Today, people are living much longer after a cancer diagnosis and treatment than in the past. In this episode, Chuck and Alicia talk with Dr. Anne Blaes, a medical oncologist and leader in cancer survivorship at the University of Minnesota, about what it means to live well with cancer. They look at how survivorship has changed over time, the importance of multidisciplinary care, and how precision medicine could help prevent long-term complications.
[00:00:03] This is The Good News About Cancer. I'm Dr. Alicia Morgans. And I'm Dr. Chuck Ryan. We're oncologists, and we've spent our careers working to understand cancer. We believe that there's more progress now in research and treatment than ever before, and we're here to share that with you. In each episode of this show, we talk with one of our colleagues about a promising development in oncology. We'll break down what's new, why it matters, and how it points the way forward.
[00:00:29] The fact that we have better treatments, we have more treatments that cause less side effects and toxicities, and we have a growing number of people living on medications, that's an exciting time. So, Alicia, you know, one of the things that our listeners may not have a full understanding of is that we often are recording our podcasts after literally just walking out of our clinics.
[00:00:54] We're seeing patients, and then we finish that part of our day, and we come over and record a podcast. And you are affected by this much more than I am because we are literally recording this minutes after you finish seeing patients. So how was your clinic today? Thanks for asking. Clinic today, like most days, was actually really great. This is why we do what we do. We get to see patients and try to help them as they're going through some incredibly difficult times in their life.
[00:01:20] But today, I had an especially fantastic experience because I saw one of my patients who travels from Maine to come and see me, and he's finished his cancer-directed therapy, the medicines and the radiation and treatments that he's needed for his cancer, and is in follow-up after all of that is over. And he was so excited to see me today because he could not wait to share that what we had talked about at our last visit
[00:01:47] related to him getting on a standardized and routine exercise program has worked for him. It's something that has absolutely transformed his day-to-day. He's now playing tennis multiple times a week. He's staying active and fit. His mood is great. His attitude is great. And his energy levels are up. And he just feels like he's doing all the things that he needs to do to feel like himself. And I love talking to people who have had that experience.
[00:02:14] And it's wonderful to be able to focus on that rather than necessarily always focusing on cancer, even though, of course, we're in a cancer clinic. Well, as you put it, this is why we do what we do. And, of course, I think I can speak for my fellow oncologists and everybody who works with cancer patients that we do what we do to be there for the hard days and the bad moments when we have to be.
[00:02:40] But we also do what we do to be there for the good days and the great moments. And I think it sounds like you experienced one of those today. And the patient you saw is now one of the 18 million cancer survivors in the United States, which is not a small number of people out there. And you have a very pivotal role in serving that community as the director of the adult survivorship program at Dana-Farber.
[00:03:06] You're very influential in the field in doing that and are really sitting at the front row and helping to shape a new field of medicine. Thank you so much for saying that. And I appreciate that at Dana-Farber, in the survivorship program, we are able to focus on this. And I would also say that every oncologist, to some level, is trying to focus on helping people live well after a cancer diagnosis. But at programs like ours, as well as the program at University of Minnesota,
[00:03:34] this program, of course, led by Dr. Anne Blaise, who is also the division director of hematology, oncology, and transplantation, as well as being the co-director of the Cancer Prevention and Control Program at the Masonic Cancer Center. She works in this group to advance the science, to build this newer specialty in oncology, to ensure that every patient can live well after a cancer diagnosis. Anne is a friend and a close colleague and has done a lot of thoughtful work over the years
[00:04:02] in forging the program there at the University of Minnesota on cancer survivorship, but also in building this field of cancer survivorship, not only at that center, but across the country and indeed around the world. And she had a lot of wonderful things to say in our recent chat with her. So let's take a listen to that.
[00:04:30] Anne Blaise, it's great to see you and great to have you on the Good News About Cancer podcast. We're focusing on cancer survivorship, which we think is an area of very good news for cancer patients and cancer survivors. Maybe you could start off just by telling us, Anne, what is cancer survivorship and why should we be focused on it? Thanks for asking the question, Chuck. Chuck, so I could talk for a super long time about this topic. And I think just like you mentioned, it is good news.
[00:04:57] There are over 18 million cancer survivors in the U.S. today, and that is a number that continues to climb. And I would say not only do we have a growing number, we also have a growing number of older individuals and longer-term survivors, so people that are 10, 15, and 20 years out from their cancer diagnosis. And that's really exciting. That is not something when I started my career that anyone was really talking about.
[00:05:25] We also have a growing number of people living with cancer. So initially, when people thought about the topic of cancer survivorship, this was really brought up back in the early 2000s when a landmark report came out by the Institute of Medicine. The formal title of it was called Cancer Patient to Cancer Survivor Lost in Translation. And at that time, I would say the highlight was on people that were cured, but recognizing that they actually had a lot of unique needs.
