WEBVTT

NOTE duration:"00:58:09.5900000"

NOTE recognizability:0.930

NOTE language:en-us

NOTE Confidence: 0.918431141666667

00:00:00.000 --> 00:00:01.600
Fantastic. Let's get started.

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I we have the pleasure of having Dr.

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Kevin Billingsley, our Milo CMO today to

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to start us off and welcome everyone. You

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know, I I am thrilled to be here

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and I want to thank the audience.

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For not just participating in this event,

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00:00:22.350 --> 00:00:25.038
but for the participation over the

NOTE Confidence: 0.913695446666667

00:00:25.038 --> 00:00:28.280
months in this series of Smilow shares,

NOTE Confidence: 0.913695446666667

00:00:28.280 --> 00:00:31.305
the partnership and collaboration between

NOTE Confidence: 0.913695446666667

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clinical oncologists and primary care

NOTE Confidence: 0.913695446666667

00:00:34.092 --> 00:00:37.228
physicians is not only fun and rewarding,

NOTE Confidence: 0.913695446666667

00:00:37.230 --> 00:00:39.444
it's the best possible thing for

NOTE Confidence: 0.913695446666667

00:00:39.444 --> 00:00:41.630
all of our patients together.

NOTE Confidence: 0.913695446666667

00:00:41.630 --> 00:00:44.290
So I have to say I'm incredibly

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excited about the topic this evening.

NOTE Confidence: 0.9010504425

00:00:48.770 --> 00:00:49.370
You know the the

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00:00:49.370 --> 00:00:51.575
statistics in 2022 are that

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00:00:51.575 --> 00:00:53.780
there are currently over 18

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00:00:53.869 --> 00:00:55.861
million cancer survivors out

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00:00:55.861 --> 00:00:58.849
there in the United States today.

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00:00:58.850 --> 00:01:01.886
You know I think it is,

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it's extraordinarily gratifying.

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00:01:03.222 --> 00:01:06.330
I think it's a testament to the

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00:01:06.402 --> 00:01:08.587
development and our our abilities

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00:01:08.587 --> 00:01:11.250
to treat patients and sustain them

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00:01:11.250 --> 00:01:13.686
through the course of their illness,

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00:01:13.690 --> 00:01:16.818
but it is also.

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A testament to our medical

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community in general,

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particularly our primary care

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00:01:22.276 --> 00:01:24.920
physicians who support patients and

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families through the continuum of

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healthcare throughout their lifetime,

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including supporting them through

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00:01:31.720 --> 00:01:34.020
significant illness like cancer,

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00:01:34.020 --> 00:01:35.845
heart disease and other other

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chronic diseases that they manage

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00:01:37.732 --> 00:01:39.817
them in partnership with specialists

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00:01:42.140 --> 00:01:44.990
so. I think we have a

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fabulous panel this evening.

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I'm just going to say I'm incredibly excited.

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00:01:49.470 --> 00:01:52.269
I think it's going to be a great discussion.

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And I want to also take a minute

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to recognize and thank our

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fearless Co leaders in this.

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00:02:00.350 --> 00:02:01.409
In this program.

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00:02:01.409 --> 00:02:03.527
Doctor Ann Chang who's the Associate

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00:02:03.527 --> 00:02:05.537
Cancer Center Director here at the

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00:02:05.537 --> 00:02:07.584
Yale Cancer Center and our Director

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00:02:07.584 --> 00:02:09.549
of Clinical Initiatives and Dr.

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00:02:09.550 --> 00:02:11.482
Karen Brown who's the Medical Director

NOTE Confidence: 0.933065448571429

00:02:11.482 --> 00:02:13.390
of Primary Care for Northeast.

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00:02:13.390 --> 00:02:14.664
Medical Group,

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00:02:14.664 --> 00:02:18.486
thank you both for really leading

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00:02:18.486 --> 00:02:21.465
this effort and driving this level

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00:02:21.465 --> 00:02:23.165
of communication and engagement

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00:02:23.165 --> 00:02:25.173
between the primary care docs

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00:02:25.173 --> 00:02:26.509
and our our oncologist.

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So terrific and I know you guys

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will introduce our panelists.

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So over to you Ann and Karen.

NOTE Confidence: 0.943608066666667

00:02:34.390 --> 00:02:35.830
Thank you Kevin,

NOTE Confidence: 0.9201268

00:02:37.990 --> 00:02:42.894
we. This is our last program for the

NOTE Confidence: 0.9201268

00:02:42.894 --> 00:02:45.633
year that Karen and I am working on

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00:02:45.633 --> 00:02:47.810
and this really came out of discussions

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00:02:47.810 --> 00:02:50.530
that we had where we felt that there

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00:02:50.530 --> 00:02:53.144
could be a better relationship and

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00:02:53.144 --> 00:02:54.932
better communication about cancer.

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00:02:54.932 --> 00:02:57.187
And updates, but really from

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the primary care perspective.

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00:02:59.540 --> 00:03:02.444
So I see some of you have been

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regulars and we really appreciate

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you coming and appreciate your

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feedback on this since we, you know,

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00:03:10.380 --> 00:03:11.940
we're we're talking about what

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00:03:16.620 --> 00:03:18.699
And I your audio just got quiet.

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OK Can you hear me OK?

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00:03:23.780 --> 00:03:26.920
Yeah, OK. Sorry about that.

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00:03:26.920 --> 00:03:30.070
So we're going to have three

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cases tonight and then we will

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have time about 10 or 15 minutes

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hopefully for for questions.

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And I know that you all have really

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00:03:38.272 --> 00:03:39.939
great questions and I think that

NOTE Confidence: 0.926835838333333

00:03:39.939 --> 00:03:41.309
the presentation of the cases

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00:03:41.309 --> 00:03:42.809
tonight will really prompt that

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00:03:42.809 --> 00:03:44.274
we'll have questions for Dr.

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00:03:44.280 --> 00:03:46.653
stamped around survivorship

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00:03:46.653 --> 00:03:49.817
after the first case.

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00:03:49.820 --> 00:03:51.297
And then the rest of the question.

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So please have a few questions

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ready and then we'll have time for

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00:03:55.202 --> 00:03:56.978
the rest of the questions later.

NOTE Confidence: 0.926835838333333

00:03:56.980 --> 00:03:58.820
And then without further ado,

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00:03:58.820 --> 00:04:00.952
I will introduced Dr.

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00:04:00.952 --> 00:04:02.018
Tara Sam,

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00:04:02.020 --> 00:04:04.312
who's an Associate Professor

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00:04:04.312 --> 00:04:07.468
of Medicine and she's our Chief

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00:04:07.468 --> 00:04:09.476
Patient Experience Officer and

NOTE Confidence: 0.926835838333333

00:04:09.476 --> 00:04:11.580
Smilo and the Medical Director

NOTE Confidence: 0.926835838333333

00:04:11.580 --> 00:04:13.180
of the Survivorship Clinic.

NOTE Confidence: 0.926835838333333

00:04:13.180 --> 00:04:15.265
She is doctor Stamp earned

NOTE Confidence: 0.926835838333333

00:04:15.265 --> 00:04:17.350
her medical degree from the

NOTE Confidence: 0.926835838333333

00:04:17.436 --> 00:04:19.680
Medical College of Wisconsin.

NOTE Confidence: 0.926835838333333

00:04:19.680 --> 00:04:21.460
She completed her residency

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00:04:21.460 --> 00:04:23.240
and fellowship at Northwestern.

NOTE Confidence: 0.926835838333333

00:04:23.240 --> 00:04:26.208
She is board certified in both medical

NOTE Confidence: 0.926835838333333

00:04:26.208 --> 00:04:29.279
oncology and Hospice and palliative medicine,

NOTE Confidence: 0.926835838333333

00:04:29.280 --> 00:04:32.088
which she feels helps to her to treat the

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00:04:32.088 --> 00:04:34.596
whole person and not just the disease.

NOTE Confidence: 0.926835838333333

00:04:34.600 --> 00:04:36.280
And as a breast oncologist,

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00:04:36.280 --> 00:04:38.908
she is a very busy practice and

NOTE Confidence: 0.926835838333333

00:04:38.908 --> 00:04:41.716
enjoys taking care of women with

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00:04:41.716 --> 00:04:43.967
newly diagnosed breast cancer and

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00:04:43.967 --> 00:04:45.976
in her role as the chief patient.

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00:04:45.980 --> 00:04:47.560
Experienced officer She focuses

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00:04:47.560 --> 00:04:49.535
on how to improve care,

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00:04:51.620 --> 00:04:54.100
especially where the provider

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00:04:54.100 --> 00:04:56.580
and patient experience overlap.

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00:04:56.580 --> 00:04:58.524
She is the director of our

NOTE Confidence: 0.964154175

00:04:58.524 --> 00:04:59.496
Smiler Survivorship Clinic,

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00:04:59.500 --> 00:05:01.670
one of the nation's only

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00:05:01.670 --> 00:05:02.538
multidisciplinary clinics,

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00:05:02.540 --> 00:05:04.799
especially in specializing

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00:05:04.799 --> 00:05:07.058
in cancer survivorship.

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00:05:07.060 --> 00:05:08.900
And she learns from patients

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00:05:08.900 --> 00:05:10.740
about key issues after treatment,

NOTE Confidence: 0.964154175

00:05:10.740 --> 00:05:13.106
which also informs her role as chair

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00:05:13.106 --> 00:05:15.549
of the National Comprehensive Cancer.

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00:05:15.550 --> 00:05:17.179
Network survivorship guidelines

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00:05:17.179 --> 00:05:19.894
and finally her research interests

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00:05:19.894 --> 00:05:22.439
focus on healthy lifestyles and

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00:05:22.439 --> 00:05:24.744
quality of life after cancer

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00:05:27.710 --> 00:05:29.870
and we welcome her tonight.

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00:05:29.870 --> 00:05:33.155
Doctor Lesburg is an Associate

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00:05:33.155 --> 00:05:36.798
Professor of Medical Oncology and

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00:05:36.798 --> 00:05:40.610
the Director and Chief of the

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00:05:40.610 --> 00:05:42.870
Breast Medical Oncology Division.

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00:05:42.870 --> 00:05:46.264
She. Received her medical degree

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00:05:46.264 --> 00:05:48.219
from the University of Maryland,

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00:05:48.220 --> 00:05:50.104
where she completed her residency and

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00:05:50.104 --> 00:05:52.659
she went on to complete a fellowship

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00:05:52.659 --> 00:05:55.124
in Medical Oncology and Breast Medical

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00:05:55.124 --> 00:05:57.572
Oncology at the Ohio State University

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00:05:57.572 --> 00:06:00.264
before joining the faculty there in 2010.

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00:06:00.264 --> 00:06:03.092
And she also earned the master's in

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00:06:03.092 --> 00:06:05.720
Public health Public health from the

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00:06:05.720 --> 00:06:11.040
Ohio State University in 2013. Her.

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00:06:11.040 --> 00:06:14.600
Her he's been recognized for her

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00:06:14.600 --> 00:06:17.060
patient focused care with awards,

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00:06:17.060 --> 00:06:22.230
multiple awards and including being

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00:06:22.230 --> 00:06:24.840
rated by Forbes is one of the top breast

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00:06:24.911 --> 00:06:27.056
medical oncologists in the nation.

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00:06:27.060 --> 00:06:29.598
She has an emphasis on improving

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00:06:29.598 --> 00:06:31.290
longterm outcomes for patients

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00:06:31.363 --> 00:06:32.907
with breast cancer who.

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00:06:32.910 --> 00:06:35.265
Develop side effects associated with

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00:06:35.265 --> 00:06:38.104
treatments and is doing novel and

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00:06:38.104 --> 00:06:40.489
really exciting research on novel

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00:06:40.489 --> 00:06:43.014
blood based biomarkers to identify

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00:06:43.014 --> 00:06:45.544
recurrence and toxicity of treatment.

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00:06:45.550 --> 00:06:47.275
Earlier she worked,

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00:06:47.275 --> 00:06:50.638
she's an NCI funded investigator active

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00:06:50.638 --> 00:06:53.078
in cancer cooperative group research

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00:06:53.078 --> 00:06:55.533
and she collaborates widely with

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00:06:55.533 --> 00:06:58.092
researchers from around the world and

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00:06:58.092 --> 00:07:00.384
she really thrives in creating innovative.

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00:07:00.390 --> 00:07:02.670
Multidisciplinary scientific teams,

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00:07:05.070 --> 00:07:07.278
I'm going to turn that over

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00:07:07.278 --> 00:07:09.770
to Doctor Brown to introduce

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00:07:09.770 --> 00:07:11.950
Doctor Williams. Good, thanks.

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00:07:12.430 --> 00:07:15.398
And and I'll just echo my welcome

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00:07:15.398 --> 00:07:18.670
to everybody as well and to stress

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00:07:18.670 --> 00:07:21.806
how important all of this is.

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00:07:21.806 --> 00:07:24.426
Our relationship in primary care,

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00:07:24.430 --> 00:07:27.636
new cancer is kind of an emergency.

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00:07:27.640 --> 00:07:29.705
And and knowing that our Smile O

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00:07:29.705 --> 00:07:32.072
team kind of has our backs and is

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00:07:32.072 --> 00:07:34.418
able to help with that transition is

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00:07:34.418 --> 00:07:36.740
is really important and we continue

NOTE Confidence: 0.900602830909091

00:07:36.740 --> 00:07:39.120
to work at doing that even better.

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00:07:39.120 --> 00:07:41.073
And even though this talk is about

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00:07:41.073 --> 00:07:43.423
kind of the other end where we're

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00:07:43.423 --> 00:07:45.601
passing patients back to primary care.

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00:07:45.610 --> 00:07:48.214
So it is my pleasure to introduce

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00:07:48.214 --> 00:07:49.330
Doctor Brian Williams,

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00:07:49.330 --> 00:07:51.690
a close colleague and friend.

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00:07:51.690 --> 00:07:53.928
He is the Medical Director of

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00:07:53.928 --> 00:07:55.420
Clinical Informatics within the

NOTE Confidence: 0.900602830909091

00:07:55.481 --> 00:07:57.935
Northeast Medical Group and one of

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00:07:57.935 --> 00:07:59.571
the medical information officers

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00:07:59.639 --> 00:08:01.753
offer EPIC in the system.

NOTE Confidence: 0.900602830909091

00:08:01.753 --> 00:08:04.258
His passion is streamlining clinical

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00:08:04.258 --> 00:08:06.959
care to support both employee

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00:08:06.959 --> 00:08:10.169
and clinician Wellness as well as

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00:08:10.169 --> 00:08:13.009
patient experience and efficiency.

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00:08:13.010 --> 00:08:16.867
He is an active primary care clinician

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00:08:16.867 --> 00:08:19.934
in Mystic and where he serves

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00:08:19.934 --> 00:08:22.970
with his wife in the same office.

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00:08:22.970 --> 00:08:25.825
He's fortunate to serve as a medical

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00:08:25.825 --> 00:08:28.411
director on in the beginning of

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00:08:28.411 --> 00:08:31.329
his career at the How Come while?

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00:08:31.330 --> 00:08:32.226
Oh no,

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it's a Health Center in Hawaii from

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00:08:35.370 --> 00:08:38.202
2005 till 2010 and that was where he

NOTE Confidence: 0.900602830909091

00:08:38.202 --> 00:08:41.020
learned from a visionary leadership team.

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00:08:41.020 --> 00:08:43.370
On where integrating the electronic

NOTE Confidence: 0.900602830909091

00:08:43.370 --> 00:08:45.250
medical record and clinical

NOTE Confidence: 0.900602830909091

00:08:45.250 --> 00:08:47.438
quality programs had such potential

NOTE Confidence: 0.900602830909091

00:08:47.438 --> 00:08:49.498
to make patient care better.

NOTE Confidence: 0.900602830909091

00:08:49.500 --> 00:08:51.860
He subsequently came here East

NOTE Confidence: 0.900602830909091

00:08:51.860 --> 00:08:54.700
and was the Medical Director of

NOTE Confidence: 0.900602830909091

00:08:54.700 --> 00:08:56.718
Informatics at the LNM Medical

NOTE Confidence: 0.900602830909091

00:08:56.718 --> 00:08:59.226
Group through through 2016 when that

NOTE Confidence: 0.900602830909091

00:08:59.226 --> 00:09:01.284
group merged with Northeast Medical

NOTE Confidence: 0.900602830909091

00:09:01.284 --> 00:09:04.196
Group and he then became part of our

NOTE Confidence: 0.900602830909091

00:09:04.271 --> 00:09:06.499
informatics and clinical program.

NOTE Confidence: 0.900602830909091

00:09:06.500 --> 00:09:08.120
He graduated from the University

NOTE Confidence: 0.900602830909091

00:09:08.120 --> 00:09:09.740
of Colorado Health Science Center

NOTE Confidence: 0.900602830909091

00:09:09.792 --> 00:09:11.020
and completed his family.

NOTE Confidence: 0.900602830909091

00:09:11.020 --> 00:09:12.748
And us since the University of

NOTE Confidence: 0.900602830909091

00:09:12.748 --> 00:09:16.698
Texan in Austin, in Austin, TX.

NOTE Confidence: 0.900602830909091

00:09:16.700 --> 00:09:18.820
And Brian will actually start

NOTE Confidence: 0.900602830909091

00:09:18.820 --> 00:09:20.940
off the presentation with Case.

NOTE Confidence: 0.939414983333333

00:09:25.340 --> 00:09:26.900
Thank you, Dr. Brown. I'm so

NOTE Confidence: 0.939414983333333

00:09:26.900 --> 00:09:28.779
sorry to throw you the curveball.

NOTE Confidence: 0.939414983333333

00:09:28.780 --> 00:09:30.900
It's Hamakua Health Center.

NOTE Confidence: 0.94629164

00:09:31.700 --> 00:09:33.100
Thank you for the correction.

NOTE Confidence: 0.917606243333333

00:09:33.660 --> 00:09:34.592
Absolutely. Yeah.

NOTE Confidence: 0.917606243333333

00:09:34.592 --> 00:09:37.672
That's a tough one, but a beautiful place.

NOTE Confidence: 0.917606243333333

00:09:37.672 --> 00:09:40.286
And I'm really pleased to have been asked

NOTE Confidence: 0.917606243333333

00:09:40.286 --> 00:09:42.476
to participate in this particular topic.

NOTE Confidence: 0.917606243333333

00:09:42.480 --> 00:09:44.406
I think this you know survivorship

NOTE Confidence: 0.917606243333333

00:09:44.406 --> 00:09:46.101
sits squarely at the intersection

NOTE Confidence: 0.917606243333333

00:09:46.101 --> 00:09:48.201
of what our colleagues and oncology

NOTE Confidence: 0.917606243333333

00:09:48.201 --> 00:09:50.600
do and what we do in primary care.

NOTE Confidence: 0.917606243333333

00:09:50.600 --> 00:09:53.280
And I think this is, this is an area

NOTE Confidence: 0.917606243333333

00:09:53.280 --> 00:09:56.772
where more information is better.

NOTE Confidence: 0.917606243333333

00:09:56.772 --> 00:09:59.559
It's frequently I think a

NOTE Confidence: 0.917606243333333

00:09:59.559 --> 00:10:02.037
little bit vague in terms of.

NOTE Confidence: 0.917606243333333

00:10:02.040 --> 00:10:02.892
Concrete information that's

NOTE Confidence: 0.917606243333333

00:10:02.892 --> 00:10:04.880
available for us to kind of guide

NOTE Confidence: 0.917606243333333

00:10:04.929 --> 00:10:06.279
our decision making and care.

NOTE Confidence: 0.917606243333333

00:10:06.280 --> 00:10:07.655
So I'm really looking forward

NOTE Confidence: 0.917606243333333

00:10:07.655 --> 00:10:08.480
to this session.

NOTE Confidence: 0.917606243333333

00:10:08.480 --> 00:10:12.128
So we're going to kick it off with Case one,

NOTE Confidence: 0.917606243333333

00:10:12.128 --> 00:10:16.280
which is a 76 year old male that had

NOTE Confidence: 0.917606243333333

00:10:16.280 --> 00:10:19.986
a 60 pack year smoking history who

NOTE Confidence: 0.917606243333333

00:10:19.986 --> 00:10:22.408
presented in June of 2019 with complaints

NOTE Confidence: 0.917606243333333

00:10:22.408 --> 00:10:24.479
of increased difficulty swallowing.

