talk about
11:46 --> 11:48maintaining a healthy lifestyle
11:48 --> 11:50and a healthy body mass index.
11:50 --> 11:53Once a case is discussed at
11:53 --> 11:55the Multidisciplinary conference,
11:55 --> 11:57we will then make recommendations.
11:57 --> 12:00The patient gets established with
12:00 --> 12:02medical oncologist or radiation oncologist,
12:02 --> 12:06and it's really a very good
12:06 --> 12:07collaborative approach.
12:08 --> 12:10The other thing that we often
12:10 --> 12:13talk about on the show is things like
12:13 --> 12:15personalized medicine and genomics.
12:15 --> 12:17So are those things available in
12:17 --> 12:19Community settings or are those
12:19 --> 12:21really only the purview of the
12:21 --> 12:23larger academic centers?
12:23 --> 12:26There has been so much progress in
12:26 --> 12:29these things that they are now
12:29 --> 12:32easily available to us as well.
12:32 --> 12:36Our goal is always to be able to
12:36 --> 12:40at least offer standard a standard of care,
12:40 --> 12:43which means if you were to see
12:43 --> 12:47an oncologist here or you went to the
12:47 --> 12:50West Coast and used an oncologist there,
12:50 --> 12:52the therapy recommended
12:52 --> 12:55would be similar,
12:55 --> 12:57if not identical,
12:57 --> 13:00so that is called standardized
13:00 --> 13:02care and it is based now
13:02 --> 13:05on genomics, which do play a huge role
13:05 --> 13:07in determining treatment for cancer,
13:07 --> 13:09it has been a significant advance.
13:11 --> 13:13In the treatment of breast cancer,
13:13 --> 13:15when we look back we find that
13:15 --> 13:18we were probably over treating a lot of
13:18 --> 13:21the breast cancer patients with chemotherapy.
13:21 --> 13:24Now we have tests that can actually
13:24 --> 13:26determine benefit from chemotherapy,
13:26 --> 13:28and these are based on genomic
13:28 --> 13:31tests allowed for a lot of the
13:31 --> 13:32cancers including lung cancer,
13:32 --> 13:34colon cancer we are doing
13:34 --> 13:36molecular testing we're
13:36 --> 13:38identifying targets on these cells,
13:38 --> 13:41which we know drive the growth
13:41 --> 13:43of cancer cells,
13:43 --> 13:46and then we can actually pick
13:46 --> 13:48medications that would specifically
13:48 --> 13:50block these drivers and that
13:51 --> 13:54is sort of the tailor made approach
13:54 --> 13:56for treating cancer.
13:56 --> 13:58So it sounds like
13:58 --> 14:00you know patients can get that
14:00 --> 14:04same kind of genomic testing in
14:04 --> 14:06that personalized therapies
14:06 --> 14:08even staying closer to home.
14:08 --> 14:10We're going to take a short break
14:10 --> 14:13for a medical minute and come
14:13 --> 14:16back and talk more about cancer
14:16 --> 14:18care in the community with my
14:18 --> 14:20guest Doctor Katoch.
14:20 --> 14:23Support for Yale Cancer Answers comes from
14:23 --> 14:25AstraZeneca, working to eliminate
14:25 --> 14:27cancer as a cause of death.
14:27 --> 14:31Learn more at astrazeneca-us.com.
14:31 --> 14:33This is a medical minute
14:33 --> 14:34about colorectal cancer.
14:34 --> 14:35When detected early,
14:35 --> 14:38colorectal cancer is easily treated
14:38 --> 14:41and highly curable and as a result
14:41 --> 14:43it's recommended that men and women
14:43 --> 14:46over the age of 45 have regular
14:46 --> 14:48colonoscopies to screen for the disease.
14:48 --> 14:50Tumor gene analysis has helped
14:50 --> 14:52improve management of colorectal
14:52 --> 14:54cancer by identifying the patients
14:54 --> 14:56most likely to benefit from
14:56 --> 14:58chemotherapy and newer targeted agents,
14:58 --> 15:00resulting in more patient
15:00 --> 15:01specific treatments.
15:01 --> 15:03More information is available
15:03 --> 15:04at yalecancercenter.org.
15:04 --> 15:07You're listening to Connecticut Public Radio.
