Bill Klaproth (Host): This is Columbus Community Hospital Healthcasts. I'm Bill Klaproth. And with me is Dr. Chris Veale, a radiation-oncologist with Columbus Cancer Care, here to discuss supporting patients through their cancer journey. Dr. Veale, welcome.

Christopher Veale, MD: Hi, Bill. Good morning. Happy to be here.

Host: Yeah, happy to talk to you. I know cancer is a very scary diagnosis for people. So, looking forward to this conversation today. So, cancer can be overwhelming for patients and families. What are some of the first things that you focus on when meeting a new patient who may feel scared or uncertain about their diagnosis?

Christopher Veale, MD: Yes. I completely agree. Getting an unfortunate diagnosis of cancer is extremely stressful, overwhelming, emotional. So when I see people for the first time, one of the first things that I do is introduce myself. And actually, I give them the floor. I let them know that I've looked over all of your notes, your images, your surgeries, your pathology reports. So, I tell them I have a pretty good idea that I know what's going on. But then, I give them an opportunity, and I ask them, "What is your understanding?"

So, one of the things that I really try to do is let them talk first and get the initial things out that's bothering them, questions about. And then, after I hear from them, I actually go through step by step. So, I say, you know, "This is how this started. This is my understanding. Correct me if I'm wrong." So, I go through month by month, procedure by procedure, what I understand. And then, I ask them, "Is that your understanding?" And oftentimes, it does agree.

So, what I try to do initially is let them know that I understand why you're here, I'm hearing you out. We're on the same page. And I think trying to put myself in their shoes, I would be curious like, "Does this person have a good understanding of what's going on? I am anxious. Do they know why I'm here?" And I try to set that very early on that I'm hearing you out, and I feel like I know what's going on before we start talking about next steps.

Host: When people feel heard, that really gives them comfort. I love that you listen to them first and you say, "Tell me what you're feeling. Give me your questions. Let me hear from you." I think that is so important. And I bet you hear back that it's extremely valuable that you do that.

Christopher Veale, MD: Yes. Some people, I'm not the first person that they see oftentimes with a diagnosis. So by the time they come to me, maybe they've forgotten. I've heard people say, "You know, I'm not quite sure why I'm here. It was so much going on, I don't remember." And some people remember very well. So, knowing that people are seeing me at different stages, different responses to initially finding out about their diagnosis, I try to get everyone on the same page so that we can optimize and maximize our conversation and the reason that they're here so that when they leave, they feel better, they have a better understanding of what's going on and the next steps.

Host: So, as we said, this is a very difficult time for people getting a cancer diagnosis. How do you then approach building trust with your patients, especially when emotions are high and decisions are complex? I love that you listen to them first. But there's also, I would imagine, a step and a step after that, especially in an emotionally charged discussion. How do you build that trust and continue that moving forward?

Christopher Veale, MD: Yeah. So after I make sure that we're on the same page or like, "Hey, this is what's happened up to this point." And they're like, "Yep, that's good. We are now at today's visit." We've agreed and reviewed everything. I ask about their symptoms, so that is another opportunity for them to be like, "This hurts" or "Nothing hurts. I'm shocked that I even have cancer." We go through that. And then, I actually give almost everyone the opportunity to look at their images. I'm like, "I've seen your images. Do you want to see your images?" Some people are like, "Yes, I do." Other people say like, "I don't want to see this spot in my brain. I just don't want to see it." It's a hundred percent whatever they want, whatever they're comfortable with.

And the reason why I've established this kind of process is because I want to reinforce, "I've spent time looking up your case before coming here." Our office usually starts getting records a week before people show up. And by the time someone comes, I let them know, "I've already talked with your medical oncologist. I've already talked with your surgeon. I've actually talked with a radiologist about these findings if needed." And then, "This is what I've found, and I go through images slice by slice, image by image. Here's your PET scan," if they want to see it. And like, "This is the spot, this is how big it is." And I kind of point on their body so that they, instead of this, "I have a cancer diagnosis," and it seems like a real abstract idea. It kind of makes it more real, but I've often found in a good way where it seems like this definitive, tangible situation instead of, "I have cancer. What do I do?" So, I try to walk through with them through 45 minutes or an hour these steps. And what I've found is that builds trust, then they can listen to me and I can listen to them and we can really move forward about plans.

