Medically Speaking #18

Welcome to today's episode of Medically Speaking. I have two very special guests with me today to talk about oncology, which is, of course, cancer and cancer treatment. And we'll start with just some introductions. Of course, I'm Matt Logan, President and CEO of South Regional Healthcare, and I really enjoy having some time to share with our really expert clinicians, and I'm looking forward to our conversation today. So we'll start with introductions. Dr. Yen, tell us a little bit about yourself, your background, and how did you find yourself at South Regional Healthcare in Greenwood, South Carolina? So I'm really a medical oncologist. Of course, when I found here, that is because I don't like cold weather. So when I'm trying to find a job i actually draw a line the south of virginia and going that way i do the interview otherwise in on the north i don't so when i came here for the interview second interview here dr sedesky who's late always because of the patient care and she has a lunch with me and only five minutes we talked it's sort of like click then it's clicked i said i don't do any more interview i stayed um people always ask me do you have a tie with this deep south in south carolina or greenwood i don't that is always i told everybody i said i don't have families i don't have friends just in that deep south. But now I found I'm wrong. Why I saying that? Over the time when I talk to, you know, taking care of my patients, they are, I think that both us, them and me, we just embraced together. We just have like a family. So when I taking care my family sure you know I miss spending a hundred more than a hundred percent of the time taking care of my family so yes I do have ties now I'm ends up this it will be my ten years practicing here that's awesome and you tell us where you did your oncology expert training I actually went to this is a long story short. Actually, I was doing stem cell research, cord blooded stem cells, and I thought, well, maybe I should go back to the clinic, particularly oncology, because stem cell transplant is part of the things. So I finished my residency in Georgia, Savannah, and then applied for my fellowship, which ends up to the Baylor College of Medicine, Houston, across the street with MD Anderson Cancer Center. Good part about that is we cross-train for both fellows. So we get lots of opportunities to learn from them and research part and then learn from us from clinical aspect. Awesome. Very good. Dr. Sadurski, tell us a little bit about your background and how you and your family ended up in Greenwood. So I was in Medical University of South Carolina finishing my hematology oncology fellowship. And my name is Joanna Metzner-Sadurski. In finishing fellowship, I was actually got a grant for HER2 research at MUSC. And I thought, I'm going to stay there. But my second child came and my husband was finishing training in Augusta and he had one more year. So at that point, I thought I felt that the best for my family would be to be closer together. So I was looking for a job close to my husband. And it turned out that at some meeting I was talking to a drug rep and he said, well, they're looking for somebody in Greenwood. So that's how it started, the interview. and I started working here initially I worked with another group cancer centers of the Carolina starting in 2002 and I was and then I changed to self regional in 2005 when they left so initially I um you know I you come from academic center where everything is laid out for you you have all these specialities you can imagine. And suddenly you end up in a smaller cancer center. And at that point, we haven't even had a cancer center. We had three exams room on the first floor of the self-regional old hospital. And I was enthralled by a challenge. I thought, well, I think I can do it. And that's how it started. And the hospital at that point committed to build a cancer center. And I think they always had the vision which the hospital, when Mr. Self started the hospital many, many years ago and put the first brick, he said, I want to bring advanced care to this community closer to home. And that's what was always the vision to build a cancer center, to bring advanced care closer to home. And I know that it's beyond Mr. Self imagination and even beyond my imagination how it has grown. Initially, I was only one. And then now we have four amazing oncologists, Dr. Yen, Dr. Rahal, and Dr. Johnson. And we have two radiation oncologists. And it always was about delivering quality care. So we always wanted to have discussions about each patient. We all follow guidelines, NCCN guidelines. And we continue to try to do the best we can. I'll tell you one of the things that's impressed me most, and I've been at Self Regional for 20 years, and seeing the development of the cancer center and how things have changed so much during that time. And I think, Joanna, you and I probably came around this I guess the same time, pretty close. And, um, I'm telling you, you were, uh, both of y'all's leadership and truly developing, I think a state of the art, a model truly that is, uh, could be used anywhere in, in communities like ours to, to show what advanced cancer care is like and should be like in a community setting. Um, I think that's, it's, I really give you guys in your teams, the credit for where we are, but I truly think we are that. And I'm just really proud to work with you guys, and you guys do awesome work every single day. So let's just dive in a little bit. So let's talk about cancer care, some of the services we provide here that are unique, perhaps, to a community in rural South Carolina. And Daria, maybe you can start us off with