NOTE Confidence: 0.917606243333333

00:10:24.480 --> 00:10:27.279
He was having a hard time getting food down.

NOTE Confidence: 0.917606243333333

00:10:27.280 --> 00:10:28.892
He was subsequently diagnosed

NOTE Confidence: 0.917606243333333

00:10:28.892 --> 00:10:30.907
with a squamous cell carcinoma.

NOTE Confidence: 0.917606243333333

00:10:30.910 --> 00:10:32.194
That affected the base,

NOTE Confidence: 0.917606243333333

00:10:32.194 --> 00:10:35.109
the left side of the base of his tongue.

NOTE Confidence: 0.917606243333333

00:10:35.110 --> 00:10:37.310
So during July and August of that year,

NOTE Confidence: 0.917606243333333

00:10:37.310 --> 00:10:40.010
he received definitive conformal radiation

NOTE Confidence: 0.917606243333333

00:10:40.010 --> 00:10:42.790
therapy with concurrent weekly cisplatin.

NOTE Confidence: 0.917606243333333

00:10:42.790 --> 00:10:46.150
He tried tolerated treatment quite well

NOTE Confidence: 0.917606243333333

00:10:46.150 --> 00:10:47.865
and had complete response to the tumor,

NOTE Confidence: 0.917606243333333

00:10:47.870 --> 00:10:48.248
fortunately,

NOTE Confidence: 0.917606243333333

00:10:48.248 --> 00:10:50.894
so since that time he's been followed

NOTE Confidence: 0.917606243333333

00:10:50.894 --> 00:10:53.298
every six months by his oncologist.

NOTE Confidence: 0.917606243333333

00:10:53.300 --> 00:10:55.218
And there's been no evidence of recurrence.

NOTE Confidence: 0.917606243333333

00:10:55.220 --> 00:10:57.439
But he missed his last followup appointment

NOTE Confidence: 0.917606243333333

00:10:57.439 --> 00:10:59.841
and in fact would rather not ever have

NOTE Confidence: 0.917606243333333

00:10:59.841 --> 00:11:01.980
to see a doctor again in his life.

NOTE Confidence: 0.917606243333333

00:11:01.980 --> 00:11:03.430
He has some residual longterm

NOTE Confidence: 0.917606243333333

00:11:03.430 --> 00:11:04.300
effects of treatment,

NOTE Confidence: 0.917606243333333

00:11:04.300 --> 00:11:05.600
including dry mouth and

NOTE Confidence: 0.917606243333333

00:11:05.600 --> 00:11:06.575
chronic neck stiffness,

NOTE Confidence: 0.917606243333333

00:11:06.580 --> 00:11:09.046
but overall doing well with no

NOTE Confidence: 0.917606243333333

00:11:09.046 --> 00:11:11.699
evidence of disease at the present.

NOTE Confidence: 0.917606243333333

00:11:11.700 --> 00:11:12.660
Go on to the next slide.

NOTE Confidence: 0.917606243333333

00:11:12.660 --> 00:11:15.810
So he presents today for his annual

NOTE Confidence: 0.917606243333333

00:11:15.810 --> 00:11:18.420
Wellness visit to his primary care.

NOTE Confidence: 0.917606243333333

00:11:18.420 --> 00:11:20.240
No ongoing concerns other than

NOTE Confidence: 0.917606243333333

00:11:20.240 --> 00:11:23.002
the usual aches and pains and the

NOTE Confidence: 0.917606243333333

00:11:23.002 --> 00:11:24.738
continued stable neck stiffness.

NOTE Confidence: 0.917606243333333

00:11:24.740 --> 00:11:26.052
He is stoic, though.

NOTE Confidence: 0.917606243333333

00:11:26.052 --> 00:11:29.058
This guy spends all of his time out on

NOTE Confidence: 0.917606243333333

00:11:29.058 --> 00:11:31.940
his fishing boat and in his garage working.

NOTE Confidence: 0.917606243333333

00:11:31.940 --> 00:11:33.098
He doesn't like doctors and he

NOTE Confidence: 0.917606243333333

00:11:33.098 --> 00:11:34.180
doesn't want to see anyone.

NOTE Confidence: 0.917606243333333

00:11:34.180 --> 00:11:36.620
He doesn't have to.

NOTE Confidence: 0.917606243333333

00:11:36.620 --> 00:11:38.104
So the questions associated

NOTE Confidence: 0.917606243333333

00:11:38.104 --> 00:11:40.670
with this case are first of all.

NOTE Confidence: 0.917606243333333

00:11:40.670 --> 00:11:41.642
What is survivorship?

NOTE Confidence: 0.917606243333333

00:11:41.642 --> 00:11:43.910
So I'm going to openly admit that

NOTE Confidence: 0.917606243333333

00:11:43.970 --> 00:11:45.664
this was a concept that was new

NOTE Confidence: 0.917606243333333

00:11:45.664 --> 00:11:47.119
to me approaching this webinar.

NOTE Confidence: 0.917606243333333

00:11:47.119 --> 00:11:49.755
And so I'm really glad that we're sharing

NOTE Confidence: 0.917606243333333

00:11:49.755 --> 00:11:51.315
about this because it's something

NOTE Confidence: 0.917606243333333

00:11:51.315 --> 00:11:53.668
that I found to be quite important.

NOTE Confidence: 0.917606243333333

00:11:53.670 --> 00:11:54.382
Second question,

NOTE Confidence: 0.917606243333333

00:11:54.382 --> 00:11:56.874
follow up is what kind of surveillance

NOTE Confidence: 0.917606243333333

00:11:56.874 --> 00:11:58.722
guidelines are there for high risk

NOTE Confidence: 0.917606243333333

00:11:58.722 --> 00:12:00.870
patients in general and maybe a little

NOTE Confidence: 0.917606243333333

00:12:00.870 --> 00:12:02.844
bit of specifics about this particular

NOTE Confidence: 0.917606243333333

00:12:02.844 --> 00:12:06.000
patient since this is a high risk cancer?

NOTE Confidence: 0.917606243333333

00:12:06.000 --> 00:12:07.782
And then a final question we're

NOTE Confidence: 0.917606243333333

00:12:07.782 --> 00:12:10.066
going to answer is what is the

NOTE Confidence: 0.917606243333333

00:12:10.066 --> 00:12:11.786
Smile of Survivorship clinic in

NOTE Confidence: 0.917606243333333

00:12:11.786 --> 00:12:13.289
which patients are appropriate

NOTE Confidence: 0.917606243333333

00:12:13.289 --> 00:12:15.154
for referral to this clinic?

NOTE Confidence: 0.917606243333333

00:12:15.160 --> 00:12:17.920
With that I'll turn it over to Doctor Sam.

NOTE Confidence: 0.9402537125

00:12:19.520 --> 00:12:22.910
Thanks Brian. Coming off of five

NOTE Confidence: 0.9402537125

00:12:22.910 --> 00:12:25.510
days of conferencing in Chicago,

NOTE Confidence: 0.9402537125

00:12:25.510 --> 00:12:27.960
so forgive my hoarse voice.

NOTE Confidence: 0.9402537125

00:12:27.960 --> 00:12:30.168
Really pleased to be here with all of

NOTE Confidence: 0.9402537125

00:12:30.168 --> 00:12:32.329
you tonight and I see many familiar

NOTE Confidence: 0.9402537125

00:12:32.329 --> 00:12:33.879
names on the participants list,

NOTE Confidence: 0.9402537125

00:12:33.880 --> 00:12:36.360
so a shout out to my friends in the audience.

NOTE Confidence: 0.923042057142857

00:12:38.560 --> 00:12:41.836
But if we start with the definition,

NOTE Confidence: 0.923042057142857

00:12:41.840 --> 00:12:44.378
the NCI defines a cancer survivor

NOTE Confidence: 0.923042057142857

00:12:44.378 --> 00:12:47.251
as anyone who's been diagnosed with

NOTE Confidence: 0.923042057142857

00:12:47.251 --> 00:12:49.837
cancer and it starts at the time of

NOTE Confidence: 0.923042057142857

00:12:49.837 --> 00:12:51.525
diagnosis and extends through the

NOTE Confidence: 0.923042057142857

00:12:51.525 --> 00:12:53.400
balance of the individual's life.

NOTE Confidence: 0.951658717333334

00:12:55.840 --> 00:12:58.420
In that context, every patient

NOTE Confidence: 0.951658717333334

00:12:58.420 --> 00:13:01.000
who's ever been diagnosed with

NOTE Confidence: 0.951658717333334

00:13:01.090 --> 00:13:03.800
cancer is considered a survivor.

NOTE Confidence: 0.951658717333334

00:13:03.800 --> 00:13:05.800
And if you go to the next slide,

NOTE Confidence: 0.950316923333333

00:13:08.320 --> 00:13:11.200
there are three phases of survivorship,

NOTE Confidence: 0.950316923333333

00:13:11.200 --> 00:13:14.132
which I like to just briefly touch on.

NOTE Confidence: 0.950316923333333

00:13:14.132 --> 00:13:16.680
This was defined by a physician who

NOTE Confidence: 0.950316923333333

00:13:16.758 --> 00:13:19.117
had cancer and then wrote this article

NOTE Confidence: 0.950316923333333

00:13:19.117 --> 00:13:21.851
in the New England Journal in 1985.

NOTE Confidence: 0.950316923333333

00:13:21.851 --> 00:13:24.317
And he characterized these three phases

NOTE Confidence: 0.950316923333333

00:13:24.317 --> 00:13:26.397
as acute, extended and permanent,

NOTE Confidence: 0.950316923333333

00:13:26.397 --> 00:13:29.780
but I I renamed permanent to long term.

NOTE Confidence: 0.950316923333333

00:13:29.780 --> 00:13:31.580
The acute phase is really in

NOTE Confidence: 0.950316923333333

00:13:31.580 --> 00:13:32.780
that first diagnostic period.

NOTE Confidence: 0.950316923333333

00:13:32.780 --> 00:13:34.880
Probably Karen, like when you said

NOTE Confidence: 0.950316923333333

00:13:34.880 --> 00:13:37.280
this isn't an emergency like that is

NOTE Confidence: 0.950316923333333

00:13:37.280 --> 00:13:39.700
when you're going over the waterfall,

NOTE Confidence: 0.950316923333333

00:13:39.700 --> 00:13:41.584
you've just been diagnosed,

NOTE Confidence: 0.950316923333333

00:13:41.584 --> 00:13:44.283
there's lots of tests and imaging

NOTE Confidence: 0.950316923333333

00:13:44.283 --> 00:13:46.341
and you see an oncologist and

NOTE Confidence: 0.950316923333333

00:13:46.341 --> 00:13:48.039
surgeons and radiation doctors and

NOTE Confidence: 0.950316923333333

00:13:48.039 --> 00:13:49.857
you're going to have a treatment

NOTE Confidence: 0.950316923333333

00:13:49.857 --> 00:13:51.668
plan and you're in treatment.

NOTE Confidence: 0.950316923333333

00:13:51.670 --> 00:13:53.430
And the whole cancer community.

NOTE Confidence: 0.950316923333333

00:13:53.430 --> 00:13:55.621
Most a lot of times your whole

NOTE Confidence: 0.950316923333333

00:13:55.621 --> 00:13:56.958
support community comes together

NOTE Confidence: 0.950316923333333

00:13:56.958 --> 00:13:58.950
to carry you through this time,

NOTE Confidence: 0.950316923333333

00:13:58.950 --> 00:14:01.869
if you click through the animations here,

NOTE Confidence: 0.950316923333333

00:14:01.870 --> 00:14:04.110
the next period is the extended period

NOTE Confidence: 0.94780115

00:14:06.350 --> 00:14:08.624
which should be highlighted and then

NOTE Confidence: 0.94780115

00:14:08.624 --> 00:14:10.990
another Click to show the picture.

NOTE Confidence: 0.94780115

00:14:10.990 --> 00:14:11.870
I love this picture.

NOTE Confidence: 0.94780115

00:14:11.870 --> 00:14:13.190
I don't know if it's real,

NOTE Confidence: 0.94780115

00:14:13.190 --> 00:14:16.016
but you know the extended period

NOTE Confidence: 0.94780115

00:14:16.016 --> 00:14:18.390
starts after treatment is over.

NOTE Confidence: 0.94780115

00:14:18.390 --> 00:14:21.010
So usually treatments about.

NOTE Confidence: 0.94780115

00:14:21.010 --> 00:14:24.364
Maybe six months if you get chemotherapy,

NOTE Confidence: 0.94780115

00:14:24.364 --> 00:14:26.780
maybe a little less if it's not,

NOTE Confidence: 0.94780115

00:14:26.780 --> 00:14:28.698
maybe you might be on some maintenance

NOTE Confidence: 0.94780115

00:14:28.698 --> 00:14:30.140
therapy for the whole year.

NOTE Confidence: 0.94780115

00:14:30.140 --> 00:14:31.752
But generally in that,

NOTE Confidence: 0.94780115

00:14:31.752 --> 00:14:34.643
in that after that six months of

NOTE Confidence: 0.94780115

00:14:34.643 --> 00:14:37.036
really heavy going over the waterfall

NOTE Confidence: 0.94780115

00:14:37.036 --> 00:14:39.056
though the waters are calmer,

NOTE Confidence: 0.94780115

00:14:39.060 --> 00:14:40.830
but you're pretty sure the patients

NOTE Confidence: 0.94780115

00:14:40.830 --> 00:14:42.324
are pretty sure every something

NOTE Confidence: 0.94780115

00:14:42.324 --> 00:14:44.071
is going to get them every

NOTE Confidence: 0.94780115

00:14:44.071 --> 00:14:46.777
ache and pain is a recurrence.

NOTE Confidence: 0.94780115

00:14:46.780 --> 00:14:48.590
They might be dealing with

NOTE Confidence: 0.94780115

00:14:48.590 --> 00:14:49.676
their side effects.

NOTE Confidence: 0.94780115

00:14:49.680 --> 00:14:51.904
They might have a lot of post

NOTE Confidence: 0.94780115

00:14:51.904 --> 00:14:53.920
traumatic stress type symptoms.

NOTE Confidence: 0.94780115

00:14:53.920 --> 00:14:57.560
So they feel like they're it's a

NOTE Confidence: 0.94780115

00:14:57.560 --> 00:14:59.600
high uncertainty and that's where our

NOTE Confidence: 0.94780115

00:14:59.600 --> 00:15:01.600
clinic often comes in and I'm going to

NOTE Confidence: 0.94780115

00:15:01.600 --> 00:15:03.400
talk about that in in a few minutes.

NOTE Confidence: 0.94780115

00:15:03.400 --> 00:15:06.520
You click through the next animations.

NOTE Confidence: 0.94780115

00:15:06.520 --> 00:15:08.480
2 more, one more click.

NOTE Confidence: 0.94780115

00:15:08.480 --> 00:15:09.909
So in long term survivorship.

NOTE Confidence: 0.94780115

00:15:09.909 --> 00:15:12.243
This is when the the waters

NOTE Confidence: 0.94780115

00:15:12.243 --> 00:15:14.120
are much more peaceful,

NOTE Confidence: 0.94780115

00:15:14.120 --> 00:15:16.196
the risk of recurrence goes down,

NOTE Confidence: 0.94780115

00:15:16.200 --> 00:15:18.643
but the late and longterm effects serve

NOTE Confidence: 0.94780115

00:15:18.643 --> 00:15:21.596
as a reminder of what you've been through.

NOTE Confidence: 0.94780115

00:15:21.600 --> 00:15:24.260
And so for each of these phases,

NOTE Confidence: 0.94780115

00:15:24.260 --> 00:15:26.360
survivors can have different needs.

NOTE Confidence: 0.94780115

00:15:26.360 --> 00:15:27.400
And I I think that's,

NOTE Confidence: 0.94780115

00:15:27.400 --> 00:15:27.948
you know,

NOTE Confidence: 0.94780115

00:15:27.948 --> 00:15:30.140
one of the reasons why can be so

NOTE Confidence: 0.94780115

00:15:30.213 --> 00:15:32.289
hard to wrap our minds around

NOTE Confidence: 0.94780115

00:15:32.289 --> 00:15:34.549
survivorship as a field because it

NOTE Confidence: 0.94780115

00:15:34.549 --> 00:15:36.554
really encompasses so much time.

NOTE Confidence: 0.94780115

00:15:36.560 --> 00:15:37.280
Next slide, please.

NOTE Confidence: 0.952553233333333

00:15:39.740 --> 00:15:44.006
There are certain themes that tie

NOTE Confidence: 0.952553233333333

00:15:44.006 --> 00:15:46.542
every single survivor together.

NOTE Confidence: 0.952553233333333

00:15:46.542 --> 00:15:49.356
So there's we can unify each unique

NOTE Confidence: 0.952553233333333

00:15:49.356 --> 00:15:51.807
person and they have a common set

NOTE Confidence: 0.952553233333333

00:15:51.807 --> 00:15:54.179
of of needs that need to be met.

NOTE Confidence: 0.952553233333333

00:15:54.180 --> 00:15:56.012
And this is simplification,

NOTE Confidence: 0.952553233333333

00:15:56.012 --> 00:15:59.561
but but we all agree that every

NOTE Confidence: 0.952553233333333

00:15:59.561 --> 00:16:02.361
survivor needs surveillance for

NOTE Confidence: 0.952553233333333

00:16:02.361 --> 00:16:06.327
both recurrence and a new cancer.

NOTE Confidence: 0.952553233333333

00:16:06.330 --> 00:16:08.169
And in general,

NOTE Confidence: 0.952553233333333

00:16:08.170 --> 00:16:11.208
at least in that first extended period,

NOTE Confidence: 0.952553233333333

00:16:11.210 --> 00:16:13.502
the oncologists want to be doing

NOTE Confidence: 0.952553233333333

00:16:13.502 --> 00:16:15.841
that kind of surveillance and and

NOTE Confidence: 0.952553233333333

00:16:15.841 --> 00:16:17.686
patients want their oncologists to

NOTE Confidence: 0.952553233333333

00:16:17.686 --> 00:16:20.250
be doing that kind of surveillance.

NOTE Confidence: 0.952553233333333

00:16:20.250 --> 00:16:21.850
As time goes on,

NOTE Confidence: 0.952553233333333

00:16:21.850 --> 00:16:25.609
that surveillance might get less frequent,

NOTE Confidence: 0.952553233333333

00:16:25.610 --> 00:16:27.986
less necessary and the needs of

NOTE Confidence: 0.952553233333333

00:16:27.986 --> 00:16:29.570
those survivors might change.

NOTE Confidence: 0.952553233333333

00:16:29.570 --> 00:16:32.279
And who who needs to do that?

NOTE Confidence: 0.952553233333333

00:16:32.280 --> 00:16:34.275
And then every survivor needs

NOTE Confidence: 0.952553233333333

00:16:34.275 --> 00:16:35.472
identification and treatment

NOTE Confidence: 0.952553233333333

00:16:35.472 --> 00:16:37.599
of late and longterm effects.

NOTE Confidence: 0.952553233333333

00:16:37.600 --> 00:16:39.250
And we can talk about incidence

NOTE Confidence: 0.952553233333333

00:16:39.250 --> 00:16:41.125
of all of that and different

NOTE Confidence: 0.952553233333333

00:16:41.125 --> 00:16:42.915
risks that would cause that,

NOTE Confidence: 0.952553233333333

00:16:42.920 --> 00:16:46.496
but we are all charged with

NOTE Confidence: 0.952553233333333

00:16:46.496 --> 00:16:48.880
identifying and addressing those.

NOTE Confidence: 0.952553233333333

00:16:48.880 --> 00:16:51.197
And then the topic of health promotions,

NOTE Confidence: 0.952553233333333

00:16:51.200 --> 00:16:53.776
what I personally is near and dear

NOTE Confidence: 0.952553233333333

00:16:53.776 --> 00:16:56.234
to my heart because there's very few

NOTE Confidence: 0.952553233333333

00:16:56.234 --> 00:16:57.900
times in an adult life where you're

NOTE Confidence: 0.952553233333333

00:16:57.945 --> 00:16:59.200
willing to change your behavior

NOTE Confidence: 0.952553233333333

00:16:59.200 --> 00:17:00.920
and cancer is often one of those.

