Understanding Palliative Care
Find an extra layer of support
I’m a sign language interpreter, specializing in health care. Recently, I interpreted an appointment between an oncologist and Grace (not her real name), a 73-year-old deaf woman recently diagnosed with lung cancer. Grace brought her hearing twin sister Luz to the appointment. The two petite women with big brown eyes shared a home, a calm demeanor and have always looked after one another. Grace’s doctor reviewed her pathology report slowly and in mostly laymen’s terms, which allowed me to interpret slowly for Grace and check in to make sure she understood what was being said. The doctor had on bright red reading glasses and looked directly at Grace when she spoke and paused often to make sure what she said was clear to both Grace and her sister. Sometimes when an interpreter is present, healthcare providers are inclined to speak to the interpreter or another hearing person rather than the patient. Grace’s doctor was direct, yet empathic and kind.
As the doctor described what was happening in Grace’s body, she pulled out a lined pad of paper and sketched rough outlines and locations of the tumors in her lungs. After she reviewed her recommendations for treatment, she said as part of the treatment plan she would like to refer Grace to the palliative care team at the hospital.
The sisters looked confused. Grace signed. “What is palliative care?
The doctor answered: “Palliative care is a specialty field of medicine, an extra layer of support. Essentially you would have a whole team of experts to provide extra care for you and your family while you are going through treatment for your cancer. Our palliative care team here includes doctors, nurses, social workers, nutritionists, physical therapists and chaplains.”
Luz looked worried. “A chaplain? Like a priest? What does this mean? Is she going to die soon? Interpreter, please don’t interpret that. Do they come to your house? I don’t understand?”
Like Grace and her sister Luz, many of us don’t know much about palliative care. Many of us hear palliative care and panic. We think that we, or our loved one, may be imminently dying. While palliative care certainly is provided to patients whose illnesses may be life threatening, palliative care is also offered as an option for patients to help reduce suffering and enhance quality of life, while undergoing treatment for serious illness.
Palliative care services are typically provided in a hospital setting, but can be arranged for in an outpatient setting, long term care facility or at home. Those working in palliative care specialize in supporting the whole patient. Palliative care providers can:
- Help navigate the complex health care system
- Discuss prognosis and treatment plan options and changes
- Offer resources for spiritual and emotional support
- Develop respite support for families or caregivers
- Offer resources to manage symptoms such as anxiety, depression, sleep problems, constipation, nausea, loss of appetite, shortness of breath and pain
- Arrange for nutritional counseling, physical therapy, occupational therapy, massage therapy or other integrative medicine services
Depending on the individual patient’s needs, she or he may need consistent, long-term support throughout their treatment. In other cases, the patient may use palliative care periodically or for a short term. If you, or a loved one have been recently diagnosed with lung cancer, you don’t have to wait until you are experiencing symptoms to ask for and receive palliative care.
Palliative care professionals are a resource to help you and your family live most optimally while on this journey with lung cancer. The lung cancer journey takes us on roads that we are not familiar with, and we are asked to make decisions that requires expertise and extra care. In addition to your provider, palliative care can offer you an extra layer of support during a most challenging time. Speak with your provider about how to set up palliative care and check with your insurance carrier about your palliative care options.
To learn more about palliative care or find a provider in your area, go to: getpalliativecare.org
Lung Cancer Is Not A Laughing Matter
You may or may not be a fan of Kathy Griffin’s acting or comedy, but she recently became a member of a growing group of never-smoking Americans who face a lung cancer diagnosis.
She recently tweeted “Yes, I have lung cancer, even though I’ve never smoked! The doctors are very optimistic as it is stage one and contained to my left lung. Hopefully no chemo or radiation after this and I should have normal function with my breathing.”
According to data from the CDC, non-smokers account for approximately 10% to 20% of lung cancers diagnosed in the United States, or roughly 20,000 to 40,000 lung cancers annually. *
Lung cancer in early stages, such a Kathy Griffin’s, is often found by accident. In early stages, lung cancer patients don’t often experience symptoms, or if they do experience symptoms such as shortness of breath, a cough, or chest pain which commonly occur, they are often misdiagnosed and confused with other illnesses. A cough, fatigue, or shortness of breath does not usually inspire a non-smoking person to rush to their physician to specifically discuss lung cancer. As a result, by the time lung cancer is considered diagnostically, it is often at a later stage. However, if you are aware of a family history of lung cancer, long term environmental exposure to radon, asbestos, open fires, frying foods, or have a history of other inflammatory lung disease, and some of the above symptoms are present, it could signal lung cancer and it’s important to feel empowered to have a straight forward conversation with your provider.
Currently the only method available for early-stage lung cancer detection is a low dose Computed Tomography (CT) scan. Medicare part B guidelines are often used by physicians to assess whether to order a screening for patients. Unfortunately, current guidelines are restrictive and do not consider non-smoking risk factors. They are:
- The patient is ages 55-77.
- The patient does not have signs or symptoms of lung cancer (asymptomatic).
- The patient is either a current smoker or quit smoking within the last 15 years.
