Heather Lee (Host): Hi there, everyone. I'm your host, Heather Lee. And welcome to this latest episode of Medically Speaking. Joining me today is Dr. Roberto Pili, who is the VP of Oncology Services for Kaleida Health. Thank you for being here.

Dr. Roberto Pili: It is a pleasure to be here, Heather. Thank you.

Host: So, let's dive into your background. How long have you been practicing medicine for and what drew you into oncology services?

Dr. Roberto Pili: Well, I've been many years. As a matter of fact, I grew up in Rome, in Italy. And then, I came to the States to do research. And then, I did all my training. And eventually, I ended up to be an oncologist. But taking care of cancer patient has always been my dream. And actually, I live this profession like a mission. So, really, I have a lot of proud-- but this is a humbling profession, so...

Host: Very humbling.

Dr. Roberto Pili: Very humbling. And we learn every day from our patients.

Host: Exactly. And we're going to talk a little bit more about some of your research in a little bit. But first, when folks think of cancer care, sometimes they don't always think of Kaleida health. Why should somebody come to Kaleida for their care?

Dr. Roberto Pili: Well, you know, Kaleida, of course, has a big presence in the medical field here in Western New York, not just in Buffalo. And cancer care is part of Kaleida.

Host: A growing part of Kaleida.

Dr. Roberto Pili: A growing part of Kaleida. And I came here five years ago really to build them and grow this program. And this is really a partnership, a strong partnership of course with the University of Buffalo and the UBMD. And so, with Kaleida, really, we've been able to consolidate and grow this program, both on the medical oncology and the surgical oncology. And we believe that we are in the position now really to take great care of our patients that deserve the highest possible care and compassionate care.

Host: I think that's one of the key points there, right, is the compassion. Also, what does a partnership-- you know, with UBMD, for example-- what does that mean for patients in what we can offer them in terms of the services, the depth of knowledge, the number of providers, and those specialties?

Dr. Roberto Pili: A very, very good point. I think it's been really a strategic partnership that Carolina has, not just in oncologists, you know, but also in other fields, but for oncology in particularly, because it does bring that depth and expertise. Many of us are involving lab research or clinical research. And so, to have access to clinical trials, I think that's very important. And it is partly really of outstanding cancer care. So again, I think this partnership has been critical and we are very excited to continue this in the future.

Host: And I feel like, over the past several years, there have been more clinical trials that we've been able to offer to patients, again, because of that collaboration. Are there any that come to mind or, you know, any advancements that come to mind that you're particularly proud of and want people to know about?

Dr. Roberto Pili: Well, our strong interest is actually in nutrition and diet. So, we do actually have three and, hopefully, in the next few months, four clinical trials that we offer to our patients where we offer dietary restriction. We believe like many others the calorie restriction and some type of fasting and plant-based diet can help our cancer patient not only to have less side effect from chemotherapy, for example, but increase also the efficacy of our treatment in particularly immunotherapy or monotherapy for prostate cancer. So, we're very excited about that.

Host: And if I understand correctly, you have some folks that are in that right now, right?

Dr. Roberto Pili: Yes. These studies are open and accruing. We've almost completed. The first study's about 30 patients, where we offer a calorie restriction and plant-based diet. Again, these are open to any type of cancer and to any type of chemotherapy. And let me tell you, our preliminary observations are pretty astonishing. Some of these patients really have a much less side effect from chemotherapy with just fasting before each cycle of chemotherapy.

Host: So, it's basically how the diet can make the medicine more effective. But also reduce--

Dr. Roberto Pili: Absolutely. The saying food is medicine, I truly believe. And I think it is really having a healthy lifestyle, not smoking, not drinking, but having a healthy diet. And sometimes they do some calorie restriction that might actually help these patients.

Host: That sort of taps into the screening, the prevention, the early detection. What is your message to folks out there, no matter what the type of cancer? What can we all be doing to take our health into our hands and hopefully either prevent things the best we can or, if you get a diagnosis to put us on the right course to making us the healthiest.

