I’m going to pose a question now to everyone. How can the medical team improve the care of patients with brain metastases? Perhaps we can start with having Ivy and Katie speak to that.

Patients need information. That’s probably the most important thing. When you’re diagnosed, everything is thrown at you. I think patients need to understand what brain metastasis means, how that can impact their lives, if they’re asymptomatic versus symptomatic, what the options are for treatment, both short term and possibly long term. That needs to be laid out to people in an easily understandable way up front. I also think patients need to understand what the ongoing management is going to be for brain metastases, how often they’ll be scanned, if you have certain symptoms, when you should bring that up and maybe recommend moving a scan up earlier. But basically, what it comes down to is increased information.

I agree. We’ll have Ralph, after Katie has a chance to speak, but that’s exactly what the ABTA [American Brain Tumor Association] survey results showed us, too. But Katie, do you want to add to that?

I agree with everything Ivy said, although I have already said I’m the patient who doesn’t want to hear all the worst-case scenarios. I don’t know how I would have responded if a doctor said, “Listen, I need you to be looking for these things,” because then I would be like, “Oh my god, I think that symptom happened to me last week, I think I have a brain tumor, I think you need to scan me right now.” But I think I’ve gotten a little bit better now that I’m seasoned at dealing with this.

Another thing that was shocking to me was, I’m not claustrophobic, I didn’t think I was, until I got a brain scan. That’s a very different scan. If you think, “Oh, I’ve done scans, I know what I’m doing,” and suddenly you’re going headfirst down a very narrow tube with a cage on your head, it’s terrifying. To this day, if I ever hear of someone having to go in for a brain scan, I’m always very careful with how I present information to other patients. But I always do say, “That one is a little harder for me, and I take a Valium for it.” I call that a cancer perquisite. But Nick has to drive me to those scans now because they still, to this day, I get a lot of anxiety around that particular scan.

 I think your experience is not a rarity, I think other patients have had similar experiences. Ralph, do you want to add to that?

Sure. I think you all know this very well, but patients and caregivers trust you and respect you. When you take the time to sit down and give them clinical trial treatment options, they listen, they absorb it. But it’s important that you also involve your team, your nurses, and your social workers, so that when they leave the office, they trust you, but sometimes they don’t fully understand everything that you have said. Having your support staff following up, working with them on clinical trials is important. Second, the survey shows how much they lean on, and want to know more about, organizations like the ABTA. You can trust us to work with them where they are and then afterward. People like Nick, who is a phenomenal caregiver, we can talk to him about whether he’s interested in being a mentor to others after he feels like Katie is at a place where he can give time to other caregivers.

 I completely agree, Ralph. Dr. Gondi, did you want to add to, how can we as a field improve the care of a patient with brain metastases?

As I listen to Ivy, Katie and Nick speak, it reminded me, at least in my clinical experience, that when systemic cancer goes to the brain, there are a lot of emotions, understandably, there’s a lot of fear, there’s a lot of confusion, consternation. And it’s not just on the patient’s perspective, but even some medical oncologists. What I’ve appreciated is that sometimes medical oncologists, as a brain tumor specialist, and I’m sure Dr. Brastianos, you probably do the same, I just say, “You know what, I’ll take care of the brain. Everything above the neck, I’m going to watch and keep an eye on, and everything below the neck, your systemic oncologist can keep an eye on it, and we’ll do it together.” That collaboration becomes useful. Just during this Zoom call, I’ve gotten a couple of texts from medical oncologists about patients we have, and I think that gives patients and their providers some sense of calm and comfort, that everything is taken care of up here, that we’re OK. If I have a headache, call that doctor who specializes in brain stuff and let him know, so that they can address it. I do think that there is tremendous opportunity to help and augment the care of patients and their providers, especially when we’re talking about the brain.

Of the two concepts I tried to cover, one is that the neurological team, whether they are a surgeon, radiation oncologist, or whatever, they have the knowledge and expertise pertaining to the brain and to the central nervous system. That team is bringing that expertise to help the medical oncologist treat the patient in a complete way. The second concept is that it’s a complicated world, and one specialist within the neuro field cannot handle all the problems of brain metastasis. It does require a whole team of a surgeon, oncologist, radiation, radiologist, and so on and so forth. Bringing all these together in the brain metastasis concept is a great advantage for patients.

 I completely agree. On that note, we can be providing more support to caregivers. Nick, you already alluded to that earlier, but tell us more about how we can help caregivers.

This morning was a good example, my first question to Kate was, “How are you doing?” I think that’s a nice question also to ask a caregiver, how are they doing. I think I would like to see more proactive support offered, and if you do need support, here are avenues you can use to find support and information. Then what do you need as well as a caregiver, what can we do to support you, because we’re here to help the patient. The more that we can be supported to be in a better place to help the patient, the better that could be for us. Even Ivy talked about how she was the patient, she looked after the kids. I’m sure while her husband was working, that was a huge impact on him, as much as there was when I had to go to Pittsburgh, change my schedule, and be there to support Katie in the hospital every day. It would be great for a little more attention to the caregiver, to make sure things are well there, because we’re here to help the patient, and we’re part of the overall story and on the journey together.