[00:05:54] So they had a higher risk in some situations of things like cardiovascular disease, of secondary cancers. And I think if you're talking to anybody who has been touched by cancer, they'll also talk to you about the psychological impacts, the impacts on finances, the impacts on their families. So I would tell you this concept started back in 2006, really focused on thinking about those unique needs of individuals cured from treatment.
[00:06:22] But really, over the course of the last two decades, we've recognized survivorship as a much broader topic. And we're really talking about anybody from the time of their cancer diagnosis through the trajectory of their care in their life. And I think that's what's so important. You can be a cancer survivor living with cancer. You can be a cancer survivor living after cancer. And sometimes the needs are the same and sometimes the needs are different. But all of them fall under this umbrella.
[00:06:49] And it's all actually an area of significant advance because it's a relatively young part of the cancer field. And as I think about that and as we have the opportunity to talk to you, I would love to hear from your perspective, what are the maybe top one, two, or even three things? If you had to say these are the biggest advances in cancer survivorship in that last 15 to 20-year period, what would come to mind? Yeah, it's a really good question.
[00:07:18] I think first just defining it, right? So recognizing that it's not just about trying to treat cancer. It's not just about the latest chemotherapy or vaccine trial or immunotherapy that's come out. But it's really about how cancer affects the whole person is how I think about it. And if I had to sort of say what are the biggest advances, I think it's the fact that we've had advances in treatment. So people are living longer.
[00:07:45] We've had a lot of advances in symptom management and supportive care. So that's everything from how do you control infections? How do we control nausea? I would say some of the other is recognizing actually the benefits of things like physical activity. And actually, if we control symptoms, we help people live longer. So when all of us sit and prescribe new therapies for people, if we can help control symptoms, people live longer. And to me, those are probably like the biggest advances.
[00:08:14] It's almost like there's been a pivot in almost like the frame of mind of being on cancer therapy. Perhaps a generation or two ago, it was you have cancer. You're sick. It's your role to be sick. And what survivorship isn't allowing you to do is say you've got cancer. You're getting treatment for cancer. But it's your job to be healthy, right? In a way. And you would think about of the 18 million survivors out there, many of them have gone through chemotherapy, hormone therapy, immunotherapy, surgery, radiation, etc.
[00:08:42] And they've come through it with a better awareness of their health. That's kind of what I kind of hear you saying there. And that I think magnifies across years and people as we think about that. Yeah, I always think about it as or oftentimes the way I talk to patients about it is how do we keep you living well? Yeah, exactly. So whether you're cured or you're living with your treatment, like how do we keep you living well? And how did you decide that you wanted to work in cancer survivorship? Was it an active decision?
[00:09:12] Were you just doing your thing as a breast oncologist and arrived on cancer survivorship? How did that happen? I think about key people that I worked with. And one of them was a mentor of mine who honestly was a lymphoma expert. And at the time of where he was at in his career, I thought he took really good care of patients. And he had a growing number of people who were now having other problems, heart disease, second cancers, and breast cancer being one of them.
[00:09:41] And that's really what led me into sort of breast oncology and really wanting to build a program. So I hold a lot of that to a mentor and then several patients that I met along the way. I'll tell you about one patient of mine. She actually, she was a young mom in her 20s who was diagnosed with Hodgkin lymphoma. This is now like 50 years ago. At that time, she had young children at home. She was treated with chemotherapy and radiation to the chest area. She was cured from that.
[00:10:11] And as she aged, she had come into our survivorship clinic and knew she needed cardiac monitoring because of the radiation that she had. And also needed breast cancer screening. So she was diagnosed with breast cancer later. So she ended up living with her breast cancer. But it's actually not her cancer that ended up taking her life. So it was another decade or two later. And it was ultimately heart disease that took her life.
[00:10:40] And so I think many times as oncologists, when patients come to us, they're scared, like cancer is going to be the end of my life. And in this case, she lived many years with two different cancers. She got to see her kids and grandkids grow up and lived a very healthy life. So you're a medical oncologist. You treat the cancer and you do survivorship.
[00:11:07] Are most of the people who are focusing on cancer survivorship, if you will, sort of leading these teams and developing these plans coming from an oncology background? Or do you see people from other medical backgrounds who are taking on general cancer survivorship, if I can use that term, as their discipline? Yeah, thanks for asking that question. You don't have to be a medical oncologist to have an interest in survivorship. And I think that's what you're alluding to. A lot of the programs are led by really a champion. And what might their background be?
[00:11:36] It might be in nursing, honestly. There's a lot of nursing individuals and nurse practitioners who help oversee and manage programs and clinics around the country. Similarly, PAs who take an interest in that. There obviously are MDs. And MDs may not all have oncology backgrounds. There are some who are radiation oncologists who have really focused their careers on thinking about how to build programs.