- The patient has a tobacco smoking history of at least 30 “pack years” (an average of one pack [20 cigarettes] per day for 30 years).
As a person whose mother and biological grandmother both had lung cancer, I am aware that I am at increased risk of developing the disease even though I am a mother with teen age children and a non-smoker. When I recently noticed a constellation of whisper-like symptoms, I had a conversation with my physician and brought up the idea of having a low dose CT scan. Given my family history, at minimum, a baseline lung scan would be a good thing to have, I suggested. My provider said he agreed; however, he could not order the scan because I did not meet the criteria above. The HMO computer program was strictly set to those guidelines (or perhaps he was?). I believe a revision of current low dose CT scan screening guidelines to include non-smoking risk factors such as family history or environmental exposures is necessary and would save lives.
Fortunately, I was able to transfer to a more seasoned physician who understood what to by-pass in the computer system so he could order a baseline low dose CT scan for me. As a smoker or non-smoker it is important to know your risk factors for developing lung cancer, minimize exposure to known risks and not to give up if you are initially denied access to what may be a critical component of your care. Hopefully, in the near future we will have better early detection technologies as well as more inclusive policies around their use.
Learn Everything You Can About Biomarkers. It could save your life or your loved one.
About ten years ago, a friend told me that her mother had pancreatic cancer and that there was no hope for treatment for her. Her father is a physician and was not willing to simply sit back and accept that his wife would soon die. He and a colleague learned that his wife’s tumor was HER2 positive, a common biomarker for breast cancer. This was very early in the history of biomarker testing and targeted therapy. So, he reached out to doctors at the major hospitals in his area asking if they would do a trial to treat his wife, using one of the effective breast cancer drugs. He was turned down by several hospitals until he found one doctor, at a well-known hospital, who was willing to try this approach. Thankfully, this treatment was effective for her and she continues to experience a good life.
About six or seven years ago, I was visiting a dear friend who, shortly after my visit, was diagnosed with a neuroendocrine tumor. I spoke with her on the phone and said it was odd that I had recently gone to a talk where the speaker mentioned that neuroendocrine cells are often found in the lung. I told her that there was a growing area in cancer diagnosis and treatment that was based on biomarker testing and I urged her to talk with her doctors to be sure that testing was done.
What is biomarker testing and why is it important for cancer treatment?
Biomarker testing is a way to look for genes, proteins, and other substances (called biomarkers or tumor markers) to find information about cancer. Biomarker testing can provide significant information about an individual’s tumor regarding unique patterns. Knowing what biomarkers are present helps to guide the medical team to make decisions about which drugs to choose. Selecting drug therapy that targets particular biomarkers, or tumor mutations can make a lifesaving difference.
Upstage Lung Cancer’s June, 2021 Backstage @ Upstage Podcast is called, “This Podcast Could Save Your Life.” That might sound a bit over the top, but I assure you, it isn’t! Our guest on this podcast is Jill Feldman, an amazing woman who lost her grandparents, her parents and an aunt to lung cancer, only to find herself at thirty-nine, with small children, diagnosed with lung cancer. Over the past twelve years she’s battled the disease. The treatment that saved, and extended her life, was a drug that directly targeted her tumor that had a particular biomarker, an EGFR mutation.
Also In the same podcast, Dr. Jo-Ellen Murphy, medical liaison to Foundation Medicine described how testing biomarkers can help doctors diagnose and monitor cancer during and after treatment. She described how Jill’s biomarker testing reveled that she had the EGFR gene. Knowing that, allowed for treatments that directly target that mutation with drugs called EGFR inhibitors. Because of comprehensive biomarker testing and subsequent treatment, Jill has been able to sustain hope.
Biomarker testing also can also be used to help choose and enlist in a clinical trial that offers a new cancer treatments. Some studies enroll individuals based on the biomarkers in their cancer, irrespective of where the cancer started growing in the body. What is clear is that in the major teaching hospitals throughout the country, more and more oncology teams know about and request biomarker testing to help determine what treatments are likely to help and those that could not. It is not an overstatement how important it is to discuss biomarkers, as a part of diagnosis and treatment planning with your medical staff.
Young People Get Lung Cancer, Really!
In an article by Anita T. Shafer on March 23, 2016, she asked, “Can a physically fit twenty-something who never smoked a cigarette get lethal lung cancer?” You may be surprised to know that the answer is “yes.” Unfortunately, doctors don’t know how or why. Upstage Lung Cancer continues for the seventh year to join forces with Addario Lung Cancer Medical Institute (ALCMI) and GO2 Foundation for Lung Cancer (GO2 Foundation). Proceeds from our concerts help to support research to help find answers to these questions.
Unraveling genetic reasons for lung cancer striking people under 40 is one of the research passions for Bonnie and Tony Addario. Bonnie’s own battle with lung cancer began when she was in her 50s, and she proceeded to form her foundation in 2006. A distraught mother contacted Bonnie, searching for help for her 21-year-old daughter, recently diagnosed with lung cancer. Jill Costello was a member of her college rowing team and had never smoked, yet she was diagnosed with stage 4 lung cancer. She died just one year later in June 2010, shortly after graduating from the University of California, Berkeley and leading its women’s rowing team to PAC-10 and NCAA championships.