this. So here are the things, a lot of time when you talk about comprehensive cancer care, that is involved in really a troop to work with us, including different specialties. In the rural area, it's very hard to really get building up a comprehensive cancer center. of the services like cardio oncology exercise oncology social cycle oncology those are the specialties only have you know be available in a few academic centers not even in widely for the just academic centers however our position or location is very unique we got to really take in care of our community by trying to bring in these services by doing so actually dr logan if your team, your administration is really putting in support to us. That is beyond what we as a community oncologist can imagine. Because of your support, that is how your vision is aligning with our cancer care mission. That is the way to go. With this said, a few years ago, we brought cardio-oncology here. And last year, we established exercise oncology, and it's thriving. Actually, we have a poster, Dr. Sadursky leading. We are going to bring to the first rural cancer conference in this country next month. That is wonderful. Obviously, there are some social or psycho-oncology, we always want to bring in. And I know Dr. Logan and you and Dr. Kumar is trying to find so hard psychiatrists, psychologists here. So I believe in the future, near future, we can have this very advanced subspecialty cancer service in our community. The rural oncology, they are just because of population we're facing a lot of challenges. People trust you. Why you are coming here? Why Dr. Sadursky stay here 20 years? Why Dr. Yen stay here 10 years? If you're good enough, why not you go into big city rather than stay here? So first of all, the most important thing is establish trust. So that is working. As I just mentioned, I found out the way is if we're treating each other like a family, gain their trust, then bring the services locally so that patient can receive sophisticated cutting edge technologies at their doorsteps. And in South Carolina, we're not that good in terms of rural oncology practice. Hopefully, Dr. Sadusky and I, we're trying to build up under your leadership, of course, and trying to build up a model system can be adapted to other part of South Carolina. As I always say, the new data The finding is 80% of physicians in this state, it's above national average is employed. Once we get employed, we need to really work with administration as a team. When we watch out each other's back, that's how we can fly higher and longer together. 100%. My philosophy is my job is to support the work you guys do. you guys are there doing this great work and bringing these great ideas and bringing that national vision of what rural oncology can be. And, you know, I feel like my role is to not get in your way and to help you because the ideas you guys have are awesome. And like you were just talking about, you know, the, gosh, neuro-oncology, some things you wouldn't think that a community like Greenwood, South Carolina would be like a leader in stereotactic radio surgery for patients with metastatic lesions in the brain, but we are. And this, again, is that vision that you guys have really brought to where we are providing that advanced care right here in Greenwood that you would otherwise say 10 years ago have to go to Atlanta or Duke or somewhere like that to a big academic center to get, and you can get it right here now. Exactly. Since, thank you, Dr. Logan We mentioned that neuro-oncology is something we are proudly doing, working with a neuroscience group, Dr. Lau, Dr. Kilburn, Dr. Cole, and their colleagues. We really work together, tumor board, as this is the second in this. There are two neuro-oncology tumor board in this South Carolina. are one of that that is said something because our rural setting and another one is in musc which that's it we are our patients are so lucky to have to enjoy the surfaces i might say words wrong not enjoy cancer is not a good thing to do but with all the increased incidents 40% of the population in this country eventually ends up one of the cancer diagnosis, including myself. I want we, Dr. Sadursky and I, we want this community, including me, if I get cancer in the future, I wanted myself to receive best care without travel. That is the period and we have it here. And Dr. Logan, one thing I would like to say, you know, it's not every CEO like you. I have lots of friends, peers, and acquaintances. They always, when we get together in the meeting, complain more than much about saying good things. It's because of, you know, I believe education education education that's the key that is a whole dr sadowski and i along with our team trying to really you know do best education wise so that we align with your mission that's how we can go far sorry doctors very good very good no absolutely i think that's the vision and that um that you as a physician decided to say that we cannot make people who haven't had medical background make decisions for us and you have taken a role, administrative role, which is very hard with Dr. Kumar, I think it's uploading. And as somebody said, if you don't sit at the table, you might be on the menu. So that's why we need to get involved And we need to make sure that the medical needs, the patient's needs are being taken care of because you cannot make decisions about patients if you don't know what's happening in the field. And that's about advocacy, about going to Washington and asking for help, asking for advanced care, asking for making sure that we don't have drug shortages, that the patients have access to care, regardless of the zip code. Is it Washington or is it