15:10 --> 15:12Welcome back to Yale Cancer Answers.
15:12 --> 15:15We're discussing the care of
15:15 --> 15:17cancer patients in the community
15:17 --> 15:20and right before the break
15:20 --> 15:22we were talking about some of the
15:22 --> 15:25differences and the other thing that I
15:25 --> 15:27was wondering about was clinical trials.
15:27 --> 15:30So often on this show,
15:30 --> 15:33we talk about the importance of
15:33 --> 15:35clinical trials and how that's
15:35 --> 15:38one of the ways to get tomorrow's
15:38 --> 15:40therapies today in that patients
15:40 --> 15:43often will get the best care by
15:43 --> 15:45participating in clinical trials for
15:45 --> 15:47which they are eligible and for which
15:47 --> 15:50their Doctor thinks they would benefit from.
15:50 --> 15:53Talk to us about whether clinical
15:53 --> 15:55trials are available in the community setting.
15:55 --> 15:59You bring up a great point,
15:59 --> 16:02and it is true that we wouldn't
16:02 --> 16:05be where we are today in cancer if
16:05 --> 16:08we didn't encourage our patients
16:08 --> 16:10to participate in clinical trials.
16:10 --> 16:13As everyone knows, 2020 has
16:13 --> 16:15been a particularly challenging year,
16:15 --> 16:18and also for clinical trials it has been a very
16:18 --> 16:20challenging year simply because
16:20 --> 16:21clinical trials require
16:21 --> 16:22very diligent follow-up,
16:22 --> 16:24mostly for patient safety,
16:24 --> 16:27and that we all know because of covid
16:27 --> 16:29we've had to resort to
16:29 --> 16:31virtual appointments and seeing
16:31 --> 16:34patients may be a little bit
16:34 --> 16:36less frequently than we normally would,
16:36 --> 16:39so a lot of the clinical trials
16:39 --> 16:40had to be put
16:40 --> 16:44on hold, but usually we have a very
16:44 --> 16:46robust collection of clinical trials
16:46 --> 16:48for patients with breast cancer,
16:48 --> 16:50colon, cancer, lung cancer,
16:50 --> 16:51chronic leukemias,
16:51 --> 16:52and myelomas.
16:52 --> 16:54That brings up
16:54 --> 16:57a great point. The fact that you're
16:57 --> 17:00part of a network and can avail
17:00 --> 17:02yourself of clinical trials that
17:02 --> 17:05are available at larger centers.
17:05 --> 17:08Maybe not all of the trials,
17:08 --> 17:11but certainly a collaboration whereby
17:11 --> 17:13patients can avail themselves
17:13 --> 17:14of clinical trials,
17:14 --> 17:17oftentimes closer to home, and if not,
17:17 --> 17:20you can always send them to to a larger
17:20 --> 17:22center where they can participate
17:22 --> 17:25and that brings up my next question,
17:25 --> 17:28which is in those cases where
17:28 --> 17:32there is a particular nuances of the care
17:32 --> 17:35or where a second opinion might be needed,
17:35 --> 17:38is it possible for patients to
17:38 --> 17:40seek a second opinion somewhere
17:40 --> 17:42and still get treated
17:42 --> 17:43closer to home?
17:43 --> 17:46So for example getting the
17:46 --> 17:49advice of an oncologist closer to home
17:49 --> 17:52about what particular regimen to use,
17:52 --> 17:55or how a radiation plan might be structured,
17:55 --> 17:58but then still get their care closer to home?
17:58 --> 18:00Absolutely yes,
18:00 --> 18:03and this happens more
18:03 --> 18:05frequently than one would think.
18:05 --> 18:08And you know, sometimes I'll say to my
18:08 --> 18:10patients when I'm torn between two options.
18:10 --> 18:13And I'll say I would like you to see,
18:15 --> 18:17so and so maybe at the Dana Farber Institute,
18:17 --> 18:19maybe closer to home at Smilow.
