CURE Media Group

Treatment for cancer is tough, but treatment for cancer during COVID-19 times is even tougher. The infusion unit waiting room was full of vacuous eyes and silence. No support partners were allowed. 

Enter my nurse nominee, Jyl Dedier, B.S.N., RN. She was light in darkness. Jyl looked at me with kind eyes, which were the only part of her face I could see. 

She wasn’t allowed to hug me, but her voice and eyes made a connection. She was genuinely interested in my life, my family and my career. She went out of her way to ensure I was comfortable, and she connected me with support services. She remembered my details from week to week, a connection that helped to soften isolation during long infusions. We were both women, working moms, humans — not just a patient and her nurse.

One day is particularly memorable for me. I was struggling with loneliness. I had just had my port placed. I was not only mentally exhausted but physically hurting. My mother-in-law, the one relative who was retired and able to visit us to help, had come down with COVID-19, so she cancelled her trip. 

My relatives were a thousand miles away, friends couldn’t visit, and we were isolated at home 24/7. Jyl sat with me and listened. She squeezed my shoulder. She made me feel like I was her only patient when I knew she had many more to serve that shift. It was that connection again, the one I needed, that Jyl provided.

I’m forever grateful that Jyl was my chemotherapy nurse. She has been making these connections with patients for more than 20 years. I’m grateful I was one of the lucky ones to connect with her.

Jyl Dedier was nominated by Tiffany Hogan for CURE®’s 2022 Extraordinary Healer in oncology nursing award.

For more news on cancer updates, research and education, don’t forget to 

Articles

My oncology nurse has been making connections with her patients for more than 20 years. I’m forever grateful I was lucky to be her patient. 

I Wasn’t ‘Just a Patient’ to My Oncology Nurse

CRANBURY, N.J., Jan. 7, 2022 /PRNewswire/ -- 

, the industry-leading multimedia platform devoted to cancer updates, research and education that reaches over 1 million patients, survivors and caregivers, is pleased to announce the winners of the annual 

® Calendar Contest. The 12 selected artists will have their artwork displayed in the 2022 calendar, titled "Healing Through Hues."

 of Dunedin, Fla., for "The Caribou Lookout"

 of Hillsdale, N.J., for "Squirrels in Winter"

 of Hollywood, Fla., for "Through the Storm"

 of Scottsdale, Ariz., for "Pali Lookout"

 of Calabasas, Calif., for "Prelude to New Life"

 of Lancaster, Pa., for "Forever Hopeful"

 of Annapolis, Md., for "Sailors Take Warning"

"It is my pleasure to congratulate the winning artists for the outstanding work that has been selected to be featured 

® magazine's "Healing Through Hues" calendar," said Mike Hennessy Jr., president and CEO of MJH Life Sciences™, parent company of CURE Media Group. "We received so many powerful and moving submissions from across the United States and would like to thank everyone that submitted their artwork for consideration."

CURE Media Group is the leading resource for cancer updates, research and education. Launched in 2002 and now celebrating its 20th anniversary, 

® has become the most widely distributed and read consumer publication in the United States for patients with cancer, survivors, and their caregivers. The platform combines a full suite of media products, including its industry-leading website 

; innovative video programs, such as "CURE Connections®"; a series of educational and inspirational events; and 

® magazine, which reaches more than 1 million readers. CURE Media Group is a brand of 

™, the largest privately held, independent, full-service medical media company in North America, dedicated to delivering trusted health care news across multiple channels.

Twelve winners were selected from 113 submissions to have their artwork featured in its annual calendar contest.

CURE Media Group Announces Winners of 2022 Calendar Contest

Watch the entire MPN Heroes® Recognition Program here!

CURE® is proud to host the ninth annual MPN Heroes® recognition program, an evening of gratitude and celebration for individuals who go above and beyond in their efforts to support patients with MPNs.

Each MPN Hero is nominated by patients, caregivers, advocates and health care professionals for their heroic contributions in the field of MPN or in the individual lives of those living with the disease.

