June 10, 2026 • 36 mins
A cancer diagnosis can change everything in an instant. One conversation. Three words: "You have cancer." Suddenly, patients and families are faced with uncertainty, fear, and countless questions about what comes next.
In this episode of MedStar Health DocTalk, host Debra Schindler sits down with medical oncologist and hematologist Dr. Ankit Madan of MedStar Southern Maryland Hospital Center, to discuss the critical first steps after a cancer diagnosis. Dr. Madan explains how patients move from diagnosis to treatment, how cancer is staged, and why building a multidisciplinary care team is essential for the best possible outcomes.
The conversation explores the emotional impact of hearing a cancer diagnosis, the importance of patient navigators, social workers, nutritionists, mental health professionals, and the role patients play as active partners in their own care. Dr. Madan also discusses treatment advances, clinical trials, immunotherapy breakthroughs, second opinions, and practical advice for patients and families navigating one of life's most challenging journeys.
Whether you or a loved one has recently been diagnosed with cancer, this episode offers guidance, reassurance, and expert insight into what happens after the diagnosis—and how patients can move forward with confidence and support.
Topics covered:
• Coping with the emotional impact of a cancer diagnosis
• Understanding cancer staging and treatment planning
• The role of biopsies, CT scans, PET scans, and additional testing
• Building a multidisciplinary cancer care team
• Patient navigators, social workers, and support services
• Shared decision-making and patient autonomy
• When to seek a second opinion
• Clinical trials and emerging cancer treatments
• Immunotherapy and advances in cancer care
• Nutrition, exercise, and mental health during treatment
• Cancer survivorship and ongoing surveillance
To learn more about cancer care at MedStar Health, visit MedStarHealth.org/Cancer.
For more episodes of MedStar Health DocTalk, go to medstarhealth.org/doctalk.
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Episode Transcript
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(00:03):
and insightful conversations about healthand medicine happen here.
When MedStar Health Doc talk,these are real conversations
with physician experts fromaround the largest
healthcare system in theMaryland DC region.
One of the most pivotal momentsin a person's life can come
from one conversation and three words.
(00:25):
You have cancer and suddenlylife is divided into the before
and after getting thatdiagnosis in an instant,
everything changes.
Some people go blankfor some questions are
racing through their mind.
How do I tell my family? AmI going to get through this?
Fear might kick in where tobegin with options no matter
(00:47):
what the initial reactionpatients are usually asking.
Next, what now what do I do?
Today we're talking about whatcomes next, the first steps
after a cancer diagnosis, howto make sense of the moment,
grasp the decision making process,build your care team
and find your footing.
Again. Joining me is MedStar,health medical oncologist
(01:11):
and hematologist Dr.
Ankit Madan, thank you so much for beingwith us here on Doc Talk.
- Thank you Debra, for having me.
This is such an importantconversation we are going
to have today about a patient's journeythrough the diagnosis of cancer.
I want people to knowthat when they get this
diagnosis, they're not alone.
They're supportive teams aroundthem, cancer center teams
(01:34):
around them that are there to take careof them when they have
a diagnosis like this.
- Sure. Let's begin withthat emotional side.
When someone first hears they have cancer,I can imagine it would feel like the, the,
the ground is literallyshifted beneath them.
What do you want patientsto know in that moment?
(01:56):
- So first of all, you know,listening to these words
that you have cancer is, is not easy.
I always tell my patientsit is way difficult
to be sitting on thepatient side of this story
and hearing a doctor say this.
First of all, I want patientsto know that there are teams
to take care of them.
How somebody reacts to thatdiagnosis really depends on
(02:20):
where they are in life.
You know, when you geta diagnosis of cancer,
you're not prepared for it.
You're living your life,you're planning trips
with your family, you'reopening a new business,
going about your daily activities,- Right?
- Suddenly you feel ill and there you go.
You know, we find a massor we find something on the
scan that needs to be pursuedand you know, you get told
(02:43):
this diagnosis at that time.
What I've seen on the emotionalaspect with people is that
for our younger population,especially our young
breast cancer females,they have younger kids at that time.
So now suddenly they'rethrown into a position
where they're taking careof their health instead of
(03:04):
what they usually do, whichis take care of their kids.
- Right? - When you have olderpeople who view, who've been
through a few health scares in their life,manage it a little bit better.
But again, there's no rightor wrong way to deal with this situation.
This is an unusual situationthat arises when you get cancer
and the next best step for you isto start looking at the treatment process.
(03:30):
- Would you say that's probablythe most difficult part
of the job, that you have to tell peoplethat they have cancer?
- It is very difficult.
The anxiety about this diagnosisstarts from the time they
get the biopsy seeing me in the roomand when I see them, you know, majority
of our communication is non-verbal.
(03:50):
When I see them, I am seeing how they areand then I try to deliver
the news the best I can sothat they not only get
the emotional impact,but they also get that this
doctor is also talking abouthow to treat this.
But it is a very difficult part is to howto deliver this news.
And with time and experience,one gets better at this.
(04:14):
But from a patient perspectiveit's very difficult.
- Do they ask you, howlong do I have? Yeah,
- So this response can be varied.
- Yeah. - Some people, youknow, they're taken aback.
They respond with a somber response.
Some people frankly sometimeshave denial that, hey,
(04:35):
this cannot be happening to me.
And some people take it in their stride.
It's a very visceral, organic reactionthat happens when you know about it.
And then yes, patients do askme how long do I have now,
you know, we have so much datain different kinds of cancer.
So when somebody hassay stage four cancer,
we know survival data forall stage four cancer.
(04:57):
So I'm able to tellthem how long they have
so they can plan their nextfew months, years accordingly.
We have data for early stage cancers toowith different cancer
when it's stage 1, 2, 3and when it's still curable.
So we, in those situationswe talk more about
progression-free survival,how long your treatments
will hold this at bay,your overall survival.
(05:21):
But it's a, you know,it's a very loaded
question when somebody asksyou, how long do I have?
And we answer it usingevidence-based medicine.
- So I think it's importanttoo to, at this point
that the patient understandthe pace of their treatment.
I would imagine they wantto navigate it immediately.
(05:42):
A friend of mine wentthrough this recently.
He had a trip planned, hegot a colon cancer diagnosis,
he canceled the trip.
- What your friend did wasthe best thing he could
do, health is wealth.
You know, the trip canwait for a few months.
He was able to get thecolon cancer taken care
of in a curative intentand that is the the best way to do it.
(06:04):
- Patients wanna get throughthe treatment part right away.
They wanna the surgeryto get it out. Exactly.
They wanna start radiation,they wanna get rid of the cancer.
What do you tell them in those situationsthat you don't have to
navigate it instantly or do you- Instantly is better?
So when I see a patient witha new diagnosis of cancer,
I usually say the best dayto get treated was yesterday.
(06:27):
And that kind of setsthe tone that, you know,
this is something weneed to deal urgently.
Everything else can wait.
Like a trip can wait, afamily reunion can wait.
You know, most things can waitbecause with cancers,
the earlier you treat,the higher chances you have for a cure.
- Okay. What's the first thingpatients should know when
(06:49):
they're informed that a, a biopsyor a screening is showing
positive for cancer?
- So when I see somebodyin our cancer center
with a new diagnosis,say they have a lung mass
or a colon mass, the firstthing we do is biopsy that mass
to definitively establishthat they have cancer.
Once they, we know they havecancer, the next step is
(07:10):
to develop a care plan.
We want to stage the cancer, right?
Cancer comes in different stages.
Stage 1, 2, 3 being curative.
You want to definitely treat them,you do wanna do it urgently.
Stage four cases tend tohave where it's spread
to different places, patient presentwith a lot more symptoms.
