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In this episode, Dr. Lisa Newman, an internationally renowned breast surgeon and researcher, shares insight on how to manage side effects caused by breast cancer and breast cancer treatment itself.
About Dr. Newman
A New York City native, Dr. Newman received a bachelor’s degree in chemistry from Harvard University in 1981, a medical degree in 1985 from SUNY Downstate College of Medicine and a master’s degree in public health in 2001 from the Harvard T.H. Chan School of Public Health. Dr. Newman completed a general surgery residency at SUNY Downstate Medical Center, joining its faculty as an assistant professor of surgery before pursuing fellowship training in surgical oncology at the University of Texas MD Anderson Cancer Center in 1997. After completing her fellowship, she joined MD Anderson’s faculty as an assistant professor and staff surgical oncologist in 1999. She served as associate director of the Walt Breast Center at the Karmanos Cancer Institute/Wayne State University from 2000 to 2002, when she was recruited to serve as director of the Breast Care Center for the University of Michigan in Ann Arbor from 2002 to 2015. Dr. Newman left the University of Michigan in 2015 to become director of the Breast Oncology Program for the multi-hospital Henry Ford Health System, and has retained adjunct professorships with both the University of Michigan and the University of Texas M.D. Anderson Cancer Center.
Dr. Newman has held leadership positions on several national committees, including the Centers for Disease Control and Prevention’s Advisory Committee on Breast Cancer in Young Women, the National Institutes of Health’s Clinical Trials Advisory Committee, and the National Institute on Minority Health and Disparities’ Advisory Council. She has authored 136 studies published in peer-reviewed journals, and is currently on JAMA Surgery’s editorial board.
A fellow of the American Society of Clinical Oncology, Dr. Newman’s work has been recognized through several awards, including Crain’s “Health Care Hero” in 2017, the Triple Negative Breast Cancer Foundation Hero Award in 2012, and the National Medical Association Women in Medicine Award in 2010. She was named “Michigander of the Year” by the Detroit News in 2011 and a Breast Cancer Angel by O Magazine in 2012. Hour Detroit Magazine has named her one of the “Top Docs” for surgical oncology annually since 2009. She is a Castle Connolly “Top Doctor for Cancer” in America. In 2016, she was named a Komen Scholar by the Susan G. Komen Breast Cancer Foundation and was appointed to the Komen Scientific Advisory Board in 2017
Adam: [00:00] There are many ways to manage side effects caused by breast cancer and the treatment for breast cancer. Supportive care is given to improve the quality of life for people with breast cancer while symptom management aims to prevent or relieve the side effects of breast cancer and its treatment such as pain or nausea. It’s an extra layer of care given along with the treatment for the cancer. To help us learn more about how to manage the side effects of breast cancer treatment, let me introduce Dr. Lisa Newman. Dr. Newman is the director of the breast surgical program at Weill Cornell Medicine and the medical director of an international breast cancer research program. Dr. Newman, welcome to the show.
Dr. Newman: [00:40] Hi Adam. Thank you so much. It’s a pleasure to join you.
Adam: [00:42] I’m really excited to chat with you. I really enjoy getting to talk to doctors and just sort of beginning to understand some of these things from this more technical medical level. So to start out when someone says supportive care, what are they talking about?
Dr. Newman: [00:57] Supportive Care for breast cancer is actually an intentionally broad term that we use and it describes any and all of the assistance that may be necessary to improve a patient’s quality of life both during the breast cancer diagnosis and treatment experience, and also afterward during the long term survivorship experience. Now we do in fact have many wonderful and extremely effective treatments and this allows most of our patients to continue living long and productive lives, but many of these treatments actually have long term side effects. And then of course, just the emotional impact of a cancer diagnosis can have a complex and often transformative influence on a patient’s long term perspectives and interpersonal relationships. So managing this entire continuum of issues falls under the umbrella terminology that we use of supportive care.
