January 7, 2025 • 29 mins
On this episode, we will hear from integrative medical oncologist Dr. Ana Marie Lopez. Dr. Lopez will share exciting advances in cancer therapies including treatment de-escalation, new molecular treatments and the emerging research on the impact of diet and exercise in treatment responses.
Five To Thrive Live is broadcast live Tuesdays at 7PM ET and Music on W4CS Radio – The Cancer Support Network (www.w4cy.com) part of Talk 4 Radio (www.talk4radio.com) on the Talk 4 Media Network (www.talk4media.com).
Five To Thrive Live Podcast is also available on Talk 4 Media (www.talk4media.com), Talk 4 Podcasting (www.talk4podcasting.com), iHeartRadio, Amazon Music, Pandora, Spotify, Audible, and over 100 other podcast outlets.
Five To Thrive Live is broadcast live Tuesdays at 7PM ET and Music on W4CS Radio – The Cancer Support Network (www.w4cy.com) part of Talk 4 Radio (www.talk4radio.com) on the Talk 4 Media Network (www.talk4media.com).
Five To Thrive Live Podcast is also available on Talk 4 Media (www.talk4media.com), Talk 4 Podcasting (www.talk4podcasting.com), iHeartRadio, Amazon Music, Pandora, Spotify, Audible, and over 100 other podcast outlets.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Any health related information on the following show provides general
information only. Content presented on any show by any host
or guest should not be substituted for a doctor's advice.
Always consult your physician before beginning any new diet, exercise,
or treatment program.
Speaker 2 (00:30):
Hello, welcome to five to Thrive Live, a podcast about
thriving for those who have been affected by cancer and
chronic disease. I'm doctor Lisau Schuler and I co host
(00:50):
with my good friend Caroline Gazella, and you can find
all of our past show podcasts on any major podcast
outlet and a schedule on i've planned dot com. So
tonight I am going to be talking with doctor Anna
Marie Lopez, who is a medical doctor and a professor
of Metal oncology and Integrative Medicine and Nutritional Sciences at
(01:14):
the Sydney Kimmel Cancer Center of Thomas Jefferson University. She's
also the inaugural director of the Integrative Oncology program there,
and she conducts both outpatient and inpatient integrative oncology consultations
in person and virtually. She mentors medical students, residents, and
(01:34):
fellows in a clinical and research setting. She is a
graduate of the integrat of Oncology Fellowship at the University
of Arizona, where she completed her Hematology Oncology fellowship and
where she served as Professor of Medicine and Pathology at
the Arizona Cancer Center. So we're very excited to have
on our show. Before we start into that conversation, which
(01:57):
and we're going to be talking about kind of some
more recent advances, particularly in breast cancer treatments, some very
exciting things have been happening in the oncology world. So
we're going to get into that with an expert. But
before we do that, I want to thank our sponsors. First,
we have Cetria, which is a patented form of glutathione
(02:17):
clinically proven to raise blood glutathione levels. Glue iion is
the master antioxidant and the body's primary defense against free radicals,
and it also supports respiratory health and you can learn
more at Cetria Glutathione dot com. Also, cognizance citicoline nature's
way of keeping the brains energy producing centers, fire and
(02:40):
all centers. So if you want to enhance your brain function, memory, focus,
and attention, look for cognizant on the label of one
of your favorite brain supplements. You can also learn more
at Cognizan dot com. Pro Thrivers Wellness Brain is a
supplement that contains Cognizant as well as some other brain
supporting nutrients and herbs, and you can find pro Thrivers
(03:01):
Wellness Brain online at pureformulas dot com. There's also pro
Thrillers Wellness Sleep and pro Thrivers Wellness Blabinoids and multi
vitamin all available at Pureformulas dot com. And then finally
we have doctor or Hero's Probiotics, a best selling probiotic
for over thirty years with twelve probiotic strains that are
(03:22):
shelf stable without refrigeration due to a unique three year
fermentation process, and you can learn more at doctor Ohira
Probiotics dot com. And with that, doctor Lopez, welcome to
five to Thrive Life.
Speaker 3 (03:35):
Thank you. I'm very happy to be here and I
look forward to our conversation me too.
Speaker 2 (03:41):
So, you know, we like to have our gain introduce
themselves a little bit, and so maybe tell us how
you developed your interest in medical oncology and then an
integrat of oncology specifically.
Speaker 3 (03:53):
So I when I was a medical student, I kind
of went back and forth, you know, every rotation. I
wanted to do that, and then I realized that it
would be too hard to take care of children, I thought,
so I narrowed it down to adult medicine. But then
(04:16):
I really liked internal medicine. But I really liked psychiatry.
And what I loved was in medical oncology the thought
about bridging, and I think it really was an attempt
to kind of focus on mind, body spirit. I just
(04:36):
didn't know the concept of integrative oncology yet, and so
I entered medical oncology, and then I was at the
University of Arizona. The fellowship was there, I you know,
was working with folks, and my children grew up, and
I figured I had more time, so I did the fellowship,
(04:57):
and really, integrate of oncology is incredible, and I feel
it's incredibly impactful and can really just makes a tremendous
difference in patients lives. So I feel it's a dishonor
to do this work fantastic.