(07:31):
So at that time I'm doing,what I'm doing is I'm ordering a CT scan
or a PET scan for them.
So a CT scan is a simple scanwhich can look at different
parts of the body, see wherethe cancer could have spread.
And PET scan is an imagingstudy that we do for staging,
which is a step aboveCT scan where you know,
we are giving radioactive dyewith glucose attached to it
(07:54):
and that glucose ispicked up by your cancer.
So if the cancer spots tendto light up on the PET scan
and that's how we stage them.
Once a patient's stage isknown, we know the kind
of cancer they have.
What we do then is that wedevelop a treatment plan.
Does the patient need chemotherapy?
Does he need chemotherapy before surgery?
Does the patient go straight for surgery?
(08:16):
Does the patient getradiation because they're old?
We have so many complicateddecisions that we make just
by seeing the patientand then that helps in
deciding the treatment plan.
- If there is a subtype ofcancer, is that understood from
that biopsy or areadditional tests necessary
to see if there's the subtype?
(08:36):
- So majority of the timesone biopsy is enough.
You send the patient tissueis sent to a pathologist
who reads the sampleand gives you the subtype of the cancer.
At times you run across complicated caseswhere they have a mixture
of different subtypesor they have a a rare subtypes
and in those cases, oneand maybe a second biopsy is needed.
(08:58):
So we do that. We try toget all this information
before the treatment plan is implemented.
- So it is really dependent on what typeof cancer someone has
that would dictate whetheror not they need additional screenings
or additional tests to findout how advanced the cancer is.
- Exactly. So for example,there are some cancers
(09:18):
where even when the cancer is notspread enough on the CT scan,
we do an MRI of the brainbecause some of the cancers
like lung cancer are, you know,notorious for going into the brain.
So we want to make sure we getall the imaging studies done
once we know the kind of cancer you haveor a patient has to, to see
(09:40):
what all additional testing you need.
So additional testing couldsometimes be checking an
echocardiogram of the heart,make sure the heart is
ready for treatment,getting blood tests done
to make sure the liverand kidneys are working fine.
All these things need to be checkedbefore we implement any kind
of therapy for the patient.
- And what's the timelinefor all of that to happen?
(10:02):
Is it generally a weekafter a diagnosis a month?
- So typically we want to geteverything done within two
to three week window.
You know, I always tell mypatients you have this narrow
window where we candiagnose and start treating.
Logistically it takes abouta week to get the CT scan
(10:22):
'cause we have to geteverything authorized
by the insurance.
It takes about a week to get a biopsy.
If we started withouta biopsy, then you want
to at times get a mediport,which is a device we place
to give chemotherapyand then to get everything
ready takes about three weeks.
- Is there anything thatyou can do as a physician
(10:43):
or your office can do when the insurancecompanies hold things up?
- So we have actually a team of,and most cancer centers have a team
of insurance authorizationpersonnel who work
to try to expedite it as much as possible.
So if we are finding any holdupfrom the insurance providers
(11:04):
and physicians get involvedin doing peer-to-peer
conversations with the insurancecompany to justify the need
for that test and the treatments,we do come across these
roadblocks once in a while ourproviders and patient
navigators help with that.
- What is a patient navigator?
- You know, patient navigatoris a very versatile role.
(11:25):
A patient navigator is somethingthat a patient will encounter, you know,
as a patient is interactingwith a doctor, right?
We're implementing a medicalplan for the patient.
A patient navigator willnavigate the patient from
everything non-medical they need,if they have any transport issues.
The patient navigator workswith the social worker to resolve that.
(11:46):
If there are any financial constraintsthat the patient have,
the patient navigator can work with them.
They're a liaison within thewhole complex health system.
Patient navigators can helpwith chemotherapy teaching,
making sure their appointmentsand scans are scheduled,
make sure the patient hasa good idea of the calendar
for their chemotherapy.
(12:07):
So it's a very versatile role.
It changes based on theneed of each cancer center
and they really help navigate the system.
- One thing that oncologists have told methrough the years is that
they ask their patientsto write down questions
and concerns to bringto the next appointment.
But right here at thispoint in this juncture
(12:28):
that we are describing, whenyou first get that diagnosis,
what questions do theyusually bring to you?
- You know, I usually tellmy patients, you know,
the questions will not cometo your mind when we are
having a conversation about thetreatment process.
Questions will always cometo your mind when you're home
by yourself digestingthe diagnosis, knowing
(12:50):
that your treatment is coming up,that's when the questions
will come to your mind.
So make sure you write them.
Typically I get various questions.
I get your standard questions, which arewhat stage is my cancer?
What type of cancer I have?
What is the prognosis of my cancer?
Something we discussedearlier, how long do I have?
(13:12):
Then come your questions abouttreatments, chemotherapies,
what kind of side effectschemotherapy have?
How long is a chemotherapy,how many rounds
of chemo will I be getting?
How many months will I needtreatment? Do I need radiation?
And then you get questions about radiationtherapy, is it every day?
(13:33):
What are the side effects of radiation?
What are the long-termimpact of radiation?
Sometimes even though I'm nota surgeon, I just, you know,
patients ask me about surgery question,how long is the surgery?
How many days am I in the hospital?
And then sometimes Iget questions that are,
you know, a little bit different.
Like how does chemotherapyaffect my sex life?
(13:56):
If my spouse touches me,does the chemotherapy affect him or her?
Can my spouse gimme thetablets of chemotherapy?
Can I eat food during my chemotherapy?
Simple basic questions are- There
- That sometimes surprise me as towhat the patients are actually thinking.
But a majority of the time it's,it's about the effects of the therapy.
(14:17):
- I can't imagine how manyquestions there would be really,
because there is so manydifferent facets involved
with cancer care.
- Exactly. So you know, cancercare is very complicated.
There's no one doctor that'sdriving the whole process.
You know, your cancer care istypically multidisciplinary,
which means we involve physicians,different people from different
(14:39):
parts of cancer treatment.
So you have your medicaloncologist like me who talk
to patients who areinternal medicine doctors
trained in cancers.
We talk to patients abouttheir prognosis, their stage,
their diagnosis.
We are the ones who aregiving them chemotherapy,
(15:00):
immune therapy, oral therapy for cancer.
But then you have otherphysicians which include surgeons
that are curing cancers throughsurgery like breast surgery,
colon surgery.
And then you have radiationdoctors that are able
to deliver high dose radiationin a pinpoint accuracy
to treat cancers.
(15:21):
So those are your physiciansthat take care of you.
But you meet so many otherpersonnel during this journey
that can include a nurse practitioneror a physician assistant
who is an advanced practice provider.
They are essentially anextension of care that would be
provided by a physician.
They're very adept inmanaging side effects.
(15:42):
At the same time you'll findsocial workers in the cancer
centers, they will alsohelp with some of the work
that patient navigators do.
They arrange transport,arrange financial assistance,
get funds for you at times.
I've had our social workersactually walk patients
through getting insuranceif your self pay at the
(16:03):
time of diagnosis.
And then you have your pharmacistwho are mixing your chemotherapy
that you will be getting.
And they're trained inmixing different types
of chemotherapy accurately.
And then you have nurses thatactually deliver chemotherapy
and are actually an integralpart of our cancer team
because they're incontact with the patient.
(16:23):
They know patients inside out'cause they're spending three to six hours
during their treatment days.
So yes, you, you meet the wholeteam. So that is what it is.
Multidisciplinary care where differentoncology spectrums come together
to make the best treatmentplan for the patient.
You know, usually for ourcomplicated patients we discuss
(16:46):
them in our tumor boards,which happen ever so often.