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MPN Heroes® Recognition Program 2021

Kristie Kahl: Hi everyone. And welcome to today’s live broadcast, the Educated Patient Webinars: Testing and Treatment for Non-Small Cell Lung Cancer. I’m Kristie Kahl, vice president of content of CURE. We are pleased to bring you this webcast presented by CURE and sponsored by Regeneron. We have a few important announcements before we begin. We'd encourage you to ask questions during the event which you can submit by typing them in the Q&A box. You'll be receiving a survey via email tomorrow. As a thank you for watching the full webinar and completing the survey, you'll be entered to win a Visa gift card. We're pleased to be joined today by our moderator, Dr. Roy Herbst, Ensign Professor of Medicine and Professor of Pharmacology; Director of the Cancer Center for Thoracic Cancers; Chief of Medical Oncology at Yale Cancer Center and Smilow Cancer Hospital; as well as Associate Cancer Center Director of Translational Science at Yale School of Medicine. He'll be joined by Dr. Chaitali Nangia, Associate Professor of the Hematology & Oncology Division at Hoag Cancer Center Irvine; Beth Sandy, a Nurse Practitioner of Thoracic Medical Oncology at Abramson Cancer Center at the University of Pennsylvania; and Isabella De La Houssaye, a patient advocate. Thank you for joining us today and I'll now pass things off to our moderator to begin the discussion.

Dr. Roy Herbst: Thank you very much, it's really a pleasure to be here today. And we're all here. It's lung cancer awareness month, so it's a very good time to talk about lung cancer and the many things we're doing. Why don't we just start by having everyone tell them just a little bit about their background and why they're here today. Do you want to start, Isabella?

Isabella de la Houssaye: Sure. I am – I was diagnosed with stage IV non-small cell lung cancer EGFR+ in February 2018. And the testing, the biomarker testing has been a huge part of my treatment over the past four years. And so I'm here to share my experiences.

Dr. Chaitali Nangia: Yeah. Hi, there. I'm Chaitali Nangia, a medical oncologist. I'm involved a lot with research in lung cancer, especially in the immuno oncology space and run a bunch of clinical trials, especially in this targeted therapy space and have been involved in lung cancer story for quite some time.

Beth Sandy, CRNP: Yeah, I'm Beth Sandy. I'm a nurse practitioner in the cancer center at the University of Pennsylvania in Philadelphia. And my practice is lung cancer and have been doing that about 20 years as a nurse practitioner.

Dr. Roy Herbst: I'm Roy Herbst, I'm a medical oncologist, here at Yale Cancer Center, Smilow Cancer Hospital. I lead the lung cancer disease center, and also the chief of oncology. I'm happy to be your moderator tonight. OK, glad you're all here. Let's talk about biomarkers. So the first thing is why is it important, Chaitali, to have biomarker testing before treating for lung cancer?

Dr. Chaitali Nangia: [00:03:00] Yes, I think just to kind of take a deeper dive into this, I think biomarkers, what we're trying to see is when you get diagnosed with lung cancer, we want to do more personalized treatments. We want to give you therapy that's going to spare you more toxicity and hopefully spare you chemotherapy and get more targeted drugs. And so the step one is to recognize which are the patients who are going to benefit from this therapy and how do we best decide which patients should get a combination approach or should get just immunotherapy or like in Isabella's case, get a targeted drug. So it starts by testing. And nowadays, these testing have become quite sophisticated. You can do it either in the tissue or you can do it in just a blood draw. And that helps guide the physicians to see what would be the best first line therapy or what should we start out with to give you the best outcome, both in the short run and in the long run, because it makes a difference with what you got started with.

Dr. Roy Herbst: Absolutely. And Isabella as a patient, what do you understand about this? This is precision medicine, the right drug for the right person at the right time. But how much did you understand about this when you started your care? And how has that evolved?