Speaker 2 (05:15):
I agree with you one hundred percent. So you know
the other thing that's happening. We're going to get a
little bit into the integrative component. But first I want
to tap into your expertise as a medical oncologist and
cancer treatment. Conventional cancer treatment is so different now than
it was twenty years ago, even ten years ago. It's
just innovation is happening so rapidly. So what are you
(05:37):
most excited about in terms of you know, treatment innovations
specifically for breast cancers.
Speaker 3 (05:44):
So there are several things. One is this whole concept
of de escalation of therapy. And I think you know,
when I was a fellow, we were really thinking about
bone marrow transplantation for everything, so meaning you know, we
were taking women with ovarian with breast and the idea
(06:06):
was very much more is better. And here, as we
have learned more about the molecular biology, we really have
begun to think more of how do we really make
the impact and in that way not only improve outcomes,
but can we improve outcomes and decrease morbidity and toxicity
(06:29):
for people. So we've seen this a little bit for
example in ductyl carcinoma in cyto, where you know, again
the treatment traditionally has been surgery, radiation, hormonal therapy, hormonal
blockad therapy if the tumor is estrogen sensitive, but are
(06:50):
there other ways? Are there less invasive approaches for the
for the removal something like cryotherapy. Does everybody need radiation?
Does everybody need the hormonal blockade? So really thinking about
de escalation because we understand the biology of the cancer
(07:13):
better mm hmm.
Speaker 2 (07:15):
So yeah, I think what's what de escalation rests is
this idea of personalized treatment. So really understanding, like you said,
what's unique about this particular tumor in this particular person
that would make it more or less sensitive to certain treatments.
And yeah, it's just really wonderful. See I think, you know,
(07:38):
especially with the decrease in chemotherapy that's now required general,
you know for many women, some of course still benefit rightly,
but there's a lot of opportunity for As you said,
de escalation, has this changed survival in early stage or
even in advanced cancers.
Speaker 3 (07:57):
So I think we're still looking at those vival endpoints,
but has changed side effect profile. So in that sense,
you know, we there's increased number of survivors, and we
want people not only to survive, you know, patients again,
I remember patients would say, if survival is this, maybe
(08:22):
I don't want this, and so how can we have
the give people the opportunity to live well and then
survivorship has definitely increased from the concept of the targeted, precision,
personalized therapy. So I'm going to throw out some things
(08:43):
out there that I think are so exciting. So yeah,
that's it, really is molecular biology, right. So I remember
so Sell in the journals cell the Hallmarks of Cancer
were published in the very first issue of the year
two thousand and how how appropriate and how pivotal that
(09:05):
that was the beginning of the new century, the new millennium,
because we really put what was put out there was
these were the ways to think of cancer as a
molecular disease. So even though you know, Missus Jones cancer
under the microscope might look the same as Missus Smith's
(09:25):
cancer under the microscope, they could be treated radically different
because we now understood the genes, we understood the molecular biology,
and with that to then have medications that could target
those specific changes. Now, we used to, you know, when
(09:46):
this first came about, we would say, Ah, the side effects,
they're just they're just better. You know, side effects can
be hard even when they're different, but they're certainly different
and they're not the same, you know, neutropenic fever. You
are near death's door type side effects, but there's there.
(10:08):
They are treatments that are targeting more precisely the actual
cancer cells, so less harm to the normal cells and
definitely improving outcomes. So so radical things where women with
her two positive breast cancer you know, have who have
(10:31):
had metastatic disease, have had brain metastases, and then can
start on one of these antibody drug conjugates, so where
a way where the drug is able to bond to
a specific marker of the cancer and because it's bonded
(10:54):
to this marker that only the cancer cells have, it
can then deliver chemotherapy directly to the cancer cells and
then do better, which is really that's what we want, right,
patients do better. I'll share with you a story not
in breast cancer, but in my fellowship or It was
one of the very first one we were doing one
(11:16):
of the studies, one of the very first patients who
was being treated for CML with one of the new
targeted therapies. And I was covering over Christmas and the
other attending said, uh, said, you know, you may get
a call because he's not doing well. And I got all,
(11:40):
uh from the patient's wife, and you know, I kind
of braced myself. We had paper charts. I you know,
had the paper chart. I was ready with my you know,
most compassionate voice to kind of really talk about end
of life issues. And she called because her husband was
mowing the lawn. And believe it. So, these targeted therapies
(12:08):
have made a difference, have made a difference, and it
really is because we are more precisely able to reach
the cancer cells.
Speaker 2 (12:16):
Uh huh. So I mean with these targeted therapies, innovativeness
still happening in terms of getting the targets more precise,
or the smart bomb that they're delivering more powerful, or both.
