Joey Wahler (Host): It provides treatment for cancer patients. So, we're discussing oncology care. Our guest is Dr. Jason Suh. He's an oncologist with Jefferson Healthcare. This is To Your Health, the podcast from Jefferson Healthcare. Thanks so much for joining us. I'm Joey Wahler. Hi there, doctor. Welcome.

Jason Suh, MD: Hi.

Host: Great to have you aboard. We appreciate the time. So first, in a nutshell, Doc, what would you say initially drew you to both healthcare and specifically oncology?

Jason Suh, MD: Yeah, it's a long story. I grew up in South Korea, right? So when I was young, I could not find my purpose of my life, so I wandered around the world for almost two years. Then, I landed in New York where I had training. During that time, I fell in love with the cancer patient. So, that's why I became an oncologist.

Host: That's awesome. And so, you're actually one of two new medical oncologists at Jefferson Healthcare. What drew you to Jefferson?

Jason Suh, MD: It's also a long story, but I used to practice in Chicago for almost 20 years and I was looking for some place where nature-- I really enjoy hiking, right?-- so where there are a lot of trees, and that this is where it is. Originally, I had the option of working at the Fred Hutchinson. And also, I was offered some directorship at MultiCare, which is a big practice in Tacoma. But ultimately, I decided to really enjoy the small town and serve the community. That's why I came to here, Port Townsend. It's a very small town. Hospital is a 25-bed and the population is 10,000. So, I really enjoy being here.

Host: I can tell. So, that being said, what do you specialize in? What kinds of patients do you normally see?

Jason Suh, MD: So, I told you I had seven years of training. So, I had a training in hematology. I had a training in oncology. Then, I had a training in bone marrow transplantation, right? So, I see all kinds of patients. One is an oncology patient, which means a cancer patient, right? The other one is a hematology patient, which has mainly a blood problem, like anemia or blood counts problem and the coagulation. So, when I was young, I did transplantation, but I don't do it anymore. So, I'm just doing hematology and oncology, rural, the general population care.

Host: And so, since you deal with both cancer and blood, can you discuss the importance of having blood tests regularly as we get older, especially for those that may be considered at higher risk for blood cancers?

Jason Suh, MD: Yes. Well, I see a lot of times, a patient who never had their CBCs for five, 10 years, right? Then, all of a sudden develop major problem like leukemia, then the blood count's going to be completely abnormal, right? So, that's why, generally speaking, at least once a year, I think it's better to do a blood test.

There are a lot of bladder problems as you get older. It's called the bone marrow disorder, okay? Medical term, it's called myelodysplastic syndrome. These are coming on very slowly, so that's why it's very important to do CBC, which is a complete blood count at least once a year. Make sure all your blood counts are okay.

Host: Absolutely. And so, when we talk about blood cancer, Doctor, what patients are at higher risk?

Jason Suh, MD: Well, actually, age is the highest risk, right? So if you look at the blood counts problem, the most common is called the myelodysplastic syndrome, which is a bone marrow disorder. Your bone marrow is an organ too, and it just doesn't function well. So, over age 70, right? There are instances-- about 2%, which means one out of 50 general population, has low blood cancers because of the bone marrow problem called myelodysplastic syndrome. So, I see a lot of those cases here.

Host: And so, what's typically done to address that?

Jason Suh, MD: Right. So mainly, when you have anemia, we'll give an injection called the Procrit. And also, there is a new injection called Reblozyl. These are the injection that we can improve the anemia. Then, when you have low white blood cell and low platelet count, you end up giving bone marrow-modifying drug, which is called azacitidine. So, there are many different treatments. It also depends on your gene abnormalities. Sometimes we use a pill called Revlimid. So, there are a lot of different treatments.

Host: Gotcha. Now, obviously, your cancer patients, Doctor, are often going through a very challenging time, to say the least. And I know you've said you try to treat your patients like they're part of your family. So, what do you mean by that?

Jason Suh, MD: Well, as I told you, I was in New York, right? I was doing internal medicine training. Then, I really fell in love with the cancer patient. So, whenever you face a mortality, you just become truly yourself, right? So, I really enjoy guiding those patients. And generally speaking, I really treat my patient like my friend, right? I really will try to guide them, help them, and also like my family. There is really no other agenda, that I truly enjoy it. Because my job is a job that I can truly influence my patient and truly improve their quality of living.

There are a lot of oncologists that just don't pay attention at the end-of-the-life care, and they just give chemotherapy almost until the patient is dead, right? So, in my practice, I really look at the patient individually like my friend. A lot of my patients are really my friends. I really try to decide if any kind of chemotherapy, when I give it to them, can it really increase the quality of living, right? This is most important. Because I have a lot of elderly population-- this is retirement time, okay? Seventy-five percent of our populations are the retirees. So, there are a lot of 80, 85, 90, 93-year-old males, these are really, really fragile people, right? So unless you are convinced that you can really improve their quality of living some, we have to make sure that treatment side effect really does not affect them, right? So, what is the point of you living longer when you cannot function well and to truly enjoy the life?