[00:12:02] And in some programs, they're also led by like an exercise physiologist who's really had an interest in it. And they're the ones building the programs. Primary care. So there are some examples across the country as well where it's actually primary care providers who are really leading this. They oftentimes have worked closely with oncology to make sure that they understand all the cancer treatments, what do they need to be looking at, and then really facilitating that across primary care clinics.
[00:12:32] And there's several models of that around the country. So rather than being a subdivision of oncology, cancer survivorship is emerging as a standalone medical discipline. Fair statement? Yes. So we don't have a separate board certification yet. There are certain fellowships or research programs or years to actually have a certification. It's something Alicia and I sit on many conversations of, should we be developing a certificate for expertise in survivorship?
[00:13:03] So you alluded to these other folks on the team, Anne. I wonder if you can flesh that out a little bit for us. Survivorship is truly a team sport. Regular cancer care is a team sport, but we bring in other people on the care team when it comes to cancer survivorship and ensuring that patients are thinking more holistically. Who are some of the people that are key on the team from your perspective that you include in that?
[00:13:28] So when I think about who's on that team and recognizing that not every single patient is going to need to, say, meet with every single one of these individuals, just like not every survivor is going to be at risk for certain complications either. But who's part of that team? I think that it's genetics saying, hey, am I at risk for another cancer or is my family at risk for this? Nutrition. I think nutrition is extremely important. Our mental health providers are really important.
[00:13:57] In most cases, in most programs, there's some kind of connection to integrative health, whether that is thinking about spirituality and mental health with that or nutritional components with it. Physical therapy, occupational therapy, physical medicine and rehabilitation specialists. Social work and financial counselors are also part of that. And then on the medical side, there are certain specialists we think about. So cardio-oncologists, for example.
[00:14:26] Some survivors may be at higher risk for cardiac complications depending on when they were diagnosed and what kinds of treatments they had. And I think they are also important in the team. And then the other thing we sometimes forget but is actually super important is on the prevention side. So helping with addiction and tobacco use are also important. This all sounds great. There's a team. We've got the nutritionists and the physiologists, the exercise physiologists.
[00:14:55] But what can a patient who's listening to you today take back to their treatment team about survivorship that they should be asking or that they should be asking for, I should say? I think, first of all, recognize that there's actually a lot of services and things to support them that are around them that oftentimes patients don't know about. Or they hear about later and they're like, oh, my gosh, I wish I had heard about that like nine months before this.
[00:15:22] So I guess what I would tell a patient is know you have all these other resources around you. Sometimes they're in your health system. So ask. And if your oncologist doesn't know, the nurse navigator, your coordinator, they also know resources. So take advantage of that. Community resources are a great way to. And I'm being a little vague in my answer just because if you're having neuropathy.
[00:15:59] It's a very general question. If you're working three jobs because you're financially strained from how this has impacted you, then know there's social workers and financial resources to help support you. So, Anne, what would you say to someone maybe with a new diagnosis who's trying to even anticipate that whole journey? Is cancer survivorship something they should think about? And if so, what's the good news there?
[00:16:24] I think every patient should be thinking about cancer survivorship, even if they're sitting in front of me and they're like, I don't know if I'm a survivor. I'm going to tell them they are, but I would say, fine, if you don't want to use that term, that's okay. But everybody should be thinking about how do I live well? So what I would tell them is be hopeful. I think hope is really important. Hope sometimes changes along the course of a cancer trajectory, too. Like if you're a young adult, hope may be I want to have a baby and get married.
[00:16:52] When you're older, it might be I want to see a grandkid's graduation or I want to get to somebody's wedding. You know, I think hope is a really important thing. So I guess what I would tell a new patient is hope is important. Think about what that means to you. And there is a lot of reason to be hopeful today. The fact that we have better treatments, we have more treatments that cause less side effects and toxicities, and we have a growing number of people living on medications.
[00:17:22] That's an exciting time. And I think the other thing, Alicia, I would say is there's also a lot of work going on in precision medicine, thinking about who develops toxicities from drugs, who has certain things in their innate genes that puts them at high risk for second cancers or for cardiovascular complications. And that's also an exciting thing to say longer term. We may not have some of those issues.
[00:17:48] So from my perspective, I would say we all have a lot of hope and we learn from patients. So help us, too. So if you're having concerns, bring them up. And there has been a craze in the last few years on this concept of precision medicine, really identifying what is driving an individual's cancer,
[00:18:12] whether it's their inherited genes or something that's unique about the cancer, and trying to match special treatments to those individual drivers of those unique cancers. And I wonder, does that push in precision oncology end up affecting cancer survivorship in any way? Yeah, it's such an interesting thing because I think most people, when they think about precision oncology, they think about, I have a cancer.
