Author: Joanne Dragun, M.D.

Stinkin’ cancer outsmarts us so often. We hope if we slash, poison, burn and now make ourselves immune to its evil, we will gain the upper hand. Aaah to be so naive. All the while, it finds ways to make fools of us. Thank goodness, scientists never stop searching, never take a break and more brilliance is going to impact our future.

At Rush in Chicago scientists are developing a blood test to detect more than 50 cancers. Finally, an end to the endless CT scans now proven this month to cause 5% of new cancers.

JCO (Journal of Clinical Oncology) this week explored the critical gut microbiome (stomach) and found a relationship between high fiber and lower risk of skin cancer (who would think?). It is called the DIET trial and for patients with melanoma undergoing immune-therapy, hi fiber led to better response to treatment.

JCO Precision Oncology published the first large scale study to identify molecular markers associated with prolonged immune therapy response in glioblastoma brain cancer patients. Patients who have molecular marker CDK4 were more likely to benefit from bevacizumab (Avastin), blocks blood flow to tumors, with increased progression free survival.

With one in five men developing prostate cancer, Decipher Prostate ( a 22 gene classifier) is now used in the clinic and validated in over 200,000 patients. The genomic test is helping physicians predict metastasis, prostate-specific mortality and overall survival for this common disease.

Our “bag of tricks” just got trickier! Immune therapy is often mentioned here as the new addition to our regimens. The National Center of Nanoscience and Technology (China) found a physical barrier that blocks T cell–tumor interactions allowing the T cells to accumulate to give a more sustained immune response.

Johns Hopkins scientists found enzyme waves, challenging what we learned in biochem. High grade breast, liver, pancreatic, lung and colon cancers demonstrated fast pulsing, brighter waves (visualized under confocal microscope). They tagged key enzymes in glycolosis with a fluorescent marker. They found that energy doesn’t just churn inside cells, but ripples across the membrane in bands, developing fresh ATP where the cancer cell needs it. No wonder cancer can outsmart us.

These are just a few new developments this month at microcellular levels that are all conspiring to help you and your loved ones succeed in the cancer journey. As we head into hot, steamy August (already!) let’s thank our brilliant scientists who are so devoted and entranced by their discoveries that they probably rarely spend a day at the beach. Happy Vacation.

As a former Registered Dietitian and current oncologist, it’s time to weigh in on the use of popular weight loss medications. My 10 years designing diets and counseling patients (diabetics, cardiac, hypertensive etc) taught me that diets are fleeting, genetics plays an enormous role, habits are a big part, family dynamics, psychological issues and even access to nutritious food, all factor in. It is not an issue of willpower.It is not a moral failing.

We tried everything: jaws were wired shut (!), parts of stomachs removed, stapled, or filled with a balloon, and every weight loss mechanism and over the counter med was tried. Finally finding a substance that could change the hormonal milieu and result in real, dramatic life changing weight control is having a tremendous positive impact. It is almost impossible for someone to exercise away 100 lbs. We are not talking about the 10, 20 or 30 vanity pounds, we are talking about changing a life to reduce diabetes, heart disease, hypertension and even cancer.

13 cancers are directly related to obesity: breast, colon, rectal, uterus, gallbladder, stomach, kidney, liver, ovary, pancreas, thyroid, meningioma and multiple myeloma! These represent 40% of cancers diagnosed in US each year (source CDC) . It is a hyper inflammatory state effecting everything. ENDO 2025 (annual meeting of the Endocrine Society) looked at 33,000 cases of cancer deaths related to obesity and found death had tripled in the US in the last 20 years. CDC reported that 40% of adults are living with obesity.

I encourage many patients like Rosalia this week. She is 5’1″ and 210 lbs and has been treated for breast cancer, now on anti estrogen therapy. This has caused her even further weight gain. I addressed this with her. “Rosalia, you should speak with your primary care physician and discuss the weight loss injections. You are already borderline diabetic and we need to reduce your risk of further cancer”. She perks up, “Doc, everyone tells me to lose weight, but I cannot exercise this away. I would love to be more healthy and be able to play with my three children”.