Adam: [01:53] Okay, so that makes sense and you mentioned side effects, so let’s talk for just a minute. What are the short term side effects of breast cancer treatment?
Dr. Newman: [02:02] Well the short term side effects really vary depending on individual patient’s circumstances and in general it is important to note that supportive care needs are very diverse. Some of the supportive care needs are related to the age of a patient, for example, a young woman with breast cancer may need to address her childbearing goals and needs and we have wonderful fertility preservation programs that can ensure that a woman is able to continue having children and raising a family after her cancer treatment is completed. But it’s important to address these needs at the time of diagnosis so that can be coordinated appropriately with that patient’s care.
[02:51] Some supportive care needs are related to the individual patient’s family circumstances, for example, a woman in the short term going through breast cancer treatment may need to be concerned about childcare services, some patients need to worry about care for their parents and elder members of the family. Sometimes the supportive care needs are related to language barriers. Sometimes the supportive care needs in the short term are related to geographic issues, transportation to get to treatments. Some of the treatments for breast cancer such as radiation are treatments that are necessary on a five day a week schedule so these transportation needs are not necessarily trivial.
Adam: [03:33] Right, yeah I can only imagine.
Dr. Newman: [03:35] Yeah, yeah and then, of course, their financial needs. We’ve started using the term financial toxicity of cancer treatment and it’s a real thing, deal with insurance issues, employment, having time off so that they can complete their treatment and then, of course, there are treatments, specific needs.
Adam: [03:56] It sounds like there’s just a lot of logistics that I honestly, I’ve never really considered that a patient has to go through. I mean we always think about the therapies and how bad someone feels, but there’s how bad they feel and then there’s all the logistics around carrying on with their lives as best they are able to, right? That sounds like it’s a lot to manage.
Dr. Newman: [04:17] Exactly, it really is a lot to manage and so every patient indeed needs support and the type of support will vary with the individual circumstances. Most women with breast cancer will require surgery as at least one component of their care and so patients have to deal with the body altering aspects of breast cancer management. Many women with breast cancer need to undergo surgery involving removing lymph nodes of the underarm and this can have a side effect that we refer to as Lymphedema, where women have a tendency to develop swelling in the arm on that side. So women need to be aware of physical therapy programs that can minimize the risk of Lymphedema. Women should also be aware of surgical approaches that can avoid or reduce the risk of Lymphedema, but the breast surgery itself can also have an impact. Some women require mastectomy for their breast cancer management, and these women should avail themselves of the plastic surgery services for breast reconstruction whenever possible.
[05:25] Some women will be able to undergo less extensive surgery in the form of a lumpectomy, but even with lumpectomy, there can be alteration in the appearance of the breast and so oncoplastic approaches to minimize the other disfigurement of the breast is very important also. But all of these things really should be discussed at the time of diagnosis so that the woman understand her options. Chemotherapy is necessary for many women with breast cancer and one of the most obvious sequellae of chemotherapy is the temporary hair loss that can result. Fortunately, we’ve actually developed some very exciting and effective ways to avoid hair loss with chemotherapy in this form of scalp cooling programs. But these can be costly and they’re not necessarily covered by insurance and they’re not necessarily available in every facility. And then there are a whole host of other side effects of chemotherapy for which we do have approaches to minimize the side effects, but it takes to being armed empowered with knowledge up front to know what those side effects are.
Adam: [06:38] Yeah, and I mean what are some of the ways that you help prevent side effects from the breast cancer treatment?
Dr. Newman: [06:44] Being empowered with knowledge regarding some of the side effects of breast cancer treatment that is the first and critical step.
Adam: [06:54] Okay.