NOTE Confidence: 0.952553233333333

00:17:00.920 --> 00:17:01.950
And so.

NOTE Confidence: 0.952553233333333

00:17:01.950 --> 00:17:05.450
Really using that teachable moment

NOTE Confidence: 0.952553233333333

00:17:05.450 --> 00:17:07.880
to help patients meet their goals

NOTE Confidence: 0.952553233333333

00:17:07.953 --> 00:17:09.904
for their diet, their exercise,

NOTE Confidence: 0.952553233333333

00:17:09.904 --> 00:17:14.070
maybe not drinking as much as they used to.

NOTE Confidence: 0.952553233333333

00:17:14.070 --> 00:17:14.778
Smoking cessation,

NOTE Confidence: 0.952553233333333

00:17:14.778 --> 00:17:16.548
especially in head and neck

NOTE Confidence: 0.952553233333333

00:17:16.548 --> 00:17:18.109
cancer patients as we know,

NOTE Confidence: 0.952553233333333

00:17:18.110 --> 00:17:19.334
can be so important.

NOTE Confidence: 0.952553233333333

00:17:19.334 --> 00:17:19.946
Every patient,

NOTE Confidence: 0.952553233333333

00:17:19.950 --> 00:17:22.794
but those are tenants of of

NOTE Confidence: 0.952553233333333

00:17:22.794 --> 00:17:25.159
survivorship care for everyone and

NOTE Confidence: 0.952553233333333

00:17:25.159 --> 00:17:27.805
then of course why we're here is.

NOTE Confidence: 0.952553233333333

00:17:27.810 --> 00:17:29.442
That we owe it to our patients to

NOTE Confidence: 0.952553233333333

00:17:29.442 --> 00:17:31.024
coordinate this care and make sure that

NOTE Confidence: 0.952553233333333

00:17:31.024 --> 00:17:32.490
nothing is falling through the cracks,

NOTE Confidence: 0.952553233333333

00:17:32.490 --> 00:17:35.570
which is so much easier said than done.

NOTE Confidence: 0.952553233333333

00:17:35.570 --> 00:17:36.102
Next slide,

NOTE Confidence: 0.952553233333333

00:17:36.102 --> 00:17:36.368
please.

NOTE Confidence: 0.9100634

00:17:38.850 --> 00:17:42.846
I was going to plug in this gentleman's.

NOTE Confidence: 0.942575923076923

00:17:45.000 --> 00:17:47.100
Profile on an app that I thought

NOTE Confidence: 0.942575923076923

00:17:47.100 --> 00:17:49.243
was available and show you like how

NOTE Confidence: 0.942575923076923

00:17:49.243 --> 00:17:51.455
we would solve this together if you

NOTE Confidence: 0.942575923076923

00:17:51.455 --> 00:17:53.355
didn't have a survivorship clinic.

NOTE Confidence: 0.942575923076923

00:17:53.360 --> 00:17:55.880
And I I don't know what happened to the app.

NOTE Confidence: 0.942575923076923

00:17:55.880 --> 00:17:57.120
I couldn't find it.

NOTE Confidence: 0.942575923076923

00:17:57.120 --> 00:18:00.360
So in head and neck cancer patients for

NOTE Confidence: 0.942575923076923

00:18:00.360 --> 00:18:02.950
instance if you Google survivorship and

NOTE Confidence: 0.942575923076923

00:18:02.950 --> 00:18:05.788
the American Cancer Society is a wonderful

NOTE Confidence: 0.942575923076923

00:18:05.788 --> 00:18:08.236
resource for both doctors and patients,

NOTE Confidence: 0.942575923076923

00:18:08.240 --> 00:18:11.084
you're going to get a PDF of guidelines and

NOTE Confidence: 0.942575923076923

00:18:11.084 --> 00:18:14.229
if you even click on the link that says.

NOTE Confidence: 0.942575923076923

00:18:14.230 --> 00:18:16.430
You know, a simple chart.

NOTE Confidence: 0.942575923076923

00:18:16.430 --> 00:18:19.006
This is one page on the left

NOTE Confidence: 0.942575923076923

00:18:19.006 --> 00:18:21.907
hand side of a three page chart.

NOTE Confidence: 0.942575923076923

00:18:21.910 --> 00:18:24.270
This is for head and neck cancer survivors.

NOTE Confidence: 0.942575923076923

00:18:24.270 --> 00:18:26.310
There's also the same information

NOTE Confidence: 0.942575923076923

00:18:26.310 --> 00:18:27.942
for breast cancer survivors,

NOTE Confidence: 0.942575923076923

00:18:27.950 --> 00:18:29.348
colon cancer survivors,

NOTE Confidence: 0.942575923076923

00:18:29.348 --> 00:18:30.746
prostate cancer survivors.

NOTE Confidence: 0.942575923076923

00:18:30.750 --> 00:18:33.234
And that's kind of where a Ch that's like

NOTE Confidence: 0.942575923076923

00:18:33.234 --> 00:18:35.933
a CS American Cancer side of the where

NOTE Confidence: 0.942575923076923

00:18:35.933 --> 00:18:38.460
their guidelines are sort of fitting.

NOTE Confidence: 0.942575923076923

00:18:38.460 --> 00:18:40.884
So instead I just summarized sort of what

NOTE Confidence: 0.942575923076923

00:18:40.884 --> 00:18:43.935
is in this document on the right hand side.

NOTE Confidence: 0.942575923076923

00:18:43.940 --> 00:18:46.054
So again it's a three page table.

NOTE Confidence: 0.942575923076923

00:18:46.060 --> 00:18:48.710
You'll see that there are

NOTE Confidence: 0.942575923076923

00:18:48.710 --> 00:18:50.300
recommendations for surveillance,

NOTE Confidence: 0.942575923076923

00:18:50.300 --> 00:18:51.680
screening and early detection

NOTE Confidence: 0.942575923076923

00:18:51.680 --> 00:18:53.060
of second primary cancers.

NOTE Confidence: 0.942575923076923

00:18:53.060 --> 00:18:55.419
They really call that out here because

NOTE Confidence: 0.942575923076923

00:18:55.419 --> 00:18:57.456
that's a particularly high risk in the

NOTE Confidence: 0.942575923076923

00:18:57.456 --> 00:18:59.400
head and neck cancer world because of

NOTE Confidence: 0.942575923076923

00:18:59.400 --> 00:19:01.640
the treatment that's given and the risk

NOTE Confidence: 0.942575923076923

00:19:01.640 --> 00:19:04.020
factors that are often associated with it.

NOTE Confidence: 0.942575923076923

00:19:04.020 --> 00:19:05.780
Then Assessment of Management

NOTE Confidence: 0.942575923076923

00:19:05.780 --> 00:19:07.540
of Physical and Psychosocial,

NOTE Confidence: 0.942575923076923

00:19:07.540 --> 00:19:08.876
Longterm and Late Effects.

NOTE Confidence: 0.942575923076923

00:19:08.876 --> 00:19:11.620
I listed those down there at the bottom.

NOTE Confidence: 0.942575923076923

00:19:11.620 --> 00:19:13.420
And then of course Health

NOTE Confidence: 0.942575923076923

00:19:13.420 --> 00:19:14.860
Promotion and Care Coordination.

NOTE Confidence: 0.942575923076923

00:19:14.860 --> 00:19:17.380
If you look at the list of late and

NOTE Confidence: 0.942575923076923

00:19:17.380 --> 00:19:19.820
longterm effects and you read the chart,

NOTE Confidence: 0.942575923076923

00:19:19.820 --> 00:19:22.370
every single one recommends that

NOTE Confidence: 0.942575923076923

00:19:22.370 --> 00:19:25.469
you primary care screen for each

NOTE Confidence: 0.942575923076923

00:19:25.469 --> 00:19:28.235
of these things detect and refer.

NOTE Confidence: 0.942575923076923

00:19:28.240 --> 00:19:30.400
And I feel overwhelmed just reading

NOTE Confidence: 0.942575923076923

00:19:30.400 --> 00:19:32.545
through that chart and can't imagine

NOTE Confidence: 0.942575923076923

00:19:32.545 --> 00:19:34.764
what it's like in a busy primary

NOTE Confidence: 0.942575923076923

00:19:34.764 --> 00:19:36.704
care clinic to maybe have that

NOTE Confidence: 0.942575923076923

00:19:36.704 --> 00:19:39.407
sense of duty to try to detect and

NOTE Confidence: 0.942575923076923

00:19:39.407 --> 00:19:41.527
treat and refer for specialized

NOTE Confidence: 0.942575923076923

00:19:41.527 --> 00:19:44.000
treatment for all of these issues.

NOTE Confidence: 0.942575923076923

00:19:44.000 --> 00:19:45.542
So I just, you know, curious on,

NOTE Confidence: 0.942575923076923

00:19:45.542 --> 00:19:47.597
on any comments on that,

NOTE Confidence: 0.942575923076923

00:19:47.600 --> 00:19:49.598
but this is what's in the

NOTE Confidence: 0.942575923076923

00:19:49.598 --> 00:19:50.597
literature right now.

NOTE Confidence: 0.942575923076923

00:19:50.600 --> 00:19:51.278
Next slide please.

NOTE Confidence: 0.944898246153846

00:19:53.580 --> 00:19:55.484
There is also you can find this on

NOTE Confidence: 0.944898246153846

00:19:55.484 --> 00:19:57.178
the American Cancer Society website.

NOTE Confidence: 0.944898246153846

00:19:57.180 --> 00:20:00.365
There is a link to this Cancer

NOTE Confidence: 0.944898246153846

00:20:00.365 --> 00:20:02.272
Survivorship e-learning series and

NOTE Confidence: 0.944898246153846

00:20:02.272 --> 00:20:06.170
there is a one hour webinar that focuses

NOTE Confidence: 0.944898246153846

00:20:06.170 --> 00:20:09.140
on head and neck cancer survivorship.

NOTE Confidence: 0.944898246153846

00:20:09.140 --> 00:20:11.102
What I was hoping to show is how you

NOTE Confidence: 0.944898246153846

00:20:11.102 --> 00:20:13.159
could figure all of this out in a few

NOTE Confidence: 0.944898246153846

00:20:13.159 --> 00:20:14.956
minutes and and it really I think

NOTE Confidence: 0.944898246153846

00:20:14.956 --> 00:20:18.429
illustrates the fact that it this is hard.

NOTE Confidence: 0.944898246153846

00:20:18.430 --> 00:20:20.206
I don't know how many people have an

NOTE Confidence: 0.944898246153846

00:20:20.206 --> 00:20:22.128
hour and a preparation for a patient to

NOTE Confidence: 0.944898246153846

00:20:22.128 --> 00:20:24.070
go and watch this to learn more about

NOTE Confidence: 0.944898246153846

00:20:24.070 --> 00:20:27.430
addressing this particular patient's needs.

NOTE Confidence: 0.944898246153846

00:20:27.430 --> 00:20:29.710
Next slide please.

NOTE Confidence: 0.944898246153846

00:20:29.710 --> 00:20:32.041
So I'm ending with just two slides

NOTE Confidence: 0.944898246153846

00:20:32.041 --> 00:20:34.470
about the Yale Survivorship Clinic.

NOTE Confidence: 0.938664578421053

00:20:36.670 --> 00:20:39.260
We have been around longer than I've

NOTE Confidence: 0.938664578421053

00:20:39.260 --> 00:20:42.170
been at Yale so it was started by

NOTE Confidence: 0.938664578421053

00:20:42.170 --> 00:20:47.549
a cancer survivor in 2006. He he.

NOTE Confidence: 0.938664578421053

00:20:47.550 --> 00:20:49.657
Explicitly said this is what I wished

NOTE Confidence: 0.938664578421053

00:20:49.657 --> 00:20:52.109
I had had in my cancer treatment.

NOTE Confidence: 0.938664578421053

00:20:52.110 --> 00:20:54.405
So this is what this is the team you

NOTE Confidence: 0.938664578421053

00:20:54.405 --> 00:20:56.589
must assemble if you want my money.

NOTE Confidence: 0.938664578421053

00:20:56.590 --> 00:20:58.710
And so Yale said Okay,

NOTE Confidence: 0.938664578421053

00:20:58.710 --> 00:21:03.270
we serve patients of all diagnosis.

NOTE Confidence: 0.938664578421053

00:21:03.270 --> 00:21:06.154
Any patient who's had a diagnosis of

NOTE Confidence: 0.938664578421053

00:21:06.154 --> 00:21:09.067
cancer is welcome to come to our clinic

NOTE Confidence: 0.938664578421053

00:21:09.070 --> 00:21:12.400
and we meet once weekly and we go to

NOTE Confidence: 0.938664578421053

00:21:12.400 --> 00:21:16.196
the different various greater New Haven.

NOTE Confidence: 0.938664578421053

00:21:16.200 --> 00:21:18.195
Locations. So we see patients in Smila,

NOTE Confidence: 0.938664578421053

00:21:18.200 --> 00:21:19.838
but we also go to Guilford,

NOTE Confidence: 0.938664578421053

00:21:19.840 --> 00:21:23.319
North Haven and Derby starting next month.

NOTE Confidence: 0.938664578421053

00:21:23.320 --> 00:21:25.605
Just a minute, I'm I'm going to call, sorry.

NOTE Confidence: 0.938664578421053

00:21:25.605 --> 00:21:28.480
I'm also have a couple kids hanging around.

NOTE Confidence: 0.938664578421053

00:21:28.480 --> 00:21:31.234
We give just a minute honey. Okay.

NOTE Confidence: 0.938664578421053

00:21:31.234 --> 00:21:32.638
All right, I'll, I'll help you.

NOTE Confidence: 0.938664578421053

00:21:32.640 --> 00:21:35.680
Amelia, can you help her get some food?

NOTE Confidence: 0.938664578421053

00:21:35.680 --> 00:21:39.038
We see patients for a one time

NOTE Confidence: 0.938664578421053

00:21:39.038 --> 00:21:41.148
consultation and then we usually have

NOTE Confidence: 0.938664578421053

00:21:41.148 --> 00:21:43.644
one or two follow up visits so we

NOTE Confidence: 0.938664578421053

00:21:43.720 --> 00:21:46.100
do not assume care of our patients.

NOTE Confidence: 0.938664578421053

00:21:46.100 --> 00:21:48.656
But they do get a 2 hour visit each

NOTE Confidence: 0.938664578421053

00:21:48.656 --> 00:21:50.904
time with four specialists and I'll

NOTE Confidence: 0.938664578421053

00:21:50.904 --> 00:21:53.859
tell you about them in just a minute.

NOTE Confidence: 0.938664578421053

00:21:53.860 --> 00:21:55.576
I think it's important to understand

NOTE Confidence: 0.938664578421053

00:21:55.576 --> 00:21:58.298
we do not take the place of either the

NOTE Confidence: 0.938664578421053

00:21:58.298 --> 00:22:00.380
oncologist or the primary care provider,

NOTE Confidence: 0.938664578421053

00:22:00.380 --> 00:22:02.291
but we do meet the patient where

NOTE Confidence: 0.938664578421053

00:22:02.291 --> 00:22:05.157
they are at and we provide a lot

NOTE Confidence: 0.938664578421053

00:22:05.157 --> 00:22:06.745
of individualized counseling and

NOTE Confidence: 0.938664578421053

00:22:06.745 --> 00:22:08.628
references based on what the survivor

NOTE Confidence: 0.938664578421053

00:22:08.628 --> 00:22:10.100
is hoping to achieve.

NOTE Confidence: 0.938664578421053

00:22:10.100 --> 00:22:12.980
And every single patient gets an

NOTE Confidence: 0.938664578421053

00:22:12.980 --> 00:22:14.900
individualized survivorship care plan.

NOTE Confidence: 0.938664578421053

00:22:14.900 --> 00:22:16.488
Next slide please. Okay.

NOTE Confidence: 0.938664578421053

00:22:16.488 --> 00:22:18.076
So who's the team?

NOTE Confidence: 0.938664578421053

00:22:18.080 --> 00:22:19.640
So I'm the medical director.

NOTE Confidence: 0.938664578421053

00:22:19.640 --> 00:22:20.868
I do see patients,

NOTE Confidence: 0.938664578421053

00:22:20.868 --> 00:22:23.708
but really the bulk of the patients are

NOTE Confidence: 0.938664578421053

00:22:23.708 --> 00:22:26.474
seen by my fabulous physicians assistant,

NOTE Confidence: 0.938664578421053

00:22:26.480 --> 00:22:26.868
Kevin Bretta,

NOTE Confidence: 0.938664578421053

00:22:26.868 --> 00:22:28.032
who would have loved to have

NOTE Confidence: 0.938664578421053

00:22:28.032 --> 00:22:28.760
been here tonight,

NOTE Confidence: 0.938664578421053

00:22:28.760 --> 00:22:30.998
but he's actually on a vacation

NOTE Confidence: 0.938664578421053

00:22:30.998 --> 00:22:33.679
and we want him to enjoy that.

NOTE Confidence: 0.938664578421053

00:22:33.680 --> 00:22:36.398
He he's the PA there in the top left,

NOTE Confidence: 0.938664578421053

00:22:36.400 --> 00:22:38.896
and he's the one who makes

NOTE Confidence: 0.938664578421053

00:22:38.896 --> 00:22:40.560
those survivorship care plans.

NOTE Confidence: 0.938664578421053

00:22:40.560 --> 00:22:42.665
He's the one who's making

NOTE Confidence: 0.938664578421053

00:22:42.665 --> 00:22:44.349
sure patients aren't lost.

NOTE Confidence: 0.938664578421053

00:22:44.350 --> 00:22:46.750
Can transition that they're that he

NOTE Confidence: 0.938664578421053

00:22:46.750 --> 00:22:49.083
that they understand you know what

NOTE Confidence: 0.938664578421053

00:22:49.083 --> 00:22:51.010
the plan is going forward who's

NOTE Confidence: 0.938664578421053

00:22:51.010 --> 00:22:53.090
going to be doing what and you know

NOTE Confidence: 0.938664578421053

00:22:53.090 --> 00:22:55.073
he addresses late and longterm

NOTE Confidence: 0.938664578421053

00:22:55.073 --> 00:22:57.143
effects from a medical perspective.

NOTE Confidence: 0.938664578421053

00:22:57.150 --> 00:23:00.702
The LCSW licensed clinical social

NOTE Confidence: 0.938664578421053

00:23:00.702 --> 00:23:02.942
worker is next to that.

NOTE Confidence: 0.938664578421053

00:23:02.950 --> 00:23:04.950
Right now it's Kristen Clark.

NOTE Confidence: 0.938664578421053

00:23:04.950 --> 00:23:07.002
They have our social workers have

NOTE Confidence: 0.938664578421053

00:23:07.002 --> 00:23:09.153
the highest level of training in

NOTE Confidence: 0.938664578421053

00:23:09.153 --> 00:23:11.632
their field for cancer and they

NOTE Confidence: 0.938664578421053

00:23:11.632 --> 00:23:13.716
really talk about the.

NOTE Confidence: 0.938664578421053

00:23:13.720 --> 00:23:15.538
Psychosocial aspects of coping with cancer

NOTE Confidence: 0.938664578421053

00:23:15.538 --> 00:23:18.239
and and so for instance back to this case.

NOTE Confidence: 0.938664578421053

00:23:18.240 --> 00:23:19.824
You know many of our head

NOTE Confidence: 0.938664578421053

00:23:19.824 --> 00:23:20.880
and neck cancer patients,

NOTE Confidence: 0.938664578421053

00:23:20.880 --> 00:23:22.120
though this man is stoic,

NOTE Confidence: 0.938664578421053

00:23:22.120 --> 00:23:25.480
he may be having some fear of eating.

NOTE Confidence: 0.938664578421053

00:23:25.480 --> 00:23:27.762
Could be that he's doing less socially

NOTE Confidence: 0.938664578421053

00:23:27.762 --> 00:23:29.710
because he's afraid of choking in

NOTE Confidence: 0.938664578421053

00:23:29.710 --> 00:23:31.831
public because of his chronic dry mouth.

