Let's Talk Cancer

This episode talks with Amanda Rice, CEO of an incredible company called Chick Mission, a nonprofit dedicated to improving access to fertility preservation for patients with cancer. Amanda Rice: Amanda Rice was a former cancer patient and now CEO of the Chick Mission. The idea "hatched" when Amanda's fertility preservation coverage was denied by her insurance company. Staring down a long road of chemo, radiation and long-term drug therapy, Amanda understood the high likelihood of infertility after her treatment and decided to move forward covering the costs on her own. The idea of other patients choosing not to pursue preservation simply because of the cost barrier did not sit well - socioeconomic standing should not dictate whether anyone has an opportunity to have biological children after they battle and beat cancer. Wouldn’t it be incredible if every single young female cancer patient had the option to preserve her fertility ahead of lifesaving treatment? As a woman who has spent over a decade raising money for a living, Amanda utilized that skill set to help get The Chick Mission off the ground. She jumped down the rabbit hole of necessary paperwork to incorporate and the rest is history. Specifically we discuss: What are the options for fertility preservation? Egg Freezing Embryo Freezing What is the process of egg freezing like? Minimum two weeks Daily injections 1-2 times a day with multiple appointments and ultrasounds Trigger shot followed by a procedure What advice do you wish you had known before freezing your eggs? You have time to pay your medical bills What are resources to learn more? Chickmission.org American Cancer Society Letter to appeal insurance company Cancer Care Resources to help patients who cannot afford egg freezing: Apply for Chick Mission Grant (age 18-40 in California, Colorado, Illinois, New Jersey, New York & Texas) The following organizations may offer financial assistance to help alleviate these expenses: Livestrong Fertility Fertility Within Reach Reprotech The Samfund Team Maggie Ferring Health Cade Foundation Baby Quest Hope for Fertility Parental Hope

This episode talks with Lauren Shea, MSW, a social worker and cancer survivor herself who unpacks the types of supportive services available to patients with a special focus on fostering support for patients who are single, widowed or divorced. Specifically we discuss: What is Supportive care? Whole person care- care that not only treats the cancer but also improves the quality of life of the person who has cancer Including the physical, psychological, social and spiritual health of a patient What are supportive care services? Child life specialists, Social workers, Psychologists, Spiritual counseling, Social Workers, Positive image center (Cosmetologists can walk through changes in appearance), Integrative oncologists, Meditation classes What are the benefits of supportive care services? Identifying your values as a patient and improving communication with the medical team Education and Support throughout the illness How to get connected to supportive care services? Ask your oncologist or primary care doctor for a referral Referral to Social Work is a good first step and they can connect a patient to many different resources available at that hospital Ask around- “What Supportive Care Services are available here?” What specific services help patients who are single, widowed, divorced? Transportation services (Disability benefits, Go Go Grandma, ask your SW!) Caregiving Support (In-Home Supportive Services, understanding your support network) Psychosocial support- see below What resources are available for patients? American Cancer Society- Hotline Cancer Support Community - Support Groups, Individual Therapy, Financial Assistance 2-1-1: Can get access to local resources - food, housing instability Epic Experience- free Cancer Camp in Colorado Adolescent and Young Adult Resources Stupid Cancer Conference First Descents - Adventure Therapy for age 18-39 years old

This episode talks with Dr. Anna Levin, who explains how cancer can impact sexual functioning, people’s relationships with their bodies around sex and some of the ways people can get treatment. She emphasizes that these side effects are common but often not spoken about and hopes to encourage people to start talking about it- with their doctors, partners, friends or other people who share a cancer experience. Specifically we discuss: Sexual concerns are VERY common and very often NOT brought up by patients or oncologists What are the impacts of cancer on sexual function? Sexual Arousal/Desire males- ability to have an erection, maintain erection Female- lubrication, vaginal health, reach orgasm Changes in the body which impact body image and self esteem Changes in relationships What cancer treatments cause sexual dysfunction? Surgical treatments- removal of breasts, ovaries, ostomy bags, foleys Hormonal therapies Chemotherapies- can also alter hormones Systemic treatments and radiation- increases fatigue and can decrease desire What are the most common treatments? MANY treatments can help patients but sometimes the hardest part is bringing the topic into the conversation Females: Referral to gynecologist Males: Referral to urologist Couples therapy, individual therapy Sex therapist Good resources- American Cancer Society: Sexual Health for Females Sexual Health for Males Anne Levin, MD Dr. Anna Levin is a clinical health psychologist who specializes in working with people facing medical concerns, as well as with their loved ones and caregivers. She worked for many years at the University of California San Francisco (UCSF) Cancer Center in the Psycho-Oncology program before opening her private practice, New England Health Psychology Partners, where she serves patients from California via telemedicine.

