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Hello and welcome.

I'm Karen Walker.

Today we're talking about cancer.

What it is, why it develops and how it is detected and treated, and what patients and families need to know when facing a diagnosis.

The American Cancer Society estimates that more than 20,000 Arkansans will be diagnosed with cancer this year, while cancer continues to affect individuals and families in every part of our state.

Advances in prevention, detection and treatment are helping more people live longer after a diagnosis.

Cancer is not one disease, and each patient's experience is different.

Today, experts from UAMs will help us understand how cancer is detected and treated, how patients and families can find support, and how advances in cancer care are offering new reasons for hope.

Joining us are five experts from the UAMs, Winthrop Rockefeller Cancer Institute, doctor Omar, chief medical oncologist Doctor Sanjaya Vishwamitra, diagnostic radiologist Alex Watley, certified genetic counselor Carla Green, licensed clinical social worker and certified oncology social worker.

And Jill Hastings, also a licensed clinical social worker and certified oncology social worker.

Later.

Matthew Kovach, UAMs Clinical Trials Office Director, will join us virtually to discuss clinical trials and their role in cancer care.

Thank you all for joining us for this important conversation.

We also want to remind viewers that today's discussion provides general information and does not replace talking with your health care professional about your individual health and medical care.

We are so excited to have this conversation today.

Welcome everyone.

So let's get started.

Doctor Teague, let's start with you.

Can you tell us exactly what is cancer?

So cancer is a term which is utilized for over 200 different diseases.

Our bodies as our bodies have trillions of cells, and each cell goes through millions of multiplications every day.

During that time, somewhere there, there are mistakes, if you will, which we call mutations that occur that change the regular body cells into cancer cells.

The difference between the two would be the the the normal body cells know when to grow, when to rest and when to die.

The cancer cells don't know that.

And so they continue to grow and continue to invade surroundings and even travel to different parts of the body.

So that in general is how cancers occur.

All these 200 plus different diseases and various people for a number of different reasons, which would include inherited genetic mutations, which would include mutations that happen over time, which would include environment, which would include personal lifestyles and habits, especially tobacco use, alcohol use, and and other viruses which cause or at least lead to a higher risk of various cancers.

Thank you.

So can you tell us a little bit about what happens when someone receives a diagnosis?

Whenever any patient, because of their symptoms or because of screening protocols, are found to have cancer, they are generally referred to an oncologist, oncologists are physicians who specialize in management of various malignancies.

And now we have different oncologists for different cancers who specialize and focus on different illnesses.

When they come to that oncologist, along with the team, which includes nurses, social workers, genetic counselors, we have our fellow physicians like radiologists, pathologists, all of us get together with first one to figure out where is the cancer arising, from which, what's the site of origin?

There we do a biopsy, which is done generally by either interventional radiology or a surgeon, for the most part pulmonary, or lung cancer.

Physicians and gastroenterologists are stomach cancer.

Stomach and colon cancer physicians also do biopsies, but a biopsy is done to find out the type of cancer.

Then we once that is done nowadays, we would also send that specimen for something called next generation sequencing, which leads to what is usually called personalized care, if you will.

Along with that, we would order various types of blood tests not only to look for, evidence of cancer depending on the type of cancer, but also to look at other body organ functions, like the kidneys, like the liver, which are important in terms of management.

And then the more one of the more important things that we order, is imaging X-rays, CT scans, MRI scans that are colleague doctor, this one is going to talk about later.

With all of that, we want to determine the site and the type of cancer, whether or not the cancer is localized, whether or not it has gone to lymph glands called regional areas, whether or not it has spread because the management of cancer would involve all of those characteristics besides the patient's wishes, which become which are the most important factor in how we manage cancers?

Yes, that's good information to hear.

One thing you mentioned was genetics.

Alex, can you talk to us about what role does genetics play in cancer?

I mean, genetics is a huge role, right?

All cancer is genetic in some way, shape or form.

The majority of the time, the genetic mutations that occur happen at random and are acquired over a person's lifetime.

But roughly 10% of cancers have that hereditary component, meaning they were inherited likely from a parent, and are being passed within the family.

So for thinking about genetic testing, it can certainly play a role in a patient's treatment and management, but also have larger implications for family members and setting them up for success for screenings.

Well, why does the diagnosis matter to the family as well as it does to the patient?

Absolutely.

