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norman straker

Mira Beinart25min

Speaker 1

00:00

Well, let me tell you that I started my career at Sloan in 1976 and I was one of the original people who established the Department of psycho oncology. Psycho oncology is the treatment of people with cancer andor their families the emotional aspect. And we started out with six people, and it suddenly emerged as a fellowship, and then eventually a sub specialty. So I'm an original, so you can ask me any questions you want. I've seen many, many cancer patients over my, you know, experience 50 years, and I also see a lot of survivors, meaning, you know, spouses of terminally ill patients or after they lose their spouse. So I see a lot of people in grief also. So I'm open to any question you have, yeah,

Speaker 2

00:58

well, that's amazing. Do you know what cycle for survival is? What is it? Cycle for survival?

Speaker 1

01:04

Yes, of course. That's a memorial. Yes, yeah,

Speaker 2

01:07

that's, that's kind of what got me into this whole thing. One of my mom's good friends from college is Dave Flynn, the person who started cycle for survival his wife passed away from cancer. Um, but that's, I just want to ask that that is not important. But yeah, so my first question was just going to be, you know, tell me a little bit about what you do on a day to day basis. You know, what types of patients you see? I know you kind of covered that, but a little more specifics, if you could

Speaker 1

01:33

sure. So I will often see some people after a diagnosis of cancer. When they totally freak out, they hear the word you have cancer. And unfortunately, lately, what's happened is that they often find out about the diagnosis because they look at their, you know, their app from the hospital, and it says you have grade three, blah, blah, blah, and they haven't even talked to a doctor, so they are freaked Okay, which is very unfortunate, because in the old days, if you had a biopsy, and you know some tests, you would see the doctor that the oncologist, would explain exactly what you have and give you, you know, some sense of what they were going to do about it. Now, there's this gap between when they find out and when they can get an appointment, which is really not good at all. So, you know, when I first see people, it's, am I going to die? You know, the first response is, oh, my God, I have cancer. I'm gonna die. I have to prepare myself. And, you know, my first intervention is really to say, No, cancer is really a treatable disease. It's now a chronic disease. Most likely you will, you know, get a treatment that will work. And whatever it might be, you're going to go through some course of treatment, but you most likely will go into remission. So my first intervention, really, is, this is a treatable disease. Cancer is not as best as it used to be. So that's, that's a group of people who, first, you know, come to me because the diagnosis, then I have other people come to me during the course of their therapy. And the trick is to help them learn to live with the cancer. And the most important thing I have to help them with is to accept the idea they have to live with uncertainty, because cancer is, you know, a an illness in which there is, you know, a kind of roller coaster experience. You know you are responding to the treatment, and then you're not responding to the treatment, and then treatment have to be changed. And then when the treatment doesn't seem to be working, there's a, you know, a fear that, you know, maybe this is the end. And I have to sort of prompt people to accept, you know, uncertainty, which I think is a very helpful way to think about their their their treatment course, which is, you know, if the we have this idea before we have cancer that we are going to live in, you know, indefinitely. And of course, that's not true. We all live with uncertainty all the time, but you know, when you have cancer, that sort of fantasy of immortality is lost. So I would say that's one of the things that's a helpful way to deal with now. The other thing is, it's very important to help the person mobilize the family, you know, to be very involved. And sometimes there's, and I have some patients who want to keep the information from their children, to protect their children, again, depending on the age of the children and the diagnosis, you know, that's a question we have to sort of consider, is it appropriate if they have grown children, you know, I think it's important to help them to be disclosed, so that they get the support of their children. I think a lot depends on the age of the person. You know, I've seen some young people with cancer, particularly breast cancer. And again, breast cancer is most mostly a treatable condition. And unlike the old days, there is, you know, a need to kind of accept the idea that there is going to be a period in which they're going to be treated. And most likely, you know, depending on what the treatment is, it could be, hopefully it's a it's a lumpectomy. They don't do mastectomies very often anymore, but if they do, my view is that, you know, having a cosmetic procedure to replace the breast is helpful, because women who don't have it wake up every day, and after they take a shower, they see this scar, and they can't get past it, so it's it's very difficult. So I would recommend, you know that they go through that whole procedure, which usually takes a long time, but nonetheless, it's, it's helpful to do, you know, then I will see some people who will, you know, have a remission, you know, in the early at some point they will be better, and, you know, that's a kind of a critical psychological time as well. So they're better and they're discharged. But there's a sense a lot of the people have that not being seen regularly is a terrifying experience, because they don't have the feeling of having surveillance, right? So the earliest experience of you know, I'm done with the treatment, hooray, but I'm scared that I'm not being seen regularly. So that's something, you know, and to come to terms with the fact that, okay, you have to go on with your life, and you kind of put this on the side and not have it sitting in your mind. Of course, people in remission. Every time they have any kind of problem, they think the cancer is coming back, which is also a problem to work through. And then I have people who unfortunately come back because they are facing a terminal illness. And that's a whole other you could ask me about that if you want. I do a lot of work with terminally ill patients, which is not, you know, which is not an awful thing to do. Actually, a lot of good things happen when a person is terminally ill, there's a lot of psychological growth that happens, and there's a lot of opportunities to write things that have been not in not good in their life. So I find that is a real challenge for me and the person to deal with the end of their life. So I'll let you ask me,