Speaker 3 (12:34):
So I think it's both. I think it's both. But
I think the most amazing thing is that we identify
what are the characteristics of this person's cancer, and by
identifying those characteristics, can we then I develop treatments that
(12:57):
bind to that so that you know, they recognize it
and then can deliver the chemotherapy right there. The other,
you know, is are there ways that we can boost
the immune system? Are there ways that we can really
support the organism to bring on its own ability to
(13:18):
fight the cancer. So all of these are approaches. You know,
definitely a very rapidly developing area from the chemo perspective,
but also you know, from the surgical perspective. I briefly
mentioned you know, cryo therapy. You know again, can you
imagine the radical mastectomies that used to be done and
(13:42):
then that we learned that that was not necessary, So
that now even beginning because as we as we identify
cancers at earlier and earlier stages, can smaller surgeries be done,
Can for example, cryo therapy be done, or it just
(14:03):
dissolves the breast cancer and there's not that disfigurement, all
of that extra healing time that would have been present otherwise.
So I think in all of the areas so and
similarly in radiation, you know, again there was like this
is the standard, this is what everybody gets for breast cancer,
(14:26):
and then really thinking how can we tailor this to
the patient and to what we know about their disease.
Speaker 2 (14:36):
Yeah, it is very exciting, and I think that it's
all important for people to hear because there is still
I think some folks out there who feel that the
you know, medical establishment is sort of just out to
make money off of people with cancer. And while I'm
sure that's true in certain situations, there is for sure
(14:58):
a you know, the though by the most impactful trend
in conventional oncology is to de escalate, as you're saying,
and make treatment more precise and actually less needed than
you know, so there's less treatment that somebody has to
go through. And still treatments are fairly difficult and can
(15:19):
be hard for folks. So let's gears a little bit
and talk about some integrative components to care. This is
an area that you're really excited about, So I don't know,
let's just kind of start with what you think of first, Like,
what do you when you're talking to your patients, whether
they're getting a targeted therapy or you know, they're getting
(15:42):
any traditional kind of therapy, what is in your head
to talk to them first about from an integrative perspective.
Speaker 3 (15:51):
So one of the ways in which I introduce integrative
oncology to patients and families is to say that my
job is to care keep you well. You know you're
going to be going through this therapy, The therapy will
begin an end. You have a life that it's my
(16:12):
job to support, so that you can live as well
as possible for as long as possible. And so a
big target area is lifestyle. Now, we know, for example,
that there's a link between overweight and cancer risk, and
we know that lifestyle plays a factor there and that
(16:34):
it's really in many ways, cancer is a metabolic disease,
so that this concept of overweight is probably it's just
like a rough perception that we really need to think
of what are the ways that we assess metabolism and
again asset and that way assess risk, and that for
(16:57):
people who have had a diagnosis of breast cancer, that
this metabolic problem may increase the risk of recurrence by
maybe a third, maybe forty percent, So it's not insignificant.
So how can we help people with lifestyle changes? And
(17:20):
I think of it as kind of how we were
with cardiology twenty years ago, you know, where people would
come in and we would talk with them as residents
and fellows about you know, your diet, your activity, because
it was really such a prime moment for change. And
I think similarly to really think about lifestyle, to think
(17:43):
about the impact that this has on a person's risk
and that this risk, you know, this will help with
breast cancer recurrence risk, this will help with diabetes risk,
this will help with hypertension risk. I mean, there's no
downside to these lifestyle change and then kind of letting
people know what this means, which often right people know,
(18:06):
eat well, sleep well, move your body, and address your stress,
so people kind of know that those are good, healthy
things to do. But then being able to give people
the tools, like how can I help you? Where is
it that you would like to start? So I think
of it as kind of the low hanging fruit or
(18:28):
finding the one thread to help really start to unravel
and wherever the patient is being able to start there.
But I think that lifestyle piece is so important and
what is so exciting and wonderful is one there was
(18:50):
just a wealth of data right on the impact, and
two people uniformly feel better. I can say there is
no other experience that I have had as a physician
that say uniformly people feel better, which ultimately it's what
(19:12):
helps people stick to their changes, because they're the ones
who then say, you know, I may want those potato chips,
but I know how I'm going to feel afterwards, or
maybe I'm going to have one because I just kind
of want that taste again, but I know I don't
want more in that, so people themselves are regulating themselves.
Speaker 2 (19:37):
Yeah, I think that's all very true, and it's really
so true that Well, first of all, I just want
to compliment you on the fact that you see your
job as helping to keep your patients feeling well and
living as you know, a high quality lifer as long
as possible, because actually, I don't know that a lot
of conventional andcologists see that as the responsibility. They really
(19:57):
limit their role as trying to kill the cancer kind
of regardless of the cost to the patient. And I
think with your wider perspective, you know, that's just refreshing,
and I hope that oncology moves in that direction. To
be honest, you mentioned earlier on that mind body was
(20:19):
sort of your initial entree into this idea of integrative oncology.
So can you talk a little bit more about how
you incorporate that into your care and what you see
as a result of focus doing that with your patients.
Speaker 3 (20:30):
Sure? Sure, So I'll just call out that my first
mind body experience was walking on fire at Andy's house.