in South Carolina that we have the best care? We provide the same care. We follow the same guidelines. We have access to cutting-edge immunotherapy, chemotherapy. Now, is it possible that we don't have everything in here, in Greenwood? Yes. There are some things which are maybe beyond our reach at this particular moment, but we cooperate very strongly with MUSC, Medical University of South Carolina. We cooperate with clinical trials. We have open clinical trials for the last 25 years here at Self Regional. And now MUSC has, to now, they have a designated cancer center status. Within the next two years, they're applying for a comprehensive cancer center. And we are, so we have this access, this relationship with them. If we don't have something here, we will get it there. And that's exactly what also I was saying, that here in a smaller community, we have to wear many hats. If we don't have an answer for a patient, we don't say, oh, no, we don't know. We research, we ask, we cooperate, we refer to other centers if we have to. Our patients have access to MD Anderson, to MUSC, to Mayo Clinic, and they're getting the best care. I think that's key. A lot of times I think people are, well, I'm just going to see the little local hospital, but not realizing that like behind like Self Regionals Cancer Center, you have all those other resources and the trust and knowing that if someone has like an unusual cancer, something we don't see that often that we might not be experts in, that we know who to call and we're going to send you the best place that is. If that needs to be in Houston to MD Anderson or to Charleston to MUSC, we have those relationships it will send you and the the cool thing is like for example someone goes to md anderson and they see someone and they need to be on a chemotherapy regimen for a period of time they don't have to go to houston to get it they can come here to south region and get it in greenwood they'll go get that consult from that super specialist subspecialist and whatever type of cancer it is and then they can come back here and it's coordinated with the team here to get that cancer treatment right here closer to home exactly it's a beautiful thing you guys have created an amazing system. It's a phone call away. We have a great relationship. We go to meetings. We meet doctors. We have a great relationship with experts. There is no reason not to. And sometimes patients say, well, I don't know. Would you be okay if I go for a second opinion? Absolutely. You have a cancer diagnosis. It's stressful enough. Don't worry about my feelings. I want you to get the best care is it there here i want you to get the best care if i we can work together and you can get the treatment here closer to home we will help absolutely yes yeah i think it's beautiful and just that whole philosophy of it's all about that patient yes and get each individual patient with their individual type of cancer the best treatment that is available anywhere exactly and you do it right here yes and i say if we don't know we'll get you where you need to go so i actually it's interesting that i recently i got a text from uh one of my patients who was um who we didn't we we the disease progressed may last year and i remember he went to our clinic and and everybody was crying everybody was coming uh from the cna to nurse and then that it's so bad and i you know it's a funk and i said no there is no hope we have life we there is still hope So we cooperated with experts, we got him on something called BITE, and then additional treatment, and the patient is doing fantastic, and it's working, and it's enjoying his life, and he's traveling and having a great time and not worrying about cancer anymore, he's in complete remission. So when you go from something like this to here now, you're just like, it's incredible, it's just, it's very rewarding to be oncologist now, I think. That's awesome. It's absolutely wonderful. Just wanted to follow up with what Dr. Sadursky said, research is very important. That's how the cancer actually mortality dropped, less than 4 million people over 30 years because of advancement of treatment. This is one thing we are trying to bring every new technology here. said, just Dr. Sotersky said, bites. That is a very fancy name. And we are actually actively working with our pharmacist administration and evaluating which disease, what bites we need to bring hospital in community right away. This is said that we actually worked very hard, got the liquid radiation bag for treating prostate cancer. It's called Pluvicto or a generic name called Lutetium-177. We got the treatment therapy in-house starting last month. That is benefiting a lot of prostate cancer patients who, generally speaking, are older, frail, and not mentioning if you go other place, driving is already a limitation, a burden, and a lot of time because of medical conditions, they cannot drive further. We have the technology here and people can enjoy this very unique techniques on liquid radiation, again, at home. Those are the things we are trying every day to just to make sure our patient actually receive the best care possible. One of the things that I love about our cancer center is that I think that, you know, you guys and the team have created a unique culture at our cancer center that it just exudes compassion when you come there. You walk in the front door and you feel it and the team shares it. And in this, maybe talk a little bit about the culture in the cancer center. One of the things that I think is so cool is when I say a patient's going to be there for a period of time, getting a series of treatments like they have the same nurse every time you build those