This episode talks with Dr. Lauren Boreta about the different types of radiation treatment, the common side effects and common questions people have about radiation. Specifically we discuss: What is radiation treatment? High intensity X-rays that damage DNA of cancer cells and induce oxygen free radicals to preferentially kill cancer cells What is a gray? Fraction? Gray- the dose that the body feels Fraction- over how long you are getting the total amount What does a radiation treatment entail? Initial Consultation with radiation oncologist goes over: intent of treatment, dosing and schedule The second meeting: planning for radiation with specific scans to your body Then the treatment occurs most commonly 5 days a week for 2-7 weeks for 20 minute sessions What are the most common questions people ask prior to starting? Does it hurt? The actual radiation does not hurt but some of the side effects can Am I radioactive? Most of the time you are NOT unless you have a radiation implanted How to get through treatment better? Staying active reduces radiation fatigue What are the common side effects Fatigue- most common and universal side effect Other side effects are specific to the body part that is radiated Brain- headaches Head and neck- mouth soreness Breast- skin irritation Prostate- urinary symptoms Lauren Boreta, MD Dr. Lauren Boreta, M.D. is a radiation oncologist at UCSF. She has particular clinical interest in radiation for symptom management of advanced cancer and treatment of central nervous system malignancies. She has expertise in many different modern radiation therapy techniques including stereotactic radiotherapy, radiosurgery, and intensity-modulated radiation therapy. Dr. Boreta graduated from Stanford University and subsequently received her medical degree from UCSF. She completed an internship in internal medicine at Kaiser Permanente San Francisco, and in 2019 completed her residency in Radiation Oncology at UCSF. She serves as the leader of the Palliative Radiation program at UCSF, as well as Associate Director for Quality Assurance/Improvement and as an Assistant Residency Program Director.

This episode talks with Dr. Natalie Marshall, who explains how exercise can prevent cancer as well as improve side effects and prevent recurrence for patients with cancer. Specifically we discuss: What are basic recommendations for patients with cancer and exercise? Continue to what you did prior to diagnosis Something is better than nothing How much exercise? 3 hours of moderate intensity exercise OR 1.5 hours of moderate intensity exercise PLUS Two 20 minute strength training What are the main benefits of exercise? Prevents cancer Improves side effects- mainly treatment related fatigue, lymphedema Helps tolerate treatment and complete chemotherapy Prevents recurrence Lower hospitalization rate Increases socialization and relationships What is the mechanism of exercise improving cancer outcomes? Decreases inflammation Muscle mass increases myokines which directly inhibits adipokines that can decrease insulin, growth factors and other hormones Good resources: Moving Through Cancer Natalie A. Marshall, MD Dr. Natalie A. Marshall is a breast medical oncologist,  lifestyle medicine doctor and also participates in clinical trials at UCSF.  She also works with her patients on modifying their habits with the goal of making their bodies less hospitable to cancer growth. This includes instruction and encouragement on diet, sleep, stress reduction and exercise, including a focus on strength training. It is important to her to let patients know how lifestyle modifications can lower the risk of cancer recurrence. She has a clinic in Mission Bay and works at the UCSF Cancer Center in Berkeley. Dr. Marshall earned her medical degree at the University of Texas Medical Branch at Galveston. She completed a residency in internal medicine at the University of New Mexico Hospital, followed by a fellowship in medical oncology at Yale New Haven Hospital.

This episode talks with Greta Macaire, a registered dietician, who explains how nutrition plays a role during cancer treatment and preventing cancer or cancer recurrence Specifically we discuss: What are basic Principles of Nutrition and cancer? - Keeping up with nutrition needs during cancer care by eating frequent small meals, Prioritize Nutrient Dense foods - Improving overall health: Plant based diet (does NOT mean vegan or vegetarian), 2/3 of the time eat fruits/vegetables, 4 different colors of foods a day- increases vitamins, nutrients, phytochemicals, 90/10 rule- 90% of the time eating nutrient rich foods Should you eat organic food? - Foods to prioritize: EWG.org - Dirty Dozen of organic foods Foods to avoid? - Fast foods, processed foods, red and processed meats (smoked, cured, salted have carcinogenic preservatives) Sugar sweetened drinks, Alcohol Does high sugar intake cause cancer to grow? - Maybe? But it seems best to have a slow release of sugar with fiber rich foods - But the body need carbohydrates for healthy cells as well Thoughts on Supplements? - Nutrients are better absorbed in full forms in fruits and vegetables themselves - Make sure the supplements are pure- USP or MSF certified Greta Macaire, RD Greta Macaire is a dietitian who specializes in oncology. She provides tailored nutrition plans that support individual goals and that optimize wellness and quality of life by taking into account the person's overall health, specific cancer, nutritional needs during treatment and eating patterns. She is a certified specialist in oncology nutrition, the highest credential given to registered dietitians for this area of expertise. Macaire received her bachelor of science and master of arts degrees in nutrition and dietetics from San Francisco State University. She completed her dietetic internship through San Francisco State University and the San Francisco Veterans Affairs Health Care System.

