Author: Joanne Dragun, M.D.

Confusion, intimidation, exploding information all crash in when a person begins the cancer “journey”. Nothing can prepare you for the drama. You can’t study for the tests, plan for the process or even give any direction. You will be poked, prodded, pushed. But you will be supported and delivered gently and safely to decisions.

Today’s message is not to prepare you, because nothing can. Just know that you are resilient and brave and view it all as an experience (albeit one you’d rather not endure). What is important is that, as the dust settles and biopsies are done, surgery maybe chemo maybe radiation planned, you then have to step up and take real responsibility.

This week offers good examples as I engage and counsel patients and families. In room one is Rose. “Honey, I don’t have time for all this fuss! It’s just a little skin cancer and my doctor made me come. I don’t want any treatment. I am going North next month when I turn 90 and going to party and dance!! Do we all have to be super seniors to grab control of events? I send her on her way to return for a check in a few months. Room two is Ernie, a retired captain of industry with a startling new stage IV diagnosis. It is widely metastatic, not just arthritis pain when he golfs. He is used to being in control but he and his wife are floored. “Doc, is it worth it? I hear horror stories.” I invite him to get the first round of chemo and some radiation for pain and take one month at a time. You don’t have to buy into the entire plan which is overwhelming. New treatments will extend his life. He is surprised by his own tears as his wife reaches to hug him.

Roger in room three is still battling in spite of his extensive disease burden. He should be in hospice but is requesting palliation for pain, not for himself, but so that he can continue to care for his ailing wife. In room four, Daisy guards the door. The beautiful, dutiful, vigilant guide dog is at high attention for Phil, an injured Veteran. “Doc, she’s been with me 8 years, I gotta do this for her, she’d be lost without me”.

At every turn, there is a unique issue. Not only are the diseases different, the patients bring with them special circumstances and personal perspectives that must be honored. No bulldozing or arm twisting here. Even the right decision today can change tomorrow. The best advice: listen to the plan. Do some research (NCCN guidelines for patients helps). Talk with your family. Don’t be intimidated and listen to your own voice and intuition. Your physicians have responsibility to present the best plan of care, but you have the duty to tell us how to help you live your best life.

Don’t be ridiculous. We all know she will probably still cook even if it’s for other Moms in the family, put away laundry, straighten up messes, walk the dog and prep for an upcoming work week. She is the supreme multi-tasker. Even the word “Mother” is an adverb, adjective, noun and verb! They take on the mantle just like a Pope and we know they are chosen by God, because it had to be someone omnipotent who came up with this job description. Right out of the gate, or delivery room, she becomes this super power that even surprises her. She is in total control- pretty much for life. Even if Dad is a disciplinarian, Mom gave him that role. Kids are meant to pester, push, challenge and generally make Moms crazy. The temper tantrums give way to “finding themselves”, moving away from the fold, exploring and even perhaps separated. But through it all, Mom didn’t retire. She will be there, even if it’s years later, when a call comes in that you need help. She will drop pickelball, cancel travel and even work just to be by your side when you are challenged. I’ve watched this magical dynamic again and again for over 30 years and I never tire of witnessing the true devotion. Powerful chemo that could put a horse down, massive radiation linear accelerators that have invisible rays, robotic wizardry surgeries, all have nothing on her sheer presence.

If you were blessed to have a mother or mother figure who showed up, even when you wanted to push back, or one who fussed constantly to help you grow, mature and succeed, say thank you. If Mom has passed or now you carry on her role as caretaker, pray to and for her.

Mom really does not need a special day, she just needs to know that she is loved and appreciated every day.

Happy Mother’s Day to my sisters, sister-in-laws, nieces, family, friends, co-workers, readers and patients. May God Bless you and keep you strong. With Love, Joanne

No, not tariffs! When you enter a center for care, I’ve detailed the effort that is tapped for your benefit including consults, conferences, all specialties input (Path, Radiology, Medical Oncology, Surgery and Radiation Therapy) . What adds even greater power to the plans is tapping into breakthroughs happening around the world. Research is continually carried out in all countries that impact you.

A few examples: We now routinely treat breast cancer with fewer episodes of radiation, initially designed by Canadian trails. England is much more interested in preserving your bladder and so trials for chemo-radiation are used to allow bladder preservation more often now. Heidelberg developed Target trial for radiation and I will use it this week for intra-operative breast radiation to avoid the weeks of post op therapy. A new prostate cancer test from Karolinska Institute Medical University in Stockholm, Sweden is using urine which is out-performing PSA blood tests for prostate cancer detection. A ubiquitous disease (number 1 for men) which has not had significant advancement in decades. Screening for prostate may be much more effective and efficient. I mentioned last month how some patients have 25 vs 47 daily radiation treatments. Just this week we have results (10 years) from Sweden on a 2 1/2 week course of radiation effectiveness. (HYPO-RT-PC trial). Life changing since cancer needs to stop being so needy and disrupting lives while trying to be controlled. England is testing cancer vaccines. Not to be outdone, all major cancer centers in the US are investigating new cell-free RNA for molecular signatures in blood samples to predict drug response (Nature April 16,2025).