Where you have the radiationoncologist, surgeon,
medical oncologist sit togetherand reviewing the images of the patient
and the pathology of thepatient, which is typically done
by the radiation radiologistand pathologist to make a care
plan that is individualizedfor the patient based on the
(17:07):
subtype of cancer they haveor the stage of cancer they have
- Or the other healthissues they may have.
Cardio oncologists,- Cardio-oncology is a very,
is a developing branch.
So we have certain cardiologistswho are trained in the heart
how the heart is affectedby different chemotherapies
(17:27):
and they make accuraterecommendations on how
to treat patients withunderlying heart failure
or who develop problems with chemotherapyto see if they can be challenged
or what medications we cangive to regenerate their heart.
So it's a very important branchthat we closely communicate
with for treatment of our patients.
(17:49):
- You gave a very thorough listreally of all of the members
of a care team,but there's two more I wanna
make sure that we mentionand that's nutritionists and
mental health professionals.
How do they play intothat comprehensive care?
- So nutrition as weknow is very important.
That is probably the most commonly askedquestion that I have.
(18:10):
What can I eat to make myself better?
So nutritionists playa very important role.
They advise patients on thebest diet that they can have,
which is a high protein diet.
And at the same time, canceris a diagnosis that carries
with it a lot of anxiety andat times depression as well.
(18:31):
So having a mental healthprofessional in your cancer team
is always helpful.
'cause sometimes patientneeds therapy to deal
with the cancer as wellas sometimes we give them
medications to improve their moodso they can deal with
the mental health aspectof this disease and they can
forge ahead with the treatment.
(18:52):
- The patient also hasto have a say they're a
member of their own team,- They're actually the
captain of the ship.
- Do you ever make a recommendationthat they don't wanna accept?
- You know, I'm a firmbeliever of patient autonomy.
I make recommendations that Ifeel are best for the patient.
We live in an era ofshared decision making,
so I may be recommending few things,but the patient have their own beliefs
(19:17):
and how they want to be treated.
Patients who are oldersometimes do not want aggressive
chemotherapy, so thenwe lower the intensity
of the chemotherapy orgive them immune therapy
or treatments that maybe easier on their body.
I'm actually feedingoff the patient's wishes
and beliefs to formulate a care planthat will be more acceptable to them.
(19:40):
So they have to be, as Isaid, captain of their ship.
They are an active partner in decidinghow we are going to treat them
- If a patient doesn'twant to go that route.
And I had this happen in my own family.
Both my grandmother and my father-in-lawopted against chemotherapy
and further treatment.
They just accepted their diseaseand accepted that they were
(20:01):
facing the end of their life.
How does that make youfeel as a physician?
Do you ever try to talkthem out of it to say,
this is surviv survivable,or maybe it's not
and maybe you recognizethat they accept that
- You know, I'll speak for myself.
I recognize what they want for themselves.
(20:23):
I will usually not tryto talk them out of it.
I'm assuming they were in their seventiesor eighties when they
were in this situation.
- That's correct, yes.
- Can I promise them thatmy chemotherapy, that plan,
that I device will notcause them side effect.
I can't promise that Ihave to know the stage
of their disease.
If it's advanced enoughand their wishes are to
(20:44):
not pursue chemotherapy,then I would actually talk to
them about quality of life,making sure the time that
they have, they spend itwith their family and
make it quality time.
And I do not force treatmenton patients who don't want it.
- On the other hand, you have seenso much advancement in cancer
(21:04):
care that I would thinkthat more often than not
there is help available.
- Exactly. You know, I tellpeople all the time, you know,
so usually people when youtalk to them about cancer,
they have a very negativeconnotation to it.
Or you talk about chemotherapy,they instantly think about,
(21:25):
oh I'll be throwing up all the time.
I tell them, Hey, it's 2026.
Our treatment optionshave come a long way.
Our cure rates have come a long way.
Clinical trials arehappening all the time.
New drugs are getting developed.
The main name of new drugs isto be less toxic than the old ones
and more efficacious than the old ones.
(21:46):
And in my last 10 years,I've seen patients that
who would've otherwise notbeen here actually get better
and survive cancer that 20years ago they would not.
So the treatment aregetting better with time.
- When should a patientask for a second opinion?
And does that offend you if they wantto find another opinion
(22:06):
from another physician?
- You know, actually Iencourage second opinions.
There are two types of secondopinions in my opinion,- Right?
- One is a second opinionwhere the patient wants
to hear your plan from another doctor.
So a patient comes to you,you develop a plan with them,
they would be at more peaceand would sleep better if
(22:26):
they knew like this is theright plan for them.
So they directly want a second opinionand I'm very happy to give
them the second opinionbecause when they hear the
same plan from a second doctor,they're kind of more reassured.
They come back more confidentand they're like, Hey doc,
when can we start treatment?
So I'm always encouraging.
(22:47):
There are certain second opinionsthat I seek when I see a very
complicated patient who'smaybe elderly, who maybe
has a heart condition,maybe has single kidney, that
I do want medical oncologists,surgeons up at a bigger
hospital at tertiary care centerwith more experience in complicated cases
or who are more specializedwith particular underlying conditions.
(23:10):
Then in those cases Iactively seek a second opinion
because at that time Ineed their recommendations.
So I'm very encouragingof a second opinion does
not offend me at all.
- You talked about a socialworker getting involved,
an oncology social worker specifically,or a patient navigator can be a lifeline
to help manage the stress of cancer.
You don't have to have hadcancer to see what it can do
(23:33):
to someone or their family with stress.
So connecting those individuals, patientsand their families with resources
and navigating real lifeconcerns is very important.
Like talking with childrenor handling your work challenges,
how do you encourageyour patients to seek out
that kind of support?
- You know, you bring upa very important point.
(23:54):
A lot of us actually don'tseek help when we need,
when somebody has acancer diagnosis, you have
to actively tell themthat you have to seek help
because this is the time you need it.
Social workers are there.
You know, a lot of timespatients don't open up
to physicians as much as they doto somebody like a social worker
(24:15):
who is a person they cantalk to about anything.
They can be vulnerable with them.
They can tell them about whatfood constraints they have,
what work constraints they have, what kindof help they need in terms of
paperwork, getting the FMLAor their job to get the adequate time off
so they can actually focus on theiror their family members'
health, whoever has cancer.
(24:39):
So it's very important thatwe take help when it's needed.
And actually you would be surprisedhow much resources we have,
people who don't have cars,we are able to set them
up with taxi companiesto bring them patients
who don't have transport.
We can schedule set them up with Uberor Lyft to get them to
our cancer center sothat they can come for
(25:00):
their treatments when thecopays are too high.
We've actually had patientsget financial assistance
and get their medications for freebecause the drug company
was able to provide themand our social worker worked with them.
A lot of patients anxiouswhether insurance will
approve their treatment or not.
And I always tell them, Hey,we have a team that works
(25:22):
with insurance companies to get your TEtreatment authorized.
So that is off your plate.
All you need to do is focus on your healthand come get your treatment.
- What about clinical trials?
Is that up to thepatient to seek that out,
to find what's available?
Or is that something thatyou might bring to a patient
and say, Hey, there's aclinical trial happening here,
(25:44):
it involves this kind of a medication.
I think you're a good candidate for it.
- So clinical trials arevery important in the field
of oncology.
All the drugs that we usehave gone through the process
of phase one, two, andthree clinical trials.
Sometimes I offer clinical trials to themthat are available in our institute
and we recognize whichpatient would be a candidate
(26:07):
and we offer it to themand it is on them to volunteer
to be on the clinical trial.
Sometimes these clinical trialstend to be therapeutic trial
where we are comparing thestandard of care chemotherapy
with something that's new inaddition to standard of care.
Sometimes these clinical trials are morefor mindfulness supplements.