So if we're thinking that there is an inherited genetic mutation that's being passed within the family, say for a parent who is recently diagnosed with cancer, they've come and seen us in the cancer genetics clinic for risk assessment.

We've ordered testing.

We've identified the why perhaps, they may have developed cancer, but then we know, okay, this is something that not only impacts the patient sitting in front of us, but can be passed on to the next generation so it can impact their children and other close family members thinking about, you know, siblings, nieces, nephews, for example.

And all of this is about early detection.

And so if we know that there is an inherited genetic mutation within the family, early testing can help to identify this patient tested positive.

We want to screen them more closely.

So that way if they were to ever develop cancer it's caught at the earliest sign.

When do you recommend that people start having, screenings for cancer?

It really so so adding on to what Alex is and it's very important.

What she has said is that sometimes we can also use, genetic counseling for prevention of cancer, like patients who are at high risk of breast cancer with something called bracken mutations.

They can have mastectomies and or, hysterectomy, by bilateral supports as been good for artemisia, which is essentially using, you know, removing the organs where the cancers can occur depending on the risk of cancer.

And as you mentioned, we would we can also then determine the screening for that high risk person, which would be the family.

And it can be done earlier.

So screenings are generally recommended for patients at various ages.

For example, breast cancer mammography or MRI scan.

And Doctor Vishwamitra is probably going to add to that.

Is generally started on an average person around age 40.

And then the colon cancer screening was was started at 50.

But now there is evidence to suggest that it should be started at 45.

And there are various types of cancer.

Cervical cancer screening is done much earlier and in fact can be prevented with, with the vaccination.

So various cancer screenings are done at various times where it has been determined by data that that can prevent mortality or morbidity.

Going into the details probably would be better left to a person talking to their individual physician about it.

Yes.

That's given we meet with patients, so they have so many questions a lot of times on am I going to pass this down to my other family members?

And so I think it's just so very helpful that they can get those answers from a specialist.

Yeah.

Meeting with a genetics professional such as the genetic counselors integral.

You know, we work as a team at UAMs.

And when we think about how one person's test result can impact not only their treatment and downstream screenings, but also for their family members, and that can involve a lot of emotions of guilt, anger, sadness, anxiousness, and, and, you know, relying on our colleagues in social work.

Right.

And, it could be so important.

So it is real important that there's always a team to do.

So can you tell us, doctor, what role does biopsies and imaging play in in the cancer journey?

Thank you for that question.

As you heard from doctor, there are, you know, cancer starts in one small location.

And typically to identify the type of cancer, as you mentioned, you do a biopsy of that particular area.

You also heard from our list that, you know, there are certain predisposing features or factors that might make a patient, a person, become more prone to, to cancer as well.

So if you just look at the two cancers which are often spoken about, that's breast cancer and lung cancer, just as an example, and you have, you know, excellent screening programs which are in place to diagnose them early.

The earlier you detect a cancer, the lower the stage of that particular cancer is.

And what that simply means is that it is in a, you know, in an area which can be treated accurately and aggressively, with minimal invasive methods.

And that will, give the, the, the patient the best chance of, of survival is just a general word that we use.

But quality of life also becomes very important in that situation.

So again, if you just look at those two major, cancers, just to give you an idea or give you audience an idea about screening programs, mammography, something Doctor Teague mentioned, we typically started the age of 40 in, in women in generally, but you might want to start that earlier if they have a family history of breast cancer or if they have some genetic predisposition to breast cancer, then those women might need to start even earlier, than 40 years.

And then we do that, do it yearly.

Mainly when you, when you go through the breast cancer program, has a fantastic breast center.

And Doctor Brian Smith, who is the, the chief of the division, is, is passionate about making sure that the women are well taken care of.

So part of the, the thing about screening for me is you're taking a person.

They're not a patient yet.

You're taking a person who comes in without any history of cancer, and you need to treat them right.

You need to make it comfortable.

The environment where they get these exams need to be comfortable.

And Doctor Brian Smith is fantastic and doing so in the breast center just as an example.

That's good.

You know, if you take lung cancer screening, it has it's a little bit different.

So with lung cancer, we have and we look at patient and we look at people again who have a history of smoking that's main predisposing factors.

And if they smoke more than 20 years that's one pack per day for 20 years, or two pack per day for ten years, as an example.

And if they smoke, and if they are between the age of 50 and 80, they have a larger, higher risk of getting lung cancer.