18:19 --> 18:21And then I always give them the
18:21 --> 18:24option that if this is
18:26 --> 18:28recommended and if it's not on a clinical
18:28 --> 18:31trial and we are able to do it here,
18:31 --> 18:33you are welcome to come here and
18:33 --> 18:36we would love to treat you here
18:36 --> 18:37if that is your preference,
18:37 --> 18:38so this is,
18:38 --> 18:40you know a very sort of open
18:40 --> 18:42discussion with patients,
18:42 --> 18:44and sometimes patients will finish
18:44 --> 18:46their clinical trial and then will
18:46 --> 18:48continue to follow with you as their
18:48 --> 18:50primary oncologist.
18:50 --> 18:52Ultimately it's about the patient.
18:52 --> 18:54What is best for the patient,
18:54 --> 18:57and I make sure that our patients
18:58 --> 19:00know that and they're not feeling pressured
19:00 --> 19:02and not feeling that their
19:02 --> 19:03offending us in any way.
19:03 --> 19:05It's important
19:05 --> 19:07for patients and everybody listening
19:07 --> 19:08to really understand that.
19:08 --> 19:11You know this is a collaboration
19:11 --> 19:12and it's a collaboration amongst
19:12 --> 19:15physicians who are all trying to
19:15 --> 19:17treat you in the best possible way.
19:17 --> 19:20And so you're not going to offend
19:20 --> 19:23anybody and for for the most part
19:23 --> 19:25many of us actually do seek the opinions
19:25 --> 19:28of our colleagues at multidisciplinary
19:28 --> 19:30tumor conferences like you mentioned,
19:30 --> 19:32as well as outside the institution
19:32 --> 19:35and frequently you can get the
19:35 --> 19:37same care then closer to home.
19:37 --> 19:39If somebody has a better idea
19:39 --> 19:42of how to treat something.
19:42 --> 19:44Whereby those services
19:44 --> 19:46are available in the community.
19:46 --> 19:48You can still do so.
19:48 --> 19:51Talk to me a little bit
19:51 --> 19:53about kind of community support.
19:53 --> 19:57You mentioned one of the
19:57 --> 19:58disadvantages sometimes of going
19:58 --> 20:01into a larger center is that you
20:01 --> 20:04know frequently if care is required,
20:04 --> 20:06say for example with radiation therapy,
20:06 --> 20:09five days a week for many weeks
20:09 --> 20:13that a 2 hour drive might not be
20:14 --> 20:16the most feasible thing one would
20:16 --> 20:19also imagine that just being
20:19 --> 20:21in the community where you're at,
20:21 --> 20:23being around loved ones and so
20:23 --> 20:26on can sometimes be a little bit
20:26 --> 20:27more comfortable for
20:27 --> 20:30patients. Do you find that that's the case?
20:30 --> 20:32So I would say that in cancer care
20:32 --> 20:34that is of utmost importance.
20:34 --> 20:37This is 1 diagnosis where
20:37 --> 20:39just having the support of the
20:39 --> 20:42people you love is so meaningful
20:42 --> 20:44because it's not just a physical
20:44 --> 20:46diagnosis. It's an emotional,
20:46 --> 20:49psychological diagnosis that
20:49 --> 20:51affects all the people around you.
20:51 --> 20:54So it's really important to have that social
20:54 --> 20:57support not only from your family,
20:57 --> 21:00but also from where you are being
21:00 --> 21:02treated so where we are
21:02 --> 21:04for example, at the Yale Cancer Center
21:04 --> 21:07we have a radiation oncology division,
21:07 --> 21:09which is in the same building.
21:09 --> 21:11So people who need radiation
21:11 --> 21:12can come right there.
21:12 --> 21:15If we are doing something which is a
21:15 --> 21:17combination chemotherapy and radiation,
21:17 --> 21:18we will
21:18 --> 21:20try to make sure
21:20 --> 21:22that their appointments
21:22 --> 21:23can be coordinated that life really
21:23 --> 21:26can be as simple as possible for them.
21:26 --> 21:28Sometimes people don't have transport,
21:28 --> 21:30so we have a social worker on site who will
21:30 --> 21:33arrange for transport for people and
21:34 --> 21:36we will tell our patients, our elderly
21:36 --> 21:38patients who often rely on their childrenm
21:39 --> 21:40but their children work,
21:40 --> 21:42so it's not always possible for
21:42 --> 21:44somebody to give you a ride each
21:44 --> 21:46and every day back and forth.
21:46 --> 21:48So we have that kind of support and
21:48 --> 21:51we want our patients to know about it.
