Category: Cancer support

The phrase “go big or go home” doesn’t apply to cancer care. As the ASTRO (American Society of Therapeutic Radiation and Oncology) wraps this week in San Fran, thousands of docs learned even more about the strange, wonderful, clever and challenging issues regarding cancer. An overall thread running through is how genetics of body and tumor, nano technology, neosomes and epigenetics play such major roles in managing cancer. It’s all about the tiny… microscopic and even nanoscopic.

What’s in it for you when cancer is such a big and overbearing factor in your life? The minutia are so meaningful. Even discovering how cancer outsmarts us makes us smarter. We find that even the oft used radiation for spinal mets, is improved with genomic profiling to see who responds. Adding systemic (through the body) treatment to local radiation for metastatic prostate is synergistic (EXTEND trial). Confirming that stereo radiation is comparable to surgery for some lung cancers. For those hobbling, low dose radiation for knee arthritis shows promise. (Just cancelled my planned knee replacement in a few weeks to try this). Simple genetic test tells us who benefits from hormone therapy for prostate cancer and another presentation, if lymph nodes need therapy or can be avoided.

Just a few examples of practical use in the clinic that is changing every month. This week, Charles asked if he could stop hormone therapy since it is causing such dramatic muscle weakness… a newly developed test could help him decide. As we head into Breast cancer awareness month, great strides in localized breast as opposed to whole breast treatments were discussed and Muriel who was “gifted with abundance” will benefit to avoid large fields of radiation damaging the breast.

In the center this week, I was delighted to see so many genetic tests leading therapy. Certainly a change from a year ago. So, friends, have faith that once again with powerful world wide knowledge, there is improvement coming your way. Discovering the cancer may start the new dynamic in your life but be assured, as you navigate this bumpy terrain, the ground is shifting and hope is here in abundance.

Up and down the East coast this week people prepare. Lifeguards set up stations and red flags are flown for fierce rip currents. Living and working near the beach requires heightened awareness. The hurricane season is flexing muscle, so please be safe.

For Sally it is another kind of preparedness and I hope to help and advise her and her husband, James. The scans are sadly terrible. The two years flew by and the treatments are now unfortunately outsmarted. Damn cancer. He is weak, tired, deflated and she is terrified. “Doc, Jim has taken care of everything for 52 years. I wouldn’t know where to begin”. The patient nods his head. Because Sally is very active and social, she will most likely have years beyond James. I advise a plan. Sally needs to accept. Put down the pickel-ball paddle, move away from the majhong and even give up gardening and sit with James. His closure needs to include setting Sally up for success. He is tired but has more work to do, something he has been putting off. He now needs to make lists of finances, banks, insurances, deeds, advisors, even handymen. There are websites with more info. Consider power of attorney or at least medical power. Sally’s hands wring and I know she is concerned for herself, but James looks relieved as I to push to empower her. Having a Doc advise these necessary steps is an awakening. She cannot be naive and helpless.

Why message this today? Because Sally and James portray a very common dynamic. We must set each other up for success- even if it is a sibling or child. Share the knowledge. Help to make their lives easier. There will be enough drama when the time comes. If they can be assured of their own ability, then you have continued to enrich their lives. I have discussed this often, but for some reason, this dynamic presented, so I assume someone needs to hear it today. I recall Herb. Before his wife passed, she finally taught him how to do his own laundry and care for the house. He was so proud and they both giggled as they bonded over the mundane.

Caring for others isn’t doing for them. It’s empowering them, even if they resist. Sally pushes back, “I am not smart enough for this”. If she cannot gain confidence, then they need an advisor. Every single day someone is moving into a more challenged dynamic. It is best if we don’t leave loved ones to struggle too. It takes work and you may not feel strong enough, but you and they will be relieved that you worked on the next chapter together. Don’t let cancer care steal family care. Trust that your loved ones will be very grateful and that your devotion now will live on.

In the inky predawn the tiny bunny scampered across the road. Good that the headlight caught his bright fuzzy white tail. He brought a smile to start the day. Several minutes later engulfed in the warm (it’s Florida) pool water, I was treated to a magical arc of perfectly spaced birds (about thirty!) traveling over head. I marveled at how really miraculous even the smallest demonstrations of life are.