Dr. Roberto Pili: Absolutely. I mean, of course the prevention should be our goal, and we don't do enough. Unfortunately, the resources are limited. You know, work with your primary care physician that is in the frontline to really offer that type of screening opportunity. But at Kaleida Cancer Care, we are really implementing with GLIN screening opportunities in breast cancer, colon cancer. We do early detection in high-risk patient for prostate cancer, opening a screening program for lung cancer. So, I think these all initiatives are very important, especially for our inner city patient population who have less access to care. And we do see this difference in cities we are serving, for example, but for general suburban, the different patient population that are there. So, the needs are different. So, screening is a top priority for our program.

Host: Absolutely. And in marginalized communities, we often see higher rates of disease. But there's also, on some levels, some mistrust with healthcare providers, what can you do to sort of help break down those barriers so that people feel comfortable, and they're not scared or they're not apprehensive about getting a screening or coming for healthcare?

Dr. Roberto Pili: You touched on a very important issue. Again, through GLIN, but also through our division at UB, we established an outreach program, you know, working with the churches and the communities, and to since make it this opportunity about screening an important aspect of daily life for this patient population here in inner city. So, we're trying to bridge that gap. It's not easy.

Host: It's going to take time.

Dr. Roberto Pili: It's going to take time, but I think Kaleida is really in the best position to address these needs. And we are all working for the same goals.

Host: There is a patient that I work with who was diagnosed with prostate cancer. And after his diagnosis, took it upon himself to go out into the community and basically scream it from the rooftops, "You need to get screened. This affects us. This is important." When you hear stories like that, I would imagine as a provider that makes you smile and makes you feel like you're starting to crack the surface of that.

Dr. Roberto Pili: Absolutely. And we all have a story like that, you know, we're making difference there in the community. It is a long way to go, but that's really a priority.

Host: Yeah. One of our priorities at Kaleida is sort of having that one-stop shop, if you will, when it comes to cancer care and perhaps some of the treatments that might be around it. If patients need blood work, infusion services, perhaps emergency services, we're able to provide that, which not everybody is.

Dr. Roberto Pili: Absolutely. And I think we're very excited about the new infusion clinic. And we open this year. We have a multidisciplinary clinic at Buffalo General, across the infusion clinic. And we are really positioned, like you said, to have a really one stop where patients can get all the cares that need in one location. So, we're very excited about that. And there is a great opportunity to grow. But we're definitely in a better position now than a few years ago.

Host: And with having the infusion center, the new infusion center at Buffalo General Medical Center, that also removes one of those barriers because, say, somebody lives in the city of Buffalo...

Dr. Roberto Pili: Absolutely. They can just walk. I mean, have some patients I have in my clinic at the D1 here at Buffalo General, and I have a patient that just walk. And so, that's amazing.

Host: They don't have to travel to the suburbs.

Dr. Roberto Pili: They don't have to travel. Yeah.

Host: Yeah. Which makes it very, very convenient. We talked about your research involving nutrition. Any other research or clinical trials that might be on the horizon that you're excited about?

Dr. Roberto Pili: Well, thanks to Kaleida's support. We have clinical research infrastructure. And so, our goal is really to try to bring clinical trials for the bigger diseases like prostate cancer, lung cancer, breast cancer, colon cancer. And in the future, we're going to be able to bring also cellular therapies, this new treatment that are on the horizon for many solid tumors. So, again, we're very excited to be able-- we're about to open here at Buffalo General an opportunity for prostate cancer to get a new compound that delivers radiation directed to the cancer cell. So again, there are more treatment coming up, more clinical trial opportunities. And we're very excited.

Host: And with that more directed radiation, what does that mean for a patient for their outlook, for their recovery time, and in their healing process?

Dr. Roberto Pili: Yeah. I mean, the future for cancer therapeutics is in this we call a drug conjugate. These are antibody warheads. They recognize the cancer cells. And so, they can deliver chemotherapy, for example, or radiation. And so, the side effect of radiation chemotherapy are much less, because it's a much more targeted therapy. So again, we're very excited to be able to provide this type of treatment to our patients.

Host: And in recently talking with one of your colleagues, he was explaining that with prostate cancer, these days, it's not automatically go in doing very aggressive surgeries. Sometimes there's a watch-and-wait approach.

Dr. Roberto Pili: Yes, in prostate cancer, one-third of the patients with early diagnosis of prostate cancer are candidates, what we call it, for this. It's not just forget about it, but it is called active surveillance. So, these patients are monitored routinely, but those are the patients that actually we can offer over the next few weeks actually opportunity for diet and intervention. And I truly believe the change in the diet, change in the exercise can actually have impact in early disease, especially in diseases like prostate cancer.