My recommendation is that you start the discussion with your primary care physician. If needed, see a bariatric specialist. Yes there are risks but obesity itself is a major risk too. Continue to exercise because muscle mass is lost, increase protein, take a multivitamin, and added D3, increase hydration. If your insurance does not cover, the manufacturers are now making lower cost meds available. We can no longer expect insurance to cover every aspect of our medical care.

The recommendation for these medications is for obese people, especially those with diabetes, who are looking to improve their overall well being and decrease the risk of major health impact. Have a discussion with your physician. Tools are finally available as never before. You should be strong, you should be fit, and you should be healthy. You should also be heard and be responsible for your wellbeing. Best wishes.

“Can you hear me now??!!” The “dialog” in room 1 became comical as Lillian and Bob between them only managed to have one working hearing aid. I am yelling, they are confused, and writing didn’t work because they forgot their glasses as well. The O2 tank and 2 walkers add to the environment. Half way through we collapsed giggling. But for Bob and his bride of almost 70 years this is no laughing matter.

As we stumble to get there, the discussion must include their input, not just review of scans and therapies. Cancer care is changing rapidly. I’ve mentioned immunotherapies for the hardest to “cure” diseases, stereotactic radiation to small lesions, with improved survival even for metastatic disease, various combinations of chemo and antibodies for many diseases, less invasive surgeries, and developing radio-nuclides. The depth and breadth of growth in the field is logarithmic. Because there are national guidelines, your docs know the latest and greatest. That is where you come into the equation. For the past years I have discussed here the need to be your own advocate. As we are aging and cancer is becoming more ubiquitous (the leading cause of cancer is age), your choices are just as critical as the plethora of options.

At 86 and 87, this lovely couple must make decisions right for them. Enter breaking news from ASCO this week. Three physicians are investigating new lung cancer therapy that can be effective and have low toxicity. Dr. Jessica Bouman from Fox Chase Cancer Center (where I was their first dietitian in the 70’s!) Dr. Julie Rotow of Dana Farber Cancer Institute and Alessio Cortellinni Bio-Medico University Rome, are considering the approaches of the standard combination chemo, vs less toxic mono therapy (one drug, such as Tagrisso). It is critically important for research to move in the direction of efficacy and convenience with low toxicity. Oncologists are managing an aging population who understand that longevity has already been attained, now it is a quality issue. Many of the medical oncologists I work with evaluate each individual for the best option, encouraging patient participation in the decision. It is perfectly okay to ask your physicians, as Lillian and Bob did with me, “What is the least I could do and still have some therapy, if not the most aggressive. Since at this point, it won’t change my longevity, but do not want to ruin whatever quality of life I have now”? Fair question. Make it easy on yourself. Ask the Doctor, what the most aggressive and effective plan of care is for your disease, and then also, what is the minimum that could achieve some benefit or even palliation. For Bob we came up with a 5 treatment course of stereotactic radiation to the lung which will be very well tolerated (and effective) then monotherapy by the medical oncologist. It is important to have at least one loved one with you so they can hear the discussion and also understand your own goals.

Every single chart note about you involves your “fitness status”. (No, not how long you hold a plank.) The ECOG* score must be stated in your record. It is a measure of fitness to treat today and considers age, other illnesses, strength and factors critical to the decision. (Like can you put your own pants on in the morning). Cancer guidelines are interesting but just a guide. None are carried out without consideration of the individual patient. If you are caring for a loved one with cancer, be there for those discussions.

We are not here to bully you into therapy. We, as your docs, need to know your goals and then advise our best recommendations. So many of my patients remind me, “Doc, a long life is just long, but a good life is good.”

*www.mdcalc.com ECOG performance status

With Summer in full swing, many of us recall the boardwalk fun, rides and games and some are fortunate to bring their children and grandchildren into those magical spaces. Since I have fear of heights, no ferris wheels or roller-coasters for me, the Scrambler and Tilta Whirl were my speed. Perhaps a good thing because nothing scrambles or tilts the world like a cancer diagnosis. Helping patients navigate as a life profession can surely make my own head tilt.