Just having that experience, so firsthand, Wow, this is a
(20:53):
mind body connection and that could be so kind of
starting from there. Really, again, I feel like this work
is just so personal and so I you know, as
part of the lifestyle discussion, there's certainly a discussion about stress,
(21:17):
about meditation, about the connection that even how we perceive,
you know, when one is calmer, our perception of our
symptoms may be different. So it's not like the pain
has to always be gone, but that perception of pain
can really differ based on how a person is thinking
(21:39):
about it, feeling it. Really, so I think having thoseions,
but even when I'm seeing a patient for a regular
breast cancer visit, we might start to talk about that
and I might patient and uh, I'm always amazed at
(22:03):
how receptive people are, you know. I think sometimes people
have this perception that, oh, it's only those kinds of
people that are interested and really people, and then once
they feel it, once they have the experience. So I
(22:23):
you know, breast cancer is a disease of increases risk
as we get older. I was caring for a patient
who had both lymphoma and ametriol and breast cancer history,
and we meditated, and what she told me is based
(22:46):
on that she meditates every day I often say to people,
you know, if you want to because everybody has, you know,
a smartphone, you know, if you want to record this,
you know. So so h yeah, I think being open
(23:10):
to whatever that opportunity comes up.
Speaker 2 (23:14):
Yeah, great, well, and I think that there is you know,
there's a lot of there's some published studies and certainly
some things that have suggested that when a patient hears
something from their physician, especially a physician whom they respect
and have been trusted their care to, carries a lot
of weight and it can be a very persuasive moment.
(23:37):
So you know, that is both an opportunity and responsibility
for physicians to be very careful about and considerate about
what they say to patients. But it's also, like you said,
hugely impactful and it can be life changing for people.
So kind of along those lines, you know, we've talked
a little bit about just lifestyle. You mentioned, you know,
(23:58):
kind of a nutrition, You've talked about mindfulness, and I'm
curious what your thoughts are on physical activity, just because
I happen to believe that's very important and I'm not
sure that it gets discussed enough. But is that something
you spend a lot of time speaking with your patients about.
Speaker 3 (24:16):
Yeah, yeah, I think that if we had one, if
we had one quote unquote pill that we could give,
I think it would be physical. But I think to
getting I like that you said physical activity and not exercise,
because I think if we think of women, you know,
(24:38):
I don't know how it was when you were in school,
but I think in high school and middle school, you know,
our biggest goal was to get out of pea, get
out of moving our bodies and U and how do
we encourage that, how do we change that mindset? And
also a lot for many people, not just women, there
(24:59):
are the image issues and people feel like you have
just the right body and just the right clothes to exercising.
But we can have all in whatever type of clothes
to move our bodies and also to move our bodies
with joy. So I really think one of the things
(25:22):
we also talk about is that how can we be
our bodies right? And that's part of the mindfulness to
be present in our bodies, and that physical activity does
that for people. You know, if you're focusing on some
yoga move, you're going to be in your body focusing.
(25:42):
So but but also the walking again, wherever the patient
is so you know, so this may seem silly, but
you know, like if a patient maybe is started in
patient service with the bone marrow transplant unit, and so
the patient may say to me, the most I can
do is walk to the mailbox, and I said, that's great.
(26:06):
You don't if you can walk to the mailbox twice.
You know, So meet people, understand what their capacity is,
and then make whatever their next step could be something
that's doable. So people have success experience as they build
(26:28):
themselves up, as they reconnect with their bodies.
Speaker 2 (26:32):
Yeah, yeah, that's great. Small steps, that's the way to
make change. Well, this has been such a good conversation,
and I wonder if you like just share one last shot.
There's a little bit of extra sound coming from your mic.
I'm hoping our engineer can get that resolved, but maybe
just speak up and give us one last thought that
(26:54):
you'd like to leave with our listeners.
Speaker 3 (26:57):
So I think that I from my experience and working
with people, I think that everybody has a chance to
improve their sense of wellbeing everybody, and I think that
includes us. You know, So that that's where the beauty
(27:19):
of these approaches are is that it's not like you
need to jump to doing X, but to think about
where you are, what is important to your well being,
and then to start. And often that start is what
helps people to then get a sense of I can,
(27:41):
which is a big thing, and then build on that.
So I really think that this is personalized therapy because
we really take into account the whole patient.
Speaker 2 (27:56):
Yeah, love it. Well, how can our listeners find you?
Speaker 3 (28:01):
I guess my email is Anna Maria dot Lopez at
Jefferson dot ETU.
Speaker 2 (28:08):
Okay, perfect, Well, thank you so much for joining me tonight.
And I'm really just grateful that you're doing the work
that you do and I hope that you know, lots
of people find your care and that you inspire many
other oncologists that you're training to do the same. And
that wraps up this episode of To Thrive Live. So
(28:31):
again we thank our sponsor Setria Glutathion, the superior glutithion
to support liver and immune health cognizance and a colling
to help enhance memory, focus and attention. Doctor or Hero's
Probiotics Award winning pre and probiotic formulas and pro thrivers
wellness supplements designed specifically for thrivers. Thank you listener for
(28:52):
joining us, made you experience joy, laughter, love, and my
dogs say goodbye to all right, it's time to thrive. Everyone,
have a great nights.