Dr. Newman: [06:54] Patients and I’ve been referring to women, but it’s important to note that men can get breast cancer also and all of these supportive care needs for men will need to be addressed as well. While patients are going through treatments it’s critical that patients are honest, frank with us regarding what symptoms they are experiencing because sometimes the likelihood of successfully minimizing the treatment sequela is related to getting a handle on those symptoms early on and addressing them before the symptoms get out of hand. Patients should also be honest simply about how they’re coping with the whole diagnosis and treatment experience. There’s been an entire field of research and an entire discipline that’s been developed called psych oncology where there are specialists who are really in tune to making sure that patients dealing with cancer are supported appropriately from the emotional and psychological perspectives.
Adam: [07:56] I love that. It sounds like from what you’re saying that really one of the best things and one of the best ways to prevent or relieve some of these side effects symptoms is really just to have clear communication with the team that’s helping with the medical treatment, right?
Dr. Newman: [08:11] Yes. You are absolutely correct about that, Adam. Being open about expectations from treatment, expectations regarding side effects and how you tolerating treatment is critical and this open communication will extend beyond the actual treatment experience. Some of the side effects, unfortunately, are long term and so patients will want to be armed with information about some of those potential long term side effects so that they can mitigate them.
Adam: [08:43] And what about pain management? We haven’t talked much about that. We talked about side effects and preventing side effects, but what about pain management? How does someone diagnosed with breast cancer and going through treatment manage their pain?
Dr. Newman: [08:53] Yeah, so that’s a great question and fortunately we have also made some wonderful strides in pain management for breast cancer. Sometimes it’s an issue of dealing with the acute pain related to surgery, sometimes it’s related to pain from more chronic conditions such as nephropathy that can develop as a side effect of chemotherapy for breast cancer and in managing all this whole spectrum of pain syndromes, we have made advances. Sometimes they involve taking medication, sometimes it involves special services such as acupuncture. Sometimes it involves using integrative care methodology, meditation programs can be helpful, and sometimes therapeutic sessions, again getting into the psych oncology field, sometimes this will have an impact on pain control.
Adam: [09:45] Yeah, I mean and some of the things that you mention are not things that I would have immediately thought of. I mean I realized that those things are very powerful tools in our toolbox, but it never really occurs to me as it relates to breast cancer treatment, right, but it sounds like that could be a really helpful thing for patients to consider.
Dr. Newman: [10:04] Yeah, absolutely, absolutely and if a patient feels that he or she is not being presented with the right answers or options, it’s always appropriate to seek the services of an additional facility and get as many opinions as possible.
Adam: [10:21] Yeah. I think that’s something that we often forget and so I think that’s really good advice. Dr. Newman, this has been really great, really informative, really interesting. Do you have any final thoughts related to supportive care that you want to share with our audience?
Dr. Newman: [10:35] Just a couple of final notes that I would like to emphasize. Number one, special emphasis on some of the programs as Susan G Komen has available. Susan G Komen has a breast care helpline, 187 GO KOMEN, which provides a free and professional support service to patients with breast cancer questions and concern. I also want to make a plug for research programs. We’ve made advances in supportive care through the research efforts of wonderful specialists and we need to make more advances, so I definitely encourage breast cancer patients to pursue research programs and clinical trial participation.
[11:17] Some of these clinical trials are related to the newly diagnosed patients, but many of them are related to studies of how to improve the long term outcomes after breast cancer management and controlling symptoms. There is wonderful information available on the Internet, but I do encourage patients to be cautious when they are utilizing Internet-based information. Some of the information comes from reputable sources such as Susan G Komen, the American Cancer Society, the National Cancer Institute. There are many reputable resources out there, but patients do have to exercise some caution because there is some information available on the Internet that might not be quite as appropriate.
Adam: [12:05] That’s right, that’s right, yeah. Make sure you know where the information’s coming from and how reputable that source happens to be. And that’s honestly what I love about working with Susan G Komen is that you know that the information they’re putting out there is well thought out, well researched, backed up by data and science. So, well Dr. Newman this has been really great, really informative. I really appreciate your time and look forward to maybe having you back on the show again sometime soon.
Dr. Newman: [12:31] Anytime. Thank you so much. It’s been a real pleasure, Adam.
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