21:51 --> 21:54We want them to use it.
21:54 --> 21:56We also have support groups.
21:56 --> 21:59We have a very robust and active
21:59 --> 22:00breast Cancer Support group.
22:00 --> 22:02Other support groups which are
22:02 --> 22:05not as robust but are present.
22:05 --> 22:08They meet once a month I think now
22:08 --> 22:11with some of them have been
22:11 --> 22:13meeting remotely but that women
22:13 --> 22:16also find a very strong sense
22:16 --> 22:18of community and support with
22:18 --> 22:20those centers and I would
22:20 --> 22:22think that the other
22:22 --> 22:24place where
22:24 --> 22:28optimizing and kind of using
22:28 --> 22:31that social support is at end of life.
22:31 --> 22:34In terms of palliative care.
22:34 --> 22:37So our palliative care resource is
22:37 --> 22:40available in the Community both on
22:40 --> 22:42inpatient as well as there is
22:42 --> 22:45such a thing as home palliative care
22:45 --> 22:48where people can really
22:48 --> 22:51take community all the way back to
22:51 --> 22:55your own home and have the services
22:55 --> 22:56that keep you comfortable at
22:56 --> 22:58the end of life at home.
22:59 --> 23:02You bring up an excellent,
23:02 --> 23:05excellent question, so valuative care is
23:05 --> 23:08a very important part of cancer care,
23:08 --> 23:11and you know it includes pain control.
23:11 --> 23:13It includes things that can
23:13 --> 23:16occur like loss of appetite,
23:16 --> 23:18loss of interest in life,
23:18 --> 23:21so we actually offer a consultative
23:21 --> 23:24service that is available through Yale.
23:24 --> 23:27We can do it either virtually
23:27 --> 23:29or we can do it
23:29 --> 23:33in the office, we actually have consultative
23:33 --> 23:35care services available on site,
23:35 --> 23:39so that is outpatient and inpatient.
23:39 --> 23:41Palliative care services are available
23:41 --> 23:42through both hospitals.
23:42 --> 23:46So both Waterbury Hospital and Saint
23:46 --> 23:48Mary's Hospital offer palliative
23:48 --> 23:51care services is an inpatient unit 4.
23:53 --> 23:56A lot of patients want to be home.
23:56 --> 23:58They want to
23:58 --> 24:00be surrounded with the loved ones they
24:00 --> 24:03want to be in familiar surroundings.
24:03 --> 24:05So we have several Hospice agencies,
24:07 --> 24:09who can make that possible
24:09 --> 24:13and who do really do a very
24:13 --> 24:16fabulous job of taking
24:16 --> 24:19care of patients at the end of
24:19 --> 24:21life, they trained to do that.
24:21 --> 24:23They are compassionate,
24:23 --> 24:25their empathetic and most patients
24:25 --> 24:27are very pleased with their services.
24:29 --> 24:31It's really important for cancer
24:31 --> 24:33patients to get treated where
24:33 --> 24:36they feel the most comfortable and
24:36 --> 24:38being surrounded by loved ones,
24:38 --> 24:41particularly at the end of life,
24:41 --> 24:44is something that they may consider.
24:47 --> 24:50You've mentioned a few times
24:50 --> 24:52this whole crisis that
24:52 --> 24:54we've been through with Covid,
24:54 --> 24:58which in and of itself has restricted
24:58 --> 25:00mobility in terms of going across
25:00 --> 25:03state lines for certain states,
25:03 --> 25:05travel and so on.
25:05 --> 25:08Talk to us a little bit about
25:08 --> 25:10how the covid epidemic affected
25:10 --> 25:13cancer care in the community.
25:14 --> 25:18Well, you know a lot of the screening
25:18 --> 25:21procedures that people would go for,
25:21 --> 25:23I think those have been the
25:23 --> 25:27first ones to have gone
25:27 --> 25:29away or have been put on hold.
25:29 --> 25:31So screening mammograms,
25:31 --> 25:32screening colonoscopies,
25:32 --> 25:34those have been a challenge,
25:34 --> 25:37so people have either put them off
25:37 --> 25:41or have just been afraid to go out.
25:41 --> 25:42And you know,
25:42 --> 25:45we've resorted to some virtual visits.