Isabella de la Houssaye: I didn't understand anything. And what was quite frightening as a patient who was stage IV and declining rapidly was how long it took to process the information. And I had the tissue biopsy and that took almost a month, and I didn't understand what's – can't we just start treating? Why do I have wait? And at the end of the day, I did a blood biopsy and things moved more quickly because then they could recognize that I was EGFR+ and I was able to start a TKI more quickly. But it was – I didn't understand it, I have come to understand it. And in my kind of cancer, EGFR+, it's important to have the biomarker testing after every bit of progression to see how the cancer's evolving because it does change overtime as it gets treated.

Dr. Roy Herbst: Right, that's well said. I've seen biomarker testing evolved when I first started working in this field in 1993-94, and then we didn't even get biopsies sometimes. And now, of course, the first EGFR inhibitor trials, I remember leading some of those when I was in the Anderson in Houston, 1996-97. It's amazing that now, you are now most advanced generation drugs and you've found those drugs and you're treated. So Beth, as an advanced care provider and working in the clinic, how do you work with the patients when they come in, they knew diagnosis of this disease, they're going to have to get a biopsy, sometimes it's needles, sometimes it's liquid, how do you educate them as to what's going on?

Beth Sandy: Yeah, I think that's really complex sometimes. There's a whole lot of different things that can happen here. Number one, you're telling them, "I'd really like to wait for these results until we start treatment." And no one wants to wait, you want to get treated right away. So [00:06:00] this idea of waiting for the results to come back can be really hard, but it is really important that we know these results. To Isabella's point, we'd like to do it, both the blood and tissue because the blood comes back faster. If it's negative, we do like to wait for the tissue, if we can, depending on if we have enough of it. So these are all things that I end up explaining to patients that we're going to wait for these results until we start therapy. And we may start therapy and then test again later depending on the circumstances. Maybe we didn't have enough tissue, and our test results were inconclusive. The thing I would say is that I want patients to be advocates for themselves, make sure that you are being tested, if you have non-small cell lung cancer, especially a non-squamous type, the most common is adenocarcinoma. Because, really, everyone in that category should have a full biomarker panel done.

Dr. Roy Herbst: Absolutely. We're getting some questions from the audience. And we're so happy to have a live audience tonight. Here's a question. At this point, is biomarker testing standard of care in cancer centers for non-small lung cancer, I felt a lot of resistance about this with my mom's diagnosis. Sherry Baker points out. Chaitali, is it standard of care, you're in Hoag, that's – you're in California, you're in Southern California?

Dr. Chaitali Nangia: It's pretty much standard of care. Especially if we're talking about advanced lung cancer patients, it's definitely standard of care. Even in early stages now, we pretty much want to know because of the role of neoadjuvant/adjuvant, that means do need treatment before definitive surgeries. It's becoming standard of care. So pretty much in your first visit when you see your provider, you should be drawn for the liquid and tissue be submitted.

Dr. Roy Herbst: Isabella, you have some thoughts on this.

Isabella de la Houssaye: I do. What I see in my face group book, a group of people with non-small cell is that the operative board is in a cancer center, and so many people are not treated. And in the first instance, we've been, at any point, in a true cancer center, and they're being treated by the local doctors, local oncologists. And actually, they're not being – the biomarker testing is not widely used in a lot of places, even in the United States. And so, unless you're treated at a cancer center, you may not be getting that.

Dr. Roy Herbst: Right. I think that's, unfortunately, it is true. Some people don't get to set into have the test done. There's also a lot of disparities in the care of patients around the United States, sadly. People that don't ever get advised to have the test or from under representative minority groups. And it's really a shame because as you've told us, Isabella, these drugs do work when you're matching their – you say they're more specific and less toxic, because you're matching the drug with the biomarker, right?

Dr. Roy Herbst: [00:09:00] Excellent. And then Beth, your perspective on this. You're at Penn, I know Isabella's in New Haven, we better do the biomarker testing at my place, so I'll have to – the heads will roll here. But, Beth, what's happening at Penn, you and Dr. 