And they get what we call a low dose CT scan, to identify nodules in the lungs, which are then taken, then, looked at by the oncologists and, and, they are then treated appropriately as well.

Again, the, has done a fantastic job and trying to look to, to, for these, people who have a higher risk of lung cancer.

We have, also invested in certain softwares, which can, I softwares and I'm sure that's going to come up at some point in this discussion, which can identify these, these small lung nodules make it easier for the radiologist to find these nodules in the, in the lung.

So this is two examples of screening programs that can be done.

That's you mentioned biopsy and and biopsy again as doctor I think as already mentioned as part of the interventional radiology program or the oncologists are selectively by the the respective surgeons or physicians who are looking at particular organs.

It's become so organ specific nowadays.

Did answer your question.

You did.

And I'm excited to see that you guys are taking advantage of the advancement in technology, even using the AI.

Carla, can you tell us what your role in helping families when they receive a diagnosis?

Yeah, absolutely.

Well, JL and myself both work, through the cancer center over at UAMs, providing support to our patients and their families when faced with diagnoses and treatments.

And, the whole component and aspect of cancer from day one to, you know, five, ten years after a diagnosis, you know, providing support, providing resources, you know, just really listening.

And sometimes that's all our patients or our family needs is something some time to talk about.

What do they understand?

What have they been told, how do they feel.

And like Alex said, there's, a bit of a guilt component when it's something a genetic, component to a diagnosis, then it's just a matter of providing them with some support and validation and trying to help them through that process.

That's good, that's good.

We know it takes a team.

How do, how does a doctor develop a treatment plan for a patient when they've been diagnosed with cancer?

So besides, are people who are on this panel, radiologists like some social workers, geneticists, genetic counselors.

We have our nursing staff.

We have other colleagues, physicians, surgeons, radiation oncologists, medical oncologists.

We have pathologists.

We have whole teams for individual cancers.

We get together usually once a week to look at all new patients who have cancer, or old patients who have had cancer, but have had a change in the biology or the aggressiveness of the cancer, or if the cancer has come back.

So we all look at that in what is called a multidisciplinary tumor board, which is specific, in general in the state of Arkansas to, from all I know, and we talk through the best way to manage that patient.

One thing that is critical is that we don't treat cancers.

We treat patients with cancer.

And all patients should know that when they walk into our clinic doors.

For all of us here and those who are not here, that is the highest privilege and honor that we get.

When a patient or a person puts his or her life in our hands.

And so we try to rise up to that station by making sure that there are multiple physicians, nurses, respiratory therapists or, geneticists, genetic counselors, licensed social workers that we all give or experience for that one person and their family to be able to get the most out of the treatment.

That may include chemotherapy, which are medicines for cancer.

There are hundreds of medicines that are all called chemotherapy, which doesn't mean they're the same.

Then more recently, we have added other group of medicines that have changed the paradigm of cancer care called immunotherapy, and something called targeted therapy that has become available because of the next generation sequencing or sequencing of the genome of cancer, which are specific for specific mutations that we talked about.

And then there is radiation therapy and surgery.

So we determine what is needed for the we, all of us together determine what's best for the patient, how should it be given.

And then we talk to the patient and the families.

There are patients who have different priorities.

They are patients who have different stations in life.

They are patients who want to do it differently.

Our job is not to tell the patient what to do.

Our job is to provide information in a way that is understood easily.

That's our job.

And then have the patient decide and if they need our help in that decision, of course, we are there for them.

So that's how this goes in a nutshell in a brief overview of it.

Yes, that's good information because a lot of times we don't really understand sometimes how you develop those plans, how you decide.

So how do you support families once they have the diagnosis.

And let's say they're going through chemotherapy and it's all can be overwhelming for families.

Yeah.

So oncology social workers I think can really be an invaluable part of a patient's care team.

So social workers can come in and they can provide support.

They can also help and connect with resources.

So with, transportation, that can sometimes be a big barrier and social workers can explore.

Are there local resources, such through the Area Agency on Aging or with the American Cancer Society Road to Recovery program or through insurance?

With Medicaid or with, Medicare Advantage plans?

Social workers can come in and they can help with lodging.

A lot of people come from out of town for treatment.

And so the social workers often have a list of local lodging resources that can talk about different amenities that are there, to help with maybe shuttles and getting back and forth or with hospital discounts.

Social workers can also help with finances, and exploring.

Are there any cancer specific grants that are out there, or are there any medication assistance programs that can help?