relationships um with the the team and um you know like you mentioned the the team like caring and like crying together it's like they really do become the patients become a part of like kind of who you are just talk about that for just a minute yeah though so culture is really healthy here and the we you know from physicians, medical oncologists, radiation oncologists, we accommodate each other being very flexible. Sometimes when patients come to the doors, not only need the medical oncology care, but also radiation oncology, we always phone call saying, "Hey, patient is here. Why bring them back Again, can you squeeze your time and just see them same day? We do this all the time. This is from top physician part. Talking about a nurse and MAs or every supportive care, everybody is treating really like a family. That's all the bondings, relationships. At the end of the day, my patient, I'm sure Dr. Sadursky's patient is doing the same thing. They just say, well, you know, I've been in remission for a long time. Now my cancer is coming back. I need to start a treatment. Can I ask my nurse? They would call the name and say, which nurse I want. They all work the best. We always accommodate that part. And add on Dr. Sadursky. Yes, absolutely. So I think that, you know, once you enter the self-regional, you are like a team self, you know, we are a team. So I have a story, actually, a patient has been seen every three months for something like anemia, I think. And then the front staff knows her already. And then suddenly she lost her husband recently and she was really sad. So, you know, Mandy, she came out from the desk and she came to her and she said, what's wrong? And she said, can I offer you something? And she held her hand and the patient was like, it was what I needed at this time. And I feel like I'm part of the family. So that's exactly the supportive stuff we have. We have everybody watching out for the patient. Sometimes you would get a phone call, a patient came, looks a little short of breath. Can you get this patient sooner? Our CNA are excellent nurses. And nurses wear many hats. You know, they are from counselors, guiding you from chemotherapy side effects. being their advocate for the patient. So they cycle social support with, of course, we have a social worker as well. So a social worker who makes sure that the patient's life doesn't get in the way of chemotherapy. So she helps with financial toxicity. She helps with overcoming the family, you know, different dynamics when you have a cancer. And I think so even in volunteers who some of them are cancer survivors, They walk with our patients, providing support and providing the hours to help them to get through the treatments like they, somebody else maybe helped them before. And the same, I cannot not mention environmental services who make sure that our rooms are clean, which also provide a healing, you know, space for patients when you come to a nice, clean exam room and chemotherapy area. So I think everybody is pulling together. We also, you know, Dr. Yen knows that we have an excellent relationship with everybody in the hospital. If we need some urgent care, emergency room always says, hey, bring the patient here. We will take care of them. We have we have grown hospitalists now group in our hospital. So while we are in clinic, they help us take care of the patients in the hospital. And then, of course, as Dr. Yin mentioned, cardio-oncology, you know, we have actually an expert who trains in oncology, chemotherapy, side effects. So we are unique. When we went with Dr. Yin for a meeting and we mentioned we do have cardio-oncology and some of the bigger cancer centers down, they were like, wow, how did you do that? You know, so. Right. Yeah. So I think we have many, many, many example stories to share. But I really wanted to share one patient's story with you, Dr. Logan. My patient on immunotherapy got side effects. Wife called in the morning immediately before, you know, mid-morning, the patient was here and got everything, treatment, et cetera. Then the patient getting better, and then what he said, he said, you know, it's not because you actually working with us so closely, I'm going to end up to ER, to the hospital. The wife actually mentioned, she said, you know what, you take care of my husband all the time, but I was asked, how am I feeling? How am I doing? This is things me, ask me that said any, everything for this hospital. She said either the patient is in an inpatient hospital, outpatient setting, no matter if it's in an imaging center or different places or some like specialties, people always not only taking care of patient, her husband, also take care of her. She emphasized asking me what I want, what I think. That said a lot. That's how she told me. That said something. The culture, actually, not only our cancer center, but self. I think this organization, I think this is the right culture for me personally, state, 10 years. Well, we'd need another 10 to 15. Exactly, yeah. That's absolutely unique. Yeah. Very healthy. Well, thank you. And, you know, we put a lot of a lot of emphasis at Self Regional on trying to be that place where, you know, you don't just get care, but you get it with compassion and love. And you guys just like the picture of that and what you guys do in the in the cancer center and for the patients you guys serve. So I'm certainly grateful for you all. So let's let's touch on a few things, just cancer in general. So what are the common cancers that you guys see? If you had to name like the top three or four cancers that we take care of most commonly at our cancer center, what are they? So it's lung cancer, breast, prostate cancer, colon