Speaker 2

08:39

yeah, well, thank you so much for that. That was very informative. Going back to what you said about living with uncertainty, you know, like, what, obviously, that is like a generally challenging concept to be able to, you know, like, really understand and live with. So what would you like? What do you say? What would you suggest to, you know, specifically young women, but obviously, anyone in general, but more specifically, young women who you know have to live with that uncertainty you know, like, what, what things would you tell them and what would you advise them to do in their day to day life, to help manage that uneasy feeling? Right? Yeah,

Speaker 1

09:16

so this concept is something that you know, I kind of came to over time, because people like to think that they have control over their lives. They like to think that, you know, if they're well, they can think, you know, ahead 20 years and that everything's going to be okay. And really, they're just fooling themselves. So I say to the people, I say, you know, we have to accept the fact that you have really lived up until this time with the idea that nothing was going to happen to you, and that was really, you know, a fantasy. And now you know that nothing is certain, but that's always been true, so adjusting to that is very helpful, because you can't say to yourself, I'm not going to make it, or I'm going to make it, because you know either way, you just don't know. So you have to accept that you really are in a position at this point in your life where you just don't know. You have to learn to accept that you really don't know, which is not easy to do. But on the other hand, it's much better than saying to yourself, oh, I'm doomed because I have cancer. So I find it a very helpful and important challenge for people to, you know, come to that acceptance which they do, which they do, yeah, because it's true, right?

Speaker 2

10:52

And then, so, you know, you know, I the one of the first things you said was, you know, a lot of times people find out, you know, they get a notification on their phone, and it's like, Oh, my God, I'm dying. And then, you know, they have to get an appointment. So what would your suggestions be to people who you know, either you know, see that on their app or in their email, or go to the doctor, get a call that you know, here's the all, if all the information, what? What would your suggestions be, you know, like first steps after you're diagnosed with cancer,

Speaker 1

11:24

again, you gotta have information, and I think it's a bad practice. I don't know that, you know, I don't like the practice. It just seems to me that you know this new way of finding out things is really an abdication of the doctor patient relationship in which the doctor has to deal with telling the patient bad news, and you kind of have left the patient on their own. So, you know, I, you know, I do this, but I think it would be better if we were back to the old system where, you know, you, the person who does the biopsy, calls you, says, come to the office. Let's discuss what, what you got. So there's, there's nothing I can really suggest, because people are going to freak out. They just are. I mean, the only thing I can say is that the more we publicly make people aware of the fact that cancer is a chronic disease now, the less likely they are to freak out. But of course, just the name cancer still makes people terrified, right? Yeah, so I don't have a solution for that. I mean, I know how to help people, but I don't have a solution for the person who looks at, I mean, you could, you could say in your in your newsletter, that when people you know get such a diagnosis, they should, you know, first say to themselves, yes, it's a it's a treatable disease. That would be very helpful, you know. And the other thing would be, talk to somebody as soon as possible about what it is that you have see. Once people have the feeling that there is a treatment and they have somebody to rely upon for the treatment, they calm down, because it's this idea of finding out that you're stuck and you're alone, and you have this disease that might kill you, and you haven't yet connected with somebody who's going to treat you, and you don't know what the journey is. So knowing what the journey is and what to expect is immediately helpful in calming people go,