This week I enter the pet scan unit knowing a darling patient and her husband are bracing for the news. I treated Isabelle seven years ago for a devastating stage four diagnosis with brain, spine, lung, liver, skin….. everything involved. A miracle ensued and new drugs that had just arrived were available and now, so many years, scans and essentially a lifetime have past. We are thrilled to see each other and now her children are in high school and college and although she has some challenges, they enjoy a wonderful and wonder-filled life. I escort her husband to waiting and he carries her purse, twisting the handle with big frightened eyes. What a toll this journey has taken, but together their smiles beam as they give each other energy. They are both so profoundly brave. While I am not a radiologist, and must await the official report, I’ve seen enough and especially Isabelle’s to give them a view. Scrolling through every few millimeters, there is no uptake to suggest cancer at all, I tell them there is nothing obvious but the report will be out after the 4th. We all hug with sighs of relief. She and her family know that every day is a gift and every scan a chance for a terrible tilt of their worlds again.

I am blessed to see patient for years. Some for their lifetimes. What I have learned is that the shocking diagnosis isn’t the event, in fact neither is the treatment. The scans are interesting but they do not make a life. I was fortunate to do a symposium with the renowned Dr. Bernie Siegel who wrote “How to Live Between Office Visits“(1993) . He is not kidding. Being brave and carrying on in spite of the scrambled life is where real living happens. You are not alone. Just as with Princess Kate, who this week bemoans the efforts to stay “normal” after a cancer diagnosis, long past the therapy, there is a changed life.

My message today, if your doctor is not seeing you long term, find a primary care who can help you. Living beyond the diagnosis takes work. There is traumatic stress, depression, fear and anxiety. Help comes from talking with others, sometimes medication for you and your loved ones, psychological and physical therapies. You can’t throw the trauma and diagnosis out . It actually recycles in your mind and heart. Do not, however, lose faith. You will not be the same person. You cannot go back. The specter of the drama remains. But, so too the benefits of recognizing what and who are important to you and how you master each day. The raised awareness is empowering beyond expectation. My friends, nothing will change you like cancer. We cannot guarantee longevity, but be assured in the knowledge that like Isabelle and her family, for what ever time we have, a new life well- lived still awaits.

U Missouri just published that boosting Hope is a game changer for mental health and resilience. “It’s a powerful emotional force that gives our lives meaning” and may be more essential to our well being than happiness or gratitude. ( see news release: showme.missouri.edu, June 18,2025)

The reason I love this concept is that it manifests every single day in the center. This week Joy arrives with family in tow. She is demonstrating very little of her namesake and the “woe is me” demeanor pervades the group. Joy has been diagnosed with one of the more difficult diseases that used to have a life expectancy of 6-12 months. She is in her 70’s, vibrant, formerly energetic and this is taking her down hard.

It will require some finesse to turn this ship around but its not my first rodeo. Joy underwent a very big surgery and all the tumor is “gone”. Chemo and radiation will be used to dust up any risk of recurrence but in her situation, not guaranteed. She appears defeated.

“Joy, I don’t want to talk about the treatment. Let’s talk about you. I have one question, why did you have the surgery and why are you here?” She perks up and the beautiful smile changes her entire countenance. ” Jim, show her” she prompts her son to show me her grandchild pic on his phone. “I need to see my grandchild grow and play ball”. I say,”Ok I get it… or piano.” Joy has just demonstrated hope. But central to her own critical power is someone else. I go on to advise that this is the reason she is set up for success. Without meaning, there is no need for hope.

The visit goes on and plans are hatched. Nothing matters now to Joy other than that she was “seen” and she was not just a body with a problem to solve. The entire group left with straight spines, a mission to fulfill and hope in their hearts. Radiation, surgery, chemo do not do that. That comes from within. Just tap in, find hope and discover your own joy in healing. God Bless.