NOTE Confidence: 0.938664578421053

00:23:31.840 --> 00:23:34.024
So this is would be an example

NOTE Confidence: 0.938664578421053

00:23:34.024 --> 00:23:36.157
of what the social worker might

NOTE Confidence: 0.938664578421053

00:23:36.157 --> 00:23:39.060
talk about and try to plug him in.

NOTE Confidence: 0.938664578421053

00:23:39.060 --> 00:23:41.412
With some help to to cope with

NOTE Confidence: 0.938664578421053

00:23:41.412 --> 00:23:42.420
that and and

NOTE Confidence: 0.93293488

00:23:42.503 --> 00:23:44.900
to validate those feelings and and

NOTE Confidence: 0.93293488

00:23:44.900 --> 00:23:48.558
maybe even treat anxiety and depression.

NOTE Confidence: 0.93293488

00:23:48.558 --> 00:23:52.152
Our physical therapist is a is actually

NOTE Confidence: 0.93293488

00:23:52.152 --> 00:23:55.195
also the head of our ank rehab program

NOTE Confidence: 0.93293488

00:23:55.195 --> 00:23:58.254
Scott Caposa and he is got he actually

NOTE Confidence: 0.93293488

00:23:58.254 --> 00:24:00.713
wrote the board of questions for

NOTE Confidence: 0.93293488

00:24:00.713 --> 00:24:03.268
the ACSM oncology certification for

NOTE Confidence: 0.93293488

00:24:03.268 --> 00:24:06.310
his for physical therapist. So he's.

NOTE Confidence: 0.93293488

00:24:06.310 --> 00:24:08.278
Been doing this for a very long time

NOTE Confidence: 0.93293488

00:24:08.278 --> 00:24:10.486
and he helps patients either get

NOTE Confidence: 0.93293488

00:24:10.486 --> 00:24:12.626
back to the physical functioning

NOTE Confidence: 0.93293488

00:24:12.626 --> 00:24:15.333
that they had before or maybe start

NOTE Confidence: 0.93293488

00:24:15.333 --> 00:24:18.189
a new plan to help meet new goals.

NOTE Confidence: 0.93293488

00:24:18.190 --> 00:24:20.890
And then of course as a PT he would be

NOTE Confidence: 0.93293488

00:24:20.966 --> 00:24:23.668
able to assess for this gentleman hit,

NOTE Confidence: 0.93293488

00:24:23.670 --> 00:24:25.506
you know, his range of motion,

NOTE Confidence: 0.93293488

00:24:25.510 --> 00:24:28.606
his ability to to stretch his neck.

NOTE Confidence: 0.93293488

00:24:28.606 --> 00:24:30.824
He would be able to prescribe a

NOTE Confidence: 0.93293488

00:24:30.824 --> 00:24:33.806
home exercise program to help with

NOTE Confidence: 0.93293488

00:24:33.806 --> 00:24:36.262
any symptoms that he's having.

NOTE Confidence: 0.93293488

00:24:36.262 --> 00:24:38.856
In his affected fields and then

NOTE Confidence: 0.93293488

00:24:38.856 --> 00:24:40.764
our last provider is a registered

NOTE Confidence: 0.93293488

00:24:40.764 --> 00:24:42.560
dietitian who's also a certified

NOTE Confidence: 0.93293488

00:24:42.560 --> 00:24:43.658
specialist in oncology.

NOTE Confidence: 0.93293488

00:24:43.660 --> 00:24:46.090
So again the highest levels of

NOTE Confidence: 0.93293488

00:24:46.090 --> 00:24:49.056
their of their field in cancer care.

NOTE Confidence: 0.93293488

00:24:49.060 --> 00:24:52.324
And right now we have a new dietitian

NOTE Confidence: 0.93293488

00:24:52.324 --> 00:24:54.612
named Natalie Smith and they

NOTE Confidence: 0.93293488

00:24:54.612 --> 00:24:56.764
really address you know not only

NOTE Confidence: 0.93293488

00:24:56.764 --> 00:24:58.294
weight gain and weight loss.

NOTE Confidence: 0.93293488

00:24:58.300 --> 00:25:00.136
So in this particular gentleman probably

NOTE Confidence: 0.93293488

00:25:00.136 --> 00:25:02.038
he's lost some weight through his

NOTE Confidence: 0.93293488

00:25:02.038 --> 00:25:03.593
treatment and possibly gaining that

NOTE Confidence: 0.93293488

00:25:03.593 --> 00:25:05.668
weight back can be really challenging.

NOTE Confidence: 0.93293488

00:25:05.670 --> 00:25:08.398
And lots of wellintentioned family

NOTE Confidence: 0.93293488

00:25:08.398 --> 00:25:10.387
members may have told him that all

NOTE Confidence: 0.93293488

00:25:10.387 --> 00:25:11.632
these supplements that he needs

NOTE Confidence: 0.93293488

00:25:11.632 --> 00:25:13.190
to take to prevent recurrence.

NOTE Confidence: 0.93293488

00:25:13.190 --> 00:25:16.050
And our dietitian really addresses

NOTE Confidence: 0.93293488

00:25:16.050 --> 00:25:18.910
myths about nutrition and cancer,

NOTE Confidence: 0.93293488

00:25:18.910 --> 00:25:21.094
of which there are many because the diet

NOTE Confidence: 0.93293488

00:25:21.094 --> 00:25:23.069
industry is a billion dollar industry.

NOTE Confidence: 0.938995675

00:25:26.110 --> 00:25:29.790
If we forget if there's one more slide,

NOTE Confidence: 0.938995675

00:25:29.790 --> 00:25:34.410
that's it. So I we.

NOTE Confidence: 0.938995675

00:25:34.410 --> 00:25:36.505
We would be happy to see any

NOTE Confidence: 0.938995675

00:25:36.505 --> 00:25:38.600
patient that you felt could benefit

NOTE Confidence: 0.938995675

00:25:38.600 --> 00:25:40.610
from what I just described.

NOTE Confidence: 0.938995675

00:25:40.610 --> 00:25:42.452
It doesn't matter if they're within

NOTE Confidence: 0.938995675

00:25:42.452 --> 00:25:44.476
that year or maybe they're three

NOTE Confidence: 0.938995675

00:25:44.476 --> 00:25:46.666
years and and sometimes we've even

NOTE Confidence: 0.938995675

00:25:46.666 --> 00:25:48.648
gotten patients who are 10 years out.

NOTE Confidence: 0.938995675

00:25:48.650 --> 00:25:51.338
And we we also try to face

NOTE Confidence: 0.938995675

00:25:51.338 --> 00:25:53.010
our patients every year.

NOTE Confidence: 0.938995675

00:25:53.010 --> 00:25:55.050
There's June is cancer survivorship

NOTE Confidence: 0.938995675

00:25:55.050 --> 00:25:58.418
month and we try to go directly to

NOTE Confidence: 0.938995675

00:25:58.418 --> 00:26:00.874
patients with webinars just like this

NOTE Confidence: 0.938995675

00:26:00.874 --> 00:26:04.150
to address issues and this will be our.

NOTE Confidence: 0.938995675

00:26:04.150 --> 00:26:05.670
I think our 4th June,

NOTE Confidence: 0.938995675

00:26:05.670 --> 00:26:07.590
that's virtual and it starts tomorrow.

NOTE Confidence: 0.938995675

00:26:07.590 --> 00:26:11.850
Now I'll just say that you can find this on

NOTE Confidence: 0.938995675

00:26:11.850 --> 00:26:14.350
our website if you yourself are curious.

NOTE Confidence: 0.938995675

00:26:14.350 --> 00:26:16.310
If you wanted to send a patient,

NOTE Confidence: 0.938995675

00:26:16.310 --> 00:26:18.182
they're going to be every Wednesday

NOTE Confidence: 0.938995675

00:26:18.182 --> 00:26:20.350
in June from 6:30 to 8:00 tomorrow.

NOTE Confidence: 0.938995675

00:26:20.350 --> 00:26:23.430
We start with a panel talking about

NOTE Confidence: 0.938995675

00:26:23.430 --> 00:26:25.708
restoring your body to integrity

NOTE Confidence: 0.938995675

00:26:25.708 --> 00:26:28.530
after cancer and on June 14th

NOTE Confidence: 0.938995675

00:26:28.530 --> 00:26:30.470
living with cancer chronically.

NOTE Confidence: 0.938995675

00:26:30.470 --> 00:26:33.606
On June 21st cancer and the family.

NOTE Confidence: 0.938995675

00:26:33.610 --> 00:26:35.874
How to advocate for your loved one And

NOTE Confidence: 0.938995675

00:26:35.874 --> 00:26:39.770
on June 28th, myths and social media.

NOTE Confidence: 0.938995675

00:26:39.770 --> 00:26:41.930
So thank you very much for your time.

NOTE Confidence: 0.938995675

00:26:41.930 --> 00:26:43.530
Oh, thank you.

NOTE Confidence: 0.938995675

00:26:43.530 --> 00:26:44.778
And yeah,

NOTE Confidence: 0.938995675

00:26:44.778 --> 00:26:46.650
I'll stop there.

NOTE Confidence: 0.938995675

00:26:46.650 --> 00:26:47.050
We do

NOTE Confidence: 0.92616484

00:26:47.050 --> 00:26:48.330
have a time. We do

NOTE Confidence: 0.9402536

00:26:48.370 --> 00:26:50.248
have time for a few questions,

NOTE Confidence: 0.9402536

00:26:50.250 --> 00:26:52.410
A couple of questions for Dr. Samt.

NOTE Confidence: 0.91298245

00:26:54.690 --> 00:26:57.901
And you can put them in the, the,

NOTE Confidence: 0.91298245

00:26:57.901 --> 00:27:00.607
the chat or you can actually.

NOTE Confidence: 0.91298245

00:27:00.610 --> 00:27:02.110
I think you have to put them to

NOTE Confidence: 0.91298245

00:27:02.110 --> 00:27:04.729
the chat, actually. Or the Q&A.

NOTE Confidence: 0.871577045

00:27:09.490 --> 00:27:11.009
So Dr. Sam is I'm going to

NOTE Confidence: 0.871577045

00:27:11.009 --> 00:27:12.609
just ask a quick question.

NOTE Confidence: 0.871577045

00:27:12.610 --> 00:27:15.290
Is there space for those of us in

NOTE Confidence: 0.871577045

00:27:15.290 --> 00:27:17.586
primary care to communicate with you

NOTE Confidence: 0.871577045

00:27:17.586 --> 00:27:20.154
offline just in terms of recommendations

NOTE Confidence: 0.871577045

00:27:20.154 --> 00:27:22.650
around particular patient cases?

NOTE Confidence: 0.942649647619047

00:27:23.770 --> 00:27:26.500
Absolutely, we would, I mean we would

NOTE Confidence: 0.942649647619047

00:27:26.500 --> 00:27:29.306
love to consult on any questions or

NOTE Confidence: 0.942649647619047

00:27:29.306 --> 00:27:32.090
issues that are coming through or even.

NOTE Confidence: 0.9452853

00:27:34.110 --> 00:27:36.030
Listen and help find the answers.

NOTE Confidence: 0.9452853

00:27:36.030 --> 00:27:38.870
If we are not like immediately got them

NOTE Confidence: 0.9452853

00:27:38.870 --> 00:27:41.786
on on the nose we because of what we do,

NOTE Confidence: 0.9452853

00:27:41.790 --> 00:27:45.470
we do know where to find these answers.

NOTE Confidence: 0.9452853

00:27:45.470 --> 00:27:47.850
Probably quicker than a Google

NOTE Confidence: 0.9452853

00:27:47.850 --> 00:27:50.070
search and certainly quicker than the

NOTE Confidence: 0.9452853

00:27:50.070 --> 00:27:52.721
time you have to try to to look and

NOTE Confidence: 0.9452853

00:27:52.721 --> 00:27:55.400
figure it out so you know my e-mail.

NOTE Confidence: 0.9452853

00:27:55.400 --> 00:27:58.548
Is tara.samptatyale.edu Jeff and Britta

NOTE Confidence: 0.9452853

00:27:58.548 --> 00:28:01.934
is my PA and this is his full time job

NOTE Confidence: 0.9452853

00:28:01.934 --> 00:28:05.880
outside of helping with some of the

NOTE Confidence: 0.9452853

00:28:05.880 --> 00:28:07.560
breast patients that we see together.

NOTE Confidence: 0.9452853

00:28:07.560 --> 00:28:09.198
But this is where this is where

NOTE Confidence: 0.9452853

00:28:09.198 --> 00:28:10.599
we spend all of our time.

NOTE Confidence: 0.9452853

00:28:10.600 --> 00:28:12.856
We'd be happy to to consult offline and

NOTE Confidence: 0.9452853

00:28:12.856 --> 00:28:15.038
then help plug patients in as needed.

NOTE Confidence: 0.9046714575

00:28:16.040 --> 00:28:19.505
Yeah, I I really, truly appreciate that

NOTE Confidence: 0.9046714575

00:28:19.505 --> 00:28:24.379
and you know it in in primary care.

NOTE Confidence: 0.9046714575

00:28:24.379 --> 00:28:27.280
We're I think frequently overwhelmed

NOTE Confidence: 0.9046714575

00:28:27.280 --> 00:28:30.128
with the number of recommendations and

NOTE Confidence: 0.9046714575

00:28:30.128 --> 00:28:32.560
items that we have to pay attention to.

NOTE Confidence: 0.9046714575

00:28:32.560 --> 00:28:34.100
And you know all the things we

NOTE Confidence: 0.9046714575

00:28:34.100 --> 00:28:35.541
have to juggle with patients and

NOTE Confidence: 0.9046714575

00:28:35.541 --> 00:28:37.400
knowing that we can kind of lean on

NOTE Confidence: 0.9046714575

00:28:37.400 --> 00:28:39.356
you as colleagues is very helpful.

NOTE Confidence: 0.9046714575

00:28:39.360 --> 00:28:41.760
You know, to me I think that the two big

NOTE Confidence: 0.9046714575

00:28:41.820 --> 00:28:45.370
takeaways for this case are first that.

NOTE Confidence: 0.9046714575

00:28:45.370 --> 00:28:46.948
You know, patients with certain cancers

NOTE Confidence: 0.9046714575

00:28:46.948 --> 00:28:49.087
are at much higher risk for other cancers.

NOTE Confidence: 0.9046714575

00:28:49.090 --> 00:28:50.450
And actually I've, you know,

NOTE Confidence: 0.9046714575

00:28:50.450 --> 00:28:52.280
I've also learned that frequently

NOTE Confidence: 0.9046714575

00:28:52.280 --> 00:28:54.110
their rate of appropriate screening

NOTE Confidence: 0.9046714575

00:28:54.166 --> 00:28:56.128
is lower than the general population,

NOTE Confidence: 0.9046714575

00:28:56.130 --> 00:28:57.180
which is surprising.

NOTE Confidence: 0.9046714575

00:28:57.180 --> 00:28:59.630
But I think something for us to

NOTE Confidence: 0.9046714575

00:28:59.702 --> 00:29:01.047
all to keep in mind.

NOTE Confidence: 0.9046714575

00:29:01.050 --> 00:29:01.930
And the second thing is,

NOTE Confidence: 0.9046714575

00:29:01.930 --> 00:29:03.250
is that there are, you know,

NOTE Confidence: 0.9046714575

00:29:03.250 --> 00:29:04.972
great resources in place to help guide

NOTE Confidence: 0.9046714575

00:29:04.972 --> 00:29:07.167
kind of care decisions for these patients.

NOTE Confidence: 0.950317

00:29:08.690 --> 00:29:10.980
I'm curious the way.

NOTE Confidence: 0.92255433375

00:29:10.980 --> 00:29:12.660
You know Dr. Williams, you set this up.

NOTE Confidence: 0.92255433375

00:29:12.660 --> 00:29:15.480
Is this this gentleman really

NOTE Confidence: 0.92255433375

00:29:15.480 --> 00:29:17.736
didn't want anymore followup,

NOTE Confidence: 0.92255433375

00:29:17.740 --> 00:29:19.230
even though, you know,

NOTE Confidence: 0.92255433375

00:29:19.230 --> 00:29:20.980
he probably needed ongoing surveillance,

NOTE Confidence: 0.92255433375

00:29:20.980 --> 00:29:23.780
at least from primary care and and

NOTE Confidence: 0.92255433375

00:29:23.780 --> 00:29:26.338
maybe also from oncology or ENT.

NOTE Confidence: 0.92255433375

00:29:26.340 --> 00:29:29.670
Would would a trip to the survivorship

NOTE Confidence: 0.92255433375

00:29:29.670 --> 00:29:31.944
clinic kind of been something that

NOTE Confidence: 0.92255433375

00:29:31.944 --> 00:29:34.416
would help him to understand why or help

NOTE Confidence: 0.92255433375

00:29:34.416 --> 00:29:36.456
him kind of come to closure on this?

NOTE Confidence: 0.92255433375

00:29:36.460 --> 00:29:38.180
How would it have worked,

NOTE Confidence: 0.92255433375

00:29:38.180 --> 00:29:40.178
you know, in this particular case?

NOTE Confidence: 0.9364797575

00:29:40.540 --> 00:29:44.380
So given that this is a real patient

NOTE Confidence: 0.9364797575

00:29:44.380 --> 00:29:47.396
that I hope quite well, there's not

NOTE Confidence: 0.9364797575

00:29:47.396 --> 00:29:49.132
a prayer that he would ever go.

NOTE Confidence: 0.948304254

00:29:51.700 --> 00:29:53.420
He's he's a lovely gentleman,

NOTE Confidence: 0.948304254

00:29:53.420 --> 00:29:55.868
but he's let's just say that he's a

NOTE Confidence: 0.948304254

00:29:55.868 --> 00:29:58.252
tried and true New Englander little

NOTE Confidence: 0.948304254

00:29:58.252 --> 00:30:00.876
rough around the edges, you know,

NOTE Confidence: 0.948304254

00:30:00.876 --> 00:30:03.138
in this case, access for me.

NOTE Confidence: 0.948304254

00:30:03.138 --> 00:30:05.454
To some of these providership resources

NOTE Confidence: 0.948304254

00:30:05.454 --> 00:30:08.024
is going to be very beneficial because

NOTE Confidence: 0.948304254

00:30:08.024 --> 00:30:11.617
I can help guide him and we sort of have

NOTE Confidence: 0.948304254

00:30:11.617 --> 00:30:13.550
that ongoing connection even though he's

NOTE Confidence: 0.948304254

00:30:13.550 --> 00:30:15.630
never all that fond of even seeing me.

NOTE Confidence: 0.948304254

00:30:15.630 --> 00:30:16.710
But you know,

NOTE Confidence: 0.948304254

00:30:16.710 --> 00:30:18.870
that's a in this particular instance,

NOTE Confidence: 0.948304254

00:30:18.870 --> 00:30:20.750
that's a very helpful thing.

NOTE Confidence: 0.948304254

00:30:20.750 --> 00:30:22.634
I think other cases,

NOTE Confidence: 0.948304254

00:30:22.634 --> 00:30:24.047
definitely your suggestion

NOTE Confidence: 0.948304254

00:30:24.047 --> 00:30:25.910
that that might help,

NOTE Confidence: 0.948304254

00:30:25.910 --> 00:30:27.632
you know give him the context to

NOTE Confidence: 0.948304254

00:30:27.632 --> 00:30:29.428
think about this going down the road,

NOTE Confidence: 0.948304254

00:30:29.430 --> 00:30:30.630
it would be very beneficial.

NOTE Confidence: 0.893570771428571

00:30:31.470 --> 00:30:32.989
Can I just quickly comment on that?

NOTE Confidence: 0.893570771428571

00:30:32.990 --> 00:30:34.790
You know, there's we see

NOTE Confidence: 0.893570771428571

00:30:34.790 --> 00:30:36.634
men and women, you know,

NOTE Confidence: 0.893570771428571

00:30:36.634 --> 00:30:39.308
probably about 300 per year total that.

NOTE Confidence: 0.893570771428571

00:30:39.310 --> 00:30:41.466
So there's lots of people that don't

NOTE Confidence: 0.893570771428571

00:30:41.466 --> 00:30:43.909
make it into us for whatever reason.