Learning of Jill’s story, Bonnie assembled a network of the world’s top lung cancer researchers to ask “why?” It was clear that young people diagnosed with lung cancer had not been previously considered. “We did everything we could for Jill,” Addario recalls. “We literally reached out to everyone in the United States and around the world and nobody had any answers.”
Now, it’s fifteen years later.
Here are some statistics about young lung cancer:
- According to the American Cancer Society, the average age of people diagnosed with lung cancer in the United States is around 70.
- Between 1.2 to 6.2 percent of cases are found in people under age 40, but a small percentage adds up to large numbers. 3776-14,000 of younger people are diagnosed each year.
- Stage at diagnosis tends to be later, Stage 4, due to delayed consideration of lung cancer being a possible diagnosis in younger people.
- They tend to be never smokers.
- Despite being diagnosed at a later stage, younger people tend to fare better than older patients, although study results vary.
- Young adults with lung cancer are more likely to have an EGFR mutation. Targeted therapies are now available that address this mutation and can result in prolonged progression-free survival for many people.
The importance of this last point is that within the past decade, biomarker testing has grown in sensitivity and importance for treating cancer patients with targeted therapies. By knowing a patient’s mutation, a drug that directly targets that mutation can extend and save lives.
In Upstage Lung Cancer’s recent Backstage @ Upstage podcast Tony Addario, Founder and President of ALCMI discussed the Genomics of Young Lung Cancer, a global research project looking at possible biomarkers in younger patients. One of the lead researchers, Dr. Barbara Gitlitz said that nearly 84 percent of patients diagnosed with lung adenocarcinoma at an early age had genetic mutations that made them potential candidates for targeted therapies. These treatments weren’t available at the time of Jill Costello’s diagnosis.
Corey Wood was another guest on this podcast. She had been a college student, marathon runner, and successful mountain climber and was diagnosed with advanced stage lung cancer at 22, with an unusual symptom—a flash in her right eye. It turned out that this was caused by metastases of her lung cancer. Thankfully, Foundation One Testing showed that she had a rare biomarker, ROS1. Now there are more drugs targeting more mutations. The road hasn’t been easy for Corey, but she is an inspiration to all who live with lung cancer to not give up hope. Seven years after diagnosis, she lives her life to the fullest.
Upstage Lung Cancer supports a new research initiative from ALCMI that launches this year. Epidemiology of Young Lung Cancer (EoYLC), is a collaboration between ALCMI and GO2 Foundation, and seeks to pinpoint risk factors leading to a lung cancer diagnosis in young people. The study looks at environmental and childhood exposures and other potential risk factors that researchers hope will crack the code on lung cancer in those diagnosed under age 40.
“We’re in a race to figure out this disease so that the next generation doesn’t get it,” says Emily Bennett Taylor, a Stage IV lung cancer survivor diagnosed at age 28. Upstage Lung Cancer is proud to have supported the initial Genomics of Young Lung Cancer study for the past six years, and to continue its support of the EoYLC study.
Added thanks to Susan Smedley, National Manager, Community Fundraising and Endurance Events Go2, ALCMI
Lung Cancer Screening News
March 9, 2021, the United States Preventive Services Task Force (USPSTF) announced revisions to its existing lung cancer screening by lowering the screening age and including patients with a shorter smoking history.
The USPSTF update recommends annual lung cancer screening with low-dose computed tomography in individuals at high risk:
- 50-80 years old
- Have at least a 20-pack year smoking history
- Are currently smoking or quit within the past 15 years
This recommendation essentially doubles the number of individuals eligible for CT lung screening in the U.S. and will save lives. EARLY DETECTION is the best way to save lives and treat lung cancer early. If you, or someone you, know fit this criteria, don’t wait to be screened.
Expanding the screening guidelines is a critical step to improve survival rates and reach more of those Americans potentially at high risk for this disease,” said Harold Wimmer, President and CEO, American Lung Association. This recommendation will nearly double the number of individuals eligible for screening and has the potential to save significantly more lives than the current guidelines.
In addition, we know that people of color who are diagnosed with lung cancer face worse outcomes compared to white Americans because they are less likely to be diagnosed early, less likely to receive surgical treatment, and more likely to not receive any treatment. The expanded criteria will more than double the number of Black and Hispanic people eligible for screening and increase the number of American Indians and Alaskan Natives eligible by 2.7-fold. Close to twice as many women will also be eligible for screening under the revised guidelines.
Now, Medicare Part B (Medical Insurance) covers lung cancer screenings with Low Dose Computed Tomography (LDCT) once each year if you meet all of these conditions:
- You’re age 50-80 years old.
- You don’t have signs or symptoms of lung cancer (asymptomatic).
- You’re either a current smoker or have quit smoking within the last 15 years.
- You have a tobacco smoking history
Learn more about lung cancer screening and lung health at Saved By The Scan.