Those Russian nesting dolls always captured my attention and now some are made to be quite comical. I will use their example to describe a new- found discovery in isotopes. We use isotopes all the time in radiation and for scans such as Pet, MRI, and in brachytherapy. Scientists discovered at the US National Superconducting Cyclotron Laboratory, that, while smashing Oxygen-13 into beryllium to create isotope oxygen -11, nitrogen-9 was discovered. (I see you yawning, stay with me). You recall studying atoms with nuclei, electrons and protons, but this glimpse of a possible new isotope with nucleus spewing out 5 instead of 4 protons will further revolutionize elemental knowledge.*

What’s my point today? Scientists are ever uncloaking layers of discoveries on even the most minute level. Years ago we didn’t test for genes let alone epigenes and we never thought to adapt them to target cancers. We can appreciate on every level of cancer treatments, that even minute findings lead to magnified gains.

There is always some good news to share as exciting developments emerge. Just last month Memorial Sloan Kettering had a groundbreaking discovery. Dostarlimab immunotherapy was found to eradicate rectal cancer, negating the need for surgery and radiation! Now the study is small and we need time to see if the results are sustainable, but this will revolutionize the treatment of this common disease. Harnessing immuno-ablative therapies may potentially impact gastric, prostate and pancreatic cancers.

Do you feel all the positive vibrations of miracles in real time? Hope so. Stay strong. Shed your own fear, suffering, anxiety – you do not need those outer layers. What you need is a strong and resilient core. Trust who you are and what you believe in your heart. The determination to manage chaos and renew your life is fierce. If invisible protons, nanoparticles and epi genes can do it, imagine just how powerful you are too.

*Invariant-mass spectroscopy in projectile fragmentation reactions. R.J.Charity etal. Phys.Rev C108 10/27/23.

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Just when you are on the trajectory of your career, something magical occurs to derail all of your plans. No one is really fully prepared. The day arrives and your world tilts. Your heart sings. Your protective nature explodes. Your devotion knows no bounds. You thought you were a tough guy. You could handle everything in front of you- school, work, service, a house, finances, even a marriage. You have no frame of reference or training, yet you are facing the biggest challenge of your life….. and it is for life. Parenthood arrives unapologetically. You hold the bundle gently. You pamper and baby. You lose sleep without a care. You play, train, guide, shape, and grow along with your new charge. It is good that the child is not aware of how very confused and fumbling you are, while navigating the unknown. You will ultimately launch and observe from afar, in awe of your own ability and thankful for the grace you received along the way. There are stumbles, sometimes pain and fear but through it all, you dig deep every single day.

When Ronald comes for consultation, he is worried, alot. His wife died of cancer a few years ago. He is alone caring for their challenged handicapped son who accompanies him. He was not prepared for this and certainly not for cancer to derail his duty. Our plan is more for the two of them than just him and he is grateful. Charlie has twin girls in tow. He and his wife are guardians for these darling grandchildren. His own health issues take a back seat. Michael’s eyes are large and fearful. He tries to be strong for his daughter who is in the fight herself. He never thought after college and a nice career that she would be battling this terrible threat and need to move home for his continued care. Jason is facing down a demon from Camp Lejeune exposure. The seizures require a driver. In front of his aging dad, he is strong. As the techs move him to treatment, I hold his father back a moment.He wears his own military cap but his tense expression tells the real story. I simply say, “Dad, you taught your son to be brave. Be proud and have faith”.

The thousands of fathers I have had the privilege of caring for and treating, remain in my heart. Everyone with a story and a new reality. I pray for them daily. We work hard to help them accomplish their goals for health and comfort, and also for family. I never forget that they are blessed with their own magical powers and I honor them everyday. God Bless the fathers- for a day? No. It is truly for a lifetime. Happy Father’s Day.

Who wants to read about this, Joanne? Well frankly everyone. Pain is ubiquitous. While emotional and psychological pain is real and life altering, I want to address physical pain today, so lets get to it. Pain is the most common reason people present to their Docs.

Starting at the top, persistent headaches. If you have a cancer history be sure an MRI of the brain is performed to rule out brain metastasis. If its negative, migraine meds, sinus allergy drugs help. For severe I use a short course of steroids to knock down the inflammation – just about everywhere.