I was blessed to have a wonder filled vacation to the lush green isle of Ireland last week. Crisscrossing from Dublin to Dingle from Killarney to Kinsale, the castles, coastlines and pubs, while stunning and fun, it was the friendly and embracing people we found most memorable. While there was much beauty to savor, the cameras came out for every delightful demonstration of wildlife: the comical donkeys, feisty Shepard dogs herding the sheep, the goats of all types balancing on the slabs of scale, the horses and cows creating even more interest to the pastures, all adding to the peaceful backdrop of nature.
What all of above has in common is one fact. Life matters. Whether it’s wildlife, nature, family, friends, patients, every aspect should be revered. In cancer care we have the sacred pledge to hold the lives and hopes of our patients in our own hearts and hands. How critical to protect on all levels, never taking a moment for granted. To honor individuality and nuances of each living being and person.
We offer prayers, thoughts and outreach to friends and family when a loved one is lost. This weekend my dear friend’s brother died. Ensconced in a loving and devoted family, the loss will be hard. It always is. In healthcare, and especially cancer management, we tread lightly and reverently daily. We never ever take the morning, the work or the sacredness for granted.
Today, let’s all just take a breath and a moment to cherish. Life is precious, always. Can we be kinder, less judgmental, appreciative, respectful? Of course. We do not need concern for how we are remembered. We just simply need to love, enjoy each other and be grateful today.
God Bless dear friends.

The gains are developing so fast and furiously, it is becoming hard to keep up. Isn’t that wonderful? Need some examples?

Researchers at CHOP (Children’s hospital of Phila) discovered that hi grade glioma brain tumors have tiny pieces of mRNA missing which make it hard to treat these cancers with immune therapy. They are developing a plan targeting the cells with new immune therapeutics and expect to role this out to adult GBM and neuroendocrine tumors (August 15, CHOP)

Even with chemo, AML (Acute myelogenous leukemia is notorious for re- appearing (Blood Cancer Discovery) A way to potentially disarm the chemo resistance by flipping a genetic switch is in the works.

“Nature Medicine” published that for high risk pancreatic and colorectal cancers, that recur after therapy, a vaccine targeting genetic mutation was effective in 90% pancreatic and 50% colo-rectal cases. They added a delivery system carrying the vaccine right to the lymph nodes where immune cells are held.

Too complicated? How about tapping into something that YOU can work on? Evidence shows that 30 minutes of exercise (especially for our lovely breast cancer survivors) can stimulate anti cancer myokine protein production during and after treatment. So “just do it” becomes a cure enhancement.

Columbia Engineering built a cancer therapy that makes bacteria and viruses work as a team. Stay with me. Bacteria have affinity for tumor cells. They tapped that power and hid cancer killing viruses into the bacteria to sneak past the the immune system (Native Biomedical Engineering). Get outta here!

Virginia Tech is working with MUSC to develop a way to target the dormant GBM cells that recur, wake up after therapy and rebuild tumor. JM2 a small peptide was found in mice to attack the GBM stem cells while unharming normal brain cells, offering hope for attacking the root cause of recurrence.

Most common in men…Already for prime time , hyfu and focal treatments for localized prostate cancer, as well as pluvicto radioligand for metastatic prostate. How about most common in women, breast cancer research have scientists now looking at western honey bee venom therapy. Come on.

If it wasn’t so fantastic, it would be exhausting. This is information just in August 2025. Can you imagine what is to come? Yay for science, hooray for patients and yes, I am a geek.

A support network is critical during a cancer journey, but having a strong network of friends may actually help you escape that drama altogether. The CDC found that people with strong bonds have a 50% higher likelihood of survival. Meaningful connections are found to also reduce risk of severe health issues such as cardiovascular, stroke and high blood pressure. Friends help you cope, which makes you more resilient. They care about your well being and offer advice. They improve your self worth, confidence and sense of belonging. It’s not about numbers, it is the strength of even a few connections.

You most likely spent the majority of your life to date caring for others, raising children even grandchildren, supporting a spouse, helping siblings and parents. As we age many of these relationships have grown, changed and even moved on. Now we become the ones needing care. Others in similar situations are often more available than family (often living far) or relatives who have needs or have passed. What is becoming the solution?

