Joey Wahler (Host): It's an important part of addressing the disease. So, we're discussing cancer survivor treatment. Our guest, Dr. Kyle Youngflesh, a Palliative Medicine physician for Salinas Valley Health. This is the Salinas Valley Health Ask the Experts podcast. Thanks for listening. I'm Joey Wahler. Hi there, Dr. Youngflesh. Thanks for being with us.

Kyle Youngflesh, DO: Hey, good morning, Joey. Good to be here.

Host: Great to have you aboard. So, first for those unaware, in a nutshell, what does a palliative doctor do?

Kyle Youngflesh, DO: It's a good question. That's basically the conversation that I open every visit when folks come to my office or I see them in the hospital. Basically, as a palliative physician, I'm part of a palliative care team, generally of social worker, nurse, chaplain, sometimes other disciplines. We're here to support, make hard times a little bit easier. That can look like really just listening, getting to know the patient and their family really well so that we're able to help the rest of the team understand who it is we're dealing with and try to get you the best care we can, whether that's symptom management, making decisions, navigating the complex medical system, making plans for the future. It just really depends on where you're at and what you need.

Host: It sounds like you're wearing a lot of hats at once, right?

Kyle Youngflesh, DO: Yeah. Well, and collaborating with my team. That's one of the beauties of the work I do. There's a lot of collaboration with cancer patients, specifically with the oncologists and their whole team, as well as the other members of our palliative team. So, it's really beautiful work, and I'm grateful to be able to do it.

Host: I'm sure it is. We're going to ask you more about that as we go along here. But first, we hear about people, "beating cancer," hopefully. But often, their treatment continues thereafter, doesn't it? Which is where you and yours come in, correct?

Kyle Youngflesh, DO: Well, you know, we're involved along any stage of serious illness, so whether or not people end up being able to have their cancer cured or completing cancer treatment. In terms of this survivorship program, it's a bit of a different hat than most of my day job. The idea here really in talking about cancer survivorship, there are different definitions. Some folks say that, the moment you're diagnosed with cancer, you're a cancer survivor. And I think that makes a lot of sense. Your folks are surviving and persevering through what's often a really difficult journey, whether or not their cancer is curable.

In general, the services that we have here are obviously going to be available to folks along any stage of their illness. But oftentimes, when folks say a cancer survivor, there's a more specific definition of folks who've completed treatment and are thought to be cancer-free. There's a particular range of concerns for that population as well.

Host: Gotcha. So, you make an important distinction there that survivor, technically speaking in your book, means anyone that's still alive with the disease or having had it. So, generally speaking, then what does it mean to you to be a cancer survivor? What needs, generally speaking, before we get into a few specifics, do those patients typically have?

Kyle Youngflesh, DO: When someone gets a cancer diagnosis, you know, I'm often involved in some of these early moments of folks kind of digesting that, and it's a point that really transforms someone's life. There's before cancer and there's after cancer. So, just because treatment has ended for, you know, someone who does complete cancer treatment, their life is still much different than it was before. And often, there's been huge changes in folks' lives, in their day to day, in their relationships, in their work, in their health. So, when we think about the needs of cancer survivors, we're kind of taking into account all of the different dimensions that may have been affected of someone's life and trying to help folks navigate that and continue on.

Host: And along those lines, you alluded earlier to the Salinas Valley Health Survivorship Program. So, what kinds of support do you and your colleagues offer there?

Kyle Youngflesh, DO: Our survivorship program really is in a stage of development. Basically, the various departments that are involved in supporting folks during treatment, we're still available as folks complete treatment, but what we're trying to do is trying to get things a little bit more centralized. And it's a collaboration really between Oncology, Cancer Resource Center, Palliative Care, Rehab Services, Nutrition. And so, once folks do complete treatment, they're going to have a lot less contact in general with these departments, though we're of course always still available as needs arise.

Part of our role is to put together a good understanding for the patient of what they've been through, more technical medical area, as well as a plan moving forward for screening, and to be able to communicate with their primary care doctor as well, basically what they've been through and what the needs will be going forward. And one beautiful thing about our health system here is that it's a really wonderful practice community of physicians and providers where it's very easy for us to get in contact with each other. It's very easy for us, you know, primary care providers, to quickly check in with an oncologist if there is something that's not clear.

So, Cancer Resource Center is a good continuing point of contact if a survivor has questions about what should be happening or who they should talk to about a given issue, that's a good starting point.

Host: So, it sounds like all of the people that could be needed to address the concerns of a patient, that you're all interconnected. What are the psychosocial concerns typically that survivors have and what do you offer to them?

Kyle Youngflesh, DO: Like most cancer journeys, there are themes. But each person's experience is of course going to be unique. But some of those themes that come up are, like I alluded to, they are really big changes in people's lives with the cancer diagnosis. Changes in work, so oftentimes, people might go on disability. They may have to alter how much physical activity they can perform, for example. So, folks can have concerns about making a living, returning to work. And then, of course, the mental health impacts. Chemo itself can be exhausting. There can be physical side effects like chemo brain, fatigue, neuropathy, and those can affect folks' daily lives and what they are and aren't able to do.