[00:18:40] Let me look at the genomics and features of it. And how do I have drugs or treatments that specifically tailor that? In thinking about it from a survivorship perspective, I think there's a couple ways I would think about it. Around how do you look at a person's genomics and who might actually get toxicity from treatments? So, for example, there are certain SNPs that put people at higher risk for cardiac toxicity from certain drugs like anthracyclines.
[00:19:09] SNPs being minor variations in a gene. Yes, Mitabadi and the group out of the Childhood Cancer Survivor Study, they've actually done a fair amount of work in identifying what some of those are. And that's just one example of the precision piece of it. I think another example of it would be, again, using the Childhood Cancer Survivor Study, but looking at childhood cancer survivors and who may also get second cancers or be at risk for those, really looking at genes and particular drug exposures
[00:19:39] and developing specific risk stratifications with those tools. I think that's really exciting. I think there are also advances in things like CHIP, this clonal homatopoiesis, which is a big bunch of words there. But essentially, these are abnormalities in some of our white blood cells that might predispose us to getting heart disease just in our regular lives.
[00:20:03] And there is some thought that some of the therapies that we give may actually increase some of these abnormalities and that those individuals may be even at higher risk of developing these complications. I love that, again, this field of survivorship is going in the direction of trying to understand at the most basic level so that we can really get into prevention and tailoring our responses to people's complications from their treatment or from their cancer
[00:20:30] in a way that is just as personalized as the treatments that we give for their cancer. I agree with you, and I think the more we can understand the biology of many of these chronic health conditions and the predisposers for them, I think that helps us to do secondary prevention. So if we know what drives the original development, for example, of cancer, we can look also in a similar setting, CHIP being one example, in cancer survivors also for secondary prevention.
[00:20:58] So Anne, in the beginning, you cited the Institute of Medicine report, and I forget the year it was, forgive me. But as you look back to when that report first came out, what do you think are the key goals that have been met and maybe the key unfulfilled opportunities or goals that have not yet been met? So I think the report itself really made us aware of all these other unique things that cancer survivors need and unique things that they're at risk for.
[00:21:27] We've spent some time talking about them as a whole. Where have we actually come or where are there still gaps? You know, I think the biggest gap is we've done a lot of research to say, how do we look at somebody's treatment and what age they were when they were diagnosed and what exposures have they had and how does that impact their risk for another complication, for example, as they get older? I think what excites me the most, though, if I think about the Institute of Medicine
[00:21:54] and where we were back in 2006 compared to where we are, is that we're talking about this in your podcast, which means we have a larger number of cancer survivors. We have a growing number of people living with cancer, a growing number of people interested in it from many disciplines and how to best support patients and help people continue to live well. Anne Blaise from the University of Minnesota, it's been a pleasure talking with you and working with you for many years
[00:22:23] and seeing the work that you've done and the positive impact you've had on not only the patients you treat, but the field in which you are a leader and the other physicians around you who you also lead. So thank you so much for joining us on The Good News About Cancer. Thank you for having me and thanks for all the work you guys are doing in this space.
[00:22:50] You know, Chuck, it's amazing to think about the progress that has been made in just 20 years since that Institute of Medicine report back in 2006. At that time, there was no real subspecialty in cancer survivorship. It was clearly noted to be a deficiency. And since that time, there have been programs popping up across the country. There's been research, there's been emphasis, and there's certainly been a recognition by patients
[00:23:19] that it's important and wanted by them too. Yeah, I think that highlights a couple of really important things. First of all, the Institute of Medicine, which is an organization that basically says, here's a deficiency, here's a problem in medical care that we think needs to be addressed. And then people like Anne Blaise and yourself who take that report, take that as a challenge and build their careers and build their field and make life better for cancer survivors as a result of it. So it's a nice story.
[00:23:45] And it was a great conversation that we just had with Dr. Blaise. Well, I think certainly an exciting one and one where we have a lot more work to do. But if you think about it, many of the stories that we've done on this podcast have some relationship, have some integration with cancer survivorship. And each person has their own story, their own narrative there. And it's so wonderful for both of us that we have the opportunity to share with our own patients in many of those good news stories.
[00:24:19] Thank you for listening to the good news about cancer. I'm Dr. Alicia Morgans at Dana-Farber Cancer Institute in Boston. And I'm Dr. Chuck Ryan at Memorial Sloan Kettering Cancer Center in New York. The views we express on this show are our own and do not represent the views or opinions of the institutions where we work. Thanks to Lily for support of the show. Our production partner for this series is Citizen Racecar. This episode was produced by Anna Van Dyne with post-production by Alex Brouwer. And there's a whole lot more good news to talk about.
[00:24:49] So make sure you subscribe to this wherever you listen to your podcasts. And if you like the show, share it with somebody you think might find it interesting. And we'll be back again soon with some more good news about cancer.