With work, there can be big changes in work.

And so social workers can often help.

And educating about, you know, topics such as the Americans with Disabilities Act and workplace accommodations or talking about FMLA or Social Security disability.

If there is a loss of insurance, a lot of times social workers can help.

Talk about what are other insurance options that may be out there, for caregivers, social workers can provide, supportive counseling.

They can help with practical caregiving tips.

And they can also, you know, help refer to support groups that may be out there.

So really social workers I think are are good at identifying needs as well as providing support and helping connect with resources so the patients and their families can focus on treatment and recovery.

I think caregivers are so important in this, in this paradigm when you're treating people.

I've worked through the Cancer Institute a couple of times and you'll see signs they're saying, if you need any help, please reach out to so-and-so.

And I think that's very important.

We all know families who the patient, of course, goes through the brunt of it.

But caregivers sometimes are local.

Sometimes they have families and they are in different locations.

And they all need help.

They all need support.

It's something no one prepares you for it.

And I think what what you said was so important in terms of being helpful for caregivers as well.

And yes, throughout the trajectory of a diagnosis and a treatment, oftentimes we have our myeloma patients that are in the hospital sometimes for a month, and it's just a matter of providing the support to not only the patient but the family that sometimes we have patients that are coming from out of state.

So it doesn't make sense for them to drive back and forth.

They're staying there at the bedside with our patients for that amount of time.

So just being able and being available to them and that moment is integral.

How long can, family expect to receive support from a social worker?

As long as the patient is active in our cancer center there is a social worker available.

No time limit, no time limit.

Isn't that amazing?

Because chemo therapy is pretty brutal to the body sometimes, and it's hard for them to really just take in what's going on there.

So all having a team is so important.

What do you find is the most rewarding thing that you do at your job right now?

Anybody what's you.

Know is, as has been mentioned in our country, the richest country in the world, we don't have a functioning health care system.

We have a sick care system, which is almost chaos.

And so social workers and others actually fill that gap in a way that couldn't be filled without them.

When any person received the diagnosis of cancer, that's not his or her fault.

It's a disease.

It's not a punishment.

It's not the result of any behavior.

Although behaviors could increase the risk.

But nobody wants to get cancer.

So I think it's critical that patients and their families realize that.

But the problem is that cancer and its treatment, as you mentioned, whether it's chemotherapy, radiation, surgery is intense or could be intense, it affects the person, their work, their family life, their relationship, their finances.

There, there's an emotional toll.

There can be a familial, too, if there are young children that can be affected in a significant manner.

And all of that goes into the discussions with our team, with the patients and their families, to give them their best hope, chance of cure if possible, which is happening more and more and more with recent advances in the chance of symptom control or palliation if cure is not an objective at the time, and providing emotional support and holding hands and letting the patients and families know that we will always be there.

And that's why, you know, all of us here and those of our colleagues who are in their clinics, whether at UAMs or elsewhere.

We are their health care professionals.

We are not health care providers, which is a transactional term, whereas our relationship with our patients is transformational because the patients, if they get help, we get help too.

And so all that goes into the care that we provide at Winthrop Rockefeller Cancer Institute, at UMass and at other places, frankly, and we try to do the best we can under the circumstances that sometimes could be beyond our control and certainly beyond the control of the patients and their families.

Phenomenal.

We're going to take a short break.

And when we return, Matthew Kovach will join us virtually to explain how clinical trials fit into cancer care, when they may become an option and what patients should know before participating.

Welcome back.

We've been discussing how cancer treatment is tailored to each patient.

Clinical trials may also offer access to new approaches to cancer care.

Joining us virtually is Matthew Kovach, executive director of the clinical trials office at You and Ms.. Winthrop Rockefeller Cancer Institute.

He'll help us understand how clinical trials work, when they may become an option, and what patients should consider before participating.

Matthew, thank you for joining us.

Let's begin with the basics.

What is a clinical trial and how does it fit into cancer care?

Good morning and thank you so much for having me.

Clinical trials are an integral part, for cancer diagnosis.

Clinical trials are done to learn about new procedures, new treatments that, can be then eventually become part of standard care.

I think it's Doctor Teague really hit it on the head earlier when he was saying that, as being a, you know, academic medical center, having that multidisciplinary team, and including clinical trials.

And that is extremely important.

So, you know, it's not just the, you know, something that is considered once all treatments or once all treatments have been exhausted, it should be something that should be thought about upfront.