That’s so important, Nick, thanks for saying that. Again, thank you to Katie, Nick and Ivy for sharing these deeply personal journeys. We’re so inspired by your stories. Thank you, and we hope that you’ll continue to do well and respond to therapies. I think we’ve reached time. Thank you to everyone who participated in today’s 

® program. I want to thank Ivy and Katie for sharing your story, and my colleagues, Vinai Gondi, Ray Sawaya, Manmeet Ahluwalia, and of course, Ralph DeVitto, for this incredible discussion. To our viewing audience, we hope you found this presentation to be useful and we’ve provided you with practical information that you can discuss with your health care provider. Thank you so much, everyone.

Improving Outcomes for Patients With Brain Metastases

Ivy Elkins, Patient

Prehabilitation and baseline physiological assessments before breast cancer surgery and treatment may enhance resilience to side effects, improve recovery and identify patients at an increased risk for developing lymphedema — a chronic and often debilitating condition that causes swelling in the affected arm and can arise weeks, months or even years after cancer intervention. What if there was a simple way to minimize the effects of lymphedema that up to 80% of patients are at risk for?

You are already a champion for the best possible treatment outcomes for your patients with breast cancer. One option is a non-invasive baseline assessment using bioimpedance spectroscopy (BIS). This technology can detect subtle increases in extracellular fluid in the arm — changes that would otherwise be imperceptible — enabling earlier intervention. BIS also provides valuable data on body composition, including total body water, extracellular and intracellular fluid volumes, skeletal muscle mass, and fat mass, all of which are important for guiding survivorship care.

There is growing recognition of the value of integrating physical therapy across the continuum of comprehensive cancer care. As experts describe it, the approach represents a pragmatic, barrier-free, patient-centric, data-driven model to making rehabilitation a standard strategy. You also can predict how long it takes to monitor your patients for adverse effects, which can vary depending on the individual and the intervention. For example, research on using a Prospective Surveillance Model (PSM) of care for breast cancer related lymphedema has demonstrated that we know what time frames we should continue to monitor and evidence so far suggests we should survey patients for at least five years.

Assessing a patient’s baseline function can predict the severity of treatment-related impairments and inform survivorship care planning. Prehabilitation care can prevent treatment-related pain, loss of function and declines in quality of life. A prospective surveillance program aims to minimize risk of several common treatment-related complications including fatigue, pain, lymphedema, weight gain, chemotherapy-induced peripheral neuropathy, cardiotoxic effects of chemotherapy and radiotherapy, bone health challenges and joint pain.

People about to undergo breast cancer treatment are often overwhelmed with information, stress, and immediate concerns about survival. Their primary focus is on beating the cancer — not necessarily on what comes after. Therefore, best practices call for ongoing education, rehabilitation support and regular screening throughout the continuum of care.

Guidelines from National Comprehensive Cancer Network (NCCN) and the National Accreditation Program for Breast Centers (NAPBC) emphasize comprehensive breast cancer survivorship care. They call for creating individualized survivorship care plans, multidisciplinary collaboration, regular monitoring for treatment-related effects like lymphedema, psychosocial support, and lifestyle recommendations. BIS has gained formal recognition as a valuable tool in this process, with both NCCN and NAPBC guidelines endorsing it as an evidence-based method for lymphedema management.

Early intervention — such as compression therapy, skin care, exercise, and patient education — can significantly reduce the severity of lymphedema. Patients at higher risk, particularly those who have had multiple lymph nodes removed, should be closely monitored for signs of developing symptoms. That said, even those considered lower risk are not immune. Early-stage lymphedema (stages 0 and 1) is often reversible with prompt treatment, whereas later stages (2 and 3) are typically more difficult to manage and less responsive to treatment. This underscores the importance of proactive screening for all.

This doesn’t mean there are no barriers to overcome. While rehabilitation and exercise have been shown to help prevent or manage many of the physical side effects of breast cancer treatment, implementation remains inconsistent. Few women are referred for rehabilitation during or after treatment, despite its proven benefits. Multiple barriers contribute to this gap, most notably the lack of referrals and low patient awareness. The National Standards for Cancer Survivorship Care can guide development of innovative programs or services to assess alignment and enhance existing survivorship programs. This system-wide strategy can improve the precision of your risk-stratification and predictive models.

In addition, the financial aspect cannot be overlooked. As awareness, monitoring, and treatment of lymphedema continue to expand, there is an increasing need for insurers to recognize and address the associated costs. Out-of-pocket expenses and other financial burdens faced by patients must be thoroughly understood to inform policy decisions.

Perception does not always align with reality when it comes to cost. Healthcare leaders may view prehabilitation and early surveillance as upfront expenses, without fully accounting for the long-term savings associated with early risk identification. One study comparing prospective surveillance to traditional intervention, for example, estimated the direct costs of implementing the PSM at $636 in the first year — compared to long-term costs of $3,125 when treatment is delayed to the point of impairment-based intervention. Direct costs include a treatment visit with a physical therapist and the cost of durable medical equipment associated with condition treatment and management.

An earlier study demonstrated successful management of breast cancer-related lymphedema using a conservative compression intervention using a PSM approach. This approach utilized only minimal physical therapy and durable medical equipment resources for early-stage lymphedema management and has been shown to be clinically effective. A large part of the cost difference is in the time and intensity of treatment needed when lymphedema is more advanced and requires complete decongestive therapy along with the expense of the custom versus ready to wear garments. The cost is about a 4 to 1 ratio - a custom garment is at least four times more expensive.