Just a sample of studies but our medical journals are bursting with information from Italy, India, China, South Korea, Japan, Spain, and many countries, that will change your treatment tomorrow. No one is idle and sitting by waiting for a cure-all. Everyday, developments are happening and the confluence of dramatic and swift changes occur. Take GBM. Most aggressive brain tumor. We all know Michael Bolton. But other famous people have previously succumbed to the disease. Recently Mia Love, Robert Forster, John McCain, Ted Kennedy, Beau Biden, Ethel Merman. People with the means and ability to seek out the most state of the art care anywhere in the world. (14,000 diagnosed in US alone each year). Surgery, chemo, radiation all factor into treatment. No cure. But now instead of 3-6 months, they are beginning to live years due to improved treatments and immunotherapies as the UK research evaluates targeted therapy. In England they say “Over in Arizona” there are studies of pharmico-kinetics and dynamics in early trials. It’s a world of attention with profound improvements.

Not to be Pollyanna, people will continue facing down life threatening cancer. Our support, love and compassion is critical to their well being always. But knowing that the entire world is conspiring for your benefit, as I say so often, gives us pause for gratitude, curiosity and dare we say a world of hope?

Unlike “I will going to the gym regularly”, or “I’ll drink less wine”, or “I’ll learn a new skill”, all of which can lead to disappointment when we bail (notice I didn’t say fail) , cancer requires us to dig in and give full, honest and devoted commitment. I have huge admiration for our patients who drop everything- work and play. The focus is 100%, 100% of the time.

Whether it was my former practice, or covering another doc, I am always pleased to develop a real connection. It doesn’t matter how I manage the plan of care, it has more to do with really seeing the patient and listening to them. Always respecting that they are here to give their all. Can you imagine witnessing that level of ownership and devotion again and again? It is such an honor to work with patients toward our goals, a true partnership. My own level of commitment must rise to meet their’s every time.

So today’s message is simple, yet I believe represents power. It’s a shout out to those of you who battled, are in the fight now, or preparing. Never doubt that your commitment is recognized, respected and critical to your success.

What Easter and Passover bring to our lives is an opportunity to come together in community with peace and love. Patients frequently attribute their healing to their “church praying for me”. Many are on prayer lists and when they are alone at home, they may still venture to a service where everyone sings with one heart. It is in this beauty and reverence that healing happens.

I am reminded of the phenomenon of community in nature this week. At the edge of the pond is a magical find. Hen and drake mallards are attending to 11 new born baby ducklings. The grass is taller than they are so it is the brown ripple that suggests this new burst of life on further inspection. What happens next is a lovely demonstration of community. As the dog scampers close to the pond, the mother lifts her long neck for a broad sweep of “the threat”. The drake paddles back and forth in front of his babies. Across the pond 2 very large herons untuck their heads and stand tall spreading their wings hoping to fend off the intruders and 6 large turtles all swim toward us. It is a symphony of action and protection. They all are compelled to protect these darling ducklings. Once we turn and pose no threat they retreated to their spaces.

What a fun and natural reminder of support in a community- even among other species! Wouldn’t we all rally for each other? Of course. Again and again life provides and often we benefit. When we don’t have the strength. When we cannot find a way back. When we are in need, especially unusual for many who are self sufficient their whole lives. When we lose heart and hope. Know that there are others surrounding who will engage, lift, support, care for and pray for and with you. That is how we come back to renewal. Never alone. Always with God’s love providing us with protection and strength. The next day, the ducklings found water and started to learn how to swim. But they did not do it one by one. They gathered and supported each other, following the mother who proudly brought them to a new adventure with confidence.

Let us all share in that confidence this Easter season that renewal is possible, especially when we reach for each other. Happy Easter.

When did you or a loved one recover from an event? Knee surgery, accident, heart attack, hospitalizations, maybe even a kidney transplant! All sorts of ways this rascal of a body keeps us on our toes. Every single issue you have had required recovery time, perhaps rehab, maybe even in-home nursing, certainly rest and nutrition to heal.