(26:27):
Sometimes clinical trials are newer teststhat are being tested against the standard
of care tests like circulating tumor, DNA.
And at times patients wantto seek clinical trials on their own.
And so it all depends on the patient.
But we have trialsthat we offer MedStar being
the biggest can cancernetwork within our region.
We have clinical trialsat Southern Maryland
(26:49):
that we opened last year.
We've had phase one, two,and three clinical trials at MedStar,
Georgetown University Hospital,Washington Hospital Center,
Franklin Square.
So we're encouraging moreand more patients to
be on clinical trials.
So they have access tothe newer medications
that they normallywould not have access to
outside the trials.
(27:10):
And we've had patients whoactually went on a trial,
the medication got approvedbecause it was so effication
and they're still on that medication now- And they're doing- Well.
The biggest breakthrough we'vehad in the last 10 years is
the immune therapy- Is is that Keytruda in some
medications like that? Yes,- Pembrolizumab, nivolumab.
These are new immune agentsthat actually unlock
(27:31):
your own immune systemto fight cancers.
And they came through theprocess of clinical trials,
got approved, haveadvanced survival across
so many different cancers in early stageand late stage cancers.
And always tell my patientsthe only way patients got those
medications initially.
(27:52):
But through clinical trials.
- What's your most memorablecase, would you say?
Is that, is that evenpossible to pin that down?
- You know, it's very difficultbecause all my patients are
very near and dear to me.
I've had several cases thatfrankly were so far advanced
and the initial part of the journey,this is mostly breast cancer
cases that are early stagethat happen in young women,
(28:15):
that the patients wereso nervous, so anxious when
they started the treatmentand they went ahead regardless
because that was the bestthing for them to do.
And six months down the road,they finished their chemotherapy,
went through surgery,and were got got cured and are now living
- Normal lives, a normal- Life.
(28:36):
And to me that is very rewarding.
And all those cases are memorable.
So you know, when you firstget diagnosed with cancer,
you are in so much intothe treatment part.
Once you're finished with the treatment,you go into the survivorship mode.
In those survivorshipmode, you learn to live
with the anxiety that comeswith cancer surveillance.
(28:57):
The fact that they've had itonce does not make them immune
from a future cancer or asecond different cancer.
So we always stem them to make surethat they are getting their
surveillance mammograms,surveillance tests, CT scans, blood work,
clinical appointments perthe guidelines to ensure
that they stay cancer free.
(29:18):
- When you're meeting withyour patients in the early part
of their journey and you'resharing the results of a biopsy
or now I'm sure across theboard, whatever the cancer is
that they have and whatever thediagnosis is that they have,
you are telling them don't smoke.
What else should they notdo and what should they do?
- That's an excellent question.
(29:40):
So I usually tell patientswhat we are giving you in our
cancer center is chemotherapyand immunotherapy, and that's treatment.
But there's a whole differenttreatment that you need
to do at home thatincludes good nutrition.
There's enough data outthere staying that patients
who continue smokethrough treatment do much worse
(30:00):
than those who quit smoking.
So quitting smoking is a veryessential aspect of treatment.
Avoiding alcohol, getting enough rest.
High protein diet is very important.
I've seen patients have much easier timewhen they have a good
nutritional status as comparedto somebody who is malnourished.
(30:22):
They have more side effects.
Exercise is a big part, you know,chemotherapy causes a lot of fatigue.
The only way to combat it is exercise.
And I've seen patientswho actively go to gym
or have been more exercise in thebefore they got cancer
diagnosis actually sailedthrough their chemotherapy
without much effects,to my surprise, to a point
(30:43):
that I started telling patientsthat hey, they need to
exercise as much as they can.
So their body's stronger,their heart status is better.
Mindfulness can neverdiscount getting enough sleep,
making sure you're surroundedby family at all times
and have social support.
So there's a whole set of thingsthat you need to do at home
(31:05):
so that you know you'reeasy, it's easier for you
to get treated for your cancer.
- So for someone listening right nowwho was recently diagnosed
and feeling scaredor has a loved one who has
been recently diagnosedwith cancer, what would you say to them?
- So I would tell them totake one step at a time.
You have a diagnosis,the next best thing you can
(31:25):
do is meet an oncologist,develop your care plan,
write down all the questionsthat you have about your diagnosis,
possible treatment options,get your scans done in a timely fashion.
Get started on your treatmentfor the best outcome.
- Perfect. I want to remindthe listeners of this
(31:47):
before each visit, writedown your questions
and bring someone you trustto help listen and take notes.
Keep track of any medications,tests, or next steps.
And don't hesitate torepeat information back
to your care team to besure you understand it.
- Yes. So you know, I'velearned through experience,
whatever I'm telling themabout 50% will stick,
(32:08):
a lot will not stickbecause you're not in
a usual state. You've- Just- Been told about a diagnosis
that will be life alteringfor some period of time.
And to digest that andgrasp that information
and have your treatments, your surgery,so many things going on in your mind
that you only grasp 50%of what's being told.
(32:29):
And that's why we kind of become redundantand discuss a lot of it again
on the following visits.
We keep discussing our overallplan at different times
of the treatment and after.
I've noticed that once peoplestart their treatment process,
they're much less anxious,they're much more in control
of the situationand they're much, you know,
in a much better stateto move ahead with treatment
(32:54):
- And ask questions.
- Always,- Always ask- Questions.
You know, always find itinteresting when I find questions
that are different.
Like the other day, somebodyasked me about lunch,
can I have lunch duringmy chemotherapy session?
Nope. Something as basic asthat has never been asked. Sure.
So I always encourage they can,- They can eat,- They can eat.
(33:16):
- Interesting.
- I've had caseswhere the patients had
their treatment approvedby the insurance, had
treatment on the schedule,medication ordered,
but the patient was notready for the treatment
because they're stillthinking about the treatment,
processing the information,deciding which one
to move forward with.
(33:36):
We've had to hold treatmentsto give patients a time to come
to terms with what kindof treatment they want.
Coming back to the patient autonomy,it's a shared decision making.
We discuss with the patientand move forward with the plan
that is best for both of us.
- Well that's interestingbecause that sort
of counters the thing thatwe talked about earlier
(33:57):
where I thought patientswould be more of in a hurry
for treatment to happen.
But like you said, everybody's different.
- Everybody's different.
No two people are alike.
- And no two cancers are alike.
- No two cancers arealike. No two people are.
Some people want the treatment next week.
Some people want tothink through the process
and start when they want to.
(34:19):
And some people don't want treatmentand you have to respect all three of them.
- Why did you go intooncology and hematology?
Did you know that you wanted to dothat while you were in medical school or
before you went to medical school?
- Actually I decided that inmy internal medicine residency,
you know, I like to havelong-term relationship
(34:40):
with the patient's medical health.
I found myself to havethat comforting personality
for a patient with cancer.
'cause I've always felt like empathizingand connecting with people is my forte.
Like I can do that well.
And to have somebody likethat be a part of a diagnosis
(35:01):
that is life changing,I will be of more help
and I'll be, I'll gel along with thatand I'll follow them
throughout their process.
You know, we cannot cureeverybody, but we can help
and treat everybody.
So that's what kind ofdrew me into oncology
and I love doing it.
- Well, I'm glad that you have, I'm gladthat you made that choice.
(35:21):
What motivates you inthe work that you do?
- You know, what motivatesme most is to see somebody
and possibly one of the mostdifficult phases of their life,
having been told that theyhave cancer, to treat them
to a point that theyget cured, to treat them
and give them a lifebefore this diagnosis,
which was a normal life.
(35:43):
To be able to give, get them backto their work normally is a big joy.
And I cite the exampleof my own brother two
years ago was diagnosedwith acute leukemia and he's my age
and he was very sick at that time.