As the number of breast cancer survivors continues to grow, so too does the need for care models that anticipate long-term challenges and intervene early. Comprehensive prehabilitation and screening strategies — especially when supported by tools like BIS and the Prospective Surveillance Model — may help patients feel informed, prepared and empowered. At a time when they may feel most vulnerable, this approach puts control back in their hands. It is time to elevate prehabilitation and proactive monitoring from ‘nice to have’ to standard practice in survivorship care.

For more news on cancer updates, research and education, 

don’t forget to subscribe to CURE®’s newsletters here.

Prehabilitation and baseline physiological assessments before breast cancer surgery can enhance resilience to side effects, improve recovery, and identify patients at risk for lymphedema. Bioimpedance spectroscopy (BIS) is a non-invasive tool that detects subtle fluid changes, enabling early intervention. Prospective surveillance models (PSM) integrate physical therapy into cancer care, minimizing treatment-related complications. Early intervention and regular monitoring are crucial for managing lymphedema. Despite proven benefits, rehabilitation implementation is inconsistent due to barriers like lack of referrals. Financial considerations highlight the cost-effectiveness of early surveillance over delayed intervention.

Prehabilitation and early screening, including BIS, can ease recovery, reduce side effects and help manage lymphedema after breast cancer treatment.

Screening, Prehab May Reduce Breast Cancer Survivorship Burden

Spencer, Assistant Editor of CURE®, has been with MJH Life Sciences since 2024. A graduate of Rowan University with a bachelor's degree in health communication, Spencer enjoys spending time with family and friends, hiking, playing guitar and rock climbing.

Spencer Feldman

I would like to pivot a little bit and talk in our remaining minutes about everyone’s favorite topic: COVID-19. How has that affected your process? How has that affected the care that I offer my patients? You mentioned that the pandemic influenced your decision-making about working.

: Yes, very much so. I don’t know that I would’ve worked in any situation because in preschools, they’re precious little babies. However, they’re Petri dishes; that would’ve been a little risky. The other thing is, I’m alone during my infusion. Like I had mentioned before, I had gone with a friend a couple of times when she had her treatments, but I can’t have anybody with me because of COVID-19. When I come to see you, I get a COVID-19 test. It didn’t impact my choice of treatment in any way, and it didn’t change anything as far as the duration of my treatment. I don’t know if it will change my treatment down the road. I know I will have surgery in December, and then some reconstructive surgery. I don’t know what the timing on that will be, or if COVID-19 will affect that because of elective versus necessary surgery. That’s still to be determined, I think. One of the things I want to stress is, my breast cancer was found on an annual screening mammogram. I had no idea there was a problem. I would believe that a lot of people are pushing off appointments like that right now because of COVID-19. It’s very safe to go in and get these tests done. If I had waited and thought, “Oh, it’ll be fine,” my situation could be very different than it is. I have HER2-positive breast cancer. It’s aggressive, and I hope that women are going and getting their screening regardless of the pandemic.

 Absolutely. Thank you for emphasizing that. You’d have to be deaf, dumb, and blind to have been in this country in the last 20 years and not witness the push for routine screening mammograms and the notion that the earlier we catch a breast cancer, the more capable we are of eradicating it. Yes, we’re all concerned about what are going to be the long-term effects of potentially people delaying their screening studies. From the provider perspective, I think there’s good and bad about the way the pandemic has affected us. To me, the good news is I have not been unable to schedule people for their treatment. We haven’t had to alter the interval for treatment, and we haven’t had delays in getting people started in treatment. We’re very fortunate in that in this center. I am very aware that there are other cancer centers, cancer practices, and infusion centers elsewhere that can’t claim that. Thankfully, here, through a combination of diligent and vigilant planning and safety precautions, we’ve been able to treat people throughout. Periodically, there have been interruptions in surgeries, but thankfully again, we’ve not gotten to the point where an oncologic surgery would be delayed. No one’s lumpectomy or mastectomy has been delayed due to the pandemic, but reconstructive surgeries have been. While those are being delayed because they are “elective” or they’re for non–life-threatening issues, clearly that has a significant psychological impact, and we’re all very sympathetic.

Thankfully, as I said, medically, I haven’t really been impacted in terms of having to choose different regimens because, “I can’t use this one because of COVID-19.” Timing hasn’t been altered, which is great, and my monitoring has been pretty similar to before. At one point early on, we were doing more virtual visits and alternating those. For many of my patients on treatment, we were still doing those visits face-to-face when possible; that physical exam is very important. What the negative has been is as you said, I think it’s got to be really hard. I hate that people can’t bring a visitor or a family member with them to infusion. It is a long day to be in there on your own. The stress of having to get a COVID-19 test before treatment and having to come in here a whole extra day to get a COVID-19 test; I think people must feel like they already live here. I hate to have somebody incur yet another visit to this place. This pandemic has been a stressful, frightening time, in general, and having to add that to the significant stress of going through a cancer diagnosis and treatment program, I’m sure that’s challenging. We sure do our best to try to ease the way and make up for people’s lack of ability to have somebody in the infusion suite with them. I know we don’t substitute for a partner, a child, a parent, or a friend. The bottom line is, it’s probably been a lot psychologically harder to go through cancer treatment during this process. However, I’m very thankful that at least here the quality of care hasn’t been affected.