25:45 --> 25:46Which I would say patients are
25:46 --> 25:48thankful that they're seeing a doctor,
25:48 --> 25:50even if they're not coming into
25:50 --> 25:52the office and patients who have
25:52 --> 25:54been able to come to the office
25:54 --> 25:56are just so delighted to be there,
25:56 --> 25:58and they have often said to me
25:58 --> 26:00that this is my first
26:00 --> 26:02outing in the last three months.
26:02 --> 26:05I cannot tell you how happy I am to be here,
26:05 --> 26:10so it's sort of kind of funny to hear that.
26:13 --> 26:16But a lot of people have delayed their
26:16 --> 26:20care and we are beginning to see
26:20 --> 26:22a little bit of an uptick
26:22 --> 26:25now in patients presenting with slightly
26:25 --> 26:27advanced cancers at this time because
26:27 --> 26:30of the lack of screening, you
26:30 --> 26:33think lack of screening and self delayed
26:33 --> 26:35patient care, obviously,
26:35 --> 26:38for reasons that are understandable.
26:39 --> 26:41And so are you recommending that
26:41 --> 26:44people get back into screening now?
26:44 --> 26:47Do you think that we have gotten over
26:47 --> 26:49the height of the pandemic such
26:49 --> 26:53that people should really get back into
26:53 --> 26:55doing those screening mammograms and
26:55 --> 26:56colonoscopies?
26:56 --> 26:58I think in the Community
26:58 --> 27:00people are already back to it.
27:00 --> 27:03You know our centers, they are
27:03 --> 27:05asking everybody
27:05 --> 27:07to wear masks, temperature checks.
27:07 --> 27:09Most people now have been immunized.
27:09 --> 27:11I would say at least 90%
27:11 --> 27:13of my patient population,
27:13 --> 27:16who I ask has either received the
27:16 --> 27:18vaccine or is going to receive
27:18 --> 27:21it in the next few days so I do
27:21 --> 27:24get a sense that at least as far
27:24 --> 27:25as medical care is concerned,
27:25 --> 27:28that the Community is getting back to normal.
27:29 --> 27:32And do you think that some of the things
27:32 --> 27:35that we've kind of learned about medicine
27:35 --> 27:38and how medicine can be delivered?
27:38 --> 27:41For example, you know virtual visits
27:41 --> 27:42and telemedicine really opened up
27:42 --> 27:46a whole horizon for people for
27:46 --> 27:48whom transportation was a big issue.
27:48 --> 27:51Do you think that that's here to stay?
27:51 --> 27:53That will continue to have Tele
27:53 --> 27:55medicine visits into the future?
27:56 --> 27:57Excellent
27:57 --> 27:59question and I think that it
27:59 --> 28:02is here to stay and it has made
28:02 --> 28:05life simpler for a lot of people.
28:05 --> 28:07But it has also brought
28:07 --> 28:08along many challenges.
28:08 --> 28:10The older patients
28:10 --> 28:12cannot get the video connection.
28:12 --> 28:15They are so frustrated
28:15 --> 28:18by the end of the visit.
28:18 --> 28:20But I would say the telephone
28:20 --> 28:22visits go much smoother,
28:22 --> 28:25especially if you're dealing with
28:25 --> 28:26an older population or you
28:26 --> 28:28know people who are just not
28:28 --> 28:30comfortable doing it on the phone.
28:32 --> 28:33Other than the technology challenge,
28:33 --> 28:36I think it is here to stay.
28:36 --> 28:37Doctor Anamika Katoch is an
28:37 --> 28:39assistant professor of clinical
28:39 --> 28:40medicine and medical oncology
28:40 --> 28:42at the Yale School of Medicine.
28:42 --> 28:44If you have questions,
28:44 --> 28:45the address is canceranswers@yale.edu
28:45 --> 28:47and past editions of the program
28:47 --> 28:49are available in audio and written
28:49 --> 28:51form at yalecancercenter.org.
28:51 --> 28:54We hope you'll join us next week to
28:54 --> 28:57learn more about the fight against
28:57 --> 29:00cancer here on Connecticut Public Radio.

Information

Cancer Care in the Community with guest Dr. Anamika Katoch April 18, 2021 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095