Gabby Cinnamon (Host): Welcome back to Conversations on Cancer brought to you by the Riverside Cancer Institute.

I'm your host, Gabby Cinnamon, and today I'm very excited to be joined by Dr. Cassandra Lacher, an Oncologist and Hematologist at the Riverside Cancer Institute, to share insights about starting a cancer treatment journey. Thank you so much for coming back on the podcast, Dr. Lacher. You've been a recurring guest for us, but for listeners just tuning in, or maybe haven't caught an episode with you before, can you kind of remind everyone of your background?

Cassandra Lacher, DO, MHA: oncologist Yes, I work as an Oncologist and Hematologist here at Riverside. I've been in this area for about two years, but previously I was working in other community oncology settings and have a passion for patients in the community who have cancer.

Host: Awesome. Well, we're very excited to have you here with us to talk about this important topic. I think, I'm sure with a cancer diagnosis, there comes a lot of uncertainty and I think that this kind of discussion will help put people at ease. As we get into the topic, can you walk us through what the first appointment for a patient might look like when they come to visit you or one of your colleagues?

Cassandra Lacher, DO, MHA: Absolutely. So our first visit, we will meet together in the office and review. Usually I'll ask people, what do you know about what your diagnosis is? And then try to fill in the blanks for what they may not already be aware of. Usually people want to know what is the diagnosis, what's my prognosis, or how long will I live with this cancer, and then what are my treatment options.

We also will talk a lot about family history and social history, so being able to gather that information before the appointment is really helpful, because knowing if you have an extensive family history of cancer helps us to know what further we need to do for workup in terms of genetic risks. The other thing I try to do for patients is let them know that they're a part of the decision making.

So this isn't just me making the decision for a patient, but they get to be a part of the team who makes the decision. I want them to really understand what each next step will be leading up to their next appointment.

Host: So you mentioned prognosis and I'm sure that sometimes it's a concern for patients and their families or caregivers who are helping them out. Can you talk about some of the other concerns that patients and their caregivers come in with when they first come to see you?

Cassandra Lacher, DO, MHA: Yeah, everyone always wants to know how long I'm going to live, but then they also want to know what are going to be the side effects of my treatment. Can I continue to work? Can I continue to do the things I enjoy? Usually I get a question if I can continue to golf. And so trying to meet those goals as part of what we want to discuss so that we know how to make that a possibility for people.

Host: What are some common misconceptions you hear from patients and their support team during that first appointment just in the beginning of their cancer journey in general?

Cassandra Lacher, DO, MHA: I think that people just have a lot of fear when it comes to cancer diagnosis that they don't totally understand what the options are now for treatment. Cancer treatment itself has changed so much in the last 15 years, really even since I started in oncology. It's a totally different treatment than I was doing when I first started in fellowship. And so when people have heard stories, horror stories sometimes from the 80s and 90s about vomiting all the time and these horrible radiation reactions and the difficulty tolerating treatment, people come in with a lot of fear. And being able to kind of talk through that and recognize that we've come a long way in how we're managing not only treatment itself, but also the side effects of treatment that cancer treatment shouldn't take away from quality of life as much as we can prevent that.

Host: What advice or guidance do you give patients in the early days, weeks of their treatment to help put them at ease?

Cassandra Lacher, DO, MHA: The first thing I tell people is to stay off Google.

Host: Dr. Google is usually nine times out of 10, not, not the best place to be.

Cassandra Lacher, DO, MHA: It's so true. I usually tell people that we're always so quick to complain and so when we look at something up online we find a concentration of negativity and not very often are people going online and saying oh, my treatment went exactly like it was supposed to and everything was great and I love getting cancer treatment. We don't hear that on internet searches. What we hear is, oh, I had all these horrible side effects. And that tends to be the minority, but it's so concentrated online that we just don't know.

You can't that. The other thing that I tell people is when you get a cancer diagnosis, you're going to have people come out of the woodwork who you never knew had cancer or whose cousins, brothers, uncle had cancer. And they're all going to have some sort of anecdotal advice about what fixed their cancer. And some of that is, evidence based

and some of that is not. So I tell people take everything with a grain of salt. And if they have questions, just to bring it to me. And I'm always happy to have those conversations about evidence based or otherwise treatments or vitamins or whatever that we can do to help them feel comfortable with what we're doing.

And then I also just want people to know that chemotherapy treatment for cancer, while it has side effects, my goal is for it to be helpful more than it is hurtful. And so being able to know that we can make adjustments, that there's an art to oncology, which is one of the things I love about it, that we have a lot of flexibility in helping people tolerate treatment, helping people get through treatment, but still giving the benefit of treatment.

Host: Yeah, I think, people do have good intentions and even, you know, in online forums I like to think that people aren't trying to be malicious, but unfortunately there is a lot of fear mongering, with anything in the medical field and especially, you know, cancer treatment, which is a very emotional thing to go through.

So yeah, I think that's important to keep in mind. Like, hey, you know, take what people say with a grain of salt and talk with your provider and you'll probably be happiest and, hopefully would make things easier that way for the patient. How can caregivers, family members, or friends support someone close to them who is starting a cancer journey?

Cassandra Lacher, DO, MHA: I think there's a couple of things I would recommend. The first thing is just to listen. Sometimes we want to give advice and it can be overwhelming for patients who are already have their minds swimming with information, to be gathering more information from all these other people can just feel like a lot. So I always tell people try to give space to talk if they want to talk or be, in a space where you can be quiet together, but try to support by just listening. And the other thing is to offer specific help. So don't just say, hey, I'm here. If you need something, please let me know. But say, hey, I'm going to come pick up your laundry and take it to the laundromat. Or I'm coming over and doing your dishes. Or I'm bringing you a meal. Give a specific thing. Or I'm going to come mow your yard. Or we need to build you a wheelchair ramp. Whatever it might be, it's hard when your brain is already swimming to think of a specific task to delegate, but for someone to say, I can help with this specific thing, it's a lot easier to say, yes, that is something I need help with.