 It will be very interesting down the road, as you alluded to; we’ve got a lot of concerns about people missing out on their routine primary care visits, their routine age-appropriate cancer screenings, and what the downstream effects of that will be. I think we all can agree that much ink will be shed over the years 2020 and 2021. Hopefully, not beyond that.

 Thank you so very much for sharing your perspectives, and for embarking on this discussion this morning with me. To our viewing audience, we hope that you found this 

 program to be rich and informative. Thank you for being here with me today.

Patient Jocelyn Mueller and oncologist Julia Fisher, M.D., describe some of the adjustments that had to be made to Jocelyn’s treatment for HER2-positive breast cancer due to the COVID-19 pandemic.

HER2-positive Breast Cancer and COVID-19

Julie Fisher, MD

My name is Donna Fox and I was diagnosed with renal cell carcinoma in January of 2008. My cancer has returned six more times.

How has it affected my mindset and outlook on life? That's a tough question to which there is no simple answer. I was shocked by my original diagnosis as I had no obvious symptoms despite a three and 1/2 lb. tumor growing inside me. At the time there was no chemotherapy or radiation to treat kidney cancer. There was a clinical trial, but the potential side effects frightened, me so I declined.

I never said "why me" and I guess I believe it certainly could be me so I spent time communicating with family and friends and trying to keep normalcy in my life. I didn't want my life to be different post cancer but as for my outlook....I began to take stock of what I was doing and where I was going and decided to just keep it simple. I really did not change many things in my life and after I recovered from the surgery I felt fine so getting back to "normal" was not difficult. I never used the words "new normal."

I enthusiastically became a member of a cancer support group which was the best thing I ever did. We all had different cancer diagnoses but the fears and the feelings were the same. There was such joy and laughter in that group that I could not be sad or hopeless. 

Because my cancer has returned so many times with five additional surgeries and one cyberKnife treatment I value each day. I try, desperately I might add, to surround myself with positive people which is not always easy. I hold on to my spiritual beliefs and laugh whenever I can and bring joy to those around me whenever I can.

I have no idea what the future or the next set of CT scans will show but I do know this......I will continue to be me plain and simple and laugh when I can because to me laughter is the best!

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

How Cancer Changed My Mindset

Donna Fox

There was no evidence that CAR T directly caused secondary malignancies, despite FDA warnings, citing prior treatments as the cause, according to research.

A Study Investigates If CAR T Therapy Directly Causes Secondary Malignancies

Despite the Food and Drug Administration (FDA) requesting that approved BCMA- or CD-19-targeted CAR T-cell therapies come with a warning following reports of T-cell malignancies, including CAR-positive lymphoma, among patients who received the treatment, researchers have announced that they have found no evidence that the therapy caused secondary cancer in modified T cells.

That’s according to research published in 

 from the Perelman School of Medicine at the University of Pennsylvania and Penn Medicine’s Abramson Cancer Center.

CAR T-cell therapy, as defined by the National Cancer Institute, utilizes a patient’s T cells, part of the immune system, which are extracted, changed in a laboratory to attack cancer cells, grown in the laboratory and infused back into the patient. The treatment, according to a news release from Penn Medicine, involves the use of engineered viruses to deliver genetic instructions that enable a patient’s T cells to target and eliminate cancer cells. There is, according to the release, a risk of a cancer-associated gene mistakenly being turned on and causing unregulated growth, which is known as insertional mutagenesis.

Researchers drew on data from 783 adult and pediatric patients who received treatment with CAR T-cell therapy at Penn Medicine and Children’s Hospital of Philadelphia in clinical trials, and found 18 cases of secondary cancers, noting that there was no evidence that these cancers were caused by intentional mutagenesis. Instead, researchers cited suppression of the immune system from prior cancer treatments as the cause of the secondary cancers.

 associated with CAR T-cell therapy in Nov. 2023, and 

 to pharmaceutical companies behind CAR T-cell therapies asking that their labeling contain a warning of secondary malignancies and that patient counseling information and medication guide also mention the risk for cancers.

 study’s co-senior author, Dr. Joseph Fraietta, about the findings and what they mean for patients. Fraietta is an assistant professor of microbiology at the Perelman School of Medicine at the University of Pennsylvania.

After looking at over 38 clinical trials of cell therapies and engineered T cell therapies — not only CAR T-cell therapies — with over 2,200 years of total patient follow-up, the frequency of secondary malignancies is very low, actually. Across our trials, none of them were directly attributed to the engineered cell product. In other words, the cell product really didn't grow out and cause any issues.

I hope [the study] puts CAR T-cell therapies more into context in terms of the relative risk with other sorts of therapies as well. And notably, this is our experience at the University of Pennsylvania, although similar studies by other groups, these large safety data sets, they're coming out. But with that, there are also isolated instances of some of these products causing secondary malignancies, but they're very few and far between. I'm not sure how the FDA will look at it, because there's still a risk. However, these secondary malignancies that are directly attributed to the CAR T-cell products are infrequent.

Transcript has been edited for clarity and conciseness.

Dr. Joseph Fraietta is an assistant professor of microbiology at the Perelman School of Medicine at the University of Pennsylvania.

Dr. Joseph Fraietta

“Is it OK if I take care of you today?”

That was the question Robin asked, soon after my arrival and check-in at the Infusion Center for a routine blood transfusion. Pleasantly surprised to see her in an unexpected location, and amused by the question, I readily agreed! After all, I knew Robin quite well, as she was my primary nurse while hospitalized for a bone marrow transplant six months earlier. I soon learned she had recently transferred from the Bone Marrow Transplant (BMT) program to the Infusion Center.