NOTE Confidence: 0.893570771428571

00:30:43.910 --> 00:30:45.254
They either don't know or they don't

NOTE Confidence: 0.893570771428571

00:30:45.254 --> 00:30:47.109
want to or they don't think they need us.

NOTE Confidence: 0.893570771428571

00:30:47.110 --> 00:30:49.542
Often times for men,

NOTE Confidence: 0.893570771428571

00:30:49.542 --> 00:30:52.922
wives bring them or children bring them and

NOTE Confidence: 0.893570771428571

00:30:52.922 --> 00:30:56.206
really you know it is kind of a little bit.

NOTE Confidence: 0.893570771428571

00:30:56.210 --> 00:30:58.088
Against their will in some ways.

NOTE Confidence: 0.893570771428571

00:30:58.090 --> 00:31:00.050
The reason why we have 4 specialists there,

NOTE Confidence: 0.893570771428571

00:31:00.050 --> 00:31:01.960
including a social worker and

NOTE Confidence: 0.893570771428571

00:31:01.960 --> 00:31:04.606
you see every single one is to

NOTE Confidence: 0.893570771428571

00:31:04.606 --> 00:31:06.334
really give that space that yeah,

NOTE Confidence: 0.893570771428571

00:31:06.334 --> 00:31:07.546
you would never have agreed to

NOTE Confidence: 0.893570771428571

00:31:07.546 --> 00:31:09.259
see a social worker and talk about

NOTE Confidence: 0.893570771428571

00:31:09.259 --> 00:31:10.524
how you're coping with cancer.

NOTE Confidence: 0.893570771428571

00:31:10.530 --> 00:31:13.130
But when it's built in,

NOTE Confidence: 0.893570771428571

00:31:13.130 --> 00:31:14.820
it's shocking how therapeutic it

NOTE Confidence: 0.893570771428571

00:31:14.820 --> 00:31:17.289
can be and how much people say,

NOTE Confidence: 0.893570771428571

00:31:17.290 --> 00:31:18.809
I didn't know that I really how

NOTE Confidence: 0.893570771428571

00:31:18.809 --> 00:31:22.250
much I really needed that. So.

NOTE Confidence: 0.893570771428571

00:31:22.250 --> 00:31:24.371
So I appreciate all those points.

NOTE Confidence: 0.893570771428571

00:31:24.371 --> 00:31:24.838
One

NOTE Confidence: 0.958367674

00:31:24.840 --> 00:31:28.024
more question from Jill Banatowski and

NOTE Confidence: 0.958367674

00:31:28.024 --> 00:31:30.600
that is you know the role of community

NOTE Confidence: 0.958367674

00:31:30.600 --> 00:31:33.400
PT versus this specific PT is there,

NOTE Confidence: 0.940253528

00:31:33.760 --> 00:31:35.000
is there kind of handoff,

NOTE Confidence: 0.950316921666667

00:31:35.600 --> 00:31:37.478
is there something special about it?

NOTE Confidence: 0.928177468

00:31:38.880 --> 00:31:42.586
Yes and yes. So the cancer ank rehab

NOTE Confidence: 0.928177468

00:31:42.586 --> 00:31:45.948
is a is a specialized field and and

NOTE Confidence: 0.928177468

00:31:45.948 --> 00:31:49.106
our patients really do many of them

NOTE Confidence: 0.928177468

00:31:49.106 --> 00:31:51.300
do need someone who understands the.

NOTE Confidence: 0.928177468

00:31:51.300 --> 00:31:53.610
You don't want somebody who's going

NOTE Confidence: 0.928177468

00:31:53.674 --> 00:31:55.479
to be manipulating something that's

NOTE Confidence: 0.928177468

00:31:55.479 --> 00:31:57.950
not right and then cause more harm.

NOTE Confidence: 0.928177468

00:31:57.950 --> 00:32:00.350
Thankfully though,

NOTE Confidence: 0.928177468

00:32:00.350 --> 00:32:02.878
many of the P T's in Connecticut are

NOTE Confidence: 0.928177468

00:32:02.878 --> 00:32:04.415
extremely reputable and experienced

NOTE Confidence: 0.928177468

00:32:04.415 --> 00:32:06.340
and local physical therapies. Fine.

NOTE Confidence: 0.928177468

00:32:06.340 --> 00:32:08.744
What we do is we first try to get Scott

NOTE Confidence: 0.928177468

00:32:08.744 --> 00:32:11.183
to see the patient in clinic and then he

NOTE Confidence: 0.928177468

00:32:11.250 --> 00:32:13.786
knows all of these providers and he'll say,

NOTE Confidence: 0.928177468

00:32:13.790 --> 00:32:15.230
oh, in your area.

NOTE Confidence: 0.928177468

00:32:15.230 --> 00:32:15.950
This person,

NOTE Confidence: 0.928177468

00:32:15.950 --> 00:32:17.150
she's even lymphedema specialized,

NOTE Confidence: 0.928177468

00:32:17.150 --> 00:32:19.559
so she could even assess you for head

NOTE Confidence: 0.928177468

00:32:19.559 --> 00:32:21.194
and neck lymphedema, for instance.

NOTE Confidence: 0.928177468

00:32:21.194 --> 00:32:22.400
And you know,

NOTE Confidence: 0.928177468

00:32:22.400 --> 00:32:25.235
often times he'll even make the connection

NOTE Confidence: 0.928177468

00:32:25.240 --> 00:32:26.800
through e-mail or something like that.

NOTE Confidence: 0.928177468

00:32:26.800 --> 00:32:29.280
So, so yes and yes,

NOTE Confidence: 0.928177468

00:32:29.280 --> 00:32:31.744
local is fine and a rehab specialist

NOTE Confidence: 0.928177468

00:32:31.744 --> 00:32:34.043
can be really helpful to get

NOTE Confidence: 0.928177468

00:32:34.043 --> 00:32:35.983
the ball rolling and especially

NOTE Confidence: 0.928177468

00:32:35.983 --> 00:32:37.370
ours who maintain relationships

NOTE Confidence: 0.928177468

00:32:37.370 --> 00:32:39.200
with people all over the state

NOTE Confidence: 0.905270864285714

00:32:40.600 --> 00:32:41.320
been fantastic.

NOTE Confidence: 0.905270864285714

00:32:41.320 --> 00:32:43.120
Thank you Tara so much.

NOTE Confidence: 0.905270864285714

00:32:43.120 --> 00:32:44.709
And I, I know you have a

NOTE Confidence: 0.905270864285714

00:32:44.709 --> 00:32:45.800
family commitment to get to.

NOTE Confidence: 0.905270864285714

00:32:45.800 --> 00:32:48.614
So thanks for joining us and

NOTE Confidence: 0.905270864285714

00:32:48.614 --> 00:32:52.028
we'll move to the to the second.

NOTE Confidence: 0.905270864285714

00:32:52.030 --> 00:32:53.190
Case here. Thanks again,

NOTE Confidence: 0.919892322222222

00:32:58.870 --> 00:33:00.310
one that'll be close to many of our hearts.

NOTE Confidence: 0.919892322222222

00:33:00.310 --> 00:33:03.563
So it's a 71 year old female with

NOTE Confidence: 0.919892322222222

00:33:03.563 --> 00:33:04.682
medical history significantly

NOTE Confidence: 0.919892322222222

00:33:04.682 --> 00:33:06.547
for hypertension which is well

NOTE Confidence: 0.919892322222222

00:33:06.547 --> 00:33:07.910
controlled and hyperlipidemia.

NOTE Confidence: 0.919892322222222

00:33:07.910 --> 00:33:10.128
She was diagnosed at age 62 with

NOTE Confidence: 0.919892322222222

00:33:10.128 --> 00:33:11.673
right sided breast cancer that

NOTE Confidence: 0.919892322222222

00:33:11.673 --> 00:33:13.629
was an invasive ductal carcinoma.

NOTE Confidence: 0.919892322222222

00:33:13.630 --> 00:33:17.662
It was Grade 1 anatomic stage 1A estrogen

NOTE Confidence: 0.919892322222222

00:33:17.662 --> 00:33:19.390
and progesterone receptor positive,

NOTE Confidence: 0.919892322222222

00:33:19.390 --> 00:33:20.670
hair 2 new negative.

NOTE Confidence: 0.919892322222222

00:33:20.670 --> 00:33:23.126
So she was treated with the right

NOTE Confidence: 0.919892322222222

00:33:23.126 --> 00:33:24.994
mastectomy and a subsequent

NOTE Confidence: 0.919892322222222

00:33:24.994 --> 00:33:27.329
prophylactic left side of mastectomy

NOTE Confidence: 0.919892322222222

00:33:27.395 --> 00:33:29.330
and bilateral reconstruction.

NOTE Confidence: 0.919892322222222

00:33:29.330 --> 00:33:31.376
She continues to be followed by

NOTE Confidence: 0.919892322222222

00:33:31.376 --> 00:33:33.233
oncology annually and has been

NOTE Confidence: 0.919892322222222

00:33:33.233 --> 00:33:34.961
maintained on Mastrozole without

NOTE Confidence: 0.919892322222222

00:33:34.961 --> 00:33:36.689
any evidence of recurrence.

NOTE Confidence: 0.919892322222222

00:33:36.690 --> 00:33:37.728
She's very active.

NOTE Confidence: 0.919892322222222

00:33:37.728 --> 00:33:38.766
She stays healthy,

NOTE Confidence: 0.919892322222222

00:33:38.770 --> 00:33:40.050
takes care of herself,

NOTE Confidence: 0.919892322222222

00:33:40.050 --> 00:33:41.330
exercises daily good diet.

NOTE Confidence: 0.919892322222222

00:33:41.330 --> 00:33:44.770
Then we'll go on to the next slide.

NOTE Confidence: 0.918003766666667

00:33:48.250 --> 00:33:51.352
So she presented with subacute onset

NOTE Confidence: 0.918003766666667

00:33:51.352 --> 00:33:54.370
of localized mid lumbar back pain.

NOTE Confidence: 0.918003766666667

00:33:54.370 --> 00:33:56.128
Her pain was localized to the

NOTE Confidence: 0.918003766666667

00:33:56.130 --> 00:33:57.810
L23 region of the mid back.

NOTE Confidence: 0.918003766666667

00:33:57.810 --> 00:34:00.338
She described it as an ache with a

NOTE Confidence: 0.918003766666667

00:34:00.338 --> 00:34:02.130
maximum intensity of four out of 10.

NOTE Confidence: 0.918003766666667

00:34:02.130 --> 00:34:05.049
Gets worse when she's exercising and walking.

NOTE Confidence: 0.918003766666667

00:34:05.050 --> 00:34:07.410
It troubles her a little bit in bed as well.

NOTE Confidence: 0.918003766666667

00:34:07.410 --> 00:34:08.618
There's no other symptoms

NOTE Confidence: 0.918003766666667

00:34:08.618 --> 00:34:09.524
associated with this,

NOTE Confidence: 0.918003766666667

00:34:09.530 --> 00:34:12.770
and no bowel or bladder complaints.

NOTE Confidence: 0.918003766666667

00:34:12.770 --> 00:34:15.170
Her physical exam was largely unremarkable.

NOTE Confidence: 0.918003766666667

00:34:15.170 --> 00:34:16.307
She's not tender.

NOTE Confidence: 0.918003766666667

00:34:16.307 --> 00:34:19.456
In the area where she localizes her pain

NOTE Confidence: 0.918003766666667

00:34:19.456 --> 00:34:22.396
and her neurologic exam was non revealing.

NOTE Confidence: 0.918003766666667

00:34:22.400 --> 00:34:23.936
So the questions we might ask

NOTE Confidence: 0.918003766666667

00:34:23.936 --> 00:34:25.480
in this case include you know,

NOTE Confidence: 0.918003766666667

00:34:25.480 --> 00:34:27.466
how do we approach new complaints

NOTE Confidence: 0.918003766666667

00:34:27.466 --> 00:34:30.028
that may be related to cancer and

NOTE Confidence: 0.918003766666667

00:34:30.028 --> 00:34:32.008
maybe harbingers of recurrence and

NOTE Confidence: 0.918003766666667

00:34:32.008 --> 00:34:33.640
specifically in this situation,

NOTE Confidence: 0.918003766666667

00:34:33.640 --> 00:34:35.838
how common is recurrence in breast cancer?

NOTE Confidence: 0.908257535

00:34:40.200 --> 00:34:42.240
Thank you Brian for for

NOTE Confidence: 0.908257535

00:34:42.240 --> 00:34:44.280
for overview of that case.

NOTE Confidence: 0.908257535

00:34:44.280 --> 00:34:45.944
Hi everyone. Thank you.

NOTE Confidence: 0.908257535

00:34:45.944 --> 00:34:49.170
For joining out of your busy evening,

NOTE Confidence: 0.908257535

00:34:49.170 --> 00:34:52.145
as you heard, I've been treating breast

NOTE Confidence: 0.908257535

00:34:52.145 --> 00:34:55.006
cancer patients for a number of years and

NOTE Confidence: 0.908257535

00:34:55.010 --> 00:34:58.167
very thrilled to be speaking with you.

NOTE Confidence: 0.908257535

00:34:58.170 --> 00:34:59.698
So the question is,

NOTE Confidence: 0.908257535

00:34:59.698 --> 00:35:03.079
you know how often do you do recurrences

NOTE Confidence: 0.908257535

00:35:03.079 --> 00:35:06.874
happen in in breast cancer and we we tend

NOTE Confidence: 0.908257535

00:35:06.874 --> 00:35:09.288
to see two peaks of recurrences where

NOTE Confidence: 0.908257535

00:35:09.288 --> 00:35:11.955
we have an early peak of recurrences.

NOTE Confidence: 0.908257535

00:35:11.960 --> 00:35:13.616
That can happen in the first

NOTE Confidence: 0.908257535

00:35:13.616 --> 00:35:14.720
three to five years.

NOTE Confidence: 0.908257535

00:35:14.720 --> 00:35:16.044
In this particular case,

NOTE Confidence: 0.908257535

00:35:16.044 --> 00:35:17.037
if you remember,

NOTE Confidence: 0.908257535

00:35:17.040 --> 00:35:22.208
she's in her 9th year and she has this

NOTE Confidence: 0.908257535

00:35:22.208 --> 00:35:24.318
hormone receptor positive breast cancer.

NOTE Confidence: 0.908257535

00:35:24.320 --> 00:35:27.600
Late recurrences can happen sometimes

NOTE Confidence: 0.908257535

00:35:27.600 --> 00:35:29.898
more than five years or sometimes

NOTE Confidence: 0.908257535

00:35:29.898 --> 00:35:32.160
decades from the initial diagnosis,

NOTE Confidence: 0.908257535

00:35:32.160 --> 00:35:35.624
and these are more common in hormone

NOTE Confidence: 0.908257535

00:35:35.624 --> 00:35:37.672
receptor positive breast cancers

NOTE Confidence: 0.908257535

00:35:37.672 --> 00:35:39.720
where they're more favorable.

NOTE Confidence: 0.908257535

00:35:39.720 --> 00:35:41.652
But they also tend to have this

NOTE Confidence: 0.908257535

00:35:41.652 --> 00:35:43.729
period of dormancy where even if all

NOTE Confidence: 0.908257535

00:35:43.729 --> 00:35:45.517
the right treatments have been done,

NOTE Confidence: 0.908257535

00:35:45.520 --> 00:35:48.677
patients have done all the right things,

NOTE Confidence: 0.908257535

00:35:48.680 --> 00:35:50.740
we could see recurrences that

NOTE Confidence: 0.908257535

00:35:50.740 --> 00:35:52.800
happen here down the road.

NOTE Confidence: 0.908257535

00:35:52.800 --> 00:35:57.080
So next to the next slide,

NOTE Confidence: 0.908257535

00:35:57.080 --> 00:36:00.450
press one more time for this, yes, so.

NOTE Confidence: 0.908257535

00:36:00.450 --> 00:36:05.452
Kind of give you a little bit more about

NOTE Confidence: 0.908257535

00:36:05.452 --> 00:36:08.260
how common these late recurrences are.

NOTE Confidence: 0.908257535

00:36:08.260 --> 00:36:10.900
They're very much proportionate to the

NOTE Confidence: 0.908257535

00:36:10.900 --> 00:36:13.890
initial risk of the of the disease.

NOTE Confidence: 0.908257535

00:36:13.890 --> 00:36:15.530
In the yellow line,

NOTE Confidence: 0.908257535

00:36:15.530 --> 00:36:18.008
you see lymph node negative breast cancer,

NOTE Confidence: 0.908257535

00:36:18.010 --> 00:36:20.926
which was this particular patient's case.

NOTE Confidence: 0.908257535

00:36:20.930 --> 00:36:23.476
And as you can see, you know,

NOTE Confidence: 0.908257535

00:36:23.476 --> 00:36:26.647
five years, even up to 10 years,

NOTE Confidence: 0.908257535

00:36:26.650 --> 00:36:28.696
the rate of death from breast

NOTE Confidence: 0.908257535

00:36:28.696 --> 00:36:30.410
cancer can be quite low.

NOTE Confidence: 0.908257535

00:36:30.410 --> 00:36:32.090
However, as time passes,

NOTE Confidence: 0.908257535

00:36:32.090 --> 00:36:35.235
a proportion of these patients can actually

NOTE Confidence: 0.908257535

00:36:35.235 --> 00:36:37.965
progress to metastatic breast cancer,

NOTE Confidence: 0.908257535

00:36:37.970 --> 00:36:40.394
which is the predominant way that

NOTE Confidence: 0.908257535

00:36:40.394 --> 00:36:42.650
individuals from breast cancer actually.

NOTE Confidence: 0.908257535

00:36:42.650 --> 00:36:43.642
Die from breast cancer.

NOTE Confidence: 0.908257535

00:36:43.642 --> 00:36:45.130
It's not from early stage disease,

NOTE Confidence: 0.908257535

00:36:45.130 --> 00:36:47.330
it's from metastatic breast cancer.

NOTE Confidence: 0.908257535

00:36:47.330 --> 00:36:51.210
In the blue and red lines you can see how

NOTE Confidence: 0.908257535

00:36:51.210 --> 00:36:53.849
patients who have higher stages of disease,

NOTE Confidence: 0.908257535

00:36:53.850 --> 00:36:56.110
lymph node positive disease,

NOTE Confidence: 0.908257535

00:36:56.110 --> 00:37:00.250
then the curves are very steeply rising.

NOTE Confidence: 0.908257535

00:37:00.250 --> 00:37:01.436
For example,

NOTE Confidence: 0.908257535

00:37:01.436 --> 00:37:05.362
half of the patients who who had a

NOTE Confidence: 0.908257535

00:37:05.362 --> 00:37:07.690
number of lungs not positive disease,

NOTE Confidence: 0.908257535

00:37:07.690 --> 00:37:11.314
this would fall into the stage 3 category.

NOTE Confidence: 0.908257535

00:37:11.320 --> 00:37:13.105
Can potentially recur,

NOTE Confidence: 0.908257535

00:37:13.105 --> 00:37:15.485
sometimes several decades after

NOTE Confidence: 0.908257535

00:37:15.485 --> 00:37:16.675
initial diagnosis.

NOTE Confidence: 0.908257535

00:37:16.680 --> 00:37:20.250
So when we see those media campaigns

NOTE Confidence: 0.908257535

00:37:20.250 --> 00:37:23.396
saying breast cancer caught early is

NOTE Confidence: 0.908257535

00:37:23.396 --> 00:37:26.180
a curable disease, it absolutely is.

NOTE Confidence: 0.908257535

00:37:26.180 --> 00:37:29.753
But a lot of those fear statistics and

NOTE Confidence: 0.908257535

00:37:29.753 --> 00:37:32.498
American Cancer Society statistics are

NOTE Confidence: 0.908257535

00:37:32.498 --> 00:37:35.669
geared toward these first five years.

NOTE Confidence: 0.908257535

00:37:35.670 --> 00:37:36.642
However, what what,

NOTE Confidence: 0.908257535

00:37:36.642 --> 00:37:39.373
what our data are not showing is what

NOTE Confidence: 0.908257535

00:37:39.373 --> 00:37:41.348
can happen several decades later.