How the COVID-19 Legacy Could Change Cancer Care for the Better
Everyone has been impacted by the COVID-19 pandemic, but not everyone has been impacted equally or in the same ways. We’ve known since early in the pandemic that people with comorbidities such as chronic illness, heart disease, obesity, and cancer are more vulnerable to the virus. Not only that, but these populations are also more vulnerable to societal and financial disruptions caused by the pandemic.
According to a survey by the American Cancer Society Cancer Action Network, the spring, 2020 shutdown of elective procedures delayed healthcare services for 79% of patients in active treatment for cancer, with 17% reporting a delay in their cancer therapy specifically. Even though elective procedures have since resumed, cancer patients and their families are now burdened with the difficult math of weighing the risks of delaying treatment against the risks of possible exposure to COVID-19.
Another subset of cancer patients who have been and will be negatively impacted by the pandemic are those who don’t yet know they have cancer. One study found that cancer screenings for breast and colorectal cancer dropped by 89% and 85% through March and April of 2020, respectively. Missing the window for early diagnosis and intervention can have serious consequences that alter the course of the disease.
And yet, the news is not all bad. The pandemic forced physicians, surgeons, and patient advocacy organizations to adapt how they treat and support vulnerable populations, but the upshot is that we’ve come up with creative ways to meet the challenges of delivering care during a pandemic. Many of these adaptations will likely prove to stick around and change cancer care for the better long after COVID-19 recedes from our daily lives. Consider the following areas:
Many aspects of cancer treatment cannot be performed virtually, but oncology teams have identified opportunities along the patient journey where in-person visits can be swapped for a virtual appointment, such as routine symptom check-ups. Right now, even making a handful of appointments virtual can help reduce a cancer patient’s risk of exposure. In the future, telehealth will continue to make check-ups more accessible and convenient for cancer patients.
Again, the majority of cancer screenings cannot be performed remotely. However, pre-pandemic, practitioners were not taking advantage of the few that are (such as stool samples for colorectal screening or visual inspections of abnormal moles via video call) as often as they could be. The pandemic has encouraged oncology teams to identify screenings that can be adapted to remote delivery and the patient populations that are prime candidates.
Undergoing cancer treatment is physically and emotionally grueling. Cancer patients rely on the support of family and friends in appointments, during treatments, and at home. But as hospitals and treatment centers restrict visitors, many patients are facing treatment alone. During the pandemic, physicians and care teams have had to step in and step up to provide emotional support and compassionate care to patients.
That can look like taking notes during a tough appointment, pausing more often to allow for mental processing, and making sure the patient understands any new information delivered. Many providers have also developed smartphone apps that provide easy access to resources and even allow patients to contact a nurse or advocate with questions.
Virtual Support Group
In addition to leaning on family and friends, many cancer patients also participate in cancer support groups. These groups are a safe space for cancer patients to discuss their experiences and emotions with other people who are also fighting cancer.
During the pandemic, in-person support groups could no longer safely meet, leaving cancer patients without this essential source of social support. To fill the gap, patient advocacy organizations stepped in to organize virtual support programs, such as virtual meetings or online forums. For example, Breast Cancer Now UK hosts a virtual support group for patients living with secondary breast cancer and the Cancer Support Community maintains an online community for cancer patients called MyLifeLine.
Even after the pandemic, there may be days or weeks when a cancer patient doesn’t feel up to attending an in-person meeting, and these online resources will be valuable outlets to connect with the cancer community.
The American Cancer Society’s survey found that nearly half of cancer patients experienced a loss of income that affected their ability to pay for or access care. To respond to this need, several U.S. patient advocacy organizations and biopharmaceutical companies launched financial assistance programs for cancer patients whose income was negatively impacted by COVID-19, allowing them to continue treatment.
As we look ahead to the post-pandemic future, we should reflect on how we can let go of the pre-pandemic practices that weren’t serving patients and replace them with the pandemic adaptations that have made the biggest difference in the patient experience. The impact of COVID-19 has been devastating for many, but we can make the legacy of how we responded to the challenges a positive one.
What other positive changes have resulted from adapting to COVID-19? Let us know what examples you’ve encountered or read about!
All in the Family
Janet McCarthy’s lung cancer was first detected eight years ago, serendipitously, on her final 5-year follow up MRI for her previously diagnosed breast cancer. Unfortunately, this was not Janet’s first close encounter with lung cancer. Her beloved husband, Jack, had his own battle with lung cancer and eventually succumbed from complications involving an inoperable tumor close to his heart. Sadly, the radiation treatment he received for lung cancer weakened his heart causing a multitude of health issues for 10-years following his initial diagnosis. After multiple hospitalizations due to poor lung function, he made the difficult decision to discontinue hospitalization and treatment. Instead, he chose hospice for support and comfort for the end of his life.
At the time of Jack’s initial diagnosis for lung cancer, Janet had just enrolled in college to be a radiology technician. Her husband’s diagnosis now meant she had to juggle raising two young children, caring for her husband, and completing school-related requirements. While carrying out these responsibilities, she was conscious of the real possibility she would become the sole provider for herself and children and therefore worked hard continuing her studies. In her words: I knew I needed a career, so I could keep a roof over my head.” With the help of her family, she was able to achieve her goals for a new career.