Over the next few hours, as Robin administered expert nursing care, we caught up on each other’s lives and celebrated my post-transplant health improvement. It was a nice way to spend a morning; hospital visits are rarely (if ever!) better than this one.

Robin gained my unequivocal trust at our very first encounter during my hospital stay. Disguised as a relaxed and friendly conversation, she interviewed me to better understand my history as a lymphoma patient, the precise circumstances of the ongoing BMT process, and perhaps most importantly, my concerns and fears. Though other healthcare providers were coming and going, she made no attempt to prevent them from hearing the conversation; that is, until the questions became more personal. At that point, Robin inspected my IV access port, allowing her to continue the conversation with one-on-one privacy. It was skillfully done with the utmost calm, gentleness, and sincerity, and gave me space to answer questions with complete honesty.

Over the next two weeks, at every encounter, trust in Robin’s abilities as a skilled nurse, as well as an empathetic and compassionate human being, was reinforced. She became a confidant to me and my wife, Sue, patiently answering our questions and helping us navigate a difficult and often frightening process.

A simple gesture, though one that provided a great deal of tranquility, was Robin’s practice of telling me her schedule at the beginning of each work shift. As she regularly worked 12-hour days, it was comforting to know the same person would care for me for an extended period. This is not to imply concerns for those days and times when others were on duty, as I received consistently high-quality and professional care from everyone in the transplant unit: nurses, nurse aides, doctors, NPs, and PAs, as well as myriad others like custodians and the cafeteria staff who delivered my meals. Rather, it was the bond of trust, through the repetition of skilled nursing care and many, many conversations, that made Robin stand out among an amazing group of caregivers.

At my company, we pride ourselves in “taking care of people”. The expectation for each employee is to give full attention to the needs of our clients and do the best job possible while at work. For myself, as a project manager, this means producing construction documents that reflect our clients’ physical space requirements, and then working with contractors to get designs built accurately and within budget. Analogous to Robin’s work as a nurse, it focuses effort on the needs of others.

A profound difference between my work as an architectural consultant and nursing care at UW Health, however, is the personal and very “hands-on” aspect of nursing. This is particularly true for those of us requiring extended care for difficult and sometimes life-threatening conditions. The care and compassion displayed by Robin was truly extraordinary and will always be remembered. The DAISY Award sculpture entitled “A Healer’s Touch” is apropos for her attention to detail. As Robin passed the foot of my bed at the end of each visit, she would often give my big toe a gentle wiggle, as if saying “Don’t worry, Jeff, I have you covered – you’re safe”.

I can think of no one who better exemplifies the ideals of “taking care of people” and the mission of The DAISY Foundation.

The narrative highlights the exceptional care provided by a nurse named Robin during a patient's bone marrow transplant and subsequent visits to the Infusion Center. Robin's empathetic and skilled approach fostered a strong bond of trust with the patient and his wife, offering comfort and reassurance throughout the treatment process. Her dedication to patient care, characterized by personal attention and compassion, exemplifies the ideals of "taking care of people" and aligns with the mission of The DAISY Foundation, which honors extraordinary nursing professionals.

A Healer’s Touch During My Experience With Cancer Care

Jeff Gaard 

A dear friend I have known for many years gave me a call on his way home from the hospital on one Saturday night. His wife just had breast cancer surgery. He was uplifting as always and happy to talk, sharing news about her and what they had to do in the following months. We talked about our faith and how our lives have gone through some detours.

As I listened to him, I paused … I was reliving some of the moments of the past year. It has been almost a year since my first appointment with my breast cancer surgeon, Dr. Pat Whitworth. I can still smell the cool October air.

On October 16, 2019, my life drastically changed, and I had to embrace a completely new journey. The past 11 months have brought many transformations with a lot of sweet “aha” moments and pure tears of joy. It has been a year of deep forgiveness and healing. It was my personal journey to find my anchors and evaluate many priorities in my life, let go of the things that did not matter anymore and say yes to the happy me.

Looking back at the past year, my quest was to embrace the change and find love tucked in my heart that I somehow lost a few years ago following my divorce. As I write this, the sunshine that peeks through the curtains reminds me of the good days ahead … Sometimes you might ask yourself, “Why do I go through all these challenges and trials.”

Then I realized, I was providing support to a dear friend and his wife who too had breast cancer. At the end of the call, my friend asked what I did differently that brought me out of the fear zone and into the warrior mode.

There was a pause then I answered, “It was my choice to either let life happen to me or pray for God’s wisdom to make the right decisions and be proactive in my healing journey.”

We have a blind faith and maybe it is important to be faithful, but the truth is that healing does not happen by doing nothing. It takes bold faith and action. It requires discovering who you are and finding your way.

You can choose to find your calm and your anchor. You can choose to stay positive. You can also surround yourself with women who have been in your shoes and could give you solid advice.

There is an amazing level of inner strength that you feel coming from these warriors. They might be fragile and petite, but they are strong.

Every day is a battle. But we have a choice to make things happen every day. We can look at our life as an opportunity to grow even when it hurts, or we can give up and not care.

So, let’s highlight some things you must become to get through any life challenge, especially breast cancer.