While many are embracing the senior living concept (not nursing home or assisted living). Dynamic fun filled relaxed days with like minded seniors are a big growth phase now. Developments offering options are selling out quickly. So what have I learned with many patients in the midst of cancer care and senior living? Gretchen told me it was good at first and she didn’t become a burden to her children. There were others to check in and even drive her to treatments. That’s great. But….. as the journey continues, others develop their own needs or grow weary of care giving when the pickle ball (addictive) awaits. So Gretchen is moving out of the village and going into an apartment with some days of home health care. “Doc, now peace and quiet is a plus and I am still not a burden”. For Terri, the solution is more intimate and a really rapidly developing one. Friends choosing to live together. Hire cleaners, trade off or hire a cook, care for the home, drive each other to activities or appointments, even have a nurse or aid come into home to check up. This communal living is a great way to establish health and well-being with camaraderie and serve a developing need. Folks gravitating to the excitement of big active developments are not ready to downsize their living adventures. While women have greater longevity, I foresee this new communal space growing. Even Steve said, “Doc this is my friend, Joe who is bringing me. We decided after our wives passed to consolidate living. It’s less expensive and nice to have someone to talk with in the next recliner. Once a week we still play golf with our buddies.”

Today is a reminder that you did the work. You launched your family. Now look around an make way for the next chapter by taking control before someone else does. As I said recently to a friend, children cannot and should not make a new life for us. The best way to support them is to take care of ourselves into senior -hood and secure our own safety. It may even come with fun, probably some wine and now we know, definitely improved longevity.

It’s Labor Day weekend and the party is over. “Can’t we get one more long weekend before we start up again?” Nope! Vacation is over and kids are back to school, college, dorms and parents are investing in their future. As a physician, I am leaning into this dynamic because all of it will benefit all of us. These younger generations have to get a move on. No more summer job, lazin by the beach, traveling on trips and slurping ice cream. They have things to do, people to see and……..patients to cure.

That’s right. These brilliant “youngsters” are the hope for the future. They must explore nuances of nano particles. They need to imagine immunotherapy in new ways. Even to drill down and find out why and how all the treatments to date are not enough. Take the tough ones: pancreatic cancers… so many gains just this summer. From new surgeries and immunotherapies. Even now a new finding regarding GBM. Treatment can be successful but scientists have recently discovered why it is difficult. A few cancer cells have been found to cause all the mischief by hiding from therapy then regrowing. Attacking these cells is becoming the goal. Now who is going to look at these complex issues and discover the next best cure?

So get crackin’ “kids”. There are people waiting for your brilliance to save them. You, and every single discovery, is certain to impact patients, families and the world. We have faith in your enthusiasm. We too have responsibility to guide you to greatness. We can encourage and help you believe that all things are possible. Parents are the real influencers. Ha! You thought you were done when you sent them off to school….no -no there is much more to come and become. For the students, you are our super heroes. Good luck. Do your best. Be brave and…. thank you.

The tech calls through the microphone to the patient on the treatment table: “Take a deep breath and hold it. Ok, let it out alittle”. This goes on throughout the entire treatment about 15 minutes and allows for treating a left sided breast cancer while moving the breast away from heart and lung. Dr. Frank Vicini from Michigan, a famous breast Radiation Oncologist has well documented the “deep inspiration breathhold technique” resulting in less risk to normal tissue using this technology. The beam can only turn on and treat if the patient is within the range; computerization of care is everywhere.

Too technical? Guess what? Today’s message isn’t about this. Instead, it’s about letting the breath OUT! When we evaluate people diagnosed with a life threatening disease, I find they are physically holding onto that breath. It is why its so important to help them see the light, express themselves, be part of the decisions, regain control. You cannot talk and think if you keep holding your breath. The sighs of relief when we set the plan, discuss options and deliver verdicts are real.

Docs know you are frightened. That your family is searching for hope and assurances. That there is fear, some anger and disappointment that you have been dealt these cards now. Trust that you can take a breath. Nothing is happening to you today. Just enjoy this moment. Stop anticipating and worrying. “Oh, easy to say, Doc, but…..” No, its actually easy to do and stimulates the parasympathetic nervous system to bring stress relief. (Try box or 4-7-8 breathing* to help with awareness).