When a diagnosis of cancer is made, however, we may have a tendency to think like chicken little. It is intimidating. However, so many improvements are rapidly developing to change the trajectory of cancer treatments to help us be survivors. Perhaps we should take a breath and see this diagnosis differently, not to make light of it, but to add light to life with it. Why allow cancer to hold more power over you than we give to other insults in our long lives? It is not your identity. I suggest we change the narrative in our hearts and be determined to overcome.

It’s a simple switch. Resolve that recovery is possible and then seek out the process. Do not let cancer define you. Didn’t you go to PT after a joint surgery- fully expecting to ultimately heal? Didn’t you nurture yourself after a hospitalization? Haven’t you managed to deal with side effects of medications to enhance your well being? Why not put cancer into this category…. “I can recover this event. I can be strong and healthy. I will work toward my own power, have no fear and not be a victim.”

As we age and 1-2 of every 3 of us is faced with this once terrifying disease, let’s take a different approach and believe. Let’s diminish the impact on our thoughts and have expectations of a healing journey. Why let cancer have the power when we know from our very own experiences that we have strength to manage, recover and come out of the battle with success?

After all, you are the one who heals- not someone or something else for you. This week we can look for a real example of research using our own defense system. TILs (immune cells part of our own body taken right out of the tumor) can be multiplied in the lab, re-injected and shrink tumors previously thought terminal . (Gastric cancer research at NIH). These clever bodies of ours have most of the answers and as we unlock them, let’s have some pride in how truly amazing they are. Well, it is Passover and the Easter season. What better time to have faith?

The men gather in the waiting room at the busy prostate clinic. I am well aware of the discussions and “comparisons” people make there as well as in chemo chairs in the clinic. When meeting with them, many express how great it is to have others “in the same boat”. Then, what comes from these interactions are some treatment -related questions. “Why is he getting 28 treatments and I am getting 44?” (Has to do with staging and volume of therapy). How come some are getting anti- androgen (hormone therapy and I am not? (be glad for it, again related to stage and aggressiveness). How come I had my prostate removed, but still need treatment? (If the PSA has not come down to undetectable- cells are probably still present). Confusing? Yes it can be. What Doctors excel at, thank goodness, is evaluating the research and drilling down a plan of care specific to your case and even the same diagnosis is dramatically different in each situation and person.

Women witness this all the time. Bilateral mastectomies are performed for genetic predisposition even without cancer. But another may have an aggressive cancer and still save her breast, while another will only require a small portion of the breast treated. Still others, whole breast radiation as well and lymph node treatment. Some are managed at surgery with radiation in the OR, others come for 3 weeks, still more for 6 and a half weeks of daily therapy. New research is evaluating no surgery at all if the tumor responds completely to chemo. Your head could spin. Some will receive chemo, others hormones or both. Bottom line… every single case has a very nuanced plan of care. Discussions in cancer conference with other physicians and specialities, look at options, protocols and improvements in management on a weekly basis.

So, while “the boys’ in the center chat it up, support each other and enjoy the camaraderie, it can lead to some confusion and even suspicions. Be sure to ask your doctor what makes you a candidate for your therapy… or even no therapy and watch for now (also common in prostate cancer). Allaying fears, giving confidence, even if it includes way “TMI”.

Bill Gates is famous for saying last month that robots will replace doctors. AI will definitely help physicians and improve discovering cancer treatment meds much faster than current research protocols. While there are some scans, machine work, even displaying algorithms robotic systems will handle, the physician will evaluate all the nuances of data, discussing with peers of all specialties and actually look at and examine the patient. The knowledge combined with expertise and appreciation of all aspects of patient- focused care, will, Mr. Gates, require Docs to keep their day jobs.

The good and the bad (contradictory qualities) emerge the more you learn about amazing discoveries in cancer care. The disease is caused by disruption in our immune cells which decrease as we age (ugh) and even faster with cancer. We have to understand before we treat. Can’t play a game without knowing the rules and so significant research is headed in the direction of boosting immunity. More updates on research this week for example, trying to save bladders (this cancer with higher risk in elderly) as opposed to removing them and instead of just chemo within the bladder or IV, adding radiation as well, now immunetherapy appears to enter the role of treatment leading to organ preservation.

Scientists are looking at CDK2 enzyme as a new target for cancer treatment. These cyclin-dependent kinases are a critical factor in cancer progression. Thank goodness drug companies are finding ways to attack these demons with impact for several cancers. How much do we love our biomedical scientists? Last month blood tests were found to help detect pancreatic cancers at early stages while still curable. Called the PAC-MANN a test at OHSU could save lives.