Beth Sandy: Yeah, it's absolutely standard of care at the University of Penn. But exactly what Isabella said. I talked to some of colleagues around the country and it may not be done everywhere. There used to be, years ago, this thought, "It's mainly in the non-smoker, so we're just going to test them." But that's not true, really. And the majority of the newer biomarkers that we know about are more common actually in smokers. So it doesn't matter whether you're a smoker or non-smoker, everyone needs to be tested for these biomarkers. Because like you said, Dr. Herbst, if you don't find it, you can't actually use the targeted drug to manage that, which will work best for the cancer.

Dr. Roy Herbst: We're on the CURE webinar now. And Isabella, how important your advocacy that works like this? So patients are watching, I'm sure, you said, face group, so you have a group that you're online with. Do patients talk and advocates talk and advise people? At least someone in that room is asking about biomarkers, it's the physicians or the advanced care provider or one of the nurses does it, as suggested. And hopefully the patient will ask about it, right?

Isabella de la Houssaye: Right. One of the things that with lung cancer and particularly biomarker testing is it's so individualized that it's actually more effective when you break into groups that are specific to the different biomarkers, because then patients can relate better and ask more relevant questions. So that's why I tend to go to the Facebook group more, because it's an EGFR specific, there are RAS specific and ALK specific groups as well. And organizations, like CURE, are awesome. There are resources, but I find the most effective are when they break into specific to my kind of cancer or within kinds of cancer.

Dr. Roy Herbst: Got it. Chaitali, there's a question here. How much more effective is tissue biomarker than blood biomarker? Do you do one, the other or both?

Dr. Chaitali Nangia: If you look at the data, the liquid, which is the blood biomarkers, quite specific. So that means that if it's positive, it truly is positive, sometimes we debate the question, could it miss a task? Or could it falsely be negative that you actually have it, it's just not shedding it in the bloodstream? So I think a tissue is the gold standard, but liquid is pretty close to it. And it's more easy to do, easy to navigate through, so I think that's how it plays was if I get my answer in the liquid? Then yeah, the tissue can [INAUDIBLE] but if I don't get my answer, if it's negative, I shouldn't always assume that that would be the case in the tissue, if that answers your [00:12:00] question.

Dr. Roy Herbst: Absolutely, and I would agree. We had a good first discussion, let's move on to another topic. Topic two, understanding the results. It's one thing to do the testing but then you've got to understand what to do, so some patients apparently are overwhelmed by the results. How do we work with the team? How does the teamwork with the patient understand it? So I'll start with you, Chaitali, again. And that you get the result back, how does your office work with the patient? How do you work with a patient? Could you explain to them what it means and what needs to be done?

Dr. Chaitali Nangia: For me, anytime is a – when you're just starting out your journey, there's a lot of apprehension, there's a lot of confusion, there's so much information. It's always difficult to sought out for the non-medical people. Even for us, it's difficult. So I like to invite the family, the caregivers and the patient to come and definitely for the subsequent needing when I have the results to go over. Because it really is a team effort, it's not just one person doing it, it's not even just the patient and the provider doing it, it's the whole care of team that needs to be involved in it. And as you know, that once after 10 minutes, the patients, what I always teach my followers, they stop listening, it's too much for them. So if they have more family members with them, then hopefully everybody [INAUDIBLE] there's a piece of that information. So I like to work it as a team approach. Obviously, from our side, we will always have our entire team present in that meeting as well.

Dr. Roy Herbst: What's your experience, Isabella, with this?

Isabella de la Houssaye: It's complicated. I know in my own, my own understanding has grown tremendously over the past four years and what I thought I understood at the beginning. I've – that's evolved tremendously. And that's why – and your time with your care team can be limited, so I think there's a huge role for support organizations to help patients in this area.

Dr. Roy Herbst: Thanks. Another question. Patients, Beth, might ask you. Is there additional information, other sources where I can go to to learn more about these biomarkers, what they mean? What do you tell them?