And I think that's where our, our team sits with that, you know, being part of the tumor boards, making sure that our portfolios of clinical trials are available to all the disciplines, to be able to make those important decisions.

That's good.

So, doctor, can you tell us, what makes at what point in the cancer journey do you recommend a clinical trial for a patient?

Great question.

So, as, Matt was explaining, clinical trials are an integral part of management of cancer.

So we have come a long ways, from even 30 years ago, our cancer mortality rate has gone down by 30% in our country, which is wonderful.

And it is the result of clinical trials helping us improve cancer care.

So even now, not all patients are cured.

Eventually we want to cure all patients.

And clinical trials are the means to help us get there in an organized fashion to where the the benefits of the trial outweigh the risks for the patients.

So most of us for for almost all of us at UAMs, Winthrop Rockefeller Cancer Institute clinical trial is always the first consideration, simply because that is what can become the standard of care tomorrow.

The clinical trials are exceptionally well designed or very critically monitored, not only by UAMs and our what we call the Institutional Review Board, or IRB, but also by the National Cancer Institute and other agencies to make sure that the patient's best benefits are protected.

So in surgery, for example, we want to have new surgical procedures that are less invasive and still reach the same effectiveness that the current procedures have.

So we need a clinical trial for that.

In radiation oncology we want to have less radiation to reach the same outcome.

So we can that is done by clinical trial in chemotherapy or systemic therapy whether it's chemotherapy immunotherapy, targeted therapy.

We want to reduce the adverse effects also called side effects.

But we want to improve the quality of life and eventually the the quantity of life or the longevity.

That is where clinical trials come in.

So for most of us at UAMs, for all of almost all of us or all of us at UAMs, clinical trials are the way to go if they are available.

Now, we do not have clinical trials for each and every situation, but wherever we have those available and we have them available for a lot of situations, that's the way to go.

And Matt and his team in our clinical trials office do a tremendous job of helping patients and their families on on explaining the clinical trials, giving their pros and cons because it has to be an informed decision by the patient.

And the patient should also know that Matt would probably, come to in a minute is that they can refuse a trial and still get the best standard of care, but they can also come out of the trial at any time, with or without a reason.

So at the end of the day, we want to make sure that we do what's best for the patient, but the patient perceives us as that, and the patient's wishes remain paramount.

They are always in control.

So so we consider them in pretty much any and all situations.

It's good to hear it's a patient first mentality.

Without question.

That's beautiful.

Matthew, can you tell us some misconceptions that people have around clinical trials?

I think there are a lot of misconceptions around clinical trials, and I think education is extremely important.

That's something that we're really striving for at UAMs, not only for the central Arkansas area, but throughout.

You know, one of the misconceptions is you're, you know, a guinea pig, that you're, you know, being tested on and, you know, as doctor alluded to, you know, everything goes through a stringent review process.

We have multiple layers of approval before a study will be activated.

And I'd like to say, you know, that you're getting an added layer by being a participant on a clinical trial.

You're not only, you know, you're not losing the current doctors, the current health care team that you have, you're getting an additional layer of clinical research coordinators, clinical research nurses, and, 50 more back end people that you didn't even know existed but are helping work on to make sure that clinical trials are safe.

Another thing that I hear a lot on is, you know, I don't want to, you know, get a placebo and not receive any treatment.

In the in the cancer world, you are not ever going to receive anything less than standard of care on a randomized clinical trial.

If you're randomized to the investigational arm, you will receive that investigational agent.

And then the other time you will then receive standard of care.

You will never just receive a sugar pill or anything like that and not receive any care for your cancer.

And I think that's extremely important for everyone to understand.

It's good to know.

Good to know.

So doctor V and, Alex, tell us a little bit about how genetic testing and imaging, what role does that play in eligibility for patients and even in a measure of response?

Sure, I can talk to the testing piece.

So each clinical trial will have its own eligibility requirements depending on the specific cancer diagnosis.

The pathology, the staging, and then genetic testing might be recommended to help kind of rule in a roll out if a patient may be eligible for a clinical trial and genetic testing, there are kind of two avenues that can be taken.

One that Doctor Atiq first spoke about would be testing of the tumor itself or the cancer itself.

And a patient may have a specific genetic finding that would make them eligible for receiving, you know, certain treatment from that clinical trial.

But then we also think about germline test set, which is the testing where patients undergo through our clinic through bladder saliva, and determining if there's an inherited genetic mutation.