Host: And that goes back to the prevention that we were talking about a little bit earlier. One of your specialties is bladder cancer. What should we know about bladder cancer, the risks, that lead to it and, again, what we can do to take our health into our own hands?

Dr. Roberto Pili: Yeah, absolutely. Unfortunately, there's still too many people who are smoking. So, I think a smoking cessation program is something that I know Kaleida is very involved in that. Working with the primary care physician, a general physician is very important. So, I think, I would love to go to the kids in the schools and talk about how vaping is as bad as smoking, if you want to live a healthy life.

So for bladder cancer, on the other side, there has been a great advancement with immunotherapy. Nowadays, we can really treat very effectively, even more advanced stage of bladder cancer. But, as you said, prevention is the key. So, we need to have less people smoking here in western New York.

Host: I think of mammograms for breast cancer, colonoscopies for colon cancer and prostate exams. But for some of the other cancers, are there necessarily screenings that we can do? Or, you know, what are the real preventative-- proactive measures, I should say-- that we can take to try to detect it early?

Dr. Roberto Pili: Yeah. Again, family history is important. If you have many cases of cancer in your family, that is a sign you need to get attention as you need to get screened better even for some really rare disease. And so, there are opportunities there. But as you mentioned, for colon cancer, prostate cancer, lung cancer, and breast cancer, there are screening tools available. Just ask your primary care physician. Don't be shy.

Host: I used to be one of those people that, you know, was afraid to go to the doctor because I was anxious about what I was going to find out, what they were going to tell me. But then, I think about it, if you don't go and you learn something down the line, and it's, you know, a not so great diagnosis, you don't want to be told, "Well, you should have been here 10 years ago." What is your message to people who maybe are a little bit apprehensive about the screenings, you know, going through the actual process, or just think that they don't have to worry about it? What would your message be?

Dr. Roberto Pili: Take ownership of your body and, you know, your health. That's the message. And then, again, seeing your primary care physician on a regular basis. And if there is a cancer in the family, if you're at risk for cancer because you've been smoking for a long time, ask for screening opportunities. Don't be afraid, because the screening might be negative, but you need to continue to check regularly. So, it's important. And hopefully, we can try to educate our kids to be more aware about this.

Host: Yeah. And I understand you're growing your GI team soon.

Dr. Roberto Pili: There is an opportunity for the GI teams with Dr. Gajdos as a surgical oncologist. They come in full-time at Kaleida. As you know, he's really a national expert in hepatobiliary tumors. They do high-risk surgery here, Buffalo General, for this type disease. And that we are bringing actually more medical oncologists with expertise in GI cancer. So, we're very excited that we can offer even more opportunity to our patients.

Host: And it's right here in Buffalo. It's right in our backyard. What does that mean for a patients, not only their physical well-being, but mentally not having to travel anywhere to get cancer care, being perhaps able to still work, being close to family? That seems like it's all part of the prescription as well.

Dr. Roberto Pili: Absolutely. And again, our team has the expertise to treat any type of cancer. And of course, we are a part of a larger network, so we have access to other medical centers or any cancer centers So, it is not just in silos. We follow all this, we call it NCCA guidelines, the National Comprehensive Cancer Network Guidelines. So again, patients do not need to travel. If, for some reason, there needs to be travel, we are going to be the first people to advocate for that, and we're going to take care of that.

Host: Yeah. We got some of the best of the best right here at Kaleida Health.

Dr. Roberto Pili: Absolutely.

Host: All right. Dr. Roberto Pili, VP of Oncology Services for Kaleida Health. I really enjoyed our conversation, a lot of really great information, a lot of important information.

Dr. Roberto Pili: We talked about a lot of important things, but it was a pleasure and I thank you for giving me the opportunity to chat today.

Host: Yeah. And as you have more and exciting things happening--

Dr. Roberto Pili: We'll come back.

Host: Yeah, we will be back for sure.

Dr. Roberto Pili: We'll be back.

Host: All right. Thanks for watching. Thanks for listening. And we will see you next time right here on Medically Speaking.