After her husband’s death, in just a few short years, she would have to face another overwhelming challenge, her own lung cancer diagnosis. Her children were now teenagers, and she agonized over how to share this news with them as they had already lost one parent to lung cancer. It felt important that she at least wait to tell them of her cancer until she knew the specifics of her diagnosis, treatment and prognosis. This burden along with the stress of being a single parent and sole provider for her immediate family weighed heavily on her. She ultimately relied on the help of her family to care for herself and her sons and get through this difficult time.
One of the biggest takeaways Janet has from her experience with lung cancer is understanding the impact of family and friends during this highly stressful time. Having support and care from family and friends during this trying period is truly invaluable for all cancer patients. At the same time, it is so important to recognize the stress and demands lung cancer can have on a family. The diagnosis alone is surely stressful, but with it comes the drain of financial resources and other valuable attributes such as time and employability. Janet worried about how she would survive financially while battling cancer and, in retrospect, thinks it’s important that more emphasis be given to this aspect of a lung cancer diagnosis. To that point, she makes it known that it’s beneficial to be aware of the social services different hospitals may provide.
It’s now been 8 year since Janet’s last lung cancer treatment, but she still has routine chest CT scans to monitor her lungs. As a CT tech, Janet knows how important these follow ups are for monitoring her lung health. With the arrival of COVID-19, she knows she must take special precautious given the fact her lungs are scarred from radiation. Truth be told, while she doesn’t report feeling “overwhelmed” by COVID-19, she admits part of her is “petrified.” To put herself in the best position possible, she has embarked on a health journey at this time, working with a nutritionist, undertaking a new fitness routine, and continuing to work with her pulmonologist.
Janet joined Upstage Lung Cancer’s efforts as a volunteer and board member in 2016 after meeting president and founder, Hildy Grossman at a women’s lung cancer forum. She attended an Upstage concert and knew she wanted to be a part of this organization. Janet manages the Upstage Lung Cancer (ULC) store at benefit concerts and looks forward to when there will be in-theater concerts again. In her dedication, she jumps in to provide event assistance where needed.
Anyone Can Get Lung Cancer: Here is One Thing You Can Do
The safety of our family is a top priority especially now with the threat of the coronavirus invading our world. Staying home is suggested as a means of prevention. However, there may be another invisible killer lurking in what you think is the safety of your home. Years ago, the oncologist told my husband that he had lung cancer. We sat together listening to those words. We were numb. My husband, Joe, was not a smoker, and we led a healthy life style. Asking the doctor what could have caused this, his response was “We know radon causes lung cancer.” We had never tested our home and didn’t know that radon gas exposure is the leading cause of lung cancer in nonsmokers!
Joe lived six weeks after his diagnosis, and it was one month after his death that I discovered we were living with over 4 times the EPA action level of radon for 18 years. I spent the next year and half of my life educating all the legislators in Illinois about the danger of radioactive radon gas exposure. On August 16, 2007, the Illinois governor signed the Radon Awareness Act into law. August 16 would have been our 32nd anniversary.
I urge all of you to test your homes, schools, and workplaces for radon. If you do have a mitigation system installed, please perform a simple test each year to ensure the accurate performance of the system.
You can go to Citizens for Radioactive Radon Reduction for more information on radon, subscribe to our free electronic magazine on lung cancer and radon, order a test kit, and join our crusade to save lives.
Holidays: The Best of Times, The Worst of Times
“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of light, it was the season of darkness, it was the spring of hope, it was the winter of despair.”
― Charles Dickens,
A Tale of Two Cities ,1859
Could it be said any better? Dicken’s account was from 161 years ago, but it fits our current times to a tee. I think most people living today would vote the year 2020 as one the most dreadful in their lifetimes. All around us we’re faced with political discord, enhanced awareness of racism and economic disparity and a pandemic that grows more out of control. Everyone faces the stressful challenge of physical and emotional survival while combatting isolation each day.
Now comes the holiday season. Getting together with family and friends makes this season one that inspires love, connection and traditions. While it is a season that can inspire its own stress, many people look forward to this time of year as a time of renewal with those who mean the most to us. This year, chances are that our holiday celebrations won’t be in person. My own family and friends are spread out across the country, and some are in Europe, so I am used to not being together during the holidays. But this year there isn’t even a choice to go visit. As a lung cancer survivor, I wouldn’t risk the possibility of coming into contact with Covid-19.
As with the Dicken’s quote, I’ve found myself in the roller coaster of feeling okay one day and deeply sad the next day about all the pain and suffering in the world. So, being a determined person, I’ve searched for ways to enhance my sense of wellbeing. Some of my choices are studying French with my tutor, tackling a 1000-piece puzzle, searching for series to watch on Netflix, taking distanced walks with masks with a friend. The best of times during this year have been using Zoom to see my family and friends. There have even been occasions to get my whole family together, something that hasn’t happened for many years! And I would be remiss if I didn’t give credit to my wonderful puppy, Louise Tucker, who makes me laugh every single day.
I reached out to some friends to see how they were managing the holidays this year. Here are some of their thoughts:
- Stay in touch with people and look for classes online from your community to stay connected and to keep your mind busy.