NOTE Confidence: 0.908257535

00:37:41.350 --> 00:37:43.681
So it can be actually quite hard

NOTE Confidence: 0.908257535

00:37:43.681 --> 00:37:45.334
for patients because the campaign

NOTE Confidence: 0.908257535

00:37:45.334 --> 00:37:47.630
has been just do what you're told,

NOTE Confidence: 0.908257535

00:37:47.630 --> 00:37:49.388
get your mammogram, get your treatments.

NOTE Confidence: 0.908257535

00:37:49.390 --> 00:37:51.430
And this is curable and treatable.

NOTE Confidence: 0.908257535

00:37:51.430 --> 00:37:53.110
And when these recurrences happen,

NOTE Confidence: 0.908257535

00:37:53.110 --> 00:37:55.614
it can be extremely

NOTE Confidence: 0.908257535

00:37:55.614 --> 00:37:56.866
psychologically traumatic.

NOTE Confidence: 0.908257535

00:37:56.870 --> 00:37:57.989
So next slide.

NOTE Confidence: 0.9402536

00:38:00.040 --> 00:38:01.640
So this patient, you know,

NOTE Confidence: 0.9402536

00:38:01.640 --> 00:38:03.280
had had some back pain.

NOTE Confidence: 0.9402536

00:38:03.280 --> 00:38:04.756
This is your bread and butter.

NOTE Confidence: 0.9402536

00:38:04.760 --> 00:38:06.920
You see, I'm sure multiple patients

NOTE Confidence: 0.9402536

00:38:06.920 --> 00:38:09.358
during the day present with back pain.

NOTE Confidence: 0.9402536

00:38:09.360 --> 00:38:12.720
And in no way are we suggesting that

NOTE Confidence: 0.9402536

00:38:12.720 --> 00:38:14.580
just because she has this distant

NOTE Confidence: 0.9402536

00:38:14.580 --> 00:38:17.856
history of breast cancer that you

NOTE Confidence: 0.9402536

00:38:17.856 --> 00:38:20.492
necessarily deviate from your standard

NOTE Confidence: 0.9402536

00:38:20.492 --> 00:38:22.957
algorithmic workup and your good

NOTE Confidence: 0.9402536

00:38:22.957 --> 00:38:25.183
clinical judgment of having taken

NOTE Confidence: 0.9402536

00:38:25.183 --> 00:38:27.661
care of patients for many years.

NOTE Confidence: 0.9402536

00:38:27.670 --> 00:38:30.226
But, but just I think the point of this

NOTE Confidence: 0.9402536

00:38:30.226 --> 00:38:32.414
case is that that you know that this,

NOTE Confidence: 0.9402536

00:38:32.414 --> 00:38:33.744
this history of breast cancer,

NOTE Confidence: 0.9402536

00:38:33.750 --> 00:38:36.186
even though it's almost nine years

NOTE Confidence: 0.9402536

00:38:36.190 --> 00:38:38.871
does raise the suspicion that it could

NOTE Confidence: 0.9402536

00:38:38.871 --> 00:38:40.788
possibly be related to metastatic

NOTE Confidence: 0.9402536

00:38:40.788 --> 00:38:43.238
breast cancer and to at least have

NOTE Confidence: 0.9402536

00:38:43.238 --> 00:38:46.430
that on the differential and an

NOTE Confidence: 0.9402536

00:38:46.430 --> 00:38:49.637
unexplained pain that doesn't go away.

NOTE Confidence: 0.9402536

00:38:49.637 --> 00:38:52.289
So let's say you do all your good

NOTE Confidence: 0.9402536

00:38:52.289 --> 00:38:54.803
primary care work up and conservative

NOTE Confidence: 0.9402536

00:38:54.803 --> 00:38:57.090
measures and she's not improving.

NOTE Confidence: 0.9402536

00:38:57.090 --> 00:38:58.842
I think what we would like to avoid

NOTE Confidence: 0.9402536

00:38:58.842 --> 00:39:00.330
for patients with with for example,

NOTE Confidence: 0.9402536

00:39:00.330 --> 00:39:03.207
this type of history is to perhaps

NOTE Confidence: 0.9402536

00:39:03.210 --> 00:39:04.470
raise that index of suspicion

NOTE Confidence: 0.9402536

00:39:04.470 --> 00:39:05.730
a little sooner or so,

NOTE Confidence: 0.9402536

00:39:05.730 --> 00:39:07.458
so that they would get a little bit of

NOTE Confidence: 0.9402536

00:39:07.458 --> 00:39:09.484
a closer work up sooner than a patient,

NOTE Confidence: 0.9402536

00:39:09.490 --> 00:39:11.730
let's say without a history of breast cancer.

NOTE Confidence: 0.9402536

00:39:11.730 --> 00:39:14.242
So pain is the one of the most

NOTE Confidence: 0.9402536

00:39:14.242 --> 00:39:15.735
common presentation of these

NOTE Confidence: 0.9402536

00:39:15.735 --> 00:39:17.327
types of distant recurrences,

NOTE Confidence: 0.9402536

00:39:17.330 --> 00:39:18.802
I tell my patients.

NOTE Confidence: 0.9402536

00:39:18.802 --> 00:39:19.906
As a human,

NOTE Confidence: 0.9402536

00:39:19.910 --> 00:39:21.790
you are going to have aches and pains.

NOTE Confidence: 0.9402536

00:39:21.790 --> 00:39:23.308
You're going to have back pain,

NOTE Confidence: 0.9402536

00:39:23.310 --> 00:39:24.666
you're going to have shoulder pain

NOTE Confidence: 0.9402536

00:39:24.666 --> 00:39:25.344
and knee pain.

NOTE Confidence: 0.9402536

00:39:25.350 --> 00:39:28.470
Not every sign of pain is a sign of cancer,

NOTE Confidence: 0.9402536

00:39:28.470 --> 00:39:30.125
but if something is persisting

NOTE Confidence: 0.9402536

00:39:30.125 --> 00:39:31.780
and not responding to these

NOTE Confidence: 0.9402536

00:39:31.838 --> 00:39:33.548
conservative measure measures,

NOTE Confidence: 0.9402536

00:39:33.550 --> 00:39:35.345
then then these patients should

NOTE Confidence: 0.9402536

00:39:35.345 --> 00:39:37.140
be absolutely worked up more.

NOTE Confidence: 0.9402536

00:39:37.140 --> 00:39:39.611
Shortness of breath and cough are also

NOTE Confidence: 0.9402536

00:39:39.611 --> 00:39:42.260
another more common presentation where again,

NOTE Confidence: 0.9402536

00:39:42.260 --> 00:39:44.535
you know people are going to cough,

NOTE Confidence: 0.9402536

00:39:44.540 --> 00:39:46.748
but if it's just not going away and

NOTE Confidence: 0.9402536

00:39:46.748 --> 00:39:48.711
lingering that that raises the suspicion

NOTE Confidence: 0.9402536

00:39:48.711 --> 00:39:50.733
that something more should be done.

NOTE Confidence: 0.9402536

00:39:50.740 --> 00:39:52.618
A vague abdominal pain can sometimes

NOTE Confidence: 0.9402536

00:39:52.618 --> 00:39:55.288
be be one of the initial presentation

NOTE Confidence: 0.9402536

00:39:55.288 --> 00:39:57.976
of liver metastases and breast cancer,

NOTE Confidence: 0.9402536

00:39:57.980 --> 00:40:02.489
and in the red box is this very general.

NOTE Confidence: 0.9402536

00:40:02.490 --> 00:40:04.090
Description that I also share

NOTE Confidence: 0.9402536

00:40:04.090 --> 00:40:05.050
with my patient,

NOTE Confidence: 0.9402536

00:40:05.050 --> 00:40:07.842
which is that any symptom that you're worried

NOTE Confidence: 0.9402536

00:40:07.842 --> 00:40:10.290
about that cannot be easily explained.

NOTE Confidence: 0.9402536

00:40:10.290 --> 00:40:12.394
I think we want to at least have

NOTE Confidence: 0.9402536

00:40:12.394 --> 00:40:14.607
have have our index of suspicion up.

NOTE Confidence: 0.9402536

00:40:14.610 --> 00:40:14.850
Thanks.

NOTE Confidence: 0.93943879

00:40:16.890 --> 00:40:19.725
And you know it's this partnership that

NOTE Confidence: 0.93943879

00:40:19.725 --> 00:40:22.279
the theme that we've been focusing

NOTE Confidence: 0.93943879

00:40:22.279 --> 00:40:25.219
on and we're so grateful that you're

NOTE Confidence: 0.93943879

00:40:25.297 --> 00:40:28.146
here so we can have this conversation.

NOTE Confidence: 0.93943879

00:40:28.150 --> 00:40:30.634
Patients often feel very lost in

NOTE Confidence: 0.93943879

00:40:30.634 --> 00:40:32.971
these junctures where they they they

NOTE Confidence: 0.93943879

00:40:32.971 --> 00:40:35.387
kind of don't know who to turn to

NOTE Confidence: 0.93943879

00:40:35.390 --> 00:40:37.883
and as much as we can do to show

NOTE Confidence: 0.93943879

00:40:37.883 --> 00:40:40.268
that we're partners that we are,

NOTE Confidence: 0.93943879

00:40:40.270 --> 00:40:42.484
I think it can be so helpful in terms

NOTE Confidence: 0.93943879

00:40:42.484 --> 00:40:45.090
of the anxiety and I apologize in a

NOTE Confidence: 0.93943879

00:40:45.090 --> 00:40:47.254
public setting, sorry for the background.

NOTE Confidence: 0.93943879

00:40:47.254 --> 00:40:49.878
So, so just the idea of this that we

NOTE Confidence: 0.93943879

00:40:49.878 --> 00:40:51.936
are triad together, working together

NOTE Confidence: 0.93943879

00:40:51.936 --> 00:40:54.827
to to to expedite the work up,

NOTE Confidence: 0.93943879

00:40:54.830 --> 00:40:56.545
these are the things that are really,

NOTE Confidence: 0.93943879

00:40:56.550 --> 00:40:57.642
really important.

NOTE Confidence: 0.93943879

00:40:57.642 --> 00:40:59.826
To patients next slide.

NOTE Confidence: 0.93943879

00:40:59.830 --> 00:41:02.435
And so just reemphasizing that

NOTE Confidence: 0.93943879

00:41:02.435 --> 00:41:05.590
this is a super vulnerable time.

NOTE Confidence: 0.93943879

00:41:05.590 --> 00:41:08.950
There are often a feeling of betrayal.

NOTE Confidence: 0.93943879

00:41:08.950 --> 00:41:11.645
There can be even some anger toward

NOTE Confidence: 0.93943879

00:41:11.645 --> 00:41:13.293
the original oncologist that

NOTE Confidence: 0.93943879

00:41:13.293 --> 00:41:15.383
diagnose them because we celebrated

NOTE Confidence: 0.93943879

00:41:15.383 --> 00:41:17.649
that they're cured with them we.

NOTE Confidence: 0.93943879

00:41:17.650 --> 00:41:19.540
There's a sense of why wasn't

NOTE Confidence: 0.93943879

00:41:19.540 --> 00:41:20.485
this found earlier.

NOTE Confidence: 0.93943879

00:41:20.490 --> 00:41:22.434
I went to my PCP and I complained

NOTE Confidence: 0.93943879

00:41:22.434 --> 00:41:23.808
about this two months ago.

NOTE Confidence: 0.93943879

00:41:23.810 --> 00:41:25.010
Why wasn't this worked up?

NOTE Confidence: 0.93943879

00:41:25.010 --> 00:41:27.116
So these are not that anybody

NOTE Confidence: 0.93943879

00:41:27.116 --> 00:41:28.169
did anything wrong,

NOTE Confidence: 0.93943879

00:41:28.170 --> 00:41:30.970
but I think it's that time of

NOTE Confidence: 0.93943879

00:41:30.970 --> 00:41:32.930
vulnerability for these patients.

NOTE Confidence: 0.93943879

00:41:32.930 --> 00:41:36.014
Obviously healthcare systems are

NOTE Confidence: 0.93943879

00:41:36.014 --> 00:41:39.581
very complicated and it it takes

NOTE Confidence: 0.93943879

00:41:39.581 --> 00:41:41.249
time to schedule testing.

NOTE Confidence: 0.93943879

00:41:41.250 --> 00:41:42.594
We completely understand that.

NOTE Confidence: 0.93943879

00:41:42.594 --> 00:41:45.428
But just just all of us being really

NOTE Confidence: 0.93943879

00:41:45.428 --> 00:41:47.672
cognizant that given half five anxiety

NOTE Confidence: 0.93943879

00:41:47.672 --> 00:41:50.084
state is for these patients when

NOTE Confidence: 0.93943879

00:41:50.084 --> 00:41:52.092
they're worried about potential recurrence.

NOTE Confidence: 0.93943879

00:41:52.092 --> 00:41:54.899
Anything we can do to even move

NOTE Confidence: 0.93943879

00:41:54.899 --> 00:41:57.345
things up by a day or two really goes

NOTE Confidence: 0.93943879

00:41:57.345 --> 00:41:59.690
a long way in terms of rebuilding

NOTE Confidence: 0.93943879

00:41:59.690 --> 00:42:01.650
trust within the healthcare system

NOTE Confidence: 0.93943879

00:42:01.650 --> 00:42:04.050
and making making them feel heard.

NOTE Confidence: 0.93943879

00:42:04.050 --> 00:42:06.610
And the the last point I've already said,

NOTE Confidence: 0.93943879

00:42:06.610 --> 00:42:08.530
but it's really important to repeat

NOTE Confidence: 0.93943879

00:42:08.530 --> 00:42:10.862
it which is the more we communicate

NOTE Confidence: 0.93943879

00:42:10.862 --> 00:42:13.530
with one another as as a primary care.

NOTE Confidence: 0.93943879

00:42:13.530 --> 00:42:14.946
Writers and oncologists,

NOTE Confidence: 0.93943879

00:42:14.946 --> 00:42:18.250
it is so absolutely reassuring to patients,

NOTE Confidence: 0.93943879

00:42:18.250 --> 00:42:18.591
so,

NOTE Confidence: 0.93943879

00:42:18.591 --> 00:42:21.319
so in this particular case it may have

NOTE Confidence: 0.93943879

00:42:21.319 --> 00:42:24.015
been a bread and butter musculoskeletal

NOTE Confidence: 0.93943879

00:42:24.015 --> 00:42:28.210
back pain or maybe something else,

NOTE Confidence: 0.93943879

00:42:28.210 --> 00:42:30.730
but but bone metastases are actually

NOTE Confidence: 0.93943879

00:42:30.730 --> 00:42:33.466
the most common presentation of receptor

NOTE Confidence: 0.93943879

00:42:33.466 --> 00:42:35.446
positive breast cancer metastases.

NOTE Confidence: 0.93943879

00:42:35.450 --> 00:42:37.850
So we wanted to.

NOTE Confidence: 0.93943879

00:42:37.850 --> 00:42:40.415
Kind of highlight that as as one

NOTE Confidence: 0.93943879

00:42:40.415 --> 00:42:41.840
of the more common presentations

NOTE Confidence: 0.93943879

00:42:41.840 --> 00:42:43.609
of test suites for this group.

NOTE Confidence: 0.950317

00:42:50.110 --> 00:42:51.265
Thank you Doctor Lustberg and

NOTE Confidence: 0.950317

00:42:51.265 --> 00:42:52.790
thanks for joining from the airport.

NOTE Confidence: 0.950317

00:42:52.790 --> 00:42:55.429
I know that it's really over and

NOTE Confidence: 0.950317

00:42:55.429 --> 00:42:57.636
above it's one other note that I just

NOTE Confidence: 0.950317

00:42:57.636 --> 00:42:59.245
wanted to make about this particular

NOTE Confidence: 0.950317

00:42:59.245 --> 00:43:01.296
case is you know this patient really

NOTE Confidence: 0.950317

00:43:01.296 --> 00:43:03.053
took the heart the recommendations

NOTE Confidence: 0.950317

00:43:03.053 --> 00:43:05.426
around self-care she know at the

NOTE Confidence: 0.950317

00:43:05.426 --> 00:43:08.294
time of her diagnosis she really.

NOTE Confidence: 0.950317

00:43:08.300 --> 00:43:10.670
Let's just say made some very

NOTE Confidence: 0.950317

00:43:10.670 --> 00:43:12.749
appropriate and long lasting lifestyle

NOTE Confidence: 0.950317

00:43:12.749 --> 00:43:14.894
adjustments and those do impact

NOTE Confidence: 0.950317

00:43:14.894 --> 00:43:17.429
like longer term risk of recurrence

NOTE Confidence: 0.950317

00:43:17.429 --> 00:43:20.633
and also risk of other health

NOTE Confidence: 0.950317

00:43:20.633 --> 00:43:23.498
conditions and other primary cancers.

NOTE Confidence: 0.950317

00:43:23.500 --> 00:43:26.911
So case 3, this is lung cancer and a

NOTE Confidence: 0.950317

00:43:26.911 --> 00:43:29.908
video visit an 85 year old female.

NOTE Confidence: 0.950317

00:43:29.910 --> 00:43:32.030
Without a significant past medical

NOTE Confidence: 0.950317

00:43:32.030 --> 00:43:34.937
history that was diagnosed in 2019 with

NOTE Confidence: 0.950317

00:43:34.937 --> 00:43:37.443
a non small cell adenocarcinoma of the

NOTE Confidence: 0.950317

00:43:37.443 --> 00:43:40.389
right lung that was metastatic to her brain.

NOTE Confidence: 0.950317

00:43:40.390 --> 00:43:43.071
So she was enrolled in the clinical

NOTE Confidence: 0.950317

00:43:43.071 --> 00:43:46.349
trial in November of that year with

NOTE Confidence: 0.950317

00:43:46.349 --> 00:43:48.401
pembrolizumab plus bevacisumab for

NOTE Confidence: 0.950317

00:43:48.401 --> 00:43:50.638
asymptomatic brain metastases 4

NOTE Confidence: 0.950317

00:43:50.638 --> 00:43:52.678
cycles of the combination followed

NOTE Confidence: 0.950317

00:43:52.678 --> 00:43:54.310
by pimbolism and monotherapy.

NOTE Confidence: 0.950317

00:43:54.310 --> 00:43:57.126
She completed a total of 34 cycles every

NOTE Confidence: 0.950317

00:43:57.126 --> 00:44:00.000
three weeks which was tolerated quite well.

NOTE Confidence: 0.950317

00:44:00.000 --> 00:44:01.352
And responded very well.

NOTE Confidence: 0.950317

00:44:01.352 --> 00:44:03.814
And she's been followed by oncology since

NOTE Confidence: 0.950317

00:44:03.814 --> 00:44:06.040
that time without evidence of recurrence

NOTE Confidence: 0.950317

00:44:06.040 --> 00:44:09.358
and still remains in good health.

NOTE Confidence: 0.950317

00:44:09.360 --> 00:44:10.236
And go to the next slide.

NOTE Confidence: 0.950317

00:44:10.240 --> 00:44:12.648
So she presents today for a video

NOTE Confidence: 0.950317

00:44:12.648 --> 00:44:14.472
visit complaining of nausea and

NOTE Confidence: 0.950317

00:44:14.472 --> 00:44:15.916
vomiting for five days.

NOTE Confidence: 0.950317

00:44:15.920 --> 00:44:17.385
She's been having a hard

NOTE Confidence: 0.950317

00:44:17.385 --> 00:44:18.557
time keeping food down.

NOTE Confidence: 0.950317

00:44:18.560 --> 00:44:20.780
She tested herself at home

NOTE Confidence: 0.950317

00:44:20.780 --> 00:44:23.000
and was positive for COVID.

NOTE Confidence: 0.950317

00:44:23.000 --> 00:44:25.765
So she continues to have nausea currently

NOTE Confidence: 0.950317

00:44:25.765 --> 00:44:28.904
and is able to keep sips of water down.