I headed out today to the water and did my own breath work. The hurricane this week has passed, thank goodness, and as the sun rises over the now peaceful ocean, the clouds are in the way. But what I notice is how even more spectacular the view is, because the high, multicolored puffiness is brightly outlined by the glow behind. We know the sun is there, we are just waiting for the clouds to move on. Rest assured they will. Every day will not have drama. Every breath will not be stifled by fear. As I left the beach, a friend passed and called out, “Hey Joanne! I had my scans Friday and they are all good!!” He was most likely holding his breath for those results. But, even with a history of two separate and both life-threatening cancers years ago, not one day is taken for granted. I see him walking with a spring in his step daily, a smile and exuberant greeting, engaging with others, enjoying every moment. I believe that impacts his immune system and heals.

Breathe boldly. Expect great things to happen. Take control. No one can do it for you. It’s all you. Your blessed breath will bring the lightness, hope and even joy into your body and mind. You do have the power this moment to nourish and restore. So no holding your breath this week (unless its part of the therapy! )

*How box breathing can help you destress”: http://www.Clevelandclinic.org

This discussion of cancer can always go either way. At one point we are all in. We are not going to allow cancer to play this game and ruin our lives. We will be tough, fight back and bully these damn cells. Who the heck do they think they are to mess with us?

Take one of the most aggressive cancers, GBM. This brain tumor is treated with surgery when possible, definitely chemo and radiation now immunotherapy, tumor treatment fields or Optune head device and we never give up pushing it back. Scientists have just now discovered why this is so tough to manage. Long term, cells that “hid ” from the therapies regrow. Now that they know this occurs, they are working to target those cells specifically….so more is definitely more and even more is yet to come and bring hope.

Then there is the ubiquitous breast cancer. As many of us age, and one in eight women are diagnosed by 80, managing this disease with ease becomes the main goal. This week I was able to perform target therapy in the OR for two cases both over 70 years old. No further chemo or radiation needed. Just a device with a ball at the end inserted into the tumor bed at surgery, radiation applied (safely) then off to hormone anti estrogen therapy for both patients. That’s just great. New research last week found that there was no overall survival benefit or decrease in recurrence rate even for aggressive breast cancers over the age of 70 with chemo. That there were many side effects, and chemo brain, so, this may really not be necessary. So a less is more approach.

What is fascinating about these cancers along the spectrum is how not only must we learn to get mad, aggressive and pound the cancers that are so insulting as to rob us of years, but that we are also learning to be gentle and wise, avoiding unnecessary damage as seniors that can rob us of function.

I’ve mentioned before that it’s no longer to “Do everything for everyone all the time”. The goals are now increasing awareness. Definitely age factors in as well as those wanting quality time. Like Jim said so well, “Hey Doc, I’m 86 years old- you think I am gonna live forever? Leave me alone!” Your physicians are aware and they also want what is always best for you. Keeping the dialogue going is imperative to these choices. This is your journey. We may guide, but don’t be afraid to challenge and advise. Your goals are all that matter.

Even if you are not in one of the 15 (!) states to see the northern lights this weekend, there are alot of celestial happenings. Did you catch the brilliant full moon? How about the planets Venus, Jupiter and Mercury in alignment? So vibrant in a dark sky. It’s as if the heavens are speaking to us through light and power. Not impressed? How about this…

While everyone’s hair is on fire about the use of vaccines in the MAHA movement, scientists across the pond are busy designing vaccines for therapy. Not to avoid a cancer, but after the cancer is already growing. Working off the mRNA findings used for the Covid vaccine, they are now harnessing the power to create life -altering, much needed enhancements to our armament against cancers. Over 100 patients with head and neck cancers will receive the treatment, adding to their cutting edge use of vaccines for bowel and skin cancer. Fifteen hospitals in the National Health Service will be offering these in the next year.

Not to be out done, there is significant work here at home. (Brits are better at tooting their horns) According to our own NCI, cancer treatment vaccines are an immunotherapy that help us to treat our cancers using our natural defenses. They work against the cancer cells, not the precursors that cause cancer. They attack the antigens in cancer cells, teaching the immune system to recognize these proteins and destroy them.