Host: Yeah. I was just going to say that spending of time with them, listening to them, showing them, asking them, "What questions do you have for me? Do you want to see the spot?" I would imagine that really does build trust and it makes them feel like they have a partner in you that's with them on this journey, which I think is awesome. Can you talk about the importance of teamwork at Columbus Cancer Care and how collaboration among different specialists and staff members enhances patient care?

Christopher Veale, MD: Yeah. So, cancer is obviously complex. With advances in medicine, it's obviously great, it's fantastic. However, things have been much more complicated. The chemotherapy regimens, immunotherapy, the surgeries, the scans, everything is much more complicated. So where I trained, we had a very collaborative environment. The specialists, we met all the time. And I've tried to bring that here. And we have a fantastic cancer team with the surgeons and radiologists. So, I really try to reach out to them and get their input, becauseI'm not a surgeon, I'm not a radiologist. I'm like, "This is your area, your specialty. Let's find ways that we can come together and come up with the best plan for these patients."

And then, within Columbus Cancer Care, we have our own staff, and that means that we have therapists. And we have a dosimetrist, they do the radiation plans. We have a manager, we have a nurse, we have insurance, front desk lady. I'm not able to do the radiation plans. I review them, and I approve them, but I can't do the radiation plans. I don't treat patients. We have therapists for that. I'm not a manager. I'm the medical director, but I don't actually manage administratively our staff. I don't know how insurance goes. I mean, I'm not a nurse. So, I think it's really neat that we have all these different areas of specialty where the people that work here can really thrive in their environment, and which helps them feel like they have a part in the care. And I'm not just doing that because I'm trying to help them feel good. I truly need their help in order to take care of these people. So, I think it's just awesome and I love it. That's one of the reasons I picked radiation-oncology.

Host: Well, it does take a team, and thank you for explaining that to us. You mentioned radiation. I want to ask you about that. Radiation involves a lot of coordination. How do you and your team ensure that each patient receives a treatment plan that is tailored to their individual needs?

Christopher Veale, MD: Yes. So, every radiation plan is individualized. Every patient gets their own CT scan set up in the position that they'll be treated. I then get those images and we do radiation plan on each individual patient. So, every patient is different. Cancer, unfortunately, has no boundaries and does whatever it wants. So, I'll look at Imaging scans. I'll talk with radiologists on the phone. I'll look at surgical operative notes, like what was cut out, what was left; pathology notes to really find out what needs to be treated for each person. So, it's a pretty involved process, but something I intellectually enjoy. That's why I picked this.

So, every patient's treatment is 100% individualized, even within one prostate cancer to the next prostate cancer. Maybe the prostate cancer is a different spot or involves different surrounding areas or nerves or different aggressiveness on the pathology that all tailors how we're going to treat each patient.

Host: This is what is great about cancer care at Columbus Community Hospital, and what I'm getting from you, Dr. Veale, is that communication really is a key part of the cancer journey. So, can you share with us some strategies that you use to help patients clearly understand their treatment options once they get over the initial shock of, "Oh my God, I have this,' and you listen to them and hear their questions, it's got to move into treatment. What are the strategies you use to help patients feel confident about their treatment moving forward?

Christopher Veale, MD: Well, one thing I've always tried is to put myself in their shoes. I'm a patient for obviously different reasons. I have my own doctors for various things, so I know what it's like to be a patient. So, I always try to put myself in their shoes. So after we have all these discussions that, you know, I've already discussed, I use the words like, "So, I'm guessing the next question is what now? What do we do?" And so, then I offer options. I am a radiation oncologist, so my specialty is radiation. But I'm primarily an oncologist. So, maybe radiation's part of that plan, maybe it's not, and I'm okay with that if it's not. But I want to do is take care of these patients the best that I can. I offer like, "Okay, what now? What are next steps?" And I say like, "You could do nothing, but the fact that you're here makes me think you're considering something. But you can do absolutely nothing. And this is what that would look like." You could have radiation. I may not even offer radiation if I don't think it's a good option. You could have surgery, you could have chemotherapy or some other drug therapy. So, I offer different options. And if there are options that are perfectly reasonable, I'll might say, "No, this is an aggressive side. You could do this. This is a less aggressive side. These are the side effects you can anticipate."