Being a strong woman is more than being a female version of a Roman Gladiator. There is nothing that can be compared to the strength you find when cancer attacks your body and you learn to love yourself even more. Being strong is the only choice you have and first you will cry, break down, fall apart and then you will gradually put yourself back together. Every day I would affirm I choose life. Because tomorrow is not guaranteed. You give the best to yourself first.

Speak your desires into existence. Speak healing and love into your life. That is where your strength is hidden. It is the power of your words that changes your mindset, changes your energy, and changes your life. Those words can bring peace or cause stress.

The first time I came to Dr. Whitworth’s office, there was a poster on the wall about managing stress. 

 was an amazing way to identify where you were on your healing journey.

Gratitude has led me to experience more love and the hardest thing I had to do was to learn to accept love as well. Many strong women often do not know how to love themselves fully and they have a hard time accepting love and care from others. Often it is a cultural thing or a family thing. In my Russian culture, women were taught to never complain and take care of their lives. We were taught to survive and get through times of crisis with a smile.

When you learn to accept love, you will feel worthy. And when you feel worthy of being loved and appreciated for who you are, your life will change. Your transformation will happen fast when you learn to accept love and love yourself. Because everything you will do in your life will come from the place of love for who you are, including your healing, your relationships, your career, and your business. Everything will change.

Allowing others to help you and accepting care and love is something I had to learn in the past few years. You want to be Wonder Woman, ready to take on any challenge. When you agree with the idea that having help is totally cool, you finally realize once you accept love you can give more love back into the world. Your heart is finally healing and everything else falls in place. You are more motivated to do things you have delayed for a long time and you are motivated to change your lifestyle.

Good support system and solid medical team

I have been very blessed to have an amazing surgeon. He is an incredible doctor who has been a big blessing in my life and has encouraged me to practice mindfulness and work on reducing stress.

I am grateful for my friends that provided an amazing holistic health education.

I am grateful for my church friends who supported me in so many ways. I am so grateful for my dear friends who reminded me how strong I was and who prayed for me and my healing.

I am grateful for my book agent Julie who inspired me to write and share real life experiences.

I am grateful to my sons who are my rock and joy. They are my miracles. They are my true loves.

I am grateful to my parents from whom I have managed to hide the truth about the breast cancer diagnoses for many months and finally gave in and revealed the news. I am grateful they stayed calm.

I am grateful for this journey and for my life.

Are you grateful for your inner circle? Make sure to tell them today.

When you truly embrace your strength, find gratitude and self-love and surround yourself with loving and positive people, magic things can happen.

Tatyana Gann is a publicity strategist, mindset coach, writer, lifestyle advocate and breast cancer thriver. Her aim is to inspire women to tell their story to heal their mind and body. Tatyana resides in Nashville with her two sons. You can follow her on Instagram 

Looking to change your mindset when facing down breast cancer? Here are 3 hacks to keep you calm and happy. 

3 Mindset Hacks That Can Keep Women Facing Breast Cancer Calm and Happy

Tatyana Gann

We are going to move to the last piece here: thinking about how we can do better overall. Tim and Jamie, overall, what do you think? I know you think that we do great, but think about the overall world of cancer we live in. What do you think oncologists and the oncology team can improve in terms of managing patients, in terms of education, and in terms of treatment care? There are also a lot of financial implications, and we have not touched upon those. There is a whole hour that we could spend talking about that effect. Then, of course, how do we make sure that we end up meeting your needs? Any high-level thoughts about this?

It is all those things you just touched on. You worry about it. You always hear the scary stories of people who have exhausted their life savings to live two months longer, so that is something definite that we decided. I could have kept working, but my goal was to retire at age 55, so I stayed true to that. Keeping Jamie’s job and the insurance takes a bit of the burden off me as far as getting to the right providers. I did not have to change. We have gone through three insurance companies, and we have been able to stay with the same providers. That has helped a lot for consistency and everything.

You bring up a great question overall. Yes, we feel fortunate to have fallen into your hands, Dr. Bekaii-Saab, and Kelley’s, and that is great care. Looking more holistically, that is an important question. As great a job as you guys do, sometimes the pieces are not all connected. You guys do a great job, but then I get a bill from an insurance company saying that they are not going to pay for something. Sometimes it feels like the left hand does not talk to the right hand, and I have to fight with an insurance company. I have to get the paperwork that they need because they do not understand that a medication is not indicated for this, but it is still used that way in the oncology world. All those little pieces, sometimes from a holistic perspective, are out there floating around. I do not know what the answer is, but it feels overwhelming to try to keep all the pieces together. I often think about even older patients who might not have the ability to pull all those pieces together. How do they manage with all this? We are fortunate that we are in the field we are and that we have the resources we have. Even with all that, it can be overwhelming to fight with an insurance company or to try to get documentation when you just did that last month. Those are the pieces that, as a society, we could do better at.

Absolutely. Reese, what about financial resources or directing patients to financial resources and navigating that? In addition to having a diagnosis of cancer and having to fight through that, you now have to worry about the finances and financial support as well as fighting insurers and filing for bankruptcy for some patients. There are a lot more tragedies than the eye can see. What tools are you able to use to help with this, or what tools may be needed in your viewpoint—if they are not out there—to educate folks more?