He spent five months in thehospital getting chemotherapy
every month and gettingadmitted twice a month, going
through bone marrow biopsiesas a daughter that's young.
(36:06):
And to see him today in 2026, cancer free.
- Wonderful.
- Working every day is a big joy.
- Yes.
- And I was a part of that journey.
I worked closely with his cancer doctorand you know, makes it all worthwhile.
- Absolutely. Well, thank you so muchfor sharing your expertise
and your compassion todaywith us on MedStar Health doc talk.
(36:29):
We've been talking with Dr.
Anki Maddon, an oncologist andand hematologist at MedStar
Southern Maryland HospitalCenter in Clinton, Maryland.
If you are in the areaof MedStar Southern
Maryland Hospital Centerand would like to make an appointment,
call 3 0 1 8 7 7 4 6 7 3.
Or for more information aboutoncology at MedStar Health, go
(36:51):
to MedStar health.org/cancer.
and insightful conversations about healthand medicine happen here.
When MedStar Health Doc talk,these are real conversations
with physician experts fromaround the largest
healthcare system in theMaryland DC region.
One of the most pivotal momentsin a person's life can come
from one conversation and three words.
(00:25):
You have cancer and suddenlylife is divided into the before
and after getting thatdiagnosis in an instant,
everything changes.
Some people go blankfor some questions are
racing through their mind.
How do I tell my family? AmI going to get through this?
Fear might kick in where tobegin with options no matter
(00:47):
what the initial reactionpatients are usually asking.
Next, what now what do I do?
Today we're talking about whatcomes next, the first steps
after a cancer diagnosis, howto make sense of the moment,
grasp the decision making process,build your care team
and find your footing.
Again. Joining me is MedStar,health medical oncologist
(01:11):
and hematologist Dr.
Ankit Madan, thank you so much for beingwith us here on Doc Talk.
- Thank you Debra, for having me.
This is such an importantconversation we are going
to have today about a patient's journeythrough the diagnosis of cancer.
I want people to knowthat when they get this
diagnosis, they're not alone.
They're supportive teams aroundthem, cancer center teams
(01:34):
around them that are there to take careof them when they have
a diagnosis like this.
- Sure. Let's begin withthat emotional side.
When someone first hears they have cancer,I can imagine it would feel like the, the,
the ground is literallyshifted beneath them.
What do you want patientsto know in that moment?
(01:56):
- So first of all, you know,listening to these words
that you have cancer is, is not easy.
I always tell my patientsit is way difficult
to be sitting on thepatient side of this story
and hearing a doctor say this.
First of all, I want patientsto know that there are teams
to take care of them.
How somebody reacts to thatdiagnosis really depends on
(02:20):
where they are in life.
You know, when you geta diagnosis of cancer,
you're not prepared for it.
You're living your life,you're planning trips
with your family, you'reopening a new business,
going about your daily activities,- Right?
- Suddenly you feel ill and there you go.
You know, we find a massor we find something on the
scan that needs to be pursuedand you know, you get told
(02:43):
this diagnosis at that time.
What I've seen on the emotionalaspect with people is that
for our younger population,especially our young
breast cancer females,they have younger kids at that time.
So now suddenly they'rethrown into a position
where they're taking careof their health instead of
(03:04):
what they usually do, whichis take care of their kids.
- Right? - When you have olderpeople who view, who've been
through a few health scares in their life,manage it a little bit better.
But again, there's no rightor wrong way to deal with this situation.
This is an unusual situationthat arises when you get cancer
and the next best step for you isto start looking at the treatment process.
(03:30):
- Would you say that's probablythe most difficult part
of the job, that you have to tell peoplethat they have cancer?
- It is very difficult.
The anxiety about this diagnosisstarts from the time they
get the biopsy seeing me in the roomand when I see them, you know, majority
of our communication is non-verbal.
(03:50):
When I see them, I am seeing how they areand then I try to deliver
the news the best I can sothat they not only get
the emotional impact,but they also get that this
doctor is also talking abouthow to treat this.
But it is a very difficult part is to howto deliver this news.
And with time and experience,one gets better at this.
(04:14):
But from a patient perspectiveit's very difficult.
- Do they ask you, howlong do I have? Yeah,
- So this response can be varied.
- Yeah. - Some people, youknow, they're taken aback.
They respond with a somber response.
Some people frankly sometimeshave denial that, hey,
(04:35):
this cannot be happening to me.
And some people take it in their stride.
It's a very visceral, organic reactionthat happens when you know about it.
And then yes, patients do askme how long do I have now,
you know, we have so much datain different kinds of cancer.
So when somebody hassay stage four cancer,
we know survival data forall stage four cancer.
(04:57):
So I'm able to tellthem how long they have
so they can plan their nextfew months, years accordingly.
We have data for early stage cancers toowith different cancer
when it's stage 1, 2, 3and when it's still curable.
So we, in those situationswe talk more about
progression-free survival,how long your treatments
will hold this at bay,your overall survival.
(05:21):
But it's a, you know,it's a very loaded
question when somebody asksyou, how long do I have?
And we answer it usingevidence-based medicine.
- So I think it's importanttoo to, at this point
that the patient understandthe pace of their treatment.
I would imagine they wantto navigate it immediately.
(05:42):
A friend of mine wentthrough this recently.
He had a trip planned, hegot a colon cancer diagnosis,
he canceled the trip.
- What your friend did wasthe best thing he could
do, health is wealth.
You know, the trip canwait for a few months.
He was able to get thecolon cancer taken care
of in a curative intentand that is the the best way to do it.
(06:04):
- Patients wanna get throughthe treatment part right away.
They wanna the surgeryto get it out. Exactly.
They wanna start radiation,they wanna get rid of the cancer.
What do you tell them in those situationsthat you don't have to
navigate it instantly or do you- Instantly is better?
So when I see a patient witha new diagnosis of cancer,
I usually say the best dayto get treated was yesterday.
(06:27):
And that kind of setsthe tone that, you know,
this is something weneed to deal urgently.
Everything else can wait.
Like a trip can wait, afamily reunion can wait.
You know, most things can waitbecause with cancers,
the earlier you treat,the higher chances you have for a cure.
- Okay. What's the first thingpatients should know when
(06:49):
they're informed that a, a biopsyor a screening is showing
positive for cancer?
- So when I see somebodyin our cancer center
with a new diagnosis,say they have a lung mass
or a colon mass, the firstthing we do is biopsy that mass
to definitively establishthat they have cancer.
Once they, we know they havecancer, the next step is
(07:10):
to develop a care plan.
We want to stage the cancer, right?
Cancer comes in different stages.
Stage 1, 2, 3 being curative.
You want to definitely treat them,you do wanna do it urgently.
Stage four cases tend tohave where it's spread
to different places, patient presentwith a lot more symptoms.
(07:31):
So at that time I'm doing,what I'm doing is I'm ordering a CT scan
or a PET scan for them.
So a CT scan is a simple scanwhich can look at different
parts of the body, see wherethe cancer could have spread.
And PET scan is an imagingstudy that we do for staging,
which is a step aboveCT scan where you know,
we are giving radioactive dyewith glucose attached to it
(07:54):
and that glucose ispicked up by your cancer.
So if the cancer spots tendto light up on the PET scan
and that's how we stage them.
Once a patient's stage isknown, we know the kind
of cancer they have.
What we do then is that wedevelop a treatment plan.
Does the patient need chemotherapy?
Does he need chemotherapy before surgery?
Does the patient go straight for surgery?
(08:16):
Does the patient getradiation because they're old?
We have so many complicateddecisions that we make just
by seeing the patientand then that helps in
deciding the treatment plan.
- If there is a subtype ofcancer, is that understood from
that biopsy or areadditional tests necessary
to see if there's the subtype?