I always tell people that my job is not to get them to get radiation. My job is to give them information, and then they need to be comfortable with their decision. Because the last thing I would want to do is treat someone that doesn't want to be here. That's just not good for anyone. So, give them options and support them in what their decisions.

Host: Yeah, so they feel empowered. They're making the decisions with your counsel, of course. So, that makes sense. So, I know support doesn't stop after the treatment plan is made. How do you and your team continue to care for your patients emotionally and physically throughout their time at Columbus Cancer Care?

Christopher Veale, MD: Once a patient starts radiation, you know, if they're getting radiation, I see them every single Wednesday. Once a week, usually Wednesdays. So, radiation can be one week long, it can be seven or eight weeks long, all depending on what needs to be treated. And I let them know, as long as you're getting treatment, I will see you every single week. So, this is not a meet-and-I'l- see-you-never, this is, "I'll see you every single week." So, some people I see seven or eight times. Once a week during their treatment in the beginning, they might be doing really well. Later on, might get some side effects. So, I see them once a week and kind of follow them through that process. We have a nurse here. She is like the face of the clinic. She sees these people every day. So, we definitely walk through this whole process with the patients on a weekly and, really, daily basis if they come daily.

Host: And again, I imagine that really makes them feel like they're not alone in this journey. And I can only imagine how important that is. And I know you've talked about your team and the great culture that you have there and how everybody really embraces their roles. How does the positive culture and shared purpose at Columbus Cancer Care not just impact the patients, but the care team as well?

Christopher Veale, MD: Yeah, kind of just to piggyback on what I said earlier about I would love to see everyone feel great in their role, feel empowered in their role, the staff. Like I said, it's not artificial. Like, everyone here is important. I can't do their job. They can't do anyone else's job. And I think that creates a culture of identity, purpose. I always ask other people's input what are their thoughts on things. And so, I think that does create this positive environment or hopefully creates a positive environment. People think that they can make an impact within the workplace and also in people's lives, because we're a small community. So, we'll treat neighbors, we'll treat leaders in the community or some people our patients. Like, we're seeing these people. We live life with these people. I live in Columbus. I bought a house in Columbus with my wife and our four kids. So, we're all really committed to cancer treatment here in the community. And all that hopefully improves the experience of both staff and patients alike.

Host: And I am sure that attitude shows and, ultimately, I bet it helps in patient outcomes as well. Would that be right?

Christopher Veale, MD: I believe so.

Host: Yeah. This has really been interesting, Dr. Veale. I want to thank you so much for your time as we talk about Columbus Cancer care and supporting patients through their cancer journey. I just want to ask you one last question, if there's anything else you want to add, anything we didn't cover that you want to mention as well?

Christopher Veale, MD: Yes. So, we have broken around on a new cancer center, a new comprehensive cancer center. It'll be attached to the hospital. Right now, we're at a separate location pretty close to the hospital, but across the street. It's a very exciting time in our community in Columbus, the surrounding areas, that we'll have all cancer care under one roof. We'll have radiation, we'll have chemotherapy, immunotherapy. We'll have a full-time permanent PET CT scanner attached to the hospital.

And, you know, the thought is to just maximize the patient experience, not having to travel from one site to another park, get out of their car, move in the middle of a blizzard in the winter here in Nebraska. And it increases collaboration between me and other members of the medical team, becausewe're right next door. And we're getting brand new technology just continuing to push and advance cancer treatment here and hopefully outcomes. So, very exciting times.

Host: It certainly sounds like it. Congrats on the new cancer center, and I know it's going to be well received. Dr. Veale, thank you so much for your time today.

Christopher Veale, MD: Thanks so much.

Host: You bet. Once again, that is Dr. Christopher Veale. And for more information and resources, please visit columbushosp.org. And if you found this podcast helpful, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is Columbus Community Healthcasts. Thanks for listening.