NOTE Confidence: 0.950317

00:44:28.910 --> 00:44:30.896
But she's not complaining of any

NOTE Confidence: 0.950317

00:44:30.896 --> 00:44:32.830
other symptoms relatable to the COVID,

NOTE Confidence: 0.950317

00:44:32.830 --> 00:44:34.406
such as congestion, cough,

NOTE Confidence: 0.950317

00:44:34.406 --> 00:44:35.588
shortness of breath.

NOTE Confidence: 0.950317

00:44:35.590 --> 00:44:38.822
She does feel achy all over and chilled,

NOTE Confidence: 0.950317

00:44:38.822 --> 00:44:40.550
but no fever.

NOTE Confidence: 0.950317

00:44:40.550 --> 00:44:41.934
Her physical exam limited,

NOTE Confidence: 0.950317

00:44:41.934 --> 00:44:44.050
of course, by the video visit,

NOTE Confidence: 0.950317

00:44:44.050 --> 00:44:45.825
but she appears mildly ill,

NOTE Confidence: 0.950317

00:44:45.830 --> 00:44:47.130
but not emergently ill.

NOTE Confidence: 0.950317

00:44:47.130 --> 00:44:49.080
She's alert and oriented and answers

NOTE Confidence: 0.950317

00:44:49.134 --> 00:44:51.029
all of our questions appropriately.

NOTE Confidence: 0.950317

00:44:51.030 --> 00:44:52.990
She doesn't appear to be short of breath,

NOTE Confidence: 0.950317

00:44:52.990 --> 00:44:54.310
speaking in complete sentences,

NOTE Confidence: 0.950317

00:44:54.310 --> 00:44:56.850
and there's no cough noted during her visit.

NOTE Confidence: 0.950317

00:44:56.850 --> 00:44:58.710
Her mucous membrane, she sticks out

NOTE Confidence: 0.950317

00:44:58.710 --> 00:45:00.929
her tongue and her tongue is moist.

NOTE Confidence: 0.950317

00:45:00.930 --> 00:45:03.394
So that's good news.

NOTE Confidence: 0.950317

00:45:03.394 --> 00:45:06.607
So a few questions related to this case.

NOTE Confidence: 0.950317

00:45:06.610 --> 00:45:08.997
How do we monitor patients that are

NOTE Confidence: 0.950317

00:45:08.997 --> 00:45:11.403
very high risk for recurrence and

NOTE Confidence: 0.950317

00:45:11.403 --> 00:45:13.874
how do we approach patients with an

NOTE Confidence: 0.950317

00:45:13.874 --> 00:45:16.550
acute illness that have a higher risk

NOTE Confidence: 0.950317

00:45:16.550 --> 00:45:18.450
of complications of that illness?

NOTE Confidence: 0.950317

00:45:18.450 --> 00:45:19.500
And then finally,

NOTE Confidence: 0.950317

00:45:19.500 --> 00:45:21.600
what other options are there for

NOTE Confidence: 0.950317

00:45:21.600 --> 00:45:24.087
patients to address survivorship in general?

NOTE Confidence: 0.916150095

00:45:27.380 --> 00:45:29.000
Thank you, Brian.

NOTE Confidence: 0.916150095

00:45:29.000 --> 00:45:32.400
So this case was selected to really

NOTE Confidence: 0.916150095

00:45:32.400 --> 00:45:35.070
highlight a few important points which

NOTE Confidence: 0.916150095

00:45:35.149 --> 00:45:38.352
is that advances in cancer treatment,

NOTE Confidence: 0.916150095

00:45:38.352 --> 00:45:40.262
particularly immunotherapy have

NOTE Confidence: 0.916150095

00:45:40.262 --> 00:45:41.948
dramatically improved survivorship

NOTE Confidence: 0.916150095

00:45:41.948 --> 00:45:44.758
outcomes in patients with lung

NOTE Confidence: 0.916150095

00:45:44.758 --> 00:45:46.859
cancer as well as Melanoma.

NOTE Confidence: 0.916150095

00:45:46.860 --> 00:45:49.020
So, so now we're seeing.

NOTE Confidence: 0.916150095

00:45:49.020 --> 00:45:52.158
Longterm survivors of these very serious

NOTE Confidence: 0.916150095

00:45:52.158 --> 00:45:55.220
malignancies who who are doing well,

NOTE Confidence: 0.916150095

00:45:55.220 --> 00:45:57.458
but they may have some complications

NOTE Confidence: 0.916150095

00:45:57.458 --> 00:46:00.310
related to the to the original cancer

NOTE Confidence: 0.916150095

00:46:00.310 --> 00:46:02.890
diagnosis or or to their treatments.

NOTE Confidence: 0.916150095

00:46:02.890 --> 00:46:05.550
So patients who are higher risk and

NOTE Confidence: 0.916150095

00:46:05.550 --> 00:46:08.330
have known metastatic disease typically

NOTE Confidence: 0.916150095

00:46:08.330 --> 00:46:11.930
depending on the type of malignancy,

NOTE Confidence: 0.916150095

00:46:11.930 --> 00:46:14.374
they are routinely followed

NOTE Confidence: 0.916150095

00:46:14.374 --> 00:46:16.738
with serial scans and so.

NOTE Confidence: 0.916150095

00:46:16.738 --> 00:46:18.322
So in this particular case patient

NOTE Confidence: 0.916150095

00:46:18.322 --> 00:46:20.364
had a known brain metastasis where

NOTE Confidence: 0.916150095

00:46:20.364 --> 00:46:22.542
her brain would be serially monitored

NOTE Confidence: 0.916150095

00:46:22.606 --> 00:46:24.370
and her body would be monitored.

NOTE Confidence: 0.916150095

00:46:24.370 --> 00:46:26.002
In other malignancies.

NOTE Confidence: 0.916150095

00:46:26.002 --> 00:46:29.266
Other types of surveillance modalities may

NOTE Confidence: 0.916150095

00:46:29.266 --> 00:46:32.930
be used such as bone scans and PET scans.

NOTE Confidence: 0.916150095

00:46:32.930 --> 00:46:35.835
You're going to see in your practice

NOTE Confidence: 0.916150095

00:46:35.835 --> 00:46:37.523
patients being surveillanced differently

NOTE Confidence: 0.916150095

00:46:37.523 --> 00:46:40.590
based on their type of cancer and where

NOTE Confidence: 0.916150095

00:46:40.590 --> 00:46:43.680
they are in their disease course and.

NOTE Confidence: 0.916150095

00:46:43.680 --> 00:46:46.200
In terms of symptoms,

NOTE Confidence: 0.916150095

00:46:46.200 --> 00:46:46.882
so, so,

NOTE Confidence: 0.916150095

00:46:46.882 --> 00:46:48.928
so often these patients with more

NOTE Confidence: 0.916150095

00:46:48.928 --> 00:46:50.675
advanced illness may get additional

NOTE Confidence: 0.916150095

00:46:50.675 --> 00:46:52.673
scans based on the new symptoms.

NOTE Confidence: 0.916150095

00:46:52.680 --> 00:46:53.604
So for example,

NOTE Confidence: 0.916150095

00:46:53.604 --> 00:46:55.760
a breast patient who may not be

NOTE Confidence: 0.916150095

00:46:55.834 --> 00:46:58.864
normally getting brain Mri's if she's

NOTE Confidence: 0.916150095

00:46:58.864 --> 00:47:01.504
suddenly reporting a headache that

NOTE Confidence: 0.916150095

00:47:01.504 --> 00:47:03.576
may necessitate additional imaging.

NOTE Confidence: 0.916150095

00:47:03.576 --> 00:47:06.624
Patient preference partially weighs in in

NOTE Confidence: 0.916150095

00:47:06.624 --> 00:47:09.970
terms of her surveillance some patients.

NOTE Confidence: 0.916150095

00:47:09.970 --> 00:47:12.304
Really are extremely anxious and about

NOTE Confidence: 0.916150095

00:47:12.304 --> 00:47:15.387
scans and if they've been stable for a

NOTE Confidence: 0.916150095

00:47:15.387 --> 00:47:17.565
very long time with advanced disease,

NOTE Confidence: 0.916150095

00:47:17.570 --> 00:47:19.390
we may actually lower the

NOTE Confidence: 0.916150095

00:47:19.390 --> 00:47:20.846
frequency of the scans.

NOTE Confidence: 0.916150095

00:47:20.850 --> 00:47:23.090
And then there are some patients who are

NOTE Confidence: 0.916150095

00:47:23.090 --> 00:47:25.522
be reassured on scans or if they're on

NOTE Confidence: 0.916150095

00:47:25.522 --> 00:47:27.610
a clinical trial that may necessitate

NOTE Confidence: 0.916150095

00:47:27.610 --> 00:47:29.850
additional scan frequency next,

NOTE Confidence: 0.94276945

00:47:33.330 --> 00:47:35.730
is it moving forward?

NOTE Confidence: 0.94276945

00:47:35.730 --> 00:47:38.964
And so with with our newer treatments,

NOTE Confidence: 0.94276945

00:47:38.970 --> 00:47:41.427
a lot of these patients with more

NOTE Confidence: 0.94276945

00:47:41.427 --> 00:47:43.364
advanced disease and reemphasizing the

NOTE Confidence: 0.94276945

00:47:43.364 --> 00:47:46.385
point made by doctor staff is that the

NOTE Confidence: 0.94276945

00:47:46.385 --> 00:47:48.660
definition of a survivor does not exclude

NOTE Confidence: 0.94276945

00:47:48.722 --> 00:47:50.927
patients with more advanced illness.

NOTE Confidence: 0.94276945

00:47:50.930 --> 00:47:52.945
So they're all survivors from

NOTE Confidence: 0.94276945

00:47:52.945 --> 00:47:54.960
day one of diagnosis throughout

NOTE Confidence: 0.94276945

00:47:55.030 --> 00:47:56.750
the balance of their life.

NOTE Confidence: 0.94276945

00:47:56.750 --> 00:47:58.862
So so but they may be on ongoing

NOTE Confidence: 0.94276945

00:47:58.862 --> 00:48:00.326
treatment and the checkpoint

NOTE Confidence: 0.94276945

00:48:00.326 --> 00:48:02.511
inhibitors which are the predominant

NOTE Confidence: 0.94276945

00:48:02.511 --> 00:48:04.478
immunotherapy costs that we're using

NOTE Confidence: 0.94276945

00:48:04.478 --> 00:48:06.571
in a range of malignancies can have

NOTE Confidence: 0.94276945

00:48:06.571 --> 00:48:10.070
many types of immune related cities

NOTE Confidence: 0.94276945

00:48:10.070 --> 00:48:12.440
and they may present your primary

NOTE Confidence: 0.94276945

00:48:12.440 --> 00:48:15.090
care office with symptoms that.

NOTE Confidence: 0.94276945

00:48:15.090 --> 00:48:18.093
You'll be kind of wondering is this

NOTE Confidence: 0.94276945

00:48:18.093 --> 00:48:20.868
an immune related toxicity or is it

NOTE Confidence: 0.94276945

00:48:20.868 --> 00:48:23.015
a common that just just a regular

NOTE Confidence: 0.94276945

00:48:23.015 --> 00:48:25.130
old symptom that may be unrelated.

NOTE Confidence: 0.94276945

00:48:25.130 --> 00:48:27.290
So these are the challenges that we all face.

NOTE Confidence: 0.94276945

00:48:27.290 --> 00:48:28.610
Is it related to cancer,

NOTE Confidence: 0.94276945

00:48:28.610 --> 00:48:30.500
is it related to cancer treatment

NOTE Confidence: 0.94276945

00:48:30.500 --> 00:48:32.130
or is it something else?

NOTE Confidence: 0.94276945

00:48:32.130 --> 00:48:35.018
There's also a range of oral targeted

NOTE Confidence: 0.94276945

00:48:35.018 --> 00:48:38.406
therapies that are now actively being used.

NOTE Confidence: 0.94276945

00:48:38.410 --> 00:48:40.860
So patient can essentially take a pill

NOTE Confidence: 0.94276945

00:48:40.860 --> 00:48:42.830
therapy that is specifically targeting

NOTE Confidence: 0.94276945

00:48:42.830 --> 00:48:45.805
a protein or antigen on their tumor.

NOTE Confidence: 0.94276945

00:48:45.810 --> 00:48:49.140
And again, impressive results

NOTE Confidence: 0.94276945

00:48:49.140 --> 00:48:51.690
in terms of treatment efficacy,

NOTE Confidence: 0.94276945

00:48:51.690 --> 00:48:53.398
but they can have a range of

NOTE Confidence: 0.94276945

00:48:53.398 --> 00:48:54.570
side effects including fatigue,

NOTE Confidence: 0.94276945

00:48:54.570 --> 00:48:55.392
rash, metabolic issues.

NOTE Confidence: 0.94276945

00:48:55.392 --> 00:48:57.889
So this is what we need your help with.

NOTE Confidence: 0.94276945

00:48:57.890 --> 00:48:59.710
So if they're developing hyperglycemia

NOTE Confidence: 0.94276945

00:48:59.710 --> 00:49:01.530
on these agents for example,

NOTE Confidence: 0.94276945

00:49:01.530 --> 00:49:03.815
we absolutely need your partnership

NOTE Confidence: 0.94276945

00:49:03.815 --> 00:49:05.110
to better these.

NOTE Confidence: 0.94276945

00:49:05.110 --> 00:49:05.490
Thanks.

NOTE Confidence: 0.936323642727273

00:49:07.520 --> 00:49:09.320
And so there's lots of resources

NOTE Confidence: 0.936323642727273

00:49:09.320 --> 00:49:11.200
in terms of toxicity management.

NOTE Confidence: 0.936323642727273

00:49:11.200 --> 00:49:13.632
And I think this may be a separate

NOTE Confidence: 0.936323642727273

00:49:13.632 --> 00:49:15.998
webinar if there's interest on this.

NOTE Confidence: 0.936323642727273

00:49:16.000 --> 00:49:17.540
But one thing I've highlighted

NOTE Confidence: 0.936323642727273

00:49:17.540 --> 00:49:20.109
because you will be seeing a lot of

NOTE Confidence: 0.936323642727273

00:49:20.109 --> 00:49:21.405
immunotherapy complications in the

NOTE Confidence: 0.936323642727273

00:49:21.405 --> 00:49:23.637
practice is that the American Society

NOTE Confidence: 0.936323642727273

00:49:23.637 --> 00:49:25.637
of Clinical Oncology guidelines for

NOTE Confidence: 0.936323642727273

00:49:25.637 --> 00:49:27.668
immunotherapy are readily available

NOTE Confidence: 0.936323642727273

00:49:27.668 --> 00:49:31.966
and it's a really good solid resource.

NOTE Confidence: 0.936323642727273

00:49:31.970 --> 00:49:33.725
Also, don't be afraid to reach out to us.

NOTE Confidence: 0.936323642727273

00:49:33.730 --> 00:49:35.698
Again, we're not asking you guys

NOTE Confidence: 0.936323642727273

00:49:35.698 --> 00:49:37.010
to be immunotherapy experts,

NOTE Confidence: 0.936323642727273

00:49:37.010 --> 00:49:39.026
but you just have that index of

NOTE Confidence: 0.936323642727273

00:49:39.026 --> 00:49:41.615
suspicion of if these patients are on

NOTE Confidence: 0.936323642727273

00:49:41.615 --> 00:49:43.219
targeted therapies or immunotherapy

NOTE Confidence: 0.936323642727273

00:49:43.219 --> 00:49:45.440
agents that some of the things that

NOTE Confidence: 0.936323642727273

00:49:45.440 --> 00:49:47.409
may seem routine may actually be

NOTE Confidence: 0.936323642727273

00:49:47.409 --> 00:49:51.490
related to the cancer treatment next.

NOTE Confidence: 0.936323642727273

00:49:51.490 --> 00:49:53.891
And then this was a really important

NOTE Confidence: 0.936323642727273

00:49:53.891 --> 00:49:55.540
article that really launched.

NOTE Confidence: 0.936323642727273

00:49:55.540 --> 00:49:58.214
An expansion of how we see survivorship,

NOTE Confidence: 0.936323642727273

00:49:58.220 --> 00:50:00.584
which is that patients with metastatic

NOTE Confidence: 0.936323642727273

00:50:00.584 --> 00:50:03.740
cancer, again, it fits the NCI definition.

NOTE Confidence: 0.936323642727273

00:50:03.740 --> 00:50:07.220
But for a long time as a community,

NOTE Confidence: 0.936323642727273

00:50:07.220 --> 00:50:09.500
we have sort of felt that, oh,

NOTE Confidence: 0.936323642727273

00:50:09.500 --> 00:50:11.460
it's it's only for patients with curable

NOTE Confidence: 0.936323642727273

00:50:11.460 --> 00:50:13.612
disease, which is absolutely false.

NOTE Confidence: 0.936323642727273

00:50:13.612 --> 00:50:17.575
And so Tom Smith and Terry Longbaum wrote

NOTE Confidence: 0.936323642727273

00:50:17.575 --> 00:50:19.705
this really wonderful article that was

NOTE Confidence: 0.936323642727273

00:50:19.705 --> 00:50:22.970
published in 2019 in the Journal of Medicine.

NOTE Confidence: 0.936323642727273

00:50:22.970 --> 00:50:25.982
Really highlighting a lot of the

NOTE Confidence: 0.936323642727273

00:50:25.982 --> 00:50:28.398
similarities and differences that can

NOTE Confidence: 0.936323642727273

00:50:28.398 --> 00:50:30.597
happen in the related to survivorship,

NOTE Confidence: 0.936323642727273

00:50:30.597 --> 00:50:32.233
related concerns in patients

NOTE Confidence: 0.936323642727273

00:50:32.233 --> 00:50:34.170
who are in remission.

NOTE Confidence: 0.936323642727273

00:50:34.170 --> 00:50:35.952
Kind of in that extended or

NOTE Confidence: 0.936323642727273

00:50:35.952 --> 00:50:37.610
longterm phase that you saw Dr.

NOTE Confidence: 0.936323642727273

00:50:37.610 --> 00:50:38.010
Dr.

NOTE Confidence: 0.936323642727273

00:50:38.010 --> 00:50:40.010
Singh talking about where patients

NOTE Confidence: 0.936323642727273

00:50:40.010 --> 00:50:42.450
who are actually living with cancer.

NOTE Confidence: 0.936323642727273

00:50:42.450 --> 00:50:44.466
And as you can see that could be

NOTE Confidence: 0.936323642727273

00:50:44.466 --> 00:50:45.990
physical issues, emotional issues,

NOTE Confidence: 0.936323642727273

00:50:45.990 --> 00:50:47.520
sexual health issues.

NOTE Confidence: 0.936323642727273

00:50:47.520 --> 00:50:49.064
There's actually more similarities

NOTE Confidence: 0.936323642727273

00:50:49.064 --> 00:50:51.380
than differences in terms of some

NOTE Confidence: 0.936323642727273

00:50:51.439 --> 00:50:53.199
of the domains of survivorship.

NOTE Confidence: 0.936323642727273

00:50:53.200 --> 00:50:54.192
So, so this is,

NOTE Confidence: 0.936323642727273

00:50:54.192 --> 00:50:56.342
this is an area that that we would

NOTE Confidence: 0.936323642727273

00:50:56.342 --> 00:50:58.421
love to partner with you to help

NOTE Confidence: 0.936323642727273

00:50:58.421 --> 00:51:00.209
support these patients that are

NOTE Confidence: 0.936323642727273

00:51:00.209 --> 00:51:02.351
actively being seen in both primary

NOTE Confidence: 0.936323642727273

00:51:02.360 --> 00:51:06.147
care as well as oncology offices and

NOTE Confidence: 0.936323642727273

00:51:06.147 --> 00:51:07.882
all of the survivorship resources

NOTE Confidence: 0.936323642727273

00:51:07.882 --> 00:51:09.995
that we've been talking about are

NOTE Confidence: 0.936323642727273

00:51:09.995 --> 00:51:11.999
available for these patients as well.

NOTE Confidence: 0.936323642727273

00:51:12.000 --> 00:51:12.320
Thanks.