Head and neck pain: Patients undergoing radiation and chemo for head and neck cancers have severe mucositis which is inflammation of the throat, tongue and esophagus. They need prescription magic mouthwash and anti- fungals. For patients on chemo or antibiotics, they kill off the normal bacteria allowing our normal thrush to grow, so for every patient with complaints we check their tongue- easy for you. If it’s white, you need an antithrush medications (nystatin, clotrimazole troches or fluconizole tabs). A way to keep this from happening is 1/2 tsp coconut oil twice a day- it’s anti thrush and antibiotic properties help.

Chest: David is frightened as he describes the persistent mid chest burning. I can assure him it is not heart related. Since his treatment is esophageal, its all esophagitis and need for anti thrush meds and carafate (which acts like a sealant to the mucosa) very helpful. If his pain was on the side- then it may be rib so he needs an xray to be sure bone mets are ruled out. Ribs, thigh or arm are not joints they don’t get the overuse so “non joint pain” is bone mets til proven otherwise for a cancer patient.

Abdominal and pelvic: My rule is anything that comes and goes is ok- don’t panic but anything that grows, then keeps you up and is relentless,etc is cancer til proven otherwise. A Doc thought he had a stomach problem coming off his 25 year anniversary cruise. Thank goodness he asked for a CT- unfortunately it was pancreatic cancer, a shocker but he is now under treatment doing well.

Cancer causes a hyper coagulable state in the body with increased protein-C. Some patients’ presenting symptom is a blood clot in the leg. Pain, swelling in one leg are the symptoms. Docs check to see if there is a “positive Homan’s sign”: if there is pain in the calf when you flex your foot. This needs an ultrasound and blood thinners.

Bone lesions are common in stage 4 cancer and will show up on a bone scan, pet CT and PSMA ( for prostate) scans but also xrays. While joint pain is usually arthritis, back pain is more challenging, especially in a patient with advanced cancer so I always ask for an MRI.

Narcotics mask pain. If you have a problem, seek a work up, not a medication. We must know what is the cause because you can’t take these drugs forever- let’s fix the issue. The stronger your muscles, the less your joints and bones need to work so keep walking, exercising and strengthening.

Radiation treatments are used daily for bone metastasis and highly effective. Patients can often return to their normal activity, so don’t fear the beam. Do not let your providers “write you off”. You must be an aware patient and even demand a workup. Using words like, “Oh, I’ve always had back pain” suggests that you do not need attention. Scanning is my favorite tool. Before getting a spinal injection, get an MRI. Kyphoplasty (bone building injections) can rebuild an acutely fractured spine and really relieve pain. Several patients come in after having chiropractic services. While they can be useful and helpful, the patient must be sure someone has ruled out disease especially with a cancer history.

We will all have pain. Often it will be fleeting and we will put our big people pants on and tough it out. If you have a diagnosis of cancer and the pain remains, then it’s time to insist on a scan. You have every right to live your most comfortable life.

Okay let’s do this! With all the news about Joe Biden, it’s a good opportunity to discuss the number one (after skin cancer) cause of cancer in men (overall one in eight) and second leading cause of cancer death in men (behind lung cancer). Armed with this knowledge you would wonder why screenings are stopped (too young). If you have read Zeke Emmanuel’s post in The Atlantic in 2014 (!) when he said, “Why I hope to die at 75“, (he was 55) you will understand how the creator of Obama care and oncologist from Penn crafted this concept. He doubled down recently Jan 10, 2025, at his age of 65. “Once I have lived to 75, my approach to my health care will completely change”. Look, I don’t care what he does for himself and his family, but when you influence policy and payments and screenings, as an oncologist, there is responsibility beyond your own viewpoint. Does his concept translate to everyone including children who are near the end of their lives? It there no eagerness to live the best as long as you can? Should we remove all the outstanding immuno-therapies extending life now in prostate, breast, pancreas and even brain cancers?

