Ryan Holmschild, PharmD, MS, MBA: We talked before about social determinants of health, but even transportation vulnerability [is an issue] For some of these patients. if they are being treated [at] A large center, someone may have transportation vulnerabilities and live 6 miles away or 300 miles away from a large academic center. We need to consider how we will get them throughout that journey. Some of these can cause physical and emotional stress because it’s not just for the patient, right? It is also caring. And Dr. Marshall, as you’ve been in practice for so many years and treating so many patients, what are some of the physical and emotional challenges that individuals and even some of their families or caregivers face when When they are in advanced stage of Colorectal Cancer?
John L. Marshall, MD: Just put yourself in their shoes for a second. You’re getting along and your world is fine. You are where you want to be. Things are absolutely fine. You’re going for your socially required colonoscopy. And then suddenly you wake up from your unconsciousness and your spouse is there when they shouldn’t be there. The doctor is looking at you and says you have colon cancer. They’ll know right away when you’re in the scanner, maybe that afternoon, maybe a week later, and they’ll find something in your liver. Suddenly you are hit with it without medical intervention and you have to take one appointment after another. This is what I call a type of wham effect. Suddenly you’re thrust into a new world that you never really wanted to be a part of or think about. And it’s more than just drugs [adverse] Effect. There is a belief that you can die from it or in some cases you will die from it. You have doctors and [persons] All around you you are being told this. And no matter how hard you search, Google or ChatGPT can’t tell you anything different, and you are now on a different path for your life and you are dependent on the people around you. You are dependent on your caregivers.
I think sometimes it’s more difficult to be the caregiver than the patient because that person also now has to drop whatever they were doing to help that person. And it comes back to the social determinants of health that we’ve been talking about. I think there’s probably some village around here for all of us who can stop and help us. We may also have jobs so that we can find time here and there for cancer care. But if you’re an hourly employee [coffee shop] Or somewhere, you can’t do that. And so, you have to compromise, and neither can your caregiver. So, you have a feeling of diagnosis, sadness, worry, [and] The depression that goes with it. Treatments have a physical impact on you, whether it’s…ostomy vs. social stigma [adverse] Effects of medications, etc., or fatigue that prevents you from being able to do your job. And then there are people around you who are trying to support you. It is a completely new world for people who have never experienced it before entering that world of cancer. it rocks.
Ryan Holmschild, PharmD, MS, MBA: You gave some great imagery there because I’m sure a lot of patients say, “I know exactly what he’s talking about,” like, “I remember that, and I’ll never forget it. ” I think it’s great for you as a physician, as a research scientist, to just lament that and reach out to patients. Because you’re right, it doesn’t just mean telling them about their cancer. Its [multiple factors] Coming and I want you to follow this therapy. These are going to have you [adverse] Impact and it is having a great impact on someone.
John L. Marshall, MD: But that’s why we have such a great partnership with Colorectal Cancer Alliance [CCA], because if you’re just blind-googling, you’re a patient or a caregiver…it’s a quick and scary rabbit hole. And so almost always I would suggest to patients not to blind-Google. Instead, visit the CCA website. You all have a buddy system to help the patients, not only about their medical issues, but also about the social issues that come up and help guide them. Even those with the most resources need help.
David Fenstermacher, PhD: We have Facebook groups where patients can get together based on younger onset versus older onset. Furthermore, KRAS vs. EGFR. So, we also have different groups [individuals] Can participate in. And it really helps them understand their cancer and share their experiences.
John L. Marshall, MD: I can add one more thing. The most successful cancer clan for me has been the breast cancer clan. And I always joke that when women have a disease, they go out and talk about it. When men have any illness they go and hide in their basements. Correct? So, you know, in colon cancer we need men and women. It’s young and old. And so there’s not really a locker room where you can talk about it. And we really want to encourage our patients as much as possible to get together, share tips, share feelings, if you like, because the lessons learned from one are useful for the other.
Transcript edited for clarity.