And sometimes that can also make patients eligible for certain clinical trials.

So it's integral right.

And thinking about the treatment on the front end.

But then also kind of downstream effect.

That's great.

That's great.

What about you doctor.

The as you've heard so far, we strive to have a patient centric approach, in whatever we do.

And imaging is pretty much along the same lines.

When we spoke about screening, for example, we spoke about mammography and low dose CT scans.

And you talk about diagnosis and staging and getting, into the clinical trial spectrum.

You are at the other end of imaging.

So we talk about pet CT, for example, as one example, let me talk a little bit more about that.

Pet stands for positron emission tomography.

Pet is the acronym for that.

And essentially what it does is it's a nuclear medicine technique which targets the cancer cells, so that we can see them better across the whole body.

And that gives us an idea about about where the cancer is in the, in the patient, whether it's localized to a particular area, whether it is spread to other regions as well.

So that's one of the things we do.

And we can do them at the initial staging when appropriate.

We can also do them periodically, either in the regular standard of care or as part of a clinical trial to see how they respond to a particular regimen, a particular treatment.

That's one example.

You can do the same thing with a regular CT scan, with MRI as well.

So CT stands for computed tomography is just a fancy X-ray tool that we use where we get a little bit more of a closer look at the individual organs themselves.

And we can do that with MRI.

MRI stands for magnetic resonance imaging.

And it can and each of these have their own specific roles and requirements.

So that information that we been and we report them in a very structured manner in a very structured template.

And that structure will then give the oncologist a chance to decide whether this person is there, can can go through a particular clinical trial, whether that's working and up, and it becomes their decision at that point of time.

Yes, yes.

So, Carla, thank you for that.

Doctor Carla, tell us a little bit about, you know, the trial specific demands that come along with being in, a clinical study.

Yeah, absolutely.

I know there's a good amount of patients who want to come to you.

Ms.. Who may not live in the central Arkansas area.

So oftentimes it's a matter of transportation.

You know, how do they get here?

Where do they stay day?

I mentioned earlier about the lodging options that we have around, UAMs through our cancer support center.

And just how can we help them attain the care that they want?

So, you know, do you find that providing, care to the patients, that you see them a little bit more at ease, a little bit more trusting, that they're getting the best care?

Yeah, I think initially, when patients are diagnosed, there can just be a lot of intense and strong emotions.

There can be a lot of shock.

And so, you know, it's normal to be afraid of the unknown.

And that time from when you're diagnosed to getting further testing to do, waiting to find out about treatment recommendations can just be really overwhelming because there's a lot of unanswered questions.

And I think it's important for patients and their families to know that a lot of times and meeting with the oncologist, they can feel a lot better.

Just coming up with that plan can be so reassuring.

But I think it's also important for patients to know that it's helpful to have a place to go to talk, and share their thoughts and feelings.

And that might be with a social worker or with a counselor, but that may also be, with their family members or friends.

I think journaling can be a really great way for someone to get out their thoughts and feelings and really make some space for those experiences.

It's it's important when you're navigating this journey to really lean on your supports.

And so, you know, a lot of people in your lives may want to help, but they may not know how to do that.

And so if you can give your family members and friends specific ways that they can help, that can be so beneficial.

For example, you know, can you give me a ride for treatment or can you take my dog for a walk or run to the grocery store for me?

So really reaching out, for that support as needed.

Yes.

Those are great practical ways to, to be a part of helping in the journey.

I have another question for Matthew.

Matthew, can you tell us what are some of the questions that patients should ask before enrolling in a clinical trial?

Yeah, that's a great question.

I think, you know, a lot of times they ask, you know, what's the benefit for them participating in a clinical trial?

And I think the best answer to that is, you know, while not common, you could have benefit for the new treatment.

You could receive standard of care and, have, you know, the normal care that you would if you were not part of that clinical trial?

But the real impact comes for the future, you know?

You know, we're looking to create a new standard of care.

So the new treatments for tomorrow, and that's a huge benefit.

Another thing to think about the risks.

There are risks associated with, you know, joining a clinical trial, our clinical research nurses, our investigators go through, what, you know, possible side effects could, you know, happen from being on the investigational product.

They will go through line by line.

A lot of our consent forms, are quite lengthy, but we we take all the time necessary or all the time that the patient needs to be able to go through that so that they understand, but also understanding, as Doctor Teague said, that everything is voluntary, you know, at any given time.