Speaker 1 (29:02):
Gonna be los, gotta be good.
Speaker 3 (29:06):
Loves go baby.
Speaker 2 (29:08):
Good laugh good laugh, per say.
Speaker 3 (29:12):
The stream that Jay the city is bstrang. Be love, Love,
Any health related information on the following show provides general
information only. Content presented on any show by any host
or guest should not be substituted for a doctor's advice.
Always consult your physician before beginning any new diet, exercise,
or treatment program.
Speaker 2 (00:30):
Hello, welcome to five to Thrive Live, a podcast about
thriving for those who have been affected by cancer and
chronic disease. I'm doctor Lisau Schuler and I co host
(00:50):
with my good friend Caroline Gazella, and you can find
all of our past show podcasts on any major podcast
outlet and a schedule on i've planned dot com. So
tonight I am going to be talking with doctor Anna
Marie Lopez, who is a medical doctor and a professor
of Metal oncology and Integrative Medicine and Nutritional Sciences at
(01:14):
the Sydney Kimmel Cancer Center of Thomas Jefferson University. She's
also the inaugural director of the Integrative Oncology program there,
and she conducts both outpatient and inpatient integrative oncology consultations
in person and virtually. She mentors medical students, residents, and
(01:34):
fellows in a clinical and research setting. She is a
graduate of the integrat of Oncology Fellowship at the University
of Arizona, where she completed her Hematology Oncology fellowship and
where she served as Professor of Medicine and Pathology at
the Arizona Cancer Center. So we're very excited to have
on our show. Before we start into that conversation, which
(01:57):
and we're going to be talking about kind of some
more recent advances, particularly in breast cancer treatments, some very
exciting things have been happening in the oncology world. So
we're going to get into that with an expert. But
before we do that, I want to thank our sponsors. First,
we have Cetria, which is a patented form of glutathione
(02:17):
clinically proven to raise blood glutathione levels. Glue iion is
the master antioxidant and the body's primary defense against free radicals,
and it also supports respiratory health and you can learn
more at Cetria Glutathione dot com. Also, cognizance citicoline nature's
way of keeping the brains energy producing centers, fire and
(02:40):
all centers. So if you want to enhance your brain function, memory, focus,
and attention, look for cognizant on the label of one
of your favorite brain supplements. You can also learn more
at Cognizan dot com. Pro Thrivers Wellness Brain is a
supplement that contains Cognizant as well as some other brain
supporting nutrients and herbs, and you can find pro Thrivers
(03:01):
Wellness Brain online at pureformulas dot com. There's also pro
Thrillers Wellness Sleep and pro Thrivers Wellness Blabinoids and multi
vitamin all available at Pureformulas dot com. And then finally
we have doctor or Hero's Probiotics, a best selling probiotic
for over thirty years with twelve probiotic strains that are
(03:22):
shelf stable without refrigeration due to a unique three year
fermentation process, and you can learn more at doctor Ohira
Probiotics dot com. And with that, doctor Lopez, welcome to
five to Thrive Life.
Speaker 3 (03:35):
Thank you. I'm very happy to be here and I
look forward to our conversation me too.
Speaker 2 (03:41):
So, you know, we like to have our gain introduce
themselves a little bit, and so maybe tell us how
you developed your interest in medical oncology and then an
integrat of oncology specifically.
Speaker 3 (03:53):
So I when I was a medical student, I kind
of went back and forth, you know, every rotation. I
wanted to do that, and then I realized that it
would be too hard to take care of children, I thought,
so I narrowed it down to adult medicine. But then
(04:16):
I really liked internal medicine. But I really liked psychiatry.
And what I loved was in medical oncology the thought
about bridging, and I think it really was an attempt
to kind of focus on mind, body spirit. I just
(04:36):
didn't know the concept of integrative oncology yet, and so
I entered medical oncology, and then I was at the
University of Arizona. The fellowship was there, I you know,
was working with folks, and my children grew up, and
I figured I had more time, so I did the fellowship,
(04:57):
and really, integrate of oncology is incredible, and I feel
it's incredibly impactful and can really just makes a tremendous
difference in patients lives. So I feel it's a dishonor
to do this work fantastic.
Speaker 2 (05:15):
I agree with you one hundred percent. So you know
the other thing that's happening. We're going to get a
little bit into the integrative component. But first I want
to tap into your expertise as a medical oncologist and
cancer treatment. Conventional cancer treatment is so different now than
it was twenty years ago, even ten years ago. It's
just innovation is happening so rapidly. So what are you
(05:37):
most excited about in terms of you know, treatment innovations
specifically for breast cancers.