(08:36):
- So majority of the timesone biopsy is enough.
You send the patient tissueis sent to a pathologist
who reads the sampleand gives you the subtype of the cancer.
At times you run across complicated caseswhere they have a mixture
of different subtypesor they have a a rare subtypes
and in those cases, oneand maybe a second biopsy is needed.
(08:58):
So we do that. We try toget all this information
before the treatment plan is implemented.
- So it is really dependent on what typeof cancer someone has
that would dictate whetheror not they need additional screenings
or additional tests to findout how advanced the cancer is.
- Exactly. So for example,there are some cancers
(09:18):
where even when the cancer is notspread enough on the CT scan,
we do an MRI of the brainbecause some of the cancers
like lung cancer are, you know,notorious for going into the brain.
So we want to make sure we getall the imaging studies done
once we know the kind of cancer you haveor a patient has to, to see
(09:40):
what all additional testing you need.
So additional testing couldsometimes be checking an
echocardiogram of the heart,make sure the heart is
ready for treatment,getting blood tests done
to make sure the liverand kidneys are working fine.
All these things need to be checkedbefore we implement any kind
of therapy for the patient.
- And what's the timelinefor all of that to happen?
(10:02):
Is it generally a weekafter a diagnosis a month?
- So typically we want to geteverything done within two
to three week window.
You know, I always tell mypatients you have this narrow
window where we candiagnose and start treating.
Logistically it takes abouta week to get the CT scan
(10:22):
'cause we have to geteverything authorized
by the insurance.
It takes about a week to get a biopsy.
If we started withouta biopsy, then you want
to at times get a mediport,which is a device we place
to give chemotherapyand then to get everything
ready takes about three weeks.
- Is there anything thatyou can do as a physician
(10:43):
or your office can do when the insurancecompanies hold things up?
- So we have actually a team of,and most cancer centers have a team
of insurance authorizationpersonnel who work
to try to expedite it as much as possible.
So if we are finding any holdupfrom the insurance providers
(11:04):
and physicians get involvedin doing peer-to-peer
conversations with the insurancecompany to justify the need
for that test and the treatments,we do come across these
roadblocks once in a while ourproviders and patient
navigators help with that.
- What is a patient navigator?
- You know, patient navigatoris a very versatile role.
(11:25):
A patient navigator is somethingthat a patient will encounter, you know,
as a patient is interactingwith a doctor, right?
We're implementing a medicalplan for the patient.
A patient navigator willnavigate the patient from
everything non-medical they need,if they have any transport issues.
The patient navigator workswith the social worker to resolve that.
(11:46):
If there are any financial constraintsthat the patient have,
the patient navigator can work with them.
They're a liaison within thewhole complex health system.
Patient navigators can helpwith chemotherapy teaching,
making sure their appointmentsand scans are scheduled,
make sure the patient hasa good idea of the calendar
for their chemotherapy.
(12:07):
So it's a very versatile role.
It changes based on theneed of each cancer center
and they really help navigate the system.
- One thing that oncologists have told methrough the years is that
they ask their patientsto write down questions
and concerns to bringto the next appointment.
But right here at thispoint in this juncture
(12:28):
that we are describing, whenyou first get that diagnosis,
what questions do theyusually bring to you?
- You know, I usually tellmy patients, you know,
the questions will not cometo your mind when we are
having a conversation about thetreatment process.
Questions will always cometo your mind when you're home
by yourself digestingthe diagnosis, knowing
(12:50):
that your treatment is coming up,that's when the questions
will come to your mind.
So make sure you write them.
Typically I get various questions.
I get your standard questions, which arewhat stage is my cancer?
What type of cancer I have?
What is the prognosis of my cancer?
Something we discussedearlier, how long do I have?
(13:12):
Then come your questions abouttreatments, chemotherapies,
what kind of side effectschemotherapy have?
How long is a chemotherapy,how many rounds
of chemo will I be getting?
How many months will I needtreatment? Do I need radiation?
And then you get questions about radiationtherapy, is it every day?
(13:33):
What are the side effects of radiation?
What are the long-termimpact of radiation?
Sometimes even though I'm nota surgeon, I just, you know,
patients ask me about surgery question,how long is the surgery?
How many days am I in the hospital?
And then sometimes Iget questions that are,
you know, a little bit different.
Like how does chemotherapyaffect my sex life?
(13:56):
If my spouse touches me,does the chemotherapy affect him or her?
Can my spouse gimme thetablets of chemotherapy?
Can I eat food during my chemotherapy?
Simple basic questions are- There
- That sometimes surprise me as towhat the patients are actually thinking.
But a majority of the time it's,it's about the effects of the therapy.
(14:17):
- I can't imagine how manyquestions there would be really,
because there is so manydifferent facets involved
with cancer care.
- Exactly. So you know, cancercare is very complicated.
There's no one doctor that'sdriving the whole process.
You know, your cancer care istypically multidisciplinary,
which means we involve physicians,different people from different
(14:39):
parts of cancer treatment.
So you have your medicaloncologist like me who talk
to patients who areinternal medicine doctors
trained in cancers.
We talk to patients abouttheir prognosis, their stage,
their diagnosis.
We are the ones who aregiving them chemotherapy,
(15:00):
immune therapy, oral therapy for cancer.
But then you have otherphysicians which include surgeons
that are curing cancers throughsurgery like breast surgery,
colon surgery.
And then you have radiationdoctors that are able
to deliver high dose radiationin a pinpoint accuracy
to treat cancers.
(15:21):
So those are your physiciansthat take care of you.
But you meet so many otherpersonnel during this journey
that can include a nurse practitioneror a physician assistant
who is an advanced practice provider.
They are essentially anextension of care that would be
provided by a physician.
They're very adept inmanaging side effects.
(15:42):
At the same time you'll findsocial workers in the cancer
centers, they will alsohelp with some of the work
that patient navigators do.
They arrange transport,arrange financial assistance,
get funds for you at times.
I've had our social workersactually walk patients
through getting insuranceif your self pay at the
(16:03):
time of diagnosis.
And then you have your pharmacistwho are mixing your chemotherapy
that you will be getting.
And they're trained inmixing different types
of chemotherapy accurately.
And then you have nurses thatactually deliver chemotherapy
and are actually an integralpart of our cancer team
because they're incontact with the patient.
(16:23):
They know patients inside out'cause they're spending three to six hours
during their treatment days.
So yes, you, you meet the wholeteam. So that is what it is.
Multidisciplinary care where differentoncology spectrums come together
to make the best treatmentplan for the patient.
You know, usually for ourcomplicated patients we discuss
(16:46):
them in our tumor boards,which happen ever so often.
Where you have the radiationoncologist, surgeon,
medical oncologist sit togetherand reviewing the images of the patient
and the pathology of thepatient, which is typically done
by the radiation radiologistand pathologist to make a care
plan that is individualizedfor the patient based on the
(17:07):
subtype of cancer they haveor the stage of cancer they have
- Or the other healthissues they may have.
Cardio oncologists,- Cardio-oncology is a very,
is a developing branch.
So we have certain cardiologistswho are trained in the heart
how the heart is affectedby different chemotherapies
(17:27):
and they make accuraterecommendations on how
to treat patients withunderlying heart failure
or who develop problems with chemotherapyto see if they can be challenged
or what medications we cangive to regenerate their heart.
So it's a very important branchthat we closely communicate
with for treatment of our patients.
(17:49):
- You gave a very thorough listreally of all of the members
of a care team,but there's two more I wanna
make sure that we mentionand that's nutritionists and
mental health professionals.
How do they play intothat comprehensive care?
- So nutrition as weknow is very important.
That is probably the most commonly askedquestion that I have.