If they don't feel like this is the right part of their care, they can absolutely, removed themselves from the clinical trial and even the investigator may decide, you know, is doctor review saying, you know, if if the scans are showing progression, they may need to be removed from the clinical trial and look at a new form of treatment, other big things, you know, there are social workers doing exceptional job helping with is, you know, travel, you know, being a rural state, a lot of our participants are coming from long distances, know, they may need gas cars.

They may need somewhere to stay.

Some things that we've really been trying to work into our industry sponsor clinical trials and even things to think about child care, things like that is also thinking about the caregivers, to make sure that they are considered if they're needing lodging, if they're needing meals, things like that.

And then most importantly, you know, always cost making sure that they understand their insurance company understands that, you know, taking part in a clinical trial, that they could still have their co-pays.

Anything associated with the investigational product would be covered by the, sponsor for that clinical trial, but there could still be standard of care costs.

And understanding that, and our team, as well as our billing team in EMS, does the best that we can to help patients understand that.

That's good.

So, Matthew, is there anything else that you'd like to share with us about clinical trials that we didn't ask?

I just want to reiterate that they're, you know, extremely important part of, you know, a cancer journey.

I think you, I miss were very blessed to have these multidisciplinary groups that are considering clinical trials.

If you have questions about clinical trials or cancer clinical trials at UMC Edu, you can send us an email.

Our website has a list of all of our clinical trials.

It changes daily.

And you know, even just, you know, talk to your doctor, talk to your health care team, and, and, you know, maybe that place that you're receiving treatment may not have a clinical trial, but they may be able to refer you somewhere that has trial.

And I, I just think having that forward thinking and understanding the importance of the clinical trials to, you know, hopefully, you know, one day finding that cure.

Thank you.

Thank you so much for joining us today, Matthew.

We appreciate all the information you've shared to help us understand clinical trials and how they work, and eligibility and all things good for that.

So thank you for joining us.

We look forward to having a future conversation with you as clinical trials continue to advance in our state.

Thank you.

I would like to add a couple of please do.

If I may.

The adverse effect from any clinical trial are managed by us, all of us as a team.

So nobody should think that they've done at any adverse effects that they would be let alone left alone to bear them.

No, we would always be there if there's one.

One of the most important things that we do is to make sure that the patients know that we have their back, period, regardless.

The second thing is an example that I would tell you about clinical trials is many of us know Senator Ben Sasse from Nebraska, who was diagnosed with pancreatic cancer in his public, a few months ago, and he was given 3 or 4 months to live.

He went on a clinical trial and is doing fairly well, because that drug that he received on the clinical trial has now been approved by FDA for metastatic pancreatic cancer.

And he's living and he's a living proof.

And he's he's very vocal in public about it.

So I want the patients and their families to know that no physician, no nurse, no social worker, no genetic counselor would suggest a clinical trial.

If there don't believe that that's the best option for you and that they wouldn't if the if the situation was reversed, that they wouldn't want it for themselves.

Okay.

Derek, you know, there's been so many advances in cancer.

Can you talk a little bit about some of the advances that have taken place over the years?

Yeah, I can speak to the genetic testing piece.

We're now I think we're being more proactive with offering genetic testing instead of being reactive.

So for patients who are newly diagnosed, you know, they're being sent for a cancer risk assessment.

And with our team, you know, we would evaluate their personal risk factors, their family history, and be able to, offer genetic testing, which that in of itself, you know, the technology has really exploded over the past decade.

There are so many different genes that have been implicated in hereditary cancers, but also thinking about the complexity that we can get with results and having, you know, a provider, myself as a genetic counselor, available to help interpret those, I think is integral.

But then also being able to pass on that information to the healthcare team, right, and making them aware of that.

So with genetic testing, we think about, you know, not only offering it early in the diagnosis, but also for patients who may be at home thinking about, gosh, I have a really strong family history and, talking with their doctor more about that and how they could benefit from a cancer risk assessment themselves.

Meeting with the genetic counselor to see if genetic testing is something they could benefit from, and then using those results to help guide their cancer surveillance.

And then of course, testing for family members.

So really being more proactive with our our cancer screenings.

That's great.

And that gives hope that.

Absolutely.

Yes.

What advances have you seen in the last, few years that can offer hope to cancer patients?

Literally, exponentially is what I would say.

Things are just leaping by by leaps and bounds.