Speaker 3 (05:44):
So there are several things. One is this whole concept
of de escalation of therapy. And I think you know,
when I was a fellow, we were really thinking about
bone marrow transplantation for everything, so meaning you know, we
were taking women with ovarian with breast and the idea
(06:06):
was very much more is better. And here, as we
have learned more about the molecular biology, we really have
begun to think more of how do we really make
the impact and in that way not only improve outcomes,
but can we improve outcomes and decrease morbidity and toxicity
(06:29):
for people. So we've seen this a little bit for
example in ductyl carcinoma in cyto, where you know, again
the treatment traditionally has been surgery, radiation, hormonal therapy, hormonal
blockad therapy if the tumor is estrogen sensitive, but are
(06:50):
there other ways? Are there less invasive approaches for the
for the removal something like cryotherapy. Does everybody need radiation?
Does everybody need the hormonal blockade? So really thinking about
de escalation because we understand the biology of the cancer
(07:13):
better mm hmm.
Speaker 2 (07:15):
So yeah, I think what's what de escalation rests is
this idea of personalized treatment. So really understanding, like you said,
what's unique about this particular tumor in this particular person
that would make it more or less sensitive to certain treatments.
And yeah, it's just really wonderful. See I think, you know,
(07:38):
especially with the decrease in chemotherapy that's now required general,
you know for many women, some of course still benefit rightly,
but there's a lot of opportunity for As you said,
de escalation, has this changed survival in early stage or
even in advanced cancers.
Speaker 3 (07:57):
So I think we're still looking at those vival endpoints,
but has changed side effect profile. So in that sense,
you know, we there's increased number of survivors, and we
want people not only to survive, you know, patients again,
I remember patients would say, if survival is this, maybe
(08:22):
I don't want this, and so how can we have
the give people the opportunity to live well and then
survivorship has definitely increased from the concept of the targeted, precision,
personalized therapy. So I'm going to throw out some things
(08:43):
out there that I think are so exciting. So yeah,
that's it, really is molecular biology, right. So I remember
so Sell in the journals cell the Hallmarks of Cancer
were published in the very first issue of the year
two thousand and how how appropriate and how pivotal that
(09:05):
that was the beginning of the new century, the new millennium,
because we really put what was put out there was
these were the ways to think of cancer as a
molecular disease. So even though you know, Missus Jones cancer
under the microscope might look the same as Missus Smith's
(09:25):
cancer under the microscope, they could be treated radically different
because we now understood the genes, we understood the molecular biology,
and with that to then have medications that could target
those specific changes. Now, we used to, you know, when
(09:46):
this first came about, we would say, Ah, the side effects,
they're just they're just better. You know, side effects can
be hard even when they're different, but they're certainly different
and they're not the same, you know, neutropenic fever. You
are near death's door type side effects, but there's there.
(10:08):
They are treatments that are targeting more precisely the actual
cancer cells, so less harm to the normal cells and
definitely improving outcomes. So so radical things where women with
her two positive breast cancer you know, have who have
(10:31):
had metastatic disease, have had brain metastases, and then can
start on one of these antibody drug conjugates, so where
a way where the drug is able to bond to
a specific marker of the cancer and because it's bonded
(10:54):
to this marker that only the cancer cells have, it
can then deliver chemotherapy directly to the cancer cells and
then do better, which is really that's what we want, right,
patients do better. I'll share with you a story not
in breast cancer, but in my fellowship or It was
one of the very first one we were doing one
(11:16):
of the studies, one of the very first patients who
was being treated for CML with one of the new
targeted therapies. And I was covering over Christmas and the
other attending said, uh, said, you know, you may get
a call because he's not doing well. And I got all,
(11:40):
uh from the patient's wife, and you know, I kind
of braced myself. We had paper charts. I you know,
had the paper chart. I was ready with my you know,
most compassionate voice to kind of really talk about end
of life issues. And she called because her husband was
mowing the lawn. And believe it. So, these targeted therapies
(12:08):
have made a difference, have made a difference, and it
really is because we are more precisely able to reach
the cancer cells.
Speaker 2 (12:16):
Uh huh. So I mean with these targeted therapies, innovativeness
still happening in terms of getting the targets more precise,
or the smart bomb that they're delivering more powerful, or both.
Speaker 3 (12:34):
So I think it's both. I think it's both. But
I think the most amazing thing is that we identify
what are the characteristics of this person's cancer, and by
identifying those characteristics, can we then I develop treatments that
(12:57):
bind to that so that you know, they recognize it
and then can deliver the chemotherapy right there. The other,
you know, is are there ways that we can boost
the immune system? Are there ways that we can really
support the organism to bring on its own ability to
(13:18):
fight the cancer. So all of these are approaches. You know,
definitely a very rapidly developing area from the chemo perspective,
but also you know, from the surgical perspective. I briefly
mentioned you know, cryo therapy. You know again, can you
imagine the radical mastectomies that used to be done and
(13:42):
then that we learned that that was not necessary, So
that now even beginning because as we as we identify
cancers at earlier and earlier stages, can smaller surgeries be done,
Can for example, cryo therapy be done, or it just
(14:03):
dissolves the breast cancer and there's not that disfigurement, all
of that extra healing time that would have been present otherwise.