(18:10):
What can I eat to make myself better?
So nutritionists playa very important role.
They advise patients on thebest diet that they can have,
which is a high protein diet.
And at the same time, canceris a diagnosis that carries
with it a lot of anxiety andat times depression as well.
(18:31):
So having a mental healthprofessional in your cancer team
is always helpful.
'cause sometimes patientneeds therapy to deal
with the cancer as wellas sometimes we give them
medications to improve their moodso they can deal with
the mental health aspectof this disease and they can
forge ahead with the treatment.
(18:52):
- The patient also hasto have a say they're a
member of their own team,- They're actually the
captain of the ship.
- Do you ever make a recommendationthat they don't wanna accept?
- You know, I'm a firmbeliever of patient autonomy.
I make recommendations that Ifeel are best for the patient.
We live in an era ofshared decision making,
so I may be recommending few things,but the patient have their own beliefs
(19:17):
and how they want to be treated.
Patients who are oldersometimes do not want aggressive
chemotherapy, so thenwe lower the intensity
of the chemotherapy orgive them immune therapy
or treatments that maybe easier on their body.
I'm actually feedingoff the patient's wishes
and beliefs to formulate a care planthat will be more acceptable to them.
(19:40):
So they have to be, as Isaid, captain of their ship.
They are an active partner in decidinghow we are going to treat them
- If a patient doesn'twant to go that route.
And I had this happen in my own family.
Both my grandmother and my father-in-lawopted against chemotherapy
and further treatment.
They just accepted their diseaseand accepted that they were
(20:01):
facing the end of their life.
How does that make youfeel as a physician?
Do you ever try to talkthem out of it to say,
this is surviv survivable,or maybe it's not
and maybe you recognizethat they accept that
- You know, I'll speak for myself.
I recognize what they want for themselves.
(20:23):
I will usually not tryto talk them out of it.
I'm assuming they were in their seventiesor eighties when they
were in this situation.
- That's correct, yes.
- Can I promise them thatmy chemotherapy, that plan,
that I device will notcause them side effect.
I can't promise that Ihave to know the stage
of their disease.
If it's advanced enoughand their wishes are to
(20:44):
not pursue chemotherapy,then I would actually talk to
them about quality of life,making sure the time that
they have, they spend itwith their family and
make it quality time.
And I do not force treatmenton patients who don't want it.
- On the other hand, you have seenso much advancement in cancer
(21:04):
care that I would thinkthat more often than not
there is help available.
- Exactly. You know, I tellpeople all the time, you know,
so usually people when youtalk to them about cancer,
they have a very negativeconnotation to it.
Or you talk about chemotherapy,they instantly think about,
(21:25):
oh I'll be throwing up all the time.
I tell them, Hey, it's 2026.
Our treatment optionshave come a long way.
Our cure rates have come a long way.
Clinical trials arehappening all the time.
New drugs are getting developed.
The main name of new drugs isto be less toxic than the old ones
and more efficacious than the old ones.
(21:46):
And in my last 10 years,I've seen patients that
who would've otherwise notbeen here actually get better
and survive cancer that 20years ago they would not.
So the treatment aregetting better with time.
- When should a patientask for a second opinion?
And does that offend you if they wantto find another opinion
(22:06):
from another physician?
- You know, actually Iencourage second opinions.
There are two types of secondopinions in my opinion,- Right?
- One is a second opinionwhere the patient wants
to hear your plan from another doctor.
So a patient comes to you,you develop a plan with them,
they would be at more peaceand would sleep better if
(22:26):
they knew like this is theright plan for them.
So they directly want a second opinionand I'm very happy to give
them the second opinionbecause when they hear the
same plan from a second doctor,they're kind of more reassured.
They come back more confidentand they're like, Hey doc,
when can we start treatment?
So I'm always encouraging.
(22:47):
There are certain second opinionsthat I seek when I see a very
complicated patient who'smaybe elderly, who maybe
has a heart condition,maybe has single kidney, that
I do want medical oncologists,surgeons up at a bigger
hospital at tertiary care centerwith more experience in complicated cases
or who are more specializedwith particular underlying conditions.
(23:10):
Then in those cases Iactively seek a second opinion
because at that time Ineed their recommendations.
So I'm very encouragingof a second opinion does
not offend me at all.
- You talked about a socialworker getting involved,
an oncology social worker specifically,or a patient navigator can be a lifeline
to help manage the stress of cancer.
You don't have to have hadcancer to see what it can do
(23:33):
to someone or their family with stress.
So connecting those individuals, patientsand their families with resources
and navigating real lifeconcerns is very important.
Like talking with childrenor handling your work challenges,
how do you encourageyour patients to seek out
that kind of support?
- You know, you bring upa very important point.
(23:54):
A lot of us actually don'tseek help when we need,
when somebody has acancer diagnosis, you have
to actively tell themthat you have to seek help
because this is the time you need it.
Social workers are there.
You know, a lot of timespatients don't open up
to physicians as much as they doto somebody like a social worker
(24:15):
who is a person they cantalk to about anything.
They can be vulnerable with them.
They can tell them about whatfood constraints they have,
what work constraints they have, what kindof help they need in terms of
paperwork, getting the FMLAor their job to get the adequate time off
so they can actually focus on theiror their family members'
health, whoever has cancer.
(24:39):
So it's very important thatwe take help when it's needed.
And actually you would be surprisedhow much resources we have,
people who don't have cars,we are able to set them
up with taxi companiesto bring them patients
who don't have transport.
We can schedule set them up with Uberor Lyft to get them to
our cancer center sothat they can come for
(25:00):
their treatments when thecopays are too high.
We've actually had patientsget financial assistance
and get their medications for freebecause the drug company
was able to provide themand our social worker worked with them.
A lot of patients anxiouswhether insurance will
approve their treatment or not.
And I always tell them, Hey,we have a team that works
(25:22):
with insurance companies to get your TEtreatment authorized.
So that is off your plate.
All you need to do is focus on your healthand come get your treatment.
- What about clinical trials?
Is that up to thepatient to seek that out,
to find what's available?
Or is that something thatyou might bring to a patient
and say, Hey, there's aclinical trial happening here,
(25:44):
it involves this kind of a medication.
I think you're a good candidate for it.
- So clinical trials arevery important in the field
of oncology.
All the drugs that we usehave gone through the process
of phase one, two, andthree clinical trials.
Sometimes I offer clinical trials to themthat are available in our institute
and we recognize whichpatient would be a candidate
(26:07):
and we offer it to themand it is on them to volunteer
to be on the clinical trial.
Sometimes these clinical trialstend to be therapeutic trial
where we are comparing thestandard of care chemotherapy
with something that's new inaddition to standard of care.
Sometimes these clinical trials are morefor mindfulness supplements.
(26:27):
Sometimes clinical trials are newer teststhat are being tested against the standard
of care tests like circulating tumor, DNA.
And at times patients wantto seek clinical trials on their own.
And so it all depends on the patient.
But we have trialsthat we offer MedStar being
the biggest can cancernetwork within our region.
We have clinical trialsat Southern Maryland
(26:49):
that we opened last year.
We've had phase one, two,and three clinical trials at MedStar,
Georgetown University Hospital,Washington Hospital Center,
Franklin Square.
So we're encouraging moreand more patients to
be on clinical trials.
So they have access tothe newer medications
that they normallywould not have access to
outside the trials.
(27:10):
And we've had patients whoactually went on a trial,
the medication got approvedbecause it was so effication
and they're still on that medication now- And they're doing- Well.
The biggest breakthrough we'vehad in the last 10 years is
the immune therapy- Is is that Keytruda in some
medications like that? Yes,- Pembrolizumab, nivolumab.