 Fight CRC [colorectal cancer] does not provide financial support directly, and we generally point to our partners at Triage Cancer who are in tune with the legal battles patients and their families may face as well as insurance issues and finances. We have an established relationship with them, and we will do webinars every year or so to update our community on the different things that they might need to know. I would say that, even though we do not provide the financial support or necessarily the legal advice directly, we work with others to do so. From an oncological and a medical perspective, staying abreast of what advocacy organizations do and what types of resources they offer is extremely important to be able to point patients to the resources that exist, because there is a lot out there. Sometimes, it is not necessarily projected as much as it could be, but there are resources out there that are available, and advocacy organizations know about them and are able to point patients and their loved ones to those resources.

Kelley, you help oversee, manage and ensure that the patients are navigated safely through their journey, and it takes a big team. You have the pharmacist and the nurse working with you and others as well. If you have to give guidance or give advice to other health care providers, patients or caregivers about the model that—from your viewpoint—facilitates this level of care the most, what would you say to your peers?

You have to have a conversation with your patients regularly about what they need. A lot of times, patients do not want to bother us with stuff: “I am having this thing, but I did not want to tell you because I know you are busy.” We have to listen to what our patients are telling us, and we have to educate them about letting us know what they need. We at the Mayo Clinic are pretty fortunate in that we have a lot of resources that other facilities may not necessarily have. We have social workers who are fantastic, and we have pharmacists who are brilliant. If a family member, patient or colleague outside oncology recognizes something that is happening, all they have to do is let us know. We may not have the answer for it, but we may be able to do something to make things better.

We are certainly blessed to have that level of support for our patients. There are a lot of folks who work in the background: the finance person, the nurse, the technician, the pharmacist, the nurse practitioner, the physicians, from the chemotherapy nurse to the nurse who is focused on education, the navigator. It is a big team. The complexities of the system around how we care for our patients is immense, and we certainly hope to continue improving things with the support of organizations and advocacy groups with Reese’s work. Of course, we do all this for our patients, for you, Tim, and certainly for their families, Jamie and their son.

With that, I am going to thank all of you for this wonderful exchange. It was very educational, and it is great to be able to have this discussion with all of you. Thank you.

Improving Colorectal Cancer Management

Reese Garcia, Fight Colorectal Cancer

There is never a good time to be told you have cancer. This is the story I told myself as I pulled into my driveway to share the news with my husband. Only minutes prior to arriving home I had learned that my husband had a cancerous tumor inside his stomach. He was mowing the lawn, one of his favorite things to do, and I had to ruin it by sharing with him the results of his most recent endoscopy.

I can’t say that we were completely surprised due to the many events and tests leading up to this news, but regardless, this isn’t the news that anyone asks for. I took a deep breath and headed for the backyard. He stopped the lawnmower and I asked him to sit next to me on the deck. I told him that the results of his biopsy showed that the spot in his stomach was gastric adenocarcinoma, an aggressive form of stomach cancer. Without much emotion on his face, he said, “OK, well I am going to finish mowing the lawn, and then we can talk more about it.”

I, of course, must process information immediately, whereas he can put it aside and save it for later. Or can he? This is a question that I regularly consider. What goes on in his mind? Is he just mentally tougher than I am? Is it healthy that he can compartmentalize these things? Or maybe he just puts on a strong front for me? How do patients with cancer process such news?

When your spouse has cancer, you have cancer. It may sound extreme to say, but it’s the truth, and I have heard it a dozen times from families in similar situations. We chose to be married because we didn’t want to be apart. We chose to get married because we preferred living together, more than living separately. We are both independent people who are capable of being on our own, but we don’t want to be. His problems are my problems the same way mine are his. And so, together we face the life that cancer brought us. That, however, doesn’t mean we process news the same.

Many cancer survivors and patients I speak to are not as blindsided by the news as one might expect them to be. There were events or problems that led them into the doctor’s office to begin with. There were tests done looking for something, anything to explain the abnormal ailments that are disrupting their lives. That doesn’t mean the big ‘C’ word came to them any easier though. Some hear the news and feel confident that they will fight it, they know it will be hard, but they have witnessed others successfully fight cancer. Others are hit a little harder, they feel scared, they feel worried, the unknowns come at them and not only do their minds go into overdrive, but their bodies fill with adrenaline and they shake, quiver and some even say that suddenly they can’t hear and the room goes dark.

When I asked my husband later what he felt and where his thoughts went when I told him the news, he said he was sad, and he was worried. He was sad for me; it wasn’t fair to me that I would have to go through this. He was sad for his daughters. He was 8 years old when his mother died and he had to be raised by one parent, and he wanted nothing more than his children to have two parents. What a simple request?

He worried about how we would handle it if he died. He feared how all his loved ones would process the news. Initially, there was little concern for his own wellbeing. This is not unusual, as I speak to victims of cancer, I hear similar stories. There is little worry about how they will handle treatments or death, but more worry about how the ones they love will survive the rough roads of transitioning to a life without them. They worry about how their loved ones will handle watching them suffer through the pain and discomfort that comes with surgery, radiation, chemotherapy or any other cancer treatment.

Cancer makes your mind wander in many strange directions. If ever you wanted to know what an emotional rollercoaster really felt like, get on the cancer coaster and go for a ride. One minute you are sad, sad for your future, sad for you or your loved one’s state of being, and the next minute you are angry. You’re angry it even happened to you, and anger turns to guilt.