So as soon as I decide that whatever I do, I cannot really improve the quality of living, I tend to refer those patients to hospice, because the most important thing is that all of us are going to die. When you die, what I try most is decrease suffering. There are some situations that I cannot cure the patient. Then, I really don't try to give them any kind of treatment. Because if I give them some treatment, they're going to just live a little bit longer with a miserable condition. So, whenever there's no possibility of a cure, especially with the older patient, right, it's better not to treat them and to concentrate on the hospice care. So, their lifespan can be shorter and that they suffer less that way. So, this is where I put most of my emphasis. So, sometimes it's a very difficult decision. So, I do a lot of difficult discussions with the patient, mainly because a lot of people just don't expect that they're going to eventually die. They pretend they're going to live forever, right? But there is no such a thing. You know, we all die at some point. So, as I said, when you die, you want to suffer the least. That's where I really guide the patient to really serve them as much as I can.

I'm sure.

Host: That's very comforting for people to hear. So, switching gears just a little bit, Doctor, Jefferson Healthcare, as you well know, recently opened its Castle View Wing, including a radiation-oncology clinic. So, why is it so important that Jefferson now offers both radiation-oncology and medical oncology?

Jason Suh, MD: So, what happened is, I know for all this time here, we didn't have a radiation facility, so patients have to travel almost two hours going back and forth to either Silverdale or Sequim, right? The problem with oncology care is that they're saying most of cancers, you'll never cure them with a chemotherapy alone. And also, you never cure them with a radiation treatment alone.

So, like head and neck cancer, lung cancer, blood cancer, what have you, most of the cancers, we do both. So when we give chemotherapy, radiation becomes much more effective. That's how we cure the patient. So, a lot of cancers, we have to give both chemotherapy and the radiation treatment. So when we don't have a radiation facility, that creates a lot of logistical issues, especially a lot of elderly people. They don't drive well, right? So, that's why when I came here, they just opened the radiation treatment, and I was so happy. It's very interesting. Jefferson is a tiny, bitty hospital with a 25 bed, right?

 When I was working actually in Olympia prior to this job, I saw so many delays in care because there is not enough services, right? And surprisingly, this is tiny town. But now, we have almost all services, so there's no delay in care. So, that's an extremely important thing. So, radiation treatment is just essential. You cannot do without it, right? So now, my patients, they see me in my office. Next building is radiation-oncology. So, we coordinate., It's really easy, and that they're getting the best care, by the way.

Host: That's great. So, any new technology or other treatment innovations in oncology right now that you're most excited about?

Jason Suh, MD: Well, I'll tell you this way, so I became an oncologist after seven years of training. I became a board-certified oncologist in 1997, right? So, that's 28 years ago. At that time, I had only two or three chemo. That's it, right? Nowadays, the last chemotherapy approved by FDA is more than 10 years away. So, we are completely done with the chemo. Chemotherapy, regular chemotherapy causes a lot of side effects. It's just there has been mind-boggling amount of new information that we are learning from the cancer. So nowadays, we routinely analyze all the cancer cells; gene information, then we target those mutations. So, this is a just past three years, right? It became a routine practice now. This is literally mind-boggling if you think about it, right?

So, the University of Washington did a human genome project, it took $1 billion to analyze all human genome, right? Guess how much it costs now? It is about, $1,700. $1 billion shrank to $1,700, and still the cost is going down continuously. So because of this technology improvement, we can do a gene test much easier, much cheaper. So nowadays, literally, every cancer patient. I do a complete the gene test on the cancer. So, we can treat them in a much better way. So a lot of times, we are targeting the gene mutation that caused the cancer. That's the most exciting area, and we are doing better and better now.

Host: Wow, it's really something, isn't it?

Jason Suh, MD: Yes. If you think about it, I mean, this is just mind-boggling amount of new information that we are constantly-- the understanding of the cancer cell, it's mind-boggling how much we understand each individual cancer cells, the proliferation mechanism. So, we attack all those proliferation signals.

So if you look at most interesting areas- I told you we do all gene tests, right? The next interesting area is really we call it the chemotherapy antibody conjugate. So, there are a lot of cancers that produce some antigen, right? We develop the antibodies to those antigens, right? Then we push chemo to the cancer cell only without ever damaging the regular cells. So, it's called the drug-antibody conjugate. Now, there are lots of them. And this is a major area that regular chemo, you can literally never take more than six months because it affects all of your body and there are a lot of side effects, right? I have a patient who is on dru-antibody conjugate more than one and a half years no problem, because this chemotherapy is just pushed into the cancer cell only using by the link between cancer cells' antigen expression. We develop antibody to it, and they just push the chemo to the cancer cells only. So, it's a mind-boggling technology if you think of it.

And the first drug conjugate became available almost like seven to eight years. Now, this area is exploding, because you are really looking at the treatment that it's so easy to the patient. We don't need to damage their body with side effects, right? Because chemo go into the cancer cell only not the rest of the body, right? So, this is a major area of improvement. And then, we continuously have now new medications coming out as we understand more cancer cells. We develop antibody, then we link those antibodies to the chemotherapy and push chemo into the molecular level cells. Yeah, so that's the most exciting area.

Host: It certainly sounds like it. And it seems like in so many different branches of medicine nowadays, that preciseness that you're talking about becomes the key ingredient.

Well, folks, we trust you are now more familiar with oncology care. Dr. Suh, keep up all your great work. A pleasure. Thanks so much again.

Jason Suh, MD: Thank you.

Host: Absolutely. And for more information, please visit jeffersonhealthcare.org. If you found this podcast helpful, please do share it on your social media. Thanks so much again for being part of To Your Health, a podcast from Jefferson Healthcare.