Need more evidence of amazing discoveries? Prostate cancer is number one for men and still a very high risk disease. Hormone therapy, radiation, some chemo helpful, now a radio-ligand therapy can boost survival for metastatic disease.

So where is all of this taking us? Have faith that your health is so important, researchers are feverishly working to your benefit. These are just a few examples of tranformative therapies. So where is the dichotomy? Well, research also weighs in on our own influence. For example, we all know exercise, eating well, avoiding grilled meats, refined carbs, alcohol and smoking etc impact our cancer risks. A few new studies wants us to be even more vigilant, can’t let the scientists do all the work. For example:
Peanuts are found to impact the blood vessel lining. In 2020 nuts were thought protective but in 2025 we find peanuts are a big problem, for breast and other cancers which may metastasize. Another this week is white wine. There are studies finding that when they tried to drill down the impact of wine, red or white, men and women that women had increased risk, by 22% of skin cancer, with white wine! Cut me a break…. happy hour not so happy! So there is the good and bad. We cannot stop growth and information, Some research will be a blessing while others will wish they never investigated. Just know that while, as a patient we may feel we are in this fight alone, others are conspiring to assist in big ways and… may be even steal some of our joys. Either way, it’s a wonderful new world for cancer treatments so while you guiltily sip your white wine, girls (guys, you are ok for now) rest assured conspiracies are abounding to protect you.

A post meeting exploration found me gazing in awe at the remarkable Western red rocks of Sedona. The majesty never fails to inspire. A hike through the painted desert and petrified forest of Arizona added to the magical experience. Standing in the presence of 280 million year old crystal- filled wood and rocks dwarfs the concept that we in the moment are exceptional. Yet there is an inspiration that unfolds as we witness these sacred spaces. We are all a part of the fabric of the wonder. It is imperative that we value our own amazing power. That we seek out our own majesty and exceptionalism. Why else strive so hard… for success, relationships, joy and battle so fiercely for health and wellness?

We have missions to fulfill. Love to share. Hope to inspire. We do this by developing our own personal harmony with a life that resonates. We are givers who give freely. We are mentors who help others achieve their greatness. We are contributors to a greater good than our own tiny world. We do not bend to whims and influence. We stand strong in the face of obstacles and we overcome. We refuse defeat. We join with our families and with friends, co- workers, some of us with patients to develop a fabric of living vibration that lifts and empowers each other. Cancer does not stand a chance because we rise above it. We recognize that no struggle is without gain. That patience is a virtue on the path of healing. We wear our own badge of bravery that inspires. We each face the day ahead with determination to make it count. Why else suffer the pain, confusion, fear and effort of pushing through? No disease or injury defines us. We are necessary and we are enough.

We will all face uncertainty and challenges, but the work we do is a vital part of the woven fabric of this amazing journey. Stay strong friends. Believe in yourself. Your personal harmonic vibration resonates within and without and will plant seeds of impact for generations.

While you have witnessed the caring for cancer these four years with me, have patience while I share my personal journey with you, friends. I am one to seek out work and explore knowledge, I just put my head down and do the job. Positions and responsibilities have come to me and I step up without seeking any glory. My first career as a Dietitian brought me to age 30. Few knew but I was going to be put up for “Recognized National Young Dietitian of the Year” for my work in both cardiac and cancer management of patients. I declined to participate. I knew I was doing just a fraction of work for complicated diseases. And so, with the unselfish support of my husband and children, I sought out a medical degree to fulfill a life’s mission.

My (surprising to me) successful journey found me ultimately as CEO and operating 5 offices with medical and radiation oncology, becoming chief of staff, director of oncology for several centers as well as Hospice medical director. I was not a cancer researcher as many of my friends are, I just found leadership naturally and patient care always my beloved focus.

I was invited to run for the Board of the American College of Radiation Oncology by my mentor and the College founder Dr Luther Brady. It has been another devotion and I served with pride for 10 years, ultimately President, then Chair of the Board. Now I find myself at the end of this journey.

At the national meeting in Las Vegas Friday, I was honored to receive the College’s Gold Medal Award. I didn’t have to jump hurdles, but did cross many. I didn’t have to sprint the fastest, but it was a marathon. As with any achievements, it’s all about support and family, friends, fellow physicians and staff have all played a big part in the successes and so I share this amazing honor with them. It comes toward the end of a career of passion and joy, a true privilege. And so, dear friends, celebrate with me. When we honor someone for contributions, for leadership, for driven excellence and for academic achievements, we are all lifted. We recognize effort, diligence, devotion, character and integrity in each other and that helps us all to aspire. Thank you to all of my mentors and fellow physicians upon whose shoulders I have stood. I am grateful and humbled as I accept this amazing honor.