These are new immune agentsthat actually unlock
(27:31):
your own immune systemto fight cancers.
And they came through theprocess of clinical trials,
got approved, haveadvanced survival across
so many different cancers in early stageand late stage cancers.
And always tell my patientsthe only way patients got those
medications initially.
(27:52):
But through clinical trials.
- What's your most memorablecase, would you say?
Is that, is that evenpossible to pin that down?
- You know, it's very difficultbecause all my patients are
very near and dear to me.
I've had several cases thatfrankly were so far advanced
and the initial part of the journey,this is mostly breast cancer
cases that are early stagethat happen in young women,
(28:15):
that the patients wereso nervous, so anxious when
they started the treatmentand they went ahead regardless
because that was the bestthing for them to do.
And six months down the road,they finished their chemotherapy,
went through surgery,and were got got cured and are now living
- Normal lives, a normal- Life.
(28:36):
And to me that is very rewarding.
And all those cases are memorable.
So you know, when you firstget diagnosed with cancer,
you are in so much intothe treatment part.
Once you're finished with the treatment,you go into the survivorship mode.
In those survivorshipmode, you learn to live
with the anxiety that comeswith cancer surveillance.
(28:57):
The fact that they've had itonce does not make them immune
from a future cancer or asecond different cancer.
So we always stem them to make surethat they are getting their
surveillance mammograms,surveillance tests, CT scans, blood work,
clinical appointments perthe guidelines to ensure
that they stay cancer free.
(29:18):
- When you're meeting withyour patients in the early part
of their journey and you'resharing the results of a biopsy
or now I'm sure across theboard, whatever the cancer is
that they have and whatever thediagnosis is that they have,
you are telling them don't smoke.
What else should they notdo and what should they do?
- That's an excellent question.
(29:40):
So I usually tell patientswhat we are giving you in our
cancer center is chemotherapyand immunotherapy, and that's treatment.
But there's a whole differenttreatment that you need
to do at home thatincludes good nutrition.
There's enough data outthere staying that patients
who continue smokethrough treatment do much worse
(30:00):
than those who quit smoking.
So quitting smoking is a veryessential aspect of treatment.
Avoiding alcohol, getting enough rest.
High protein diet is very important.
I've seen patients have much easier timewhen they have a good
nutritional status as comparedto somebody who is malnourished.
(30:22):
They have more side effects.
Exercise is a big part, you know,chemotherapy causes a lot of fatigue.
The only way to combat it is exercise.
And I've seen patientswho actively go to gym
or have been more exercise in thebefore they got cancer
diagnosis actually sailedthrough their chemotherapy
without much effects,to my surprise, to a point
(30:43):
that I started telling patientsthat hey, they need to
exercise as much as they can.
So their body's stronger,their heart status is better.
Mindfulness can neverdiscount getting enough sleep,
making sure you're surroundedby family at all times
and have social support.
So there's a whole set of thingsthat you need to do at home
(31:05):
so that you know you'reeasy, it's easier for you
to get treated for your cancer.
- So for someone listening right nowwho was recently diagnosed
and feeling scaredor has a loved one who has
been recently diagnosedwith cancer, what would you say to them?
- So I would tell them totake one step at a time.
You have a diagnosis,the next best thing you can
(31:25):
do is meet an oncologist,develop your care plan,
write down all the questionsthat you have about your diagnosis,
possible treatment options,get your scans done in a timely fashion.
Get started on your treatmentfor the best outcome.
- Perfect. I want to remindthe listeners of this
(31:47):
before each visit, writedown your questions
and bring someone you trustto help listen and take notes.
Keep track of any medications,tests, or next steps.
And don't hesitate torepeat information back
to your care team to besure you understand it.
- Yes. So you know, I'velearned through experience,
whatever I'm telling themabout 50% will stick,
(32:08):
a lot will not stickbecause you're not in
a usual state. You've- Just- Been told about a diagnosis
that will be life alteringfor some period of time.
And to digest that andgrasp that information
and have your treatments, your surgery,so many things going on in your mind
that you only grasp 50%of what's being told.
(32:29):
And that's why we kind of become redundantand discuss a lot of it again
on the following visits.
We keep discussing our overallplan at different times
of the treatment and after.
I've noticed that once peoplestart their treatment process,
they're much less anxious,they're much more in control
of the situationand they're much, you know,
in a much better stateto move ahead with treatment
(32:54):
- And ask questions.
- Always,- Always ask- Questions.
You know, always find itinteresting when I find questions
that are different.
Like the other day, somebodyasked me about lunch,
can I have lunch duringmy chemotherapy session?
Nope. Something as basic asthat has never been asked. Sure.
So I always encourage they can,- They can eat,- They can eat.
(33:16):
- Interesting.
- I've had caseswhere the patients had
their treatment approvedby the insurance, had
treatment on the schedule,medication ordered,
but the patient was notready for the treatment
because they're stillthinking about the treatment,
processing the information,deciding which one
to move forward with.
(33:36):
We've had to hold treatmentsto give patients a time to come
to terms with what kindof treatment they want.
Coming back to the patient autonomy,it's a shared decision making.
We discuss with the patientand move forward with the plan
that is best for both of us.
- Well that's interestingbecause that sort
of counters the thing thatwe talked about earlier
(33:57):
where I thought patientswould be more of in a hurry
for treatment to happen.
But like you said, everybody's different.
- Everybody's different.
No two people are alike.
- And no two cancers are alike.
- No two cancers arealike. No two people are.
Some people want the treatment next week.
Some people want tothink through the process
and start when they want to.
(34:19):
And some people don't want treatmentand you have to respect all three of them.
- Why did you go intooncology and hematology?
Did you know that you wanted to dothat while you were in medical school or
before you went to medical school?
- Actually I decided that inmy internal medicine residency,
you know, I like to havelong-term relationship
(34:40):
with the patient's medical health.
I found myself to havethat comforting personality
for a patient with cancer.
'cause I've always felt like empathizingand connecting with people is my forte.
Like I can do that well.
And to have somebody likethat be a part of a diagnosis
(35:01):
that is life changing,I will be of more help
and I'll be, I'll gel along with thatand I'll follow them
throughout their process.
You know, we cannot cureeverybody, but we can help
and treat everybody.
So that's what kind ofdrew me into oncology
and I love doing it.
- Well, I'm glad that you have, I'm gladthat you made that choice.
(35:21):
What motivates you inthe work that you do?
- You know, what motivatesme most is to see somebody
and possibly one of the mostdifficult phases of their life,
having been told that theyhave cancer, to treat them
to a point that theyget cured, to treat them
and give them a lifebefore this diagnosis,
which was a normal life.
(35:43):
To be able to give, get them backto their work normally is a big joy.
And I cite the exampleof my own brother two
years ago was diagnosedwith acute leukemia and he's my age
and he was very sick at that time.
He spent five months in thehospital getting chemotherapy
every month and gettingadmitted twice a month, going
through bone marrow biopsiesas a daughter that's young.
(36:06):
And to see him today in 2026, cancer free.
- Wonderful.
- Working every day is a big joy.
- Yes.
- And I was a part of that journey.
I worked closely with his cancer doctorand you know, makes it all worthwhile.
- Absolutely. Well, thank you so muchfor sharing your expertise
and your compassion todaywith us on MedStar Health doc talk.
(36:29):
We've been talking with Dr.
Anki Maddon, an oncologist andand hematologist at MedStar
Southern Maryland HospitalCenter in Clinton, Maryland.
If you are in the areaof MedStar Southern
Maryland Hospital Centerand would like to make an appointment,
call 3 0 1 8 7 7 4 6 7 3.
Or for more information aboutoncology at MedStar Health, go
(36:51):
to MedStar health.org/cancer.
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