Currently approved vaccines include Provenge for prostate, BCG and Adstiladrin for bladder, Imlygic for melanoma. Trials are underway for pancreatic with mRNA, Head and Neck HPV tumors, and at Cleveland Clinic a preventative vaccine for triple negative (aggressive) breast cancer.

Ask your own physicians about trials available. Do your homework. If the routine care stopped working and the disease is advancing, get creative. Find a specialist in your cancer type who may have more tools available. Often, you can still receive the recommended therapy by your own physician and have testing and blood work close to home.

Even when the darkness overwhelms, have faith that the stars are aligning in our favor. Make the effort. You would travel for vacation, so, do so if necessary for health. You and your loved ones are worth it.

For more information go to http://www.cancer.org for the updates from ASCO July 2025, Memorial Sloan Kettering cancer trials, cancer research.org.

This morning I was “hit by a Mack truck”. Well actually it was parked and I walked into the enormous side mirror, clocked my head and almost passed out. Sheesh! I would need that like a hole in the head. Good thing I was at the market so I grabbed a bag of frozen peas to buy and that controlled the expected huge lump! But everyone gets a chance at a “Mack truck moment” and cancer provides it in spades. No Doc, it’s just a lump….. No it’s just a headache. For thousands of patients I have seen over thirty years, it always starts with “just”. While a diagnoses of cancer is usually unexpected, how we impact the diagnosis and result is in our control.

As insurers are squeezing the healthcare out of your paid-for plan, and Docs are getting more and more scarce (you know this by now trying to get any appointment lately) being your own advocate is incredibly cumbersome but really important.

So, when to see a doctor?

Let’s start at the top. Any neurologic dysfunction requires an MRI – always. Think its a stroke, a headache that doesn’t go away? A change in speech or decreased memory or inappropriate behavior. Tell your doc you want an MRI.

Head and neck. No it’s not tonsillitis at 70 years of age. It can be HPV positive head and neck cancer or smoking related cancer. Ask for an ear nose and throat doc and a scope, especially a scan if there is swelling. Norm said he went thru rounds of antibiotics for months. His new found base of tongue cancer now is in the lymph nodes.

Chest: A cough that does not resolves in a week needs a chest xray at minimum. Any coughing of blood, a CT scan and probably scope by a pulmonologist.

Fullness in the belly not weight related? especially if there is any pain. You need a CT scan- pancreatic, liver and ovarian can increase fluid in the abdomen quickly. Seem off color? Yellow eyes and dark urine requires CT abdomen to r/o pancreatic or bile duct cancer.

Up at night to pee? You may have an enlarged prostate, but what is your PSA and family history? See a urologist. Blood in urine- do not let them just give an antibiotic. See urology for a scope. Bladder cancer increases with age.

Bone pain that is increasing, not intermittent requires an MRI, ask for it always. Multiple myeloma may be found or metastatic cancer to bone. Skin issues are everywhere…This spot isn’t going away and changing color…and now it’s bleeding – its skin cancer so get it biopsied.

Peggy told me she hasn’t had a mammogram for 30 years because she gets CT scans for lung screening (since she was a smoker and thought it would show there). No it doesn’t. When she found it, she had 3 lesions and needed surgery chemo and radiation, now hormones. “But no one in family had breast cancer.” I replied , “But 85% are not genetic”.
Yes, everything is cancer to me until proven otherwise. Mostly all the aches, pain, memory loss, skin “marks” are really signs of an aging body. But wouldn’t you like to NOT MISS something important so that you are not blindsided? We don’t need the clunk on the head. We just need to be aware of our bodies. You can’t wait until a yearly check up.

Self care is hard work and takes vigilance. No one knows your body like you do. Docs rely on your own insight; they are not clairvoyant. With one in two-three of us developing cancer in our life time, we cannot become complacent. Treatment, even for the most aggressive tumors, is most successful when found early. Be your own watch dog. Pay attention. Don’t wait for a yearly check up to take action. I say we should expect the unexpected to have the greatest chance for success. You are smart. You can do this, and frankly health is everything. Best wishes, friends.