So I think in all of the areas so and
similarly in radiation, you know, again there was like this
is the standard, this is what everybody gets for breast cancer,
(14:26):
and then really thinking how can we tailor this to
the patient and to what we know about their disease.
Speaker 2 (14:36):
Yeah, it is very exciting, and I think that it's
all important for people to hear because there is still
I think some folks out there who feel that the
you know, medical establishment is sort of just out to
make money off of people with cancer. And while I'm
sure that's true in certain situations, there is for sure
(14:58):
a you know, the though by the most impactful trend
in conventional oncology is to de escalate, as you're saying,
and make treatment more precise and actually less needed than
you know, so there's less treatment that somebody has to
go through. And still treatments are fairly difficult and can
(15:19):
be hard for folks. So let's gears a little bit
and talk about some integrative components to care. This is
an area that you're really excited about, So I don't know,
let's just kind of start with what you think of first, Like,
what do you when you're talking to your patients, whether
they're getting a targeted therapy or you know, they're getting
(15:42):
any traditional kind of therapy, what is in your head
to talk to them first about from an integrative perspective.
Speaker 3 (15:51):
So one of the ways in which I introduce integrative
oncology to patients and families is to say that my
job is to care keep you well. You know you're
going to be going through this therapy, The therapy will
begin an end. You have a life that it's my
(16:12):
job to support, so that you can live as well
as possible for as long as possible. And so a
big target area is lifestyle. Now, we know, for example,
that there's a link between overweight and cancer risk, and
we know that lifestyle plays a factor there and that
(16:34):
it's really in many ways, cancer is a metabolic disease,
so that this concept of overweight is probably it's just
like a rough perception that we really need to think
of what are the ways that we assess metabolism and
again asset and that way assess risk, and that for
(16:57):
people who have had a diagnosis of breast cancer, that
this metabolic problem may increase the risk of recurrence by
maybe a third, maybe forty percent, So it's not insignificant.
So how can we help people with lifestyle changes? And
(17:20):
I think of it as kind of how we were
with cardiology twenty years ago, you know, where people would
come in and we would talk with them as residents
and fellows about you know, your diet, your activity, because
it was really such a prime moment for change. And
I think similarly to really think about lifestyle, to think
(17:43):
about the impact that this has on a person's risk
and that this risk, you know, this will help with
breast cancer recurrence risk, this will help with diabetes risk,
this will help with hypertension risk. I mean, there's no
downside to these lifestyle change and then kind of letting
people know what this means, which often right people know,
(18:06):
eat well, sleep well, move your body, and address your stress,
so people kind of know that those are good, healthy
things to do. But then being able to give people
the tools, like how can I help you? Where is
it that you would like to start? So I think
of it as kind of the low hanging fruit or
(18:28):
finding the one thread to help really start to unravel
and wherever the patient is being able to start there.
But I think that lifestyle piece is so important and
what is so exciting and wonderful is one there was
(18:50):
just a wealth of data right on the impact, and
two people uniformly feel better. I can say there is
no other experience that I have had as a physician
that say uniformly people feel better, which ultimately it's what
(19:12):
helps people stick to their changes, because they're the ones
who then say, you know, I may want those potato chips,
but I know how I'm going to feel afterwards, or
maybe I'm going to have one because I just kind
of want that taste again, but I know I don't
want more in that, so people themselves are regulating themselves.
Speaker 2 (19:37):
Yeah, I think that's all very true, and it's really
so true that Well, first of all, I just want
to compliment you on the fact that you see your
job as helping to keep your patients feeling well and
living as you know, a high quality lifer as long
as possible, because actually, I don't know that a lot
of conventional andcologists see that as the responsibility. They really
(19:57):
limit their role as trying to kill the cancer kind
of regardless of the cost to the patient. And I
think with your wider perspective, you know, that's just refreshing,
and I hope that oncology moves in that direction. To
be honest, you mentioned earlier on that mind body was
(20:19):
sort of your initial entree into this idea of integrative oncology.
So can you talk a little bit more about how
you incorporate that into your care and what you see
as a result of focus doing that with your patients.
Speaker 3 (20:30):
Sure? Sure, So I'll just call out that my first
mind body experience was walking on fire at Andy's house.
Just having that experience, so firsthand, Wow, this is a
(20:53):
mind body connection and that could be so kind of
starting from there. Really, again, I feel like this work
is just so personal and so I you know, as
part of the lifestyle discussion, there's certainly a discussion about stress,
(21:17):
about meditation, about the connection that even how we perceive,
you know, when one is calmer, our perception of our
symptoms may be different. So it's not like the pain
has to always be gone, but that perception of pain
can really differ based on how a person is thinking
(21:39):
about it, feeling it. Really, so I think having thoseions,
but even when I'm seeing a patient for a regular
breast cancer visit, we might start to talk about that
and I might patient and uh, I'm always amazed at
(22:03):
how receptive people are, you know. I think sometimes people
have this perception that, oh, it's only those kinds of
people that are interested and really people, and then once
they feel it, once they have the experience. So I
(22:23):
you know, breast cancer is a disease of increases risk
as we get older. I was caring for a patient
who had both lymphoma and ametriol and breast cancer history,
and we meditated, and what she told me is based
(22:46):
on that she meditates every day I often say to people,
you know, if you want to because everybody has, you know,
a smartphone, you know, if you want to record this,
you know. So so h yeah, I think being open
(23:10):
to whatever that opportunity comes up.