Beth Sandy: I think that's hard, because there are some sites that will give complex information. There's a website that I use a lot called mycancergenome.com. And you can look at your molecular pathology report and type in whatever it says there, and it will give you an explanation. But a lot of times, that explanation is in medical terms, and that can be hard for a patient who doesn't understand the terminology. So I think going back to what Isabella said, is that a lot of times, look – going to online support groups is maybe sometimes a better way to get more down to earth information. That being said, I would ask your care provider, ask your nurse, ask your doctor, because it's really our responsibility [00:15:00] to relay that information to patients in an understandable way, in a way that they understand what is happening and what we're going to use to treat their cancer based on that report, or what we're not going to use, based on that report. So, unfortunately, it is complex like Isabella said, so there's not really an easy place to go online that'll spell it out in layman's terms for you. So I still think going back to your care of team and saying, "I really don't understand what K-RAS G12D means, as oppose to K-RAS G12C." And let us explain that to you.

Dr. Roy Herbst: Great. OK, we have tons of questions here. Anyone can take it, first one to hit the buzzer. If a patient doesn't feel the care of team is adequately informing them about the results or they weren't even referred to get tested, what advice do we have for those patients? Who wants to take that one first? I'm going to ask you all, but – Isabella?

Isabella de la Houssaye: I'll just say I would tell anybody, no matter how great your care of team is, to get a second opinion no matter what. And I've found that very helpful and sometimes, it's the same sort of answer but explained differently, but I think it's just very important sometimes to hear from different people on the same topic when your health is involved.

Dr. Chaitali Nangia: I think I agree with Isabella. It's nothing – I agree that patients should get a second opinion because it also tells them, reassures them that this is how the whole medical community is answering them. But obviously, the catch being, what if you don't hear exactly the same thing? So you have to be kind of know that before you go in, that you will be emotionally OK handling that kind of information, because there's certain places that are standard of care, this is how we do it. But then there's definitely gray zones and complex patients that it can be done more than one way. So I just want my patients to be aware of that. And then, depending on which provider you're seeing, you may have clinical trials that may be completely different at two different providers. So you also want to see which one would you want to go with. But no, I think it's good to hear, especially if it's standard of care.

Dr. Roy Herbst: Right. Beth, someone asks, is it better to have a mutation discover than finding them? If no mutation is standard chemo than better than targeted therapy?

Beth Sandy: Yes, I think, there's no right answer here. So I wouldn't necessarily say it's better to have one thing or the other. It's better to know what you have and then treat appropriately. So if you have a mutation but you don't know it because you were never tested for it, and we go straight to immunotherapy, it's probably not going to work very well for you, because your cancer's driven by that mutation and we should [00:18:00] be treating you based on that. And the vice versa the same. If somebody has a mutation, we need to know about it so we don't start them on the wrong therapy. So depending on certain mutations, sometimes it's better to have one that responds very, very well, so that may be better prognostically. But now in the era of immunotherapy, my goodness, we see patients living years and years with immunotherapy, so I don't necessarily think it's better or not, it just guides our therapy. So what's not good is to not know. Because then, we don't – it's like we're just going to throw this out there and hoping it works.

Dr. Chaitali Nangia: And if I may add, the way the field is progressing, because today, liquid doesn't show blood, the chances are a fast forward [INAUDIBLE] Even that blood will show mutations, it's just how the technology's progressing and how the drugs that we can use for targeting is progressing.

Dr. Roy Herbst: Exactly. We have a lot of questions now, people are asking about minimal residual disease, meaning when you know if you've had enough therapy, do blood tests help? They're also asking about resistance. A couple of stories here in the chat, where patients get these drugs and then they become resistant, what do you do next? I guess that's something everyone has a perspective on this, why don't we start with Beth this time?

Beth Sandy: Yeah, so you can – and I would advocate for if their cancer is worsening to test for resistance mutations. For certain things, we have treatments or even mostly clinical trials to evaluate for this. So I would definitely recommend re-testing at that point. I would also maybe even recommend if the first time around, you didn't have a mutation. You do your standard treatment, then the cancer's worsening, maybe consider re-testing at that point. Especially if the original tissue was not sufficient, that didn't mean that you don't have one, it just means we didn't have enough tissue in order to do it. This is where the liquid biopsy comes in really handy, because then we don't have to go in with a needle and do an invasive procedure, we can just send a blood test off. And I know someone asked the question, is there a gold standard for which company? I don't really think so, I think there's a few out there, a handful, that we use a lot. I'm going to refrain from making suggestions about different companies, but I think there's a handful that or have very good reputations, that generally, we use.