- Try new recipes and call people every day.
- ind community group meetings or religious services
- Cancel traditionally large gatherings and write notes to each person to invite them for the holidays, 2021.
- This year is like no other, and it is too much to tolerate alone. Reach out to a therapist.
- Listen to or make music every day and find a way to laugh.
The consensus is that the best way to inoculate yourself emotionally during the pandemic, and especially during the holidays, is to try to connect with other people. You know the song, “People, people who need people, are the luckiest people in the world.” It’s ok to reach out, actually important to reach out and acknowledge that we’re all in this together.
My friend Bonnie said, “In these troubled times it can be a bit depressing. BUT we must remember that we lose tomorrow reaching back for yesterday.” I agree. We can’t look back and think that what’s ahead for us is going to look normal. BUT, looking forward is an opportunity for working harder to mend differences between people. We’ll see what the near future holds as it unfolds.
Finally, words that were told to me that have stayed with me since I was a young child are, “Take a long walk, read a good book and make a new friend.”
Joint Statement on Triage Considerations for Lung Cancer Patients
Upstage Lung Cancer is a member of LungCAN—a collective of lung cancer organizations all across the U.S.
As you know, we are in the midst of a crisis that threatens to impact our lung cancer community extremely hard. Many in our community have raised justified concerns about how they will be treated in the event of triage situations when there aren’t enough ventilators or other medical supplies for those who need them. Recently, leaked triage draft guidelines circulating on the internet have suggested that, in a triage situation, a diagnosis of “terminal” cancer would likely be a disqualifying factor for lifesaving access to care, even though we all know many survivors who have been given that diagnosis and are living and breathing among us many years later. Triage is an ugly reality, but we do not believe such crucial life and death decisions should be based solely on an advanced cancer diagnosis.
Our community is in great turmoil and distress. Our ability to change the situation is limited. Here’s what we can do.
LungCAN has developed the statement in the linked document. It lays out relevant lung cancer facts and implores triage officers to consider more than just the lung cancer diagnosis. To be clear, this letter does not request any ‘special favors’ for lung cancer patients, or that they are automatically moved to the front of the line; only that their diagnosis not be the sole reason they are excluded from lifesaving care.
If you have concerns that you may need to advocate for yourself in the event of a shortage of medical supplies, there are a few things you can do:
- Print a copy of this joint statement to present to a triage officer in the Emergency Room.
- Carry a copy of your medical records with you, OR, even better, ask your doctor if they will write a very short (2-3 sentences) note that explains a little more what your cancer prognosis is. One possible factor used in triage is the ‘life-years’ that might be saved, so it might be helpful if you are stable and have a reasonably good prognosis.
- Talk to your doctor now, before it’s a crisis, and explain your concerns, and thoughts and seek their advice.
This is an unprecedented time, with complex considerations, and so many unknowns. Will I get sick? Will I be seriously ill, or will it be a mild cold? What if there are equipment shortages? What if I’m recommended for ‘comfort care’ only? We encourage you to think through these issues, discuss them with trusted friends and family, and carefully consider your own preferences. Here are a few links that might be helpful as you consider these things.
- Applying HHS’s Guidance for States and Health Care Providers on Avoiding Disability-Based Discrimination in Treatment Rationing – An excellent guide for medical care providers on complying with federal disability rights laws in developing treatment rationing plans and administering care in the event of a shortage of medical equipment, hospital beds, or health care personnel.
- COVID-19 and Anti-discrimination – An update from the GO2 Foundation for Lung Cancer that talks about what they are doing to address these community concerns.
- COVID-19 and Lung Cancer – Accurate, up-to-date information from LUNGevity on COVID-19 and how it affects those with lung cancer. Also includes a link to Breathe Easier – An Emergency Response Fund for COVID-19.
- Coronavirus and Lung Cancer – a great resource from the GO2 Foundation for Lung Cancer with helpful information for patients, providers, and advocates.
- IASLC’s Guide to COVID-19 and Lung Cancer – An insightful collection of patient and member experiences with COVID-19
- On COVID-19, Ventilators, and Triage – blog post by Janet Freeman-Daily, Stage IV Lung Cancer Survivor and Passionate Advocate.
- The Conversation Project – a helpful resource for considering and talking about end of life care.
Know of a resource you think we should include?
The Relaxed Hostess
Cancer crashed my party more than fourteen years ago. The guest from hell. Uncouth, unkempt, possessed of a nasty disposition and with no respect for boundaries. Lousy fucking company.
And then there was the matter of an underlying agenda: this guest intended to kill me. To say the ensuing relationship has been uncomfortable is an understatement. And all attempts to evict the interloper have ultimately proved unsuccessful.
Yep. Chances are cancer and I are in this for the long run. At times I think the only remaining question is which one of us is going to burn the house down first.
Now, with no shiny new weapon to pull from the arsenal, I have had a lot of time to reminisce about previous treatment modalities. Cutting, chemicals and more chemicals. In the process I have lost hair, teeth, toenails. My skin has erupted, my esophagus bled. Sometimes I have not recognized who I had become, inside or outside.