So, when Medicare, to cut costs, recommended stopping these great screening tools, we (other) Docs were up in arms. Stop prostate psa at 70, stop colonoscopies unless you are at risk, only do mammograms every other year then stop between 70-80. These are great tests to find disease early and treatable. If you wait to treat, it’s even more expensive since people don’t go from avoiding screening directly to hospice.

Radiation Oncologists and Urologists take the lead on treatment for prostate cancer, and primary care for screening, so careful what pundits you listen to. You may have a low psa that when it dramatically increases, pushes the need to do a workup, but you have to actually test and pull the head out of the sand. Gleason score 8,9,10 are so aggressive and cancer isn’t linear (from low to high grade) some do present (less than 7 % )with metastatic disease at diagnosis.

Years ago they started something called “observation”- low psa, low grade cancer probably not lethal, won’t need treatment, patient will die from something else. However that changed and now we call it “active surveillance”, since just observing didn’t work out, we recheck psa’s, we re- biopsy and in those expected to live another 5-10 years, we treat.

In oncology we often believe that advanced cancer means it has been there for awhile— not so with high grade tumors of any kind, they grow and spread rapidly, especially if the patient’s immune system is compromised.

Now you know how someone didn’t get a psa since 2014. Travesty isn’t for Joe Biden. He chooses his own care. My concern is for you and your families. If there is a family history, check younger than 50. Otherwise get yearly psa’s and don’t use a cut off of age (sorry Zeke). If your doc believes you have some longevity, you deserve all screening tests. One out of 2-3 of us will have cancer by the time we are 80. Best to find it while treatable, unless other health issues are overpowering. Also, note that African American men frequently present younger and with more aggressive disease.

At least we are talking about it, but no one is stating the true evolution of this need to cut Medicare costs . It was like “Yay screening tools!!” Then it was” Oops can’t treat everyone for everything all the time”. So it didn’t happen in a vacuum. If you are under surveillance, stay on top of it. Symptoms are rare unless it is advanced. Bone is the most common for prostate as it attracts cancer for metastasis, followed by lymph nodes. For these cases we can radiate them while a patient is on hormone therapy (pills and shots). There are new I.V. radionuclides we use for bones and PSMA treatments for all metastatic prostate disease. New immuno-therapies are now under investigation for even resistant cases. People do survive and for years. Refuse to accept the pat on the head, “Oh you don’t need this anymore” for your own health maintenance. You have been paying for insurance and into Medicare your whole life. Less is never more in cancer care. Always be your own advocate.

PS: Can you tell my hair is on fire??!

On this Memorial Day we take a moment to honor those who sacrificed for us and our country. Many did this without volunteering. They were plucked from protected lives to be placed into danger a world away. My own Father in Patton’s Army, Normandy, Battle of the Bulge, my Father in Law, uncles and my husband, a combat engineer in Vietnam, unusual for our peers. As a physician I often write of the sacred trust I feel when caring for (a better phrase than just treating) our veterans. Those who died in service or because of previous service, deserve this solemn day of recognition, even while no longer here to know our gratitude.

WWII and Korean Vets abounded in my early career. Now many are from Vietnam service and even Desert Storm, Afghanistan, Iraq wars. Each one has a unique story and they all present humble, not arrogant. They walk into the clinic with their various insignia hats, shake strong hands, look people in the eye and let us know they are up for this new battle. Last week a Vietnam veteran served the same year my husband was there. He stopped the conversation, put his heavy hand on my arm and said, “When you go home, Doc, tell your husband, ‘Welcome home'”. The camaraderie is fierce over 50 years later. They have no fear of the cancer and take it all in stride. Most were simple teen boys when they were called and their lives were changed forever. At 70,80,90 or even the unfortunate younger vets, with injuries and service families and dogs, they bring a profound force into this space. They are always grateful. They brush off side effects of therapy and they trust.

It is a privilege everyday to witness. I may give treatments and counseling, but even more heartfelt is my utmost respect. On this Memorial Day, as we celebrate the opening of Summer with family and friends, and fly the flag, please remember to thank a veteran. God Bless our men and women in uniform and the many who will follow in their steps.