Dr. Roy Herbst: Great, any other comments here?

Dr. Chaitali Nangia: I think this is a very active area of academic interest because we've seen that if you stopped with certain drugs, you get resistant to that medication. The question rises, what's the next best therapy? And what best to combine it with, and then sometimes the resistance matters with what you're starting out with, for example, if you take a case of EGFR, which is a kind of bio-marker and depending on what resistance you may have either at the get-go or subsequently, they may be in the same tree different branches that you should get as a treatment, and even in the space of [INAUDIBLE] and all this now there are so many clinical trials that are trying to address resistance mechanisms and how best to overcome them, so I think if you've not had a clinical trial opportunity at the first line while we're talking, consider that as second line that means you progressed on first line treatment to see if you can better understand that.

Dr. Roy Herbst: Very good, let's move on to another – Isabella, sorry.

Isabella de la Houssaye: Sure, I would – so I get a blood biopsy quarterly and it tells me how well the current treatment I'm working – I'm on is working, so that for me at least the mutations don't show up if the treatments are working and they begin to show up when they're not, and sometimes that gives me a heads-up before tumors progress, which is good information to have, otherwise people tend, in my world of EGFR, to get bio-marker testing every time you have progression to see what new mutations might have evolved and how that affects treatment and the other ways in terms of trials that they're using it in my community is to see whether – rather than put someone on a tough treatment and test and not know whether it's working safe for three months a blood biopsy might be able to show you in six weeks or three weeks even whether or not you're responding to that, so it can help patients determine treatments more effectively.

Dr. Roy Herbst: Absolutely, guide the therapy with bio-marker testing, so before we move on to the next section, someone has asked us why isn't everyone tested? What do you think?

Dr. Chaitali Nangia: I think that's an access to care, it depends on way you practicing, it depends on how fast you can get those turnaround tests, what the institutional practice may be, but I think it's pretty standard of care, it's covered by most insurances if done at the right indication, so it should be really, I think there's a big push to make it almost universal for the right settings.

Beth Sandy: I will say we don't test small cell lung cancer routinely because we don't generally find these bio-markers there, and at my institution we don't routinely test squamous non-small cell lung cancer because again the majority of these bio-marker question – or these bio-marker results are not found in those patients, that being said, I would test certainly squamous patients that particularly have a [00:24:00] characteristic like being a never smoker, something like that. Doctor Herbst, I would throw that back to you, do you test all non-small cell patients, or do you test the majority of non-squamous, which are predominantly at no carcinoma, what are your thoughts on that?

Dr. Roy Herbst: Well, I happen to believe you should test all non-small cell lung cancer patients, because even if it's not read as an ano-carcinoma, it can have mixed features, or it could be missed read, so we try – you should get it covered to test all patients with a diagnosis of non-small cell lung cancer, small cell I would agree with you, I think the bio-markers, think like the PDL1, which we're about to get to in a moment, but we probably wouldn't be – the actual indications there are still quite rare. Let's move on the next section, which is different options based on PDL1, very nice question Beth, you led us into the next section. First question: do we have any indication of how often PDL1 is expressed in patients with lung cancer, specifically non-small, if so what can we share about that information? So PDL1 is actually compared to the testing we give 

actually pretty easy to get, you actually get it back much quicker, how often is PDL1 expressed in lung cancer, Chaitali?

View the full CURE® Educated Patient® Webinar: Testing and Treatment for Non-Small Cell Lung Cancer on demand.

CURE Media Group

I Wasn’t ‘Just a Patient’ to My Oncology Nurse

CURE Media Group Announces Winners of 2022 Calendar Contest

MPN Heroes® Recognition Program 2021

Educated Patient® Webinar: Testing and Treatment for Non-Small Cell Lung Cancer

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