Throughout it all I have viewed myself as a warrior, my body the battleground. Fighting, always fighting.
A few months ago I decided that perhaps it was time to try another approach. I would listen to my body, talk to my cancer. “I go, you go,” I said in a reasonable tone. “But it doesn’t have to be this way.”
I’d like to tell you that my cancer perked right up, slapped itself on the forehead and told me it didn’t know what it had been thinking. Apologized for the selfishness, the nihilism, all that stress it had put us through. That now that it had seen the light, it was going to just pack up and go home. Mea Culpa.
But of course that’s not what happened. And I also discovered that my own sense of antipathy overwhelmed any sort of pseudo empathy I might be trying to pull off.
When all was said and done I realized that there was only one thing left to do. I would decide, yes decide, to simply ice cancer. Just like that. “Cancer, you’re dead to me.”
You know what? It’s working. My stress level immediately plummeted. Already familiar with the fact that not giving a fuck can be a super power (really truly) it simply hadn’t occurred to me to stop caring about cancer.
I had scans last week, a review two days ago. And even though the historical precedent has been that once progression starts, it just keeps going, I felt calm, cool and collected. I already knew. My cancer is stable. STABLE, Y’ALL.
We’ll discuss this further. But in the meantime, think about it. Pretty much everyone with cancer is stressed out all the time. 24/7. Can’t be a good thing.
What I’m doing now—deciding not to care—isn’t just some simple party trick. It takes determination and a strong, strong will. But the positive feedback was instantaneous once I figured out how to let go of the stress. Give it a go. Even if for just a few minutes or an hour or two. And then see if you can do it longer.
I am not cancer free but then again, I am cancer free insomuch as I am anxiety free. And I will wager that is bad for the cancer and good for me.
In the Fall of 2006, I bought a pair of green sandals with a cute kitten heel. I enjoyed the color and style and made sure they were comfortable, but it never occurred to me to examine the sole. Several days later I put them on and headed down my basement stairs. One step onto the threshold and out went my feet as though I’d stepped onto ice: one foot went back and the other scraped the wall in front of me. Fortunately, the basement stairs are very narrow, and I was able to catch myself by grabbing both walls of the passageway.
Thus, began an astonishing journey. After my narrow escape, I felt fine, except for some discomfort in my left wrist, elbow and right ankle. I figured I should check myself out, primarily for the twinge in my left forearm. So, I began with a referral to see a hand surgeon who wanted to give me cortisone injections, but she wasn’t sure what site to use. Next, another hand specialist who wasn’t sure the problem had to do with my hand – maybe it was tennis elbow? My referral was to a neurologist to confirm a diagnosis, but he only tested my wrist and not my elbow. He concluded there was no nerve damage in my wrist and ordered an MRI to see if I had a pinched nerve in my back. The MRI came back. It showed no pinched nerve – but it picked up two tiny spots on my right lung. My internist sent me for further tests and an eventual biopsy. The diagnosis: lung cancer!
Fortunately, my internist sent me to a top-notch surgeon, Dr. John Wain, at Massachusetts General Hospital who scheduled my surgery for three weeks later. Because of my early diagnosis, he was able to remove just the two small tumors in two lobes and a small section of tissue around the sites. They were small, early stage, and contained – they hadn’t spread. My oncologist, Jennifer Temel felt I didn’t need any further treatment as did her colleague, Dr. Tom Lynch, Chief of Thoracic Oncology. My internist reflected on all the events that led to this fortunate outcome and said to me, “Somebody up there really likes you!” I went home from the hospital to recuperate.
Most people would say there’s nothing fortunate about getting lung cancer. In fact, it was horrifying, shocking and upsetting to wrestle with the diagnosis and try to figure out what it meant for my life and life expectancy. As I came to terms with it, I also found that the experience gave me a different level of awareness of how lucky I have been. My husband, Richard and daughter, Micaela went to all of my doctors’ visits with me. My son, David, and his wife, Amy, arranged for food to be delivered. My daughters, Claire and Robin, came from San Jose and Chicago to nurse me in the hospital and when I came home. My dearest friends rallied to help me in every way possible, from researching the latest treatments and outcomes of lung cancer to bringing me dinner and keeping me company. Their extreme kindness made me vow to be a better friend to someone in need. So many people expressed concern, good wishes and a desire to be involved and updated about my recovery. I was so moved by how connected all of our lives are, even extending to good people we’ve never met.
All of us know someone who has had lung cancer. Most of us have stereotyped lung cancer: I know I have. It seemed like a disease reserved for elderly men who smoked for a lifetime. This isn’t true. It can happen to any of us. This disease touches all of our lives. It might be a member of your family, a friend or a neighbor. Perhaps you are a survivor. Or, perhaps its someone you feel you know. Did you experience the same shock and unfairness I did when learning that Dana Reeves, a young non-smoker, died after years of heroically caring for her husband Christopher Reeves following his riding accident? Perhaps after inviting Peter Jennings into your home every evening to bring you the news, you too were surprised by his illness and death. Remember how charming and funny Suzanne Pleshette was on The Bob Newhart Show? For me, no one had a voice like Beverly Sills. All of these well-known celebrities suffered and died from lung cancer.