cancer, bladder cancer. It's more like for older patients after 50. Like above the 50, we will see more breast and colon and testicular and melanoma. So younger patients have a little bit different. So the colon cancer is more common cause of death for patients under the age of 50. And the second cause for the women and for women is the second cause of death. Yeah, so those are the cancer. Now, the dynamics in the younger patients are a little bit different because they are there is 80,000 new cases a year and they actually are growing one to two percent a year. And the incidence. So we have we see more and more younger patients. We don't know exactly why younger patients have more cancer. We think, of course, it's environmental. It's maybe some preservatives, maybe plastics. microplastics are a very popular term right now. So it all needs to be studied and researched how to avoid those toxins and prevent and decrease the risk of cancer in younger patients. Yeah. Boy, I've certainly read a bit about this too. The younger people, younger folks that, you know, 10, well, longer than that, maybe 10, 15 years ago, you wouldn't really think about like high risk for things. Even a few patients I've had the opportunity to take care of in the emergency department would come in with, say, abdominal pain in a 30-year-old. And I'm thinking, gosh, does this patient have appendicitis or something more common that a young person would have? And then you find like some big giant colon cancer unexpectedly on the CT scan that you got looking for something else. And it's a little shocking, frankly. And yeah, so you mentioned some of the possible reasons. Yeah, and that's why I think that really the advocacy and then, you know, more learning about younger patients and the risk of cancer because they tend to be diagnosed later because we don't think, you know, when you have a 25-year-old patient and she says she has rectal bleeding, well, it's hemorrhoids. So then we have to, and then that's why we also decrease the age of screening for colon cancer, and it's now 45 years old. So we need to be vigilant we need to educate the community doctors about don't disregard now those patients also when they are diagnosed with cancer they have the cancer tend to be more aggressive so they get more aggressive chemotherapy and their dynamics are changing you know because they just started a new job they have family and they infer the fertility they might be infertile so all those different things and psychosocial things need to be addressed and then Dr. Yen yesterday she was talking about psycho-oncology and today so she you know fear of needles, fear of tests, test results that's all younger patients are definitely more pronounced than in older patients so and then the genetics you know and I think Dr. Yen maybe elaborated more about genetics and and genetic center so here is the thing the is the american cancer institution all the stats for 2025 what are the really leading uh deaths of cancer five big ones number one is lung cancer number two colon cancer number three pancreatic cancer number four breast cancer number five is prostate cancer. The reason why I mention about that is how we as a cancer center, we have sophisticated thoracic cancer group. We have lung cancer tumor board. We have thoracic surgeon, particularly very good about lung cancer surgical resection part. We have a good genetic center here knowing nationwide pancreatic cancer that is a lot of time it might be just family related. we have those services at the doorstep again. Breast cancer, right now we are not only, Dr. Sadursky mentioned about a younger patient coming here to get the cancer. We actually established a high-risk breast cancer. How can we manage it? How can we talk to them, trying to you know educating reduce the risk or early detections boys early stage cancer the prognosis is really excellent so we wanted to detect early we have that and we have a breast 13 is coming really good one and we have breast imagers they trained to read breast images we have that and you know with the foundation with everybody we are going to have a breast center that is so cool in the rural setting and it touching about about you know how the nationwide in this country, what are the leading cause of that? So we are tackling that. Prostate cancer, now we have a specific urologist, we have a really good urologist, we have a da Vinci, very fancy surgical equipment. We have a new technologist, ProVicto, coming here, and we are actually this year we're going to build up GU tumor board so with all those cancer type no matter what is leading deaths no matter what what we do in trying to reduce the mortality we are doing really good I'm proud of us by doing really catching up and if not the same If not better, we are catching up with really academic centers. I think so. You just were talking about tumor boards. To me, this is one of the coolest things that, I mean, a lot of places do it, but it's one of the things that I think a lot of people don't know about. So if someone is diagnosed with a, say, let's just use colon cancer as an example, there are a group of physician specialists sitting around a table talking about every single case of that type of cancer or the cancer that we're dealing with specific with that problem. And you've got a surgeon there. You've got the pathologist that's looking at it, the radiologist that's looking at it, the medical oncologist, the radiation oncologist, all sitting around a table talking about that individual patient and their specific cancer and what do we need to do to give that patient the best care, all working collaboratively as a team. And we do that for like the brain