Speaker 2 (23:14):
Yeah, great, well, and I think that there is you know,
there's a lot of there's some published studies and certainly
some things that have suggested that when a patient hears
something from their physician, especially a physician whom they respect
and have been trusted their care to, carries a lot
of weight and it can be a very persuasive moment.
(23:37):
So you know, that is both an opportunity and responsibility
for physicians to be very careful about and considerate about
what they say to patients. But it's also, like you said,
hugely impactful and it can be life changing for people.
So kind of along those lines, you know, we've talked
a little bit about just lifestyle. You mentioned, you know,
(23:58):
kind of a nutrition, You've talked about mindfulness, and I'm
curious what your thoughts are on physical activity, just because
I happen to believe that's very important and I'm not
sure that it gets discussed enough. But is that something
you spend a lot of time speaking with your patients about.
Speaker 3 (24:16):
Yeah, yeah, I think that if we had one, if
we had one quote unquote pill that we could give,
I think it would be physical. But I think to
getting I like that you said physical activity and not exercise,
because I think if we think of women, you know,
(24:38):
I don't know how it was when you were in school,
but I think in high school and middle school, you know,
our biggest goal was to get out of pea, get
out of moving our bodies and U and how do
we encourage that, how do we change that mindset? And
also a lot for many people, not just women, there
(24:59):
are the image issues and people feel like you have
just the right body and just the right clothes to exercising.
But we can have all in whatever type of clothes
to move our bodies and also to move our bodies
with joy. So I really think one of the things
(25:22):
we also talk about is that how can we be
our bodies right? And that's part of the mindfulness to
be present in our bodies, and that physical activity does
that for people. You know, if you're focusing on some
yoga move, you're going to be in your body focusing.
(25:42):
So but but also the walking again, wherever the patient
is so you know, so this may seem silly, but
you know, like if a patient maybe is started in
patient service with the bone marrow transplant unit, and so
the patient may say to me, the most I can
do is walk to the mailbox, and I said, that's great.
(26:06):
You don't if you can walk to the mailbox twice.
You know, So meet people, understand what their capacity is,
and then make whatever their next step could be something
that's doable. So people have success experience as they build
(26:28):
themselves up, as they reconnect with their bodies.
Speaker 2 (26:32):
Yeah, yeah, that's great. Small steps, that's the way to
make change. Well, this has been such a good conversation,
and I wonder if you like just share one last shot.
There's a little bit of extra sound coming from your mic.
I'm hoping our engineer can get that resolved, but maybe
just speak up and give us one last thought that
(26:54):
you'd like to leave with our listeners.
Speaker 3 (26:57):
So I think that I from my experience and working
with people, I think that everybody has a chance to
improve their sense of wellbeing everybody, and I think that
includes us. You know, So that that's where the beauty
(27:19):
of these approaches are is that it's not like you
need to jump to doing X, but to think about
where you are, what is important to your well being,
and then to start. And often that start is what
helps people to then get a sense of I can,
(27:41):
which is a big thing, and then build on that.
So I really think that this is personalized therapy because
we really take into account the whole patient.
Speaker 2 (27:56):
Yeah, love it. Well, how can our listeners find you?
Speaker 3 (28:01):
I guess my email is Anna Maria dot Lopez at
Jefferson dot ETU.
Speaker 2 (28:08):
Okay, perfect, Well, thank you so much for joining me tonight.
And I'm really just grateful that you're doing the work
that you do and I hope that you know, lots
of people find your care and that you inspire many
other oncologists that you're training to do the same. And
that wraps up this episode of To Thrive Live. So
(28:31):
again we thank our sponsor Setria Glutathion, the superior glutithion
to support liver and immune health cognizance and a colling
to help enhance memory, focus and attention. Doctor or Hero's
Probiotics Award winning pre and probiotic formulas and pro thrivers
wellness supplements designed specifically for thrivers. Thank you listener for
(28:52):
joining us, made you experience joy, laughter, love, and my
dogs say goodbye to all right, it's time to thrive. Everyone,
have a great nights.
Speaker 1 (29:02):
Gonna be los, gotta be good.
Speaker 3 (29:06):
Loves go baby.
Speaker 2 (29:08):
Good laugh good laugh, per say.
Speaker 3 (29:12):
The stream that Jay the city is bstrang. Be love, Love,
Popular Podcasts
Spooky Podcasts from iHeartRadio
Whether you’re a scaredy-cat or a brave bat, this collection of episodes from iHeartPodcasts will put you in the Halloween spirit. Binge stories, frights, and more that may keep you up at night!
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.