And then of course, I think it feels obvious to say, but just because your doctor says you don't currently have cancer and that your treatment's over, I think most cancer survivors always carry around in their back of their head, the fear of recurrence, the fear of cancer coming back. And that can be really tough. So, it really depends on which of these concerns people have specifically, but support from our social workers, whether Cancer Resource Center or in Palliative Care. Salinas Valley Health has a collaboration with Mood Health for psychotherapy services. I think not a day goes by, honestly, when I'm not encouraging folks I'm working with within the palliative context to consider psychotherapy. I think that weekly ongoing psycho-emotional support, honestly, I think most people can use that, whether you're a cancer survivor or not, a doctor or whoever you are, I think that, in tough times, that can be so essential. So, those are kind of some of the directions that takes. But again, if there are psychosocial concerns, being in contact with your primary care doctor or any of us that you've had contact with within your cancer team, we're here to help.

Host: And when you mentioned there, doctor, that cancer survivors often wonder in the back of their mind if there can be a recurrence, certainly followup exams for blood work and scans, things of that nature can be very stressful. So, the mental health aspect of what you and yours offer can certainly address that kind of anxiety, right?

Kyle Youngflesh, DO: Yeah. And I think normalizing those anxieties and concerns can be really powerful, and for folks to be able to share with someone about that. In my experience, both in my personal and professional life, I see again and again, that in tough times, it's often the feeling alone in a hard experience is often harder than the hard experience itself. If we feel like we have someone by our side, we can tolerate a lot. People can be really resilient. And so, I think just normalizing, I'm pretty healthy these days, but even just going in to the primary care doctor, I myself, as an experienced physician, I get nervous. And I think most folks, anytime they get a procedure or a test or a scan, no matter how healthy or sick they are, there's concern in the back of your head about what might be found. And I think for cancer survivors specifically who've been through this arc of treatment and feeling like they've come out the other side, for many people, each time there's a followup scan or a blood test, there's the fear about whether it may have occurred. And I think sharing that with your provider, sharing that with your family members, your friends, so you can get that support, it's invaluable.

Host: Absolutely. And when you talk about these different things that can provide new challenges for cancer survivors that may or may not be directly related to the cancer, but is certainly indirectly related at the very least, there's so much newness, so many new challenges that these patients have to deal with. And so, I'm sure that's often beyond daunting and it's a big challenge you and your team to help get them through these things that it's like they've sort of won the battle, but they're still fighting the war, so to speak, because there are still things going on as a result of their illness.

Kyle Youngflesh, DO: Yeah, that can definitely be the case. And like I said before, going to be different for each person. There are themes within a given type of cancer or type of treatment where one chemotherapy may be more likely to cause problems with the nerves, neuropathy, and a set of challenges that comes with that. There may be folks who have had to have certain types of surgeries that alter what they can and can't do. Alter their ability to have kids, these kinds of things/ it's just such a personal experience and that's our hope as a care team, is to be able to really acknowledge that and see the particularities of any given person's experience and do what we can to support and help navigate that.

Host: Couple of other things. If a patient's cancer does return or they're diagnosed with a new form, obviously compassion is a big part of it, but what have you found from your experience, doctor, that is most significant in trying to help get them through that? Because that's got to be a quite a blow as well if it occurs.

Kyle Youngflesh, DO: So, I'm not the oncologist, but I work closely with the oncologists. And I have several patients in my practice now who I'm helping support who have had a recurrence of cancer or a new diagnosis of cancer. And I've been blown away again and again by the strength of connection between the patient and their oncologist and how much confidence these folks who do have a recurrence often have in their oncologist. It's like, you know, they kind of want the blessing of that person who's helped them through such a hard time before, before we make any big changes. That relationship is incredibly important. And I think folks' ability to feel comfortable with those that they trust taking care of them.

I really do think about every day what an honor it is to have the confidence of our patients. It's a gift. And I think if the patients can really feel like those that are there for them are doing the very best they can, that they have their well-being in mind, that they can count on and rely on the team. That's a huge piece of it. And, again, as part of my work, it's often exploring what are people's social, emotional, spiritual support systems. Here in Salinas, a lot of Catholic Christian patients as well as other faiths or spiritual practices and denominations. But oftentimes, that's the thing that brings people through. And I talk about prayer. Patients bring up prayer with me every day in my practice as well. So, it depends on the person, but really that multi-dimensional approach, that that whole person approach is what's going to give people the best chance of having the easiest time.

Host: Absolutely. And you actually led me beautifully there into my last question, doc, which is in summary here, you mentioned what an honor it is to be able to serve this part of the community. What's most rewarding for you about the work that you and your colleagues at Salinas Valley Health do with cancer survivors? What are the things that make you feel best about what you're doing on a day-to-day basis?

Kyle Youngflesh, DO: I think the confidence that folks put in us in the depth of their journey and the vulnerability, the beautiful humanity, the relationships. I was previously a hospitalist, kind of general inpatient physician, and I really love that work and enjoy that work. But what's really kind of percolated out for me most meaningful as a doctor is really those relationships and getting to really witness people in their struggles, their triumphs, and just really see the beautiful humanity, the uniqueness of each person. And so, I'm really grateful for that and to be able to play some part and hopefully making people's journey a little easier. And, yeah, it really is just a privilege to witness.

Host: Well, doctor, the passion you have for your work certainly comes through in a big way to say the very least. Folks, we trust you're now more familiar with cancer survivor treatment. Dr. Kyle Youngflesh, continued success and keep up the great work you're doing. Thanks so much again.

Kyle Youngflesh, DO: Thank you, Joey. Thanks again for having me.

Host: And for more information, please visit salinasvalleyhealth.co/services/cancer-care. To listen to all of the Ask the Experts podcast please visit salinasvalleyhealth.com/podcasts. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler, and thanks again for listening to the Salinas Valley Health Ask the Experts Podcast.