type cancers, the intestinal cancer, the lung cancers, each of them with their specialized tumor boards to really make sure that every patient is getting that best level of care. To me, that's really awesome. And for a community hospital to have those resources, and then you talk about like, you know, the neuro-oncology and those special subgroups that are like dive into those specific cases. I mean, I don't think people realize what we do hear sometimes. It's amazing. Yeah, we also have major cancer type. We also have a nurse navigator specifically, so they are navigating. Basically, to me, the main term is this person, nurse navigator, they're holding their hands, starting the diagnosis all the way during their treatment. So patients feel like safe because they do have somebody to call. That is the only phone call away. They get everything, no matter how many calls they get. The people are just there. It's not a machine to answer. It's not nobody return your calls. We have people there listening, answering, and taking care of their problems. even without being a need to see the physicians come to the facilities a lot of things are already taking care of that that is a part again in the rural setting that is amazing I think they also a very cool part is that we have a tumor board also involved this genetician so we always have they are involved and we discussed the case they also say hey I think this patient needs to come for genetic testing. And that is, we do have worldwide no genetic centre in this little town, Greenwood. I think we have experts, I mean, I think it's one of few, maybe five of ten experts in genomic gene sequencing here in Greenwood. So I think we just have a very good set up here. And although we are, you know, when we think of small, I think the small is maybe our strength because we can do more together. Yeah, I do. I think it's just been very rewarding to work here. You know, you have this relationship with patient. I've been 23 years, so I know I have treated maybe patient, maybe then. Unfortunately, there was a mother of somebody, and I recently saw somebody who was in a high-risk breast clinic. And I saw her mother when she had breast cancer many years ago. And she was like, oh, are you still here? And it was just so, and I said, thank you for, you know, for taking care of my mom. And thank you for being here. So it's very rewarding. You see those patients at the store, in the church. You know, I go speak to churches as well to educate. So I think it's wonderful to have that bond in the community. Yeah. So just to add on a little side story, I actually did not know Greenwood Genetic Center is that famous until one day my friend, very good friend who is a pediatrician specifically working on genetic disorders, he is a professor in Yale right now. he actually came to visit me i mean spending long drive coming so i we we hosted him and his wife and then he said before i leave i needed to see greenwood genetic genetic center i said why why you need to go there i even don't know which door which way to go i mean he said do you don't know that's he's very famous yeah yeah yeah you've got yeah yale folks the specialists coming to south carolina to see like what we have at the greenwich agreement yeah that is amazing yeah that's he's amazing yeah yeah well anyway it is awesome not to get sidetracked but um it was interesting when i was in medical school i did a clerkship in australia and um and when i was over there um one of my professors in australia was talking about some of the research done on x-linked diseases that were discovered in greenwood south carolina when they heard i was from greenwood they're like holy goodness wow that's like the world famous genetics yeah it was just kind of funny yeah it's really cool yeah sometimes you don't know what you got right in your back door right exactly yeah but um but yeah so shout out to the green genetics center too okay so um let's let's touch on some screening for just a little bit you know we talked about some of the the most common cancers that we're seeing in the community um so just for anyone that might be listening to this what are the recommendations for screening for the common cancers you mentioned colon cancer maybe age 45 to start with screening but how about like lung cancer i know we've been putting a lot of effort on that too here lung cancer good you asked you know this is a state i learned tobacco tax is zero is still once people started smoking at a year age nine sometimes that is unbelievable so long screening yes yeah the guideline depends upon different guidelines but right now it's sort of like a starting age 50 to 77 yes and doctor um so then we have a lung nodule clinic and if we find somebody of number long nodule we will refer to Dr. Goodman Lung Nodule Clinic and they will be followed. Now, within the last two years, we have 300 cases of lung cancer and 50 cases, 18% of them, were discovered by lung nodule, lung screening technique. So I think that is a life-saving procedure and definitely encouraged. So I have a patient who was 50 at the time. He went to Chicago for some meeting And he saw a screen which said, if you were after age 50, you should have lung cancer screening if you ever saw it. So he went to a local doctor, Dr. Holman, and said, hey, do you think I need to have a lung cancer screening? And he said, OK. That was five years ago. And he had the lung cancer. He was completely asymptomatic. He had a nodule. It was removed. Still alive and doing fairly well. So I think it's just an example of how it can be detected early. Yeah. So lung cancer, low-dose CT scan, 45-year-old colon cancer, and that's either colonoscopy or the Cologuard