This episode talks with Dr. Kavita Mishra, an integrative oncologist, who explains how you can integrate many other aspects of health and wellbeing to supplement medical care to improve quality of life and cancer risk Integrative oncology topics include nutrition, physical activity, mind-body practices, yoga, sleep hygiene, acupuncture, bodywork therapy, guided imagery, meditation and more! Specifically we discuss: What is integrative Oncology? How to find an integrative oncology center? Osher Center for Integrative Oncology Society for Integrative Oncology Main topics covered with resources: Nutrition: American Institute for Cancer Research https://www.aicr.org/cancer-prevention/healthy-eating/ World Cancer Research Fund International https://www.wcrf.org/diet-activity-and-cancer/ American Cancer Society https://www.cancer.org/healthy/eat-healthy-get-active/acs-guidelines-nutrition-physical-activity-cancer-prevention/guidelines.html UCSF Osher Center for Integrative Health https://osher.ucsf.edu/patient-care/integrative-medicine-resources/cancer-and-nutrition Exercise Moving Thru Cancer – Exercise is Medicine https://www.exerciseismedicine.org/eim-in-action/moving-through-cancer/ The American College of Sports Medicine (ACSM) and American Physical Therapy Association (APTA) offer specialty training. Can search for an ACSM- or APTA-certified provider near you. https://www.acsm.org/get-stay-certified/find-a-pro https://aptaapps.apta.org/APTAPTDirectory/FindAPTDirectory.aspx American Cancer Society https://www.cancer.org/treatment/survivorship-during-and-after-treatment/staying-active/physical-activity-and-the-cancer-patient.html Mind-Body Medicine Walking meditation Greater Good in Action: https://ggia.berkeley.edu/practice/walking_meditation Anticancer Lifestyle Program: https://anticancerlifestyle.org/resources-topic/mindset/ UCSF MBSR course: https://osher.ucsf.edu/public-classes/mindfulness-based-stress-reduction-mbsr MBCR: https://www.mindfulcancerrecovery.com Herbs/Supplements: National Center for Complementary and Integrative Health: https://www.nccih.nih.gov/health/herbsataglance NCI Office of Cancer Complementary and Alternative Medicine: https://cam.cancer.gov/health_information/for_patients.htm; https://cam.cancer.gov/health_information/cam_therapies_a-z.htm NIH, Office of Dietary Supplements: https://ods.od.nih.gov; https://ods.od.nih.gov/factsheets/list-all/

This episode talks about with two social workers, Erin Schwartz and Rachel Dornhelm, who work at the UCSF Cancer Center. Specifically we discuss how social workers help with both the logistical aspects of cancer care (lodging, travel, employment) as well as the emotional aspect of a cancer diagnosis (mental health resources, advanced care planning, finding a support group). Find a social worker in your city or state to learn what resources are available to you. Below are a list of the resources mentioned in this podcast- check them out! What resources are available for travel and lodging? Uber wheelchair rides, Paratransit free rides, local lodging discounts Disability paperwork including DMV disability placards Navigating Employment during cancer treatment   Cancer and Careers Triage Cancer Legal Aid to Work Mental health resources Advanced Care planning How to find a support group? UCSF Cancer Center Support Groups Women’s Cancer Resource Center Cancer Support Community cancercare.org Imerman Angels

This episode talks about with an incredible palliative care doctor who specializes in symptom management during cancer. We talk about how to reduce the symptom burden during cancer care to improve quality of life. Specifically we discuss: Cancer related pain therapies Improving cancer fatigue, sleep Benefits of massage therapy, acupuncture, exercise, pyschedelics What is a palliative care specialist? What does it mean to discuss "goals of care?" Breize Bell, MD Dr. Brieze Bell is a physician who specializes in palliative medicine, hospital medicine, and integrative medicine. She earned her medical degree from the Icahn School of Medicine at Mount Sinai and completed her residency in internal medicine at the Massachusetts General Hospital. She went on to pursue fellowships in palliative medicine and integrative medicine at UCSF. She is currently a faculty member in the divisions of palliative medicine and hospital medicine at UCSF. In her clinical work, Dr. Bell sees patients in the Symptom Management Service at the UCSF Cancer Center, where she focuses on using biomedical and integrative tools to help her patients optimize their wellbeing and quality of life in the setting of cancer. She also takes care of general medicine patients in the main UCSF adult hospital. Dr. Bell is passionate about providing outstanding patient care, contributing to medical education, and developing programs at the intersections of the fields of general internal medicine, palliative medicine, and integrative medicine.

This episode talks in detail about chemotherapy and what the most common side effects are (fatigue, nausea, hair loss, low blood counts). She gives great tips about how to combat nausea, and when you should be concerned about your symptoms (fever, shortness of breathe, loss of consciousness) and more!  Ana I. Velázquez Mañana, MD Dr. Ana Velázquez Mañana will be joining the thoracic oncology group at the University of California San Francisco where she did completed her oncology fellowship. Prior to moving to the Bay Area, Dr. Velázquez completed her Internal Medicine residency at Mount Sinai Beth Israel in New York City, where she also was a former Chief Resident. Dr. Velázquez is a proud native Puerto Rican and a passionate advocate for diversity and inclusion. She has a long-standing commitment to serving vulnerable, underserved, and minority populations.