A cancer survivor may feel guilt that they survived the same prognosis as another patient they’ve met, or they may feel guilt for their spouse who has had to change their life to care for them. Amongst the bumps and the curves comes the question that never goes away even as a survivor, why me? How did I get cancer to begin with? What did I do wrong? A parent may fear that their child will get the same prognosis. There is no escaping all the emotions that come with cancer, and for many those highs and lows stay with them even if cancer doesn’t.

Stomach cancer is a rare breed of disease, it is one of the top three leading causes of cancer-related deaths. It isn’t a type of cancer you hear much about and it isn’t one you want to Google. As a person that likes data and has a love for science, cancer brings uncertainty and confusion. The same people that like to share statistics about how well the newest drug works are now telling you to ignore statistics. The statistics you read online don’t know you, they don’t factor in the many variables of your life. They don’t consider your unique self. Statistics only increase the level of uncertainty you feel when you are seeking answers.

There are many lessons that must be learned when you’re diagnosed with cancer and the biggest one of all is to be patient, live your life one day at a time, and stop looking ahead. Don’t plan, don’t prepare for the worst, that only wastes the time you have living what is left of your best life, yet the fear of optimism stalks you. My husband is strong, because since the removal of his stomach, he struggles to eat enough calories to fuel his body's needs, serving as a constant reminder to what he faced.

However, he didn't spend a lot of time angry that this happened to him. This changed when in the middle of a nationwide pandemic, we sat on the phone and listened to the oncologist tell us once more that he had cancer. Again, or still? It doesn’t matter, months earlier we were happy to hear that the surgery was successful in removing the tumor and all the margins were clear, yet it still didn’t stop the cancer from spreading. This time around, we talked. We sat down and we cried for a minute, then we remembered that nothing was going to happen tomorrow, or even next week. We knew what came with news like this; more tests. We knew because we had lived through this before. Even if we wanted it to, cancer doesn’t always move fast. It makes people suffer in the last years of their lives. We had processed the long-term effects of cancer once already; it didn’t take as long to process information the second time around. Is it possible to get “good at cancer?”

I saw a shred of optimism leave my husband as he got the news the second time. A person can feel confident in beating cancer, round one, but cancer round two that has spread outside of the original location feels like cancer won, and you lost. Cancer makes a person vulnerable. You see people you love cry that you didn’t think were criers. You witness people that are smart and capable of taking care of themselves rely heavily on you. Not just physically, but mentally and emotionally too. You become not only an extra set of hands, but a set of ears too.

Patients with cancer need you by their side when they meet with their oncologist. No matter how capable they are, they can’t take in and remember everything they are told at a doctor’s appointment. Their ears are ringing and tunnel vision creeps in as the news of each scan layers on more fear. Some are too numb to cry. The crying will hit them later when they least expect it. Maybe while they are watching their children or grandchildren play. Maybe it will come to them simply while they are at the grocery store. Or while they are laying in their chair unable to sleep due to symptoms of chemotherapy. The emotions will come, and they won’t always be prepared.

In some instances, after processing the news of a cancer diagnosis, the patient may realize that the fear and worry they are facing isn't permanent, and that for them cancer isn’t a death sentence. Several breast cancer survivors shared with me that they quickly realized that they would survive their diagnosis, but not without discomfort.

The breast cancer survivors had to check all the boxes, face the treatments and in some cases, undergo surgery. With recovery time they could move on with their lives and with a new level of gratitude and respect for the disease and others who face it. It may sound simple. However, treatments such as chemotherapy take every ounce of goodness out of you before you can begin to recover. One cancer survivor told me she chose to keep her cancer journey private. She said she knew that she would survive, and she didn’t want to be treated differently by her grown children, so she didn’t tell them until she was nearly finished with treatment. This may be rare, but the reasoning behind her decision isn’t rare. When you are diagnosed with cancer, people around you simply don’t know how to act, or what to say. People say things that make your skin cringe, and your eyes roll to the back or your head. They want to offer you the latest and greatest cancer treatments they heard about on the internet. It can take a lot for a person living with cancer to avoid coming unglued when they hear, “Have you heard about fill-in-the-blank-miracle-cure?”

As the caregiver, it can often fill me with frustration when a person tells me to not forget to take care of myself. First of all, I feel that I am doing a pretty good job of that, but mostly, they are forgetting what happens at home, the condition of the person suffering, you can’t ignore that to go out for some “me-time.” Your purpose has become taking care of your loved one. Be it so that they can get through this and live a long healthy life with you, or to make them as comfortable as possible for the remainder of their days. There is simply nothing perfect to say to someone that is living with cancer. I have learned that the best thing to say is a simple, “I’m sorry.” Those two words sum it up, simplify it, and keep a person from saying the wrong thing at the wrong time.

What goes on in the mind of a patient with cancer depends on the individual. Most can confirm that they feel every emotion, sometimes all in one day. They are afraid, and there are very few moments in the day that they are not thinking about cancer. Cancer follows them around wherever they go. Sometimes it shows itself with pain, discomfort and other physical symptoms. But even when it is hiding, the possibility of treatments working or not flood their mind. Cancer doesn’t go away. Cancer victims never get a day off from thinking and breathing cancer. No matter how hard they try, cancer stalks them, and they just never know when it is going to strike again.

Cancer makes your mind wander in many strange directions. If ever you wanted to know what an emotional rollercoaster really felt like, get on the cancer coaster and go for a ride.

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