card, right? And then what about prostate cancer, screening for prostate cancer? I'll let Dr. Yan. This is very controversial, but generally speaking, it is recommended patient, or not patient, men age 50 and above, if their life expectancy is more than 10 years, let's say, it's always recommended to check PSA, if not every year, every other year. But this is very controversial because there is no clear guideline to say one way or another. But I have found if patients actually advocate themselves, they wanted to get a screening, and they actually detect early stage prostate cancer, like all other cancer types is curable. They don't need to spend the rest of the time of their life thinking about, oh, I still have prostate cancer. A lot of time we're even actively watching those low-risk prostate cancer. Therefore, it's all recommendation is one way, people is doing is another way. I don't think that people are actually doing very good, not only this part, but also the rest of the country. The guidelines are very confusing. Yeah, very confusing. But I think if you have the family history of somebody with prostate cancer, I think you should advocate for yourself and ask for a PSA. Sure, sure. I know it's on the mind of our primary care doctors, too. So breast cancer, screening recommendations. Breast cancer, okay. General population start age 40. The ASCO, American Society of Clinical Oncology, or our society, recommend every year. But then if you go different society guidelines, it's always say if it's not every year, every other years. But I do recommend all the women, average women at age 40 starting screening mammogram. We do have a 3D mammogram that is a very good technique detecting early breast cancer, which is excellent outcome. If catch up sooner, treated, that is a life-saving, that really supposed to go. On the other hand, high-risk breast cancer, that is all starting alternating MRI with a mammogram, so high-risk patient always get, every six months they get breast imaging. Generally speaking, mammogram starting 30 years and older, MRI starting 25 and older. if they meet the criteria for high risk. The good part about EARTH, again, promoting EARTH, is that when people, when women come for the mammogram, they take questionnaires, and they have the calculations, the model, algorithm, and immediately, even before you leave, they get you, already assign you a score, And they tell you, and also the little information about our high-risk breast clinic. They will get this to say, "Hey, your calculation risk is high. If you wanted to go talk about that, you can." That is a whole different. So we are doing very good. – Awesome, yeah. – I think, I mean, I'm very excited about the breast comprehensive center. I think Greenwood as a community came together and then they have raised a lot of money. We still are a little short, so we would love to continue raising the money for this breast cancer centre, which is very, very needed for this community. We also know that we do have excellent mobile mammogram, which was donated by Adabo Sweeney this community to increase the awareness among women and screening for early breast cancer. I also want to mention the foundation which has donated money to exercise oncology so with cardio-oncology we improve the heart health of our community and we even started doing the yoga classes now and i said i might come but stephen said space is very limited so we need to build it bigger yeah i got you i got you yeah so uh i will just mention that the self regional healthcare foundation is raising money um for some of those specific things you're talking about the breast center of excellence i'm super excited about that and you mentioned this summer we have a fellowship trained breast surgeon dr purak who's starting um and then you mix that with uh recently within the last couple of years, some dedicated plastic surgeons to the community that can help with the breast reconstruction piece. We have dedicated mammographers who have done subspecialty training in mammography work and do biopsies and all the work that goes around that piece on the screening part. And I think we were the first in South Carolina who were doing the contrast mammogram. That's exactly right. The first in South Carolina to do contrast enhanced mammogram, which reduces the need for some of the other advanced imaging modalities like MRI. And so we really are building the pieces. And then the next piece is what the foundation is raising money for is just like the building and the infrastructure and putting together like this beautiful aesthetic center for the women in the community to to have screening and treatments, frankly, as much as we can in that area. So super excited about that. That's a little ways out, a little more funds to raise. But in the fall of this year, we plan on starting really diving in on some of the plans for that. So really excited about the future. Thank you. Thank you. Yes. Well, you guys are both really involved in advocacy. I thought I'd just touch on that for just a little bit, even at a national level. Can you all share a little bit of the work that you're doing at the national level? I'll let Dr. Yen talk about it, but I do want to say that we got just motivated by you. When you took that role of administration and started working, I think that's what actually Dr. Yen said. Well, we need to also advocate for our patients, too, because we had some drug shortages and Dr. Yen had to replace some chemotherapy in one patient, maybe end up with more neuropathy than expected. And she had trouble putting her little earrings in the ears and then trouble buttoning her shirt after that chemotherapy was the good one wasn't