NOTE Confidence: 0.93773775

00:51:14.430 --> 00:51:16.542
And so kind of coming back to the

NOTE Confidence: 0.93773775

00:51:16.542 --> 00:51:19.096
to those patients with who've had

NOTE Confidence: 0.93773775

00:51:19.096 --> 00:51:21.388
incredible responses to immunotherapy,

NOTE Confidence: 0.93773775

00:51:21.390 --> 00:51:23.868
there is not a body of literature

NOTE Confidence: 0.93773775

00:51:23.870 --> 00:51:26.468
really talking about the experience of

NOTE Confidence: 0.93773775

00:51:26.468 --> 00:51:29.189
how these patients actually feel after

NOTE Confidence: 0.93773775

00:51:29.189 --> 00:51:31.334
essentially being being told that,

NOTE Confidence: 0.93773775

00:51:31.334 --> 00:51:33.382
you know, you have advanced illness.

NOTE Confidence: 0.93773775

00:51:33.382 --> 00:51:36.029
We're not sure how long you have to live.

NOTE Confidence: 0.93773775

00:51:36.030 --> 00:51:38.292
And then because of the advanced

NOTE Confidence: 0.93773775

00:51:38.292 --> 00:51:39.423
advent of immunotherapy,

NOTE Confidence: 0.93773775

00:51:39.430 --> 00:51:41.130
they're actually living years

NOTE Confidence: 0.93773775

00:51:41.130 --> 00:51:42.830
and years after diagnosis.

NOTE Confidence: 0.93773775

00:51:42.830 --> 00:51:44.426
So there's a body of work developed.

NOTE Confidence: 0.93773775

00:51:44.430 --> 00:51:46.212
Working in terms of the this

NOTE Confidence: 0.93773775

00:51:46.212 --> 00:51:47.965
particular study showed that they feel

NOTE Confidence: 0.93773775

00:51:47.965 --> 00:51:49.750
like they live in a twilight zone.

NOTE Confidence: 0.93773775

00:51:49.750 --> 00:51:51.829
They feel like they're they're between the

NOTE Confidence: 0.93773775

00:51:51.829 --> 00:51:54.670
edge of death and the living and they not,

NOTE Confidence: 0.93773775

00:51:54.670 --> 00:51:56.870
they're not quite sure where they fit in.

NOTE Confidence: 0.93773775

00:51:56.870 --> 00:51:59.126
So kind of in the coming years you're

NOTE Confidence: 0.93773775

00:51:59.126 --> 00:52:01.730
going to see more of this type of work

NOTE Confidence: 0.93773775

00:52:01.730 --> 00:52:03.664
coming out where we're beginning to

NOTE Confidence: 0.93773775

00:52:03.664 --> 00:52:05.806
understand better the needs of these

NOTE Confidence: 0.93773775

00:52:05.806 --> 00:52:09.020
survivors with advanced illness next.

NOTE Confidence: 0.93773775

00:52:09.020 --> 00:52:10.308
So I want to make sure we

NOTE Confidence: 0.93773775

00:52:10.308 --> 00:52:11.619
have time for your questions.

NOTE Confidence: 0.93773775

00:52:11.620 --> 00:52:13.540
So just wanted to just highlight

NOTE Confidence: 0.93773775

00:52:13.540 --> 00:52:14.820
a few quick takeaways,

NOTE Confidence: 0.93773775

00:52:14.820 --> 00:52:17.496
which is that patients would advance

NOTE Confidence: 0.93773775

00:52:17.496 --> 00:52:19.700
cancer like this particular case,

NOTE Confidence: 0.93773775

00:52:19.700 --> 00:52:22.364
she may have just had COVID or she

NOTE Confidence: 0.93773775

00:52:22.364 --> 00:52:24.865
may have had COVID plus possibly

NOTE Confidence: 0.93773775

00:52:24.865 --> 00:52:27.060
a recurrence of her cancer.

NOTE Confidence: 0.93773775

00:52:27.060 --> 00:52:28.380
I think it's it's the,

NOTE Confidence: 0.93773775

00:52:28.380 --> 00:52:30.290
it's the differential that we

NOTE Confidence: 0.93773775

00:52:30.290 --> 00:52:31.818
all would think about.

NOTE Confidence: 0.93773775

00:52:31.820 --> 00:52:33.125
Brain metastasis recurrence

NOTE Confidence: 0.93773775

00:52:33.125 --> 00:52:35.300
can also present with nausea,

NOTE Confidence: 0.93773775

00:52:35.300 --> 00:52:37.886
vomiting and not not the malaise

NOTE Confidence: 0.93773775

00:52:37.886 --> 00:52:40.538
and not being able to eat so.

NOTE Confidence: 0.93773775

00:52:40.540 --> 00:52:42.724
So just kind of keeping that

NOTE Confidence: 0.93773775

00:52:42.724 --> 00:52:44.900
differential why it is important

NOTE Confidence: 0.93773775

00:52:44.900 --> 00:52:47.756
quality of life and symptom management

NOTE Confidence: 0.93773775

00:52:47.756 --> 00:52:50.214
is particularly important in these

NOTE Confidence: 0.93773775

00:52:50.214 --> 00:52:53.112
patients living with advanced illness and

NOTE Confidence: 0.93773775

00:52:53.112 --> 00:52:55.840
coordination of care with you guys is.

NOTE Confidence: 0.93773775

00:52:55.840 --> 00:52:58.240
Even more important in these patients

NOTE Confidence: 0.93773775

00:52:58.240 --> 00:53:00.211
with more complicated cancers on

NOTE Confidence: 0.93773775

00:53:00.211 --> 00:53:02.381
ongoing treatment and as much as we

NOTE Confidence: 0.93773775

00:53:02.381 --> 00:53:04.440
can regularly communicate the matter.

NOTE Confidence: 0.93773775

00:53:04.440 --> 00:53:06.029
So I'll stop there and make sure

NOTE Confidence: 0.93773775

00:53:06.029 --> 00:53:07.718
we have time for some questions.

NOTE Confidence: 0.93773775

00:53:07.720 --> 00:53:08.080
Thank you.

NOTE Confidence: 0.950317

00:53:10.840 --> 00:53:10.950
There

NOTE Confidence: 0.946962533333333

00:53:17.380 --> 00:53:18.178
are no questions

NOTE Confidence: 0.946543225

00:53:18.180 --> 00:53:19.220
from the audience yet.

NOTE Confidence: 0.946543225

00:53:19.220 --> 00:53:20.260
So if you're listening,

NOTE Confidence: 0.946543225

00:53:20.260 --> 00:53:22.660
please enter questions after

NOTE Confidence: 0.946543225

00:53:22.660 --> 00:53:24.060
Williams. Do you have any?

NOTE Confidence: 0.93220288

00:53:24.420 --> 00:53:26.430
I do have a question.

NOTE Confidence: 0.93220288

00:53:26.430 --> 00:53:28.980
So the, you know immunotherapy is

NOTE Confidence: 0.93220288

00:53:28.980 --> 00:53:31.762
is a really recent occurrence and

NOTE Confidence: 0.93220288

00:53:31.762 --> 00:53:35.877
I think many of us in primary care

NOTE Confidence: 0.93220288

00:53:35.877 --> 00:53:38.610
don't have a tremendous number of

NOTE Confidence: 0.93220288

00:53:38.610 --> 00:53:40.727
patients that have actually received

NOTE Confidence: 0.93220288

00:53:40.727 --> 00:53:43.709
immunotherapy like the ones we discussed.

NOTE Confidence: 0.93220288

00:53:43.710 --> 00:53:45.850
What's the time horizon for

NOTE Confidence: 0.93220288

00:53:45.850 --> 00:53:50.163
us to be alert for potential?

NOTE Confidence: 0.93220288

00:53:50.163 --> 00:53:52.047
Adverse effects from those

NOTE Confidence: 0.93220288

00:53:52.047 --> 00:53:53.460
from those treatments,

NOTE Confidence: 0.93220288

00:53:53.460 --> 00:53:55.362
is it mostly during the treatment

NOTE Confidence: 0.93220288

00:53:55.362 --> 00:53:58.058
window or is it something that concur

NOTE Confidence: 0.93220288

00:53:58.060 --> 00:54:00.300
kind of longer subacute or even kind

NOTE Confidence: 0.876140632

00:54:00.860 --> 00:54:03.220
of great question, Dr. Williams.

NOTE Confidence: 0.876140632

00:54:03.220 --> 00:54:06.335
So so the majority of these would

NOTE Confidence: 0.876140632

00:54:06.335 --> 00:54:09.375
be first picked up on if that is

NOTE Confidence: 0.876140632

00:54:09.375 --> 00:54:11.685
more of an acute reaction while

NOTE Confidence: 0.876140632

00:54:11.685 --> 00:54:14.258
patients are receiving immunotherapy.

NOTE Confidence: 0.876140632

00:54:14.260 --> 00:54:16.600
Thyroid dysfunction issues for example

NOTE Confidence: 0.876140632

00:54:16.600 --> 00:54:19.660
are extremely common and we actually,

NOTE Confidence: 0.876140632

00:54:19.660 --> 00:54:22.152
if you wonder why is that oncologists

NOTE Confidence: 0.876140632

00:54:22.152 --> 00:54:23.220
checking thyroid function,

NOTE Confidence: 0.876140632

00:54:23.220 --> 00:54:24.776
that's what I do.

NOTE Confidence: 0.876140632

00:54:24.776 --> 00:54:27.656
It's actually part of our chemo plans

NOTE Confidence: 0.876140632

00:54:27.656 --> 00:54:29.934
to actually be checking thyroid

NOTE Confidence: 0.876140632

00:54:29.934 --> 00:54:31.670
function and adrenal function

NOTE Confidence: 0.876140632

00:54:31.670 --> 00:54:34.100
because these toxicities can be so,

NOTE Confidence: 0.876140632

00:54:34.100 --> 00:54:36.710
so, so common.

NOTE Confidence: 0.876140632

00:54:36.710 --> 00:54:38.630
Pneumonitis and cardiac issues

NOTE Confidence: 0.876140632

00:54:38.630 --> 00:54:41.030
are a little less common,

NOTE Confidence: 0.876140632

00:54:41.030 --> 00:54:43.179
but it's something that we if the

NOTE Confidence: 0.876140632

00:54:43.179 --> 00:54:44.826
patient is presenting with with

NOTE Confidence: 0.876140632

00:54:44.826 --> 00:54:46.501
shortness of breath during treatment

NOTE Confidence: 0.876140632

00:54:46.501 --> 00:54:48.790
or really any type of cardiac issue,

NOTE Confidence: 0.876140632

00:54:48.790 --> 00:54:50.498
the cardiac immune related

NOTE Confidence: 0.876140632

00:54:50.498 --> 00:54:52.633
toxicity can actually be deadly.

NOTE Confidence: 0.876140632

00:54:52.640 --> 00:54:55.224
That's not picked up early so so

NOTE Confidence: 0.876140632

00:54:55.224 --> 00:54:56.920
you're going to see if you see your

NOTE Confidence: 0.876140632

00:54:56.976 --> 00:54:58.526
oncologist doing certain types of

NOTE Confidence: 0.876140632

00:54:58.526 --> 00:55:00.375
work up that you're you're kind

NOTE Confidence: 0.876140632

00:55:00.375 --> 00:55:02.041
of like well cardiac work up it

NOTE Confidence: 0.876140632

00:55:02.041 --> 00:55:03.960
should be something I would be

NOTE Confidence: 0.876140632

00:55:03.960 --> 00:55:05.865
doing it's it's it's related to

NOTE Confidence: 0.876140632

00:55:05.865 --> 00:55:08.395
kind of kind of that that that

NOTE Confidence: 0.876140632

00:55:08.395 --> 00:55:11.137
high index of suspicion for these

NOTE Confidence: 0.876140632

00:55:11.137 --> 00:55:12.968
immunotherapy toxicities rashes are

NOTE Confidence: 0.876140632

00:55:12.968 --> 00:55:14.660
really common with immunotherapy

NOTE Confidence: 0.876140632

00:55:14.660 --> 00:55:16.759
as well as targeted therapies.

NOTE Confidence: 0.876140632

00:55:16.759 --> 00:55:19.951
So so so so so that's that's something

NOTE Confidence: 0.876140632

00:55:19.951 --> 00:55:22.636
that's very commonly seen and then we.

NOTE Confidence: 0.876140632

00:55:22.640 --> 00:55:25.678
I also worry a lot about colitis,

NOTE Confidence: 0.876140632

00:55:25.680 --> 00:55:29.250
immune related diarrhea where we

NOTE Confidence: 0.876140632

00:55:29.250 --> 00:55:31.680
typically if we're worried about it,

NOTE Confidence: 0.876140632

00:55:31.680 --> 00:55:35.103
we would have to hold the immunotherapy

NOTE Confidence: 0.876140632

00:55:35.103 --> 00:55:38.224
typically start high dose steroids and

NOTE Confidence: 0.876140632

00:55:38.224 --> 00:55:41.248
you can imagine if somebody already

NOTE Confidence: 0.876140632

00:55:41.248 --> 00:55:43.820
has metabolic syndrome or diabetes.

NOTE Confidence: 0.876140632

00:55:43.820 --> 00:55:46.133
All the things that you guys are expert at,

NOTE Confidence: 0.876140632

00:55:46.140 --> 00:55:48.020
we can kind of get into the cycle

NOTE Confidence: 0.876140632

00:55:48.020 --> 00:55:49.575
of trouble where we're struggling

NOTE Confidence: 0.876140632

00:55:49.575 --> 00:55:51.627
these hyper steroids and then their

NOTE Confidence: 0.876140632

00:55:51.627 --> 00:55:53.257
blood sugars are spiking etc.

NOTE Confidence: 0.876140632

00:55:53.260 --> 00:55:55.564
So that's another point where good

NOTE Confidence: 0.876140632

00:55:55.564 --> 00:55:57.780
close communication is super important.

NOTE Confidence: 0.876140632

00:55:57.780 --> 00:55:58.980
But to answer your question,

NOTE Confidence: 0.876140632

00:55:58.980 --> 00:56:02.340
most of the time these toxicities

NOTE Confidence: 0.876140632

00:56:02.340 --> 00:56:04.580
do happen during treatment,

NOTE Confidence: 0.876140632

00:56:04.580 --> 00:56:06.565
but then the endocanopathies that

NOTE Confidence: 0.876140632

00:56:06.565 --> 00:56:08.153
happen during immunotherapy do

NOTE Confidence: 0.876140632

00:56:08.153 --> 00:56:10.137
not necessarily go away after

NOTE Confidence: 0.876140632

00:56:10.137 --> 00:56:11.657
the immunotherapy is over.

NOTE Confidence: 0.876140632

00:56:11.660 --> 00:56:12.054
So,

NOTE Confidence: 0.876140632

00:56:12.054 --> 00:56:13.630
so we're sort of.

NOTE Confidence: 0.876140632

00:56:13.630 --> 00:56:16.174
The patients are left to continue

NOTE Confidence: 0.876140632

00:56:16.174 --> 00:56:17.870
to manage those complications.

NOTE Confidence: 0.96440576

00:56:18.270 --> 00:56:19.630
That's helpful. That's really helpful.

NOTE Confidence: 0.96440576

00:56:19.630 --> 00:56:21.466
So is it safe to say that you know,

NOTE Confidence: 0.96440576

00:56:21.470 --> 00:56:24.386
should a patient who's actively undergoing

NOTE Confidence: 0.96440576

00:56:24.386 --> 00:56:26.290
immunotherapy present with symptoms

NOTE Confidence: 0.96440576

00:56:26.290 --> 00:56:28.670
that could possibly really related,

NOTE Confidence: 0.96440576

00:56:28.670 --> 00:56:31.000
it would be important for us to get a hold

NOTE Confidence: 0.96440576

00:56:31.061 --> 00:56:33.226
of the treating oncologist immediately?

NOTE Confidence: 0.9301902

00:56:33.430 --> 00:56:37.212
Yes, yes. And I think I think

NOTE Confidence: 0.9301902

00:56:37.212 --> 00:56:39.798
pretty much from head to toe.

NOTE Confidence: 0.9301902

00:56:39.800 --> 00:56:43.051
Any organ can be involved in,

NOTE Confidence: 0.9301902

00:56:43.051 --> 00:56:45.277
in terms of immune related toxicity.

NOTE Confidence: 0.9301902

00:56:45.280 --> 00:56:49.145
So absolutely this is exactly we

NOTE Confidence: 0.9301902

00:56:49.145 --> 00:56:52.382
would want to hear from you and we

NOTE Confidence: 0.9301902

00:56:52.382 --> 00:56:54.559
are not expecting you to be the

NOTE Confidence: 0.9301902

00:56:54.559 --> 00:56:56.760
sole clinician managing these,

NOTE Confidence: 0.9301902

00:56:56.760 --> 00:56:58.780
but even alerting us that

NOTE Confidence: 0.9301902

00:56:58.780 --> 00:57:00.396
occasion is having trouble.

NOTE Confidence: 0.9301902

00:57:00.400 --> 00:57:01.750
They may have called you before

NOTE Confidence: 0.9301902

00:57:01.750 --> 00:57:03.216
they called us and I think

NOTE Confidence: 0.9301902

00:57:03.216 --> 00:57:04.240
that's why it's important.

NOTE Confidence: 0.9339639075

00:57:06.840 --> 00:57:09.640
Well, I think we've run out of time.

NOTE Confidence: 0.9339639075

00:57:09.640 --> 00:57:11.530
I just wanted to say that last patient

NOTE Confidence: 0.9339639075

00:57:11.530 --> 00:57:13.519
was my patient and she's doing well,

NOTE Confidence: 0.9339639075

00:57:13.520 --> 00:57:15.520
she just had COVID.

NOTE Confidence: 0.9339639075

00:57:15.520 --> 00:57:18.300
So that was good news.

NOTE Confidence: 0.9339639075

00:57:18.300 --> 00:57:20.733
But just wanted to to again thank

NOTE Confidence: 0.9339639075

00:57:20.733 --> 00:57:22.803
you all for for participating

NOTE Confidence: 0.9339639075

00:57:22.803 --> 00:57:25.160
this time and throughout the year.

NOTE Confidence: 0.9339639075

00:57:25.160 --> 00:57:26.793
Please write something in the survey

NOTE Confidence: 0.9339639075

00:57:26.793 --> 00:57:28.550
about it just because we can get

NOTE Confidence: 0.9339639075

00:57:28.608 --> 00:57:30.480
your feedback as we just as we

NOTE Confidence: 0.9339639075

00:57:30.480 --> 00:57:32.720
try to figure out what to do next

NOTE Confidence: 0.9339639075

00:57:32.793 --> 00:57:35.132
year and and then I'll just hand

NOTE Confidence: 0.9339639075

00:57:35.132 --> 00:57:38.160
it over to to Karen to to close.

NOTE Confidence: 0.9515750425

00:57:39.560 --> 00:57:41.410
Just want to thank everybody

NOTE Confidence: 0.9515750425

00:57:41.410 --> 00:57:42.520
for their attendance.

NOTE Confidence: 0.9515750425

00:57:42.520 --> 00:57:45.285
Thank the panelists for their

NOTE Confidence: 0.9515750425

00:57:45.285 --> 00:57:47.026
preparation and thoughtful

NOTE Confidence: 0.9515750425

00:57:47.026 --> 00:57:49.398
approach to these issues.

NOTE Confidence: 0.9515750425

00:57:49.400 --> 00:57:51.374
And actually and I want to

NOTE Confidence: 0.9515750425

00:57:51.374 --> 00:57:53.352
thank you because it's the end

NOTE Confidence: 0.9515750425

00:57:53.352 --> 00:57:55.080
of our first year doing this.

NOTE Confidence: 0.9515750425

00:57:55.080 --> 00:57:56.864
So we will have a little

NOTE Confidence: 0.9515750425

00:57:56.864 --> 00:57:57.516
celebration together,

NOTE Confidence: 0.9515750425

00:57:57.520 --> 00:57:58.712
which does not mean we

NOTE Confidence: 0.9515750425

00:57:58.712 --> 00:57:59.760
won't have recurrence.

NOTE Confidence: 0.938576485

00:58:02.800 --> 00:58:05.528
All right, good. Thank you all, everybody.

NOTE Confidence: 0.938576485

00:58:05.528 --> 00:58:07.640
Thanks, Brian. Thanks, Miriam.

NOTE Confidence: 0.22324075

00:58:09.510 --> 00:58:09.590
Yeah.