That’s why early detection is so important.
In the days after I came home from the hospital, I worked to get my strength back. I did laps around my bedroom for exercise. I used my recovery time to reflect on my life, on what was important and how to spend my time. I found inspiration through a book recommended to me by a tour guide, Tolga, whom I’d met while on vacation in Turkey. I emailed him about my lung cancer. He wrote back, quite unsentimentally, and said to read The Alchemist, a fable by Brazilian author Paulo Coelho. It’s a book about learning to read the omens strewn along life’s path, and, above all, following our dreams.
This wise guide said it was for me to make something of my experience. After I finished reading the book, I realized that the key point was about transforming commonplace events into something of value, making something of each and every experience. This message spurred me to think about how I could find a way to make something worthwhile and life affirming out of having had lung cancer, an experience that on the surface was of no value whatsoever.
The answer was Upstage Lung Cancer.
Creating Upstage Lung Cancer
My life has been about caring for people and bringing joy into their lives when I can. I have two professions. I am a clinical psychologist and I am a professional singer. As a psychologist, I have the honor of being invited into people’s lives and connecting at a deep level. As a singer, and a member of The Follen Angels (my jazz/cabaret group), the music is also about making meaningful connections. Our group has so much pleasure creating music together and then sharing our programs with enthusiastic audiences. Music ignites deep feelings and often, important memories. For me, music is life affirming. It’s therapeutic. Could I turn these skills and interests into something that could make a valuable contribution to raising awareness of lung cancer and its serious consequences, while supporting research on early detection and new treatments for this dreaded disease?
The birth of an idea
My reflections led to ideas about creating a musical theater event that could be used to raise money to benefit lung cancer research and raise the awareness of our cause. I began to conceive of a show to feature the great showman, Florenz Ziegfeld. I called my writing partner, John Lamb and asked him if he’d be willing to put our current project, a mystery novel, on hold to help me finish writing a musical theater show I’d begun called, Ziegfeld! He too was enthusiastically on board.
I met with nationally renowned Thoracic Oncologists Tom Lynch, MD and Jennifer Temel, MD at Massachusetts General Hospital Cancer Center in Boston, Massachusetts. We discussed the exciting and innovative research going on at the Massachusetts General Hospital Cancer Center looking at early detection and new treatments for lung cancer. I told them I wanted to use the Ziegfeld! project to raise funds to support these kinds of research.
I reached out to my friend, Crispin Weinberg, and then I contacted Susan Gessner, who had been diagnosed with lung cancer six months earlier, and at a very early stage, too. Together, we created Upstage Lung Cancer. Susan agreed to serve as President of the Board of our non-profit organization. Our friend, Melissa Langa, an attorney, volunteered to help us with the papers and we submitted the application in August, 2008. From there, we contacted a group of dear friends with exceptional abilities and talents and asked them to serve on the Board of Directors of our new organization. We held our first Board meeting in September. Each member brings particular areas of expertise and energy to make us an effective, think-outside-of-the box organization. We also asked Tom Lynch, MD, Jennifer Temel, MD and John Wain, MD, all outstanding specialists in the field of lung cancer to serve as a Medical Advisory Board. They each accepted with great enthusiasm.
Our Board of Directors agreed with my vision that we could do more if we created other shows as we work on producing Ziegfeld!. In October, 2008 we had our first fundraiser, a cabaret/jazz concert in a private home. The evening included a jazz performance by the Follen Angels, and a very inspirational talk by Dr. Jennifer Temel. Dr. Temel discussed the status of lung cancer and her own work on the psychological aspects of living and dying with the disease. The event was a tremendous success, and we planned a second, similar program on March 29, 2009.
I continue to be thrilled by the outpouring of help from professionals who volunteer their time and help. Robin Friedman, of Visual Velocity, continues to creative our innovative website (In 2020 we have a brand new, exciting updated website!). Al Davis, also of Visual Velocity also videotapes all of our concerts; Bob Bond consistently dazzles with graphic designs, and so many other wonderful volunteers help to make Upstage Lung Cancer succeed with our mission.
The fact that I have had lung cancer is ever-present for me. My annual CT scans are wonderfully reassuring yet terrifying to anticipate. There is always that, “What if…?” fear.
But, instead of focusing on “What if?” I want to put my considerable energy into producing our original Ziegfeld! show. We were all set to bring it to the theater in May, 2020, but the Covid-19 pandemic put a stop to that for the time being. Over the past 12 years we have held annual concerts with Boston’s best, award-winning performers, hosted each year in the Fall by A&E Critic Joyce Kulhawik and in the Spring by WBZ-CBS radio personality, Jordan Rich. With the limitations posed by current Covid-19, we will not be stopped. I’m finishing a production of a virtual mini-concert to keep music and our mission alive. We will continue to use music and the performing arts—the elixir of life—to fight lung cancer. We’ll raise our voices to say: “Research matters. Lung cancer won’t wait.”
We won’t stop until we upstage lung cancer!