available. And we had to substitute with maybe inferior one at that time. So we said, well, we need to make sure that we have what we need for our patients. So Dr. Yedgan involved in ASCO, and it was excellent. Tell us what ASCO is, and then tell us what you're doing with them. Okay. So oncology advocacy is not luxury. It is a must. Why I'm saying that, research, that is a research fund. How the health policy actually dictate what is a research fund, how much we can get. And we know that research funds and really research decrease mortality. That is very exciting in the cancer world. Additionally, we physicians spend a lot of time to do the administrative work, such as prior authorization, which unfortunately nowadays has become more and more complicated, and which is not good for patient care delayed patient care asco actually had a survey back to 2022. 90 90 something percent of the chance delayed cares sometimes can be life death situation like for example my patient one of those waiting for get pet ct he passed away that is not acceptable in this country with just waiting for some technology or some testing and cannot get it that is a prior authorization drug shortage a lot of time even with iv fluid think about that dr logan when disaster hurricane you know helene came even iv fluid to get drug shortages the the way to think about that is very interested in the generic very cheap drugs they get shortage just like dr sadusky said carboplatin very cheap generic but we don't get that policies you know people always business they wanted to have that if they you know profit if you don't profit how can the a good business sustain so we are trying to advocate um the health policy at least to address drug shortage and prior authorization and as well as well as research funding. I started advocacy three years ago. At that time, only me, only one from South representing the whole entire South Carolina for two years. And this year, Dr. Sadursky, we went together. That is the part he said something. Three of physicians went there. two from self. That said something. And now the advocacy, like you just said, you're advocating for things that are big deals like drug shortages for patients, prior authorization where care is can't be given until someone off at an insurance company gives approval to get the care. And you guys are advocating, frankly, for the whole state of South Carolina, that our patients in the state south carolina have what they need to get the good exactly that is from national level right we also have a so-called grassroots initiatives which means physicians like during their regular time either with a virtual meeting or even go to the you know state capital to talk to the lawmakers about health policy at home. That is one part from national wise. This year, Dr. Sedursky and I, we both joined the South Carolina Oncology Society Board. We are board member. So from that level, state level, we are trying to advocate, continue advocacy for, you know, again, not only for our patient my family and my community but also for the our state and for advocacy we are i just want to tell you but we are hoping that maybe when one it's very pressing problem that when the patient um changes the treatment sometimes they have medication very expensive medication who they haven't used they still have closed but we cannot do anything with that with it we have a law which says you have to discard it some of those are all medications for chemotherapy are $15,000 so we right now in Wisconsin they passed a law but they can use those medications for other patients so I'm hoping that maybe one day we can pass that law in South Carolina because it's really heartbreaking when patients bring the medication to me and say what to do and I say well I just called the pharmacy and we will have to discard it there's nothing else we can do right now the law is saying that we need to discard it so it's very heartbreaking yeah so when doing advocacy oncology is not in the vacuum if we don't collaborate with the other parts then there is no way we can do a lot on the state level the Medicaid Medicaid fund is a big deal for rural oncology practice, Medicaid is essential. A lot of patients, they don't have means financially, transportation, a lot of issues. Medicaid actually is essential, is life-saving line for those patients. If we don't advocate for them, nobody will. nobody so that is a whole from state level actually we are joining this South Carolina Medical Association trying to address those issues and again there is a Dr. Sadusky and I we oftentimes write late letters to the lawmakers about those issues as well just to try um you know if we don't do that nobody will that's right nobody so right now up to this part after my three years advocacy effort i feel like to me advocacy is not a must for oncologists for me it's personal because i'm fighting for my patient absolutely for my family maybe one day for myself that's right but i have to say it's working because since we came back from washington i haven't had any prior authorization requests everything is approved maybe it's coincidence we don't know but no well listen you guys are awesome what you guys are doing for the community is awesome and honestly for the state and advocacy work and you guys are really leaders in this space and we are certainly proud to have you on the team team here at Self Regional and what you guys are doing for other patients that are here and trust us to care for them. And thank you. Thank you very much for what y'all do. Thank you. Thank you. So with that, we'll wrap up this episode of Medically Speaking and thank you all for tuning in today and we'll catch you next time. Thank you.