Host: That's great advice for sure. Can you talk about the multidisciplinary team aspect at the Riverside Cancer Institute? I think, what people don't realize and definitely not something that I realized before, having oncology as a service line is, you know, it's not just the oncologist. There's a whole team of people helping and taking care of you. So can you kind of talk about that for maybe someone who's starting a cancer journey and might not realize that?

Cassandra Lacher, DO, MHA: So cancer treatment itself requires a lot of physicians, and so it's not just your medical oncologist who manages systemic treatments like chemotherapy and immunotherapies, but we often work a lot with radiation oncology, pulmonology, endocrinology, rheumatology, interventional radiology, the general surgeons, we all have a part a lot of times in managing cancer treatment or side effects of treatment.

Not only that, at our institution we have some other supportive services like social work, a dietician who helps when patients are having issues with weight loss or maybe aren't able to swallow well from a side effect of their cancer, and so having someone there to help with helping gain weight or managing that is helpful.

We have a chaplain on site who comes and prays with patients if they want to be prayed with or just helps offer a listening ear and a supportive hand if they need it. We also have a therapy dog that comes around to visit, which everyone always likes. We also have a nurse navigator who helps just to make sure all the ducks stay in a row.

So she just follows all the orders and makes sure that patients get where they need to be when they need to be there. As well as just working closely with your primary care doctors and other supportive staff within the hospital too.

Host: What can patients and their family members do to prepare for that first appointment?

Cassandra Lacher, DO, MHA: So again, stay off Google, but I would say there are a lot of good areas that you can find information about your specific cancer that are worth looking at online. So you can go online, just use a site that makes sense. The American Cancer Society website is a really good place to start. They offer a lot of information about specific types of cancer and they actually have a section that says what to ask your doctor.

And so that's a great place to start just to kind of start thinking about what is my journey going to look like and that way it kind of gives you a foundation to ask questions when you come to your visit that maybe you wouldn't otherwise have to ask.

It's also good to bring a pad of paper with you to your appointment or write your questions down beforehand. Just bring those with you so you don't have to try to rely on your swimming brain to remember all the questions you have. I'm always happy to answer questions as we go through things. I want people to feel comfortable with what's going on. I also tell people to designate a family member as the information disseminator into the family.

Sometimes if you bring five or six family members to your appointment, your questions don't get answered, but their questions all get answered and they may not be your questions. So it's good to have just one person in your family, or maybe two, who can just listen and then disseminate that information so that the patient doesn't also have to be responsible for telling every other family member and distant cousin everything about what's going on.

And then just decide who you can go to for help. So knowing what friends are going to be there for you, what friends are going to be able to support you, who's going to be in your inner circle is a good place to just start so that you know where to start if you need help or need support.

Host: For sure, I know that's great advice. Why is it so important for patients and their caregivers to be able to communicate with their concerns with their healthcare team? Can you talk about the patient provider relationship and why that's important?

Cassandra Lacher, DO, MHA: I always want to make sure that patients have their questions answered. I think when we leave with unanswered questions, it can cause a lot of anxiety and it leads to a lot of discontent with treatment or a lot of concerns or fear about treatment. And so I think being able to build a relationship with the provider so that you can ask whatever question whether you think it's a silly question or not. They're all questions worth discussing. And so I want patients to always feel comfortable with that. I also try to really explain to patients why we're doing what we're doing. So whether their age affects what our treatment plan would be or whether their specific diagnosis affects our treatment plan or whether maybe they have an underlying heart disease that takes away an option for treatment.

I always try to go through that with them because you'll see, well, my family member had this type of cancer and they got a totally different treatment. And so it makes it feel uncomfortable for a patient to feel like maybe I'm not getting the right treatment. But the thing about cancer treatment now is it's a so, it's so individualized, and so just helping them understand, we're using this from the guidelines, this is why this is the right treatment for you specifically, and maybe won't be the right treatment for somebody else is really important.

Host: Someone might be listening and maybe they're starting a cancer journey and they're thinking, oh my gosh, I don't have a big support system, or I don't have a lot of family around, or, or friends, or anything like that. Can you kind of talk about what resources are available for people to use if they don't have that support system around them?

Cassandra Lacher, DO, MHA: Yeah, so in our office we have social workers who can really help with local resources and things like financial resources or meeting other needs for each individual person. We also utilize a Ride Share program that's specifically for medical patients. So patients who maybe can't drive themselves safely or don't have someone else who can drive them, we can help arrange that through our office so that people can still get to their appointments safely.

Host: Yes.

Cassandra Lacher, DO, MHA: We offer a cancer rehab program, too, through Riverside, and that program just helps to make sure people are maintaining their strength and mobility during treatment, which helps a lot in terms of being able to continue doing your own daily activities and daily life needs.

And then the hospital also has several support groups that meet virtually or some that meet in person as well that meet at various times throughout the week that can also help provide a place to just talk and listen to people going through a similar struggle.

Host: That's very, very helpful. Is there. Well, thank you so much, Dr. Lacher, for coming on the podcast today. It's always a joy to have you.

And thank you, listeners, for tuning in to Conversations on Cancer, brought to you by the Riverside Cancer Institute. For more information about cancer care at Riverside, visit riversidehealthcare.org/cancer.

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