Speaker 2

14:00

yeah, definitely. And then about communicating with, you know, family members. I know you mentioned, you know, communicating the diagnosis and prognosis with children depending on the age. Obviously, I'm assuming that this is a very like individual process. But is there a specific or general way you recommend to your patients. You know, here's how a lot of people communicate with you know, like, is there a designated family member who's in charge of sending out all the information to family and friends? Or, you know, like, is there something that you recommend or that you've seen that works? Those

Speaker 1

14:35

are good questions. So I always recommend that the person who has cancer, bring a family member with them to the to the oncologist. Why? Because the person who has cancer will be so you know, undone during the meeting that they'll miss a lot of the information. So if you have a relative or someone else to not only record what happened, and, you know, record the diagnosis of what's to happen, the person could review it. There's a certain feeling that a lot of people describe when they first start talking to the cancer doctor is they can't, they can't absorb what's going on, because they're so preoccupied with, does this mean that I'm going to die, or how long do I have, and what, who am I, you know, and they're overwhelmed with thoughts, and they can't process the information. So yeah, they should definitely go with someone, and then, as far as you know, communicating with others, I would say that, you know, very much depends on the patient. Some people are very private and they don't want anybody to know. And other people are more inclined to, you know, reach out for support. I mean, some very individual kind of thing. Yeah, you have to be very respectful of

Speaker 2

16:03

what it is they want. Yeah, and then, can you tell this is obviously very a broad question, but what do you think are the most common, you know, psychological issues that people with cancer and their close relatives struggle with during, you know the diagnosis, treatment, and you know that whole process,

Speaker 1

16:24

yeah, I think the fear of dying, fear of dying patients, fear of dying, and the spouses fear that they'll lose their spouse. So I often see spouses, spouses often come to me because the person with cancer is, you know, being treated and being supported by the medical staff, and the spouse is sort of on their own and afraid to speak to their spouse about their own fears, because they don't want to make them more scared. So I've seen a lot of spouses who tell me that they're in a panic about losing, you know, their spouse more likely than not, it's the husband who ends up in my office because the husband is terrified of losing his wife because he has no clue about how to manage his family and the men tend to be more dependent on their wives than the wives on the husbands. So I guess you would say that the fear of dying is really the most problematic fear that people have. You know, throughout throughout the illness, the fear of dying. And of course, as somebody, as people get closer to, you know, their own death, there's a lot to talk about, about how to help people manage their fear of dying. And, you know, I spend a lot of time talking to people about what their fears are about, and that's a big part of the therapy of terminally ill patients. Yeah,

Speaker 2

18:06

this is more less about the patients and more about, you know, your field. How big would you say? Like onco psychology is psycho oncology? Psycho oncology? Okay,

Speaker 1

18:16

so when we started, you know, it was a very small group of people that were trained. So Jimmy Holland was the chair of Sloan Kettering, and she's really the person who put this specialty on the map. So she began, you know, with a textbook, and then, you know, we ended up with, you know, national meetings, and then international meetings, and we trained people and sent them out, you know, everywhere. And it's, it's a very big specialty now. So it started with five people, and I think it's pretty much worldwide. So there's an international psycho oncology society, American, and they have meetings every two, three years. A lot of people involved. I used to be very involved in those organizations, and now, you know, I transferred a lot of my interest to psychoanalysts, who are now much more involved with cancer patients. So that's where I do most of my but I still teach at Memorial and I give lectures in various places. So

Speaker 2

19:37

yeah, that's amazing. I'm just a little bit about me. I am, uh, I'm gonna be a senior in college this in the fall. Um, where are you? I'm at the University of Maryland, of Maryland, Maryland.