And a good example perhaps, is that, this is the only certified center in Arkansas to have a s n m m I. And that stands for the Society of Nuclear Medicine Mononuclear Imaging Accreditation and Certification for Therapy and Diagnostics using Nuclear medicine techniques.

Now, some of your viewers may not know what nuclear medicine is, so maybe I can just spend.

A few minutes.

Discussing that.

So essentially, if you think about it, you mentioned you heard about genetics, you heard about cancer sounds.

You heard that there are different, you know, families of cancer cells.

And each of them have have different, targets, as it were.

So let's take prostate cancer as a simple example.

Okay.

It's a prostate scan.

The prostate cells which are which are can carcinogenic, express a antigen called PSA, prostate specific antigen.

And what you can do is you can find a, a drug which will which will bind to the PSA receptors.

And it can be imaged using nuclear medicine techniques.

So the imaging of that PSA study will tell you where the cancer is within the body.

You can take another drug which is has got a stronger radio localized radiotherapy effect using the same PSA antigen and treat those cancer cells.

So that becomes a therapy part of the nuclear medicine thing by using the same antigen.

But targeting one is a diagnostic study and one is a therapy study.

And Doctor Icahn, who is the division chief of nuclear medicine, has done tremendous strides in trying to bring that to UAMs and get that certification.

It is available in other places as well.

But but this is one of the things we're really looking forward to.

And there are similar type of drugs for other, cancers as well.

So this is just an example of where we are seeing increase.

Yes.

If you look at the number of potential drugs that the FDA is on the FDA's, table, as it were, in this, in the scheme of things, there are hundreds of them, which could be approved sometime in the next five years or so.

Yeah.

And each of these are then become specific therapy agents, diagnostic and therapy agents for particular cancers, leading to improved, improved care for the patient.

That's one of the one of the big things that I've seen.

We also do a whole body MRI, particularly for multiple myeloma, is a great example.

And we use but and multiple and whole body MRI to to correlate how these patients are doing and do to, to watch for treatment.

So imaging is is literally I mean if you gave me I could speak for this, but 30 minutes is I don't think you're in because necessarily required.

But but it's a, it's a huge, growth in terms of taking care of the patient.

Yes.

Lots of advances are going on.

As we're coming to the end of our conversation, I want you to think about how, treatment has changed and advances have changed over the last ten years.

What message of hope could you give to our audience, each one of you?

What would be your final thought to our viewers that are listening now as it relates to cancer and cancer care in our state?

I would think the one thing I've learned in my experience working at UAMs as a social worker is, like you said, the advancement and to Alex's point, that genetics is so different now than it was 10 or 15 years ago specifically, like the Brock, you know, that's very important to know whether or not that's something you carry.

Whereas maybe ten or so years ago that wasn't being tested for.

And it's imperative to know those things.

And just like the prostate, if you have the genetic component, that's important to know not only for yourself but your family.

And having that knowledge gives you power.

Yes, yes.

Who else would like to share a thought?

I'd also say that I think, Arkansas is making is moving in the right direction.

As far as cancer care is concerned.

You have Arkansas health initiatives for rural populations.

The, is taking a lead in terms of sending, mobile mammography units, mobile lung cancer screening units across the state to try to identify people who, who require cancer, scare cancer care early.

You heard from Doctor Deacon from the entire panel, how good and how structured and thoughtful UAMs is in terms of providing the care when they when the patients choose to have that do, to give us their trust in terms of treatments, I think they're all moving in the right direction as far as all of that.

And that comes from my management as well.

Wow, thank you so much for sharing.

I don't want to cut anyone off.

Does anyone else have a just a quick final thought for us.

Did you want to leave the audience?

Cancer is curable and for those cancers that are not curable today, they will be tomorrow.

That has that's the lesson that I've learned in my 35 years of treating cancers.

Patients who would have died within months are now living for years now.

And so there's always hope and the and and we will make sure that we do the best to get ourselves out of business if we could.

Yeah.

And, and patients should know that their healthcare professionals are all there for them, period.

Nothing supersedes that.

And that's a great way to conclude our conversation.

Thank you to all of our panelists for sharing your expertise and helping us better understand cancer treatment and the support patients and and families.

We are just so glad that we've had this conversation today.

So for additional information and resources mentioned during today's program, visit our blog at Arkansas tv.gov blog.

And remember, today's discussion provides general information and does not replace talking with your health care professional about your individual health and medical care.

Thank you for joining us.