Speaker 1

19:53

Yeah, you have an accent, do I? Yeah, Maryland, Maryland. I almost missed it. I don't

Speaker 2

19:59

know, yeah, um, and I'm double majoring in journalism, obviously, and then I'm also doing public health. So this is your area. This is Yeah, and I Yeah. So this is this position is very good for me. And so not only am I excited to, you know, interview people and write about it, but I'm also really excited to just learn about, you know, cancer and things like that, you know, science. I I'm a nerd, so I love this is this is really cool for me, and I'm really enjoying learning from you, and it's really cool that you were kind of a pioneer of this field, and I admire that a lot. Well, thank you, and I appreciate you taking the time to speak with me. I don't think that I have any more questions. You answered basically everything I was thinking of. The last thing I have to say is, if there's anyone else that you think would be helpful for me to speak to and that would be willing to speak with me that would be amazing. Okay,

Speaker 1

21:00

the only person, well, there are a couple of people. I've trained a lot of people here, but the head of psycho Oncology at Sloan is Bill Breitbart. Maybe he'll talk to you. Maybe not, because, you know, he's very busy. Yeah. One of the other people, who's pretty senior is a person called Joe Barbuto. He's also, you know, he's one of the attendings. There's a voluntary group of older people like me that that teach at Memorial stuff. So Joe might be a good person to be in touch with, because he treats cancer patients. So I think those two people I'm trying to think of, there's there's another, there's a woman who does a fair amount of work with, I guess, breast cancer patients, Sarah awkward cost, also, she's also an attending at Sloan. Okay, you could try and all those people, yeah, I would say that Joe and Sarah would be more likely because they're more available than Bill. Yeah.

Speaker 2

22:10

Okay, well, thank you so much. Okay, I really appreciate

Speaker 1

22:14

it. You know, ask me more questions. I mean, one of the things that you know, I mean, this is not, I guess, so much for people at this point, because you want to help them, you know, get to where they they are in terms of treatment. But, you know, the whole business of how to help people accept their, you know, the end of their life is really something I'm very involved but I don't know that that's pertinent to where we are right now. I think you don't you're not ready for

Speaker 2

22:46

that. Yeah, we're so we're still at the beginning stages of all this managing.

Speaker 1

22:51

Yeah, right, right, yeah. So I think that, if you you know, help people accept uncertainty and the idea that this is a chronic disease with a pretty good outcome in most situations, which should lead to a remission, you know, that's extremely helpful. And, you know, find some way to help the spouse, because the spouse is often, especially during, you know, the treatment very often are completely overwhelmed, because especially the men, you know, if a woman is deeply in treatment, she kind of leaves a lot of her usual functions to the husband, who's not used to, you know, taking care of the kids and shopping and everything else, and also working, often completely overwhelmed. Get often gets involved in drinking too much. And, you know, they often fall apart. So the whole business of support is very important for cancer family, yeah. So that's, you know, that's a start for you. Good luck to you. Thank you so much. Okay, keep me in a loop of what's going on with this. I will you know, there was a early on, when the when the internet first came out, there was a, there was an attempt to have something like this, and it didn't last. It was, it was called oncology online, or something like that, and it was supposed to be the same idea. I mean, it's very needed.

Speaker 2

24:35

Yeah, I'm hoping that we will be able to read this online, right? Yeah, yeah. It's all online. There's where we have a website. It's gonna be, it, it's, it exists right now, but it's, there's no content on it yet. This is, this is the first step in creating the content. Me interviewing you, and you know, I think there's also gonna be some social media presence. It's in the it's in the very beginning stages.

Speaker 1

25:03

Very successful, because there's a huge need for this. Yeah, definitely. Well,

Speaker 2

25:11

thank you so much. It was so nice to meet you and so nice to speak with you. Thank you so much for your time. Yes, oh, I will, don't worry. Thank you. Have a good rest of your day.

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