(gentle music) - Nearly one in two Americans will face a cancer diagnosis in their lifetime.

While remarkable advances have been made in the detection and treatment, access, equity and prevention remain uneven and are often determined by where you live, what you earn, or the color of your skin.

Joining us today are Kelly Nelson Fagan, chair of the American Cancer Society Sacramento Region, and Dr. David Tom Cooke, physician-in-chief at UC Davis Comprehensive Cancer Center.

Kelly, let's start with you.

When we look at some of the common barriers that face patients who are looking for cancer treatment, what are those, not just medically, but emotionally and socially as well?

- I think in discussing these barriers, we go back to your preamble with access and often where we live.

A cancer diagnosis does not come if you do not see the doctor, if you are not symptomatic, if you are not being screened, and if you don't have robust primary care often.

So all of those factors are important in that journey for someone, for survivorship and their wellbeing.

In our region, it's especially significant.

And Dr. Cooke, you can certainly speak to this.

In Northern California, from Sacramento to our Oregon border, all of these counties are still considered rural counties.

In the majority of these counties, 20 plus, most of these folks are living at or around poverty level.

So a question of access, both to care, transportation are important.

We have a diverse cultural base and population where communication and language is a barrier.

But rooted in all of this is messaging and access to that first line of care.

And you can have a diagnosis.

And then where do you go?

- Good question, which leads me, Dr. Cooke, is I've heard tell that you have a philosophy of equality of great quality.

How does that come to life in a practice like yours in what is considered to be an international center of excellence like UC Davis Comprehensive Cancer Center?

- Yeah, well, first of all, Scott, thank you for inviting me here today.

And Kelly, I look forward to learning from you during this conversation.

But quality of great quality, what that means, as Kelly actually you pointed out, we have a diaspora of background in our Sacramento region, which extends up to the Oregon border and west of Nevada and to the Bay Area.

And within that are individuals who are multi-generational farmers, rural background, urban centers, geographical disparities, economic disparities.

But if you can get a patient with a diagnosis of cancer or a suspicion of cancer into a comprehensive treatment center, then many of those disparities just evaporate and go away.

If you get a patient who's at high at risk for developing lung cancer and they get screened for lung cancer, then their survival rate is the same as any individual from a privileged background.

So the key is access.

And then once you can get access into a comprehensive cancer center such as ours, then those disparities can melt away.

- Kelly, when I hear talk about access, when I think of mental health care, okay, as a lay person, I think of the National Association for Mentally Ill, NAMI.

When I think about domestic violence, locally we have an amazing organization called WEAVE.

The work of the American Cancer Society is important.

And it's not just national, it's international.

What is it that we don't know that we should know about ACS Sacramento that can get those types of connections that Dr. Cooke just referenced so if we are in trouble, we know where to go and what to do.

- I love the the quality of, and speaking to access and equity and care and the quality of care and Dr. Cooke's point in saying, if we can access that diagnosis in these services, then the journey becomes easy.

But the journey is not always clinical and medical.

It's rarely clinical and medical.

- Tell us more about that.

- And for the American Cancer Society, I think something that many people don't know, they understand the role that research plays in our mission, but we often don't do a good job of communicating and I so appreciate being here to do this, is the integrative approach and collaborative approach that starts with science and research, because that's where it begins in terms of our service, the advocacy for what is right and what is science-based, that turns into a delivery of services and resources.

Because for us, what many people don't know is the average length that a patient travels as a new consult to our breast specialist for breast cancer diagnosis is 52 miles one way at UC Davis.

So that means- - Really?

- That's the average distance they're traveling.

Means some people are traveling two miles, some are traveling 150 or 200 miles.

So you're traveling a hundred miles each visit, each treatment.

The burden of that in transportation can be mitigated by services.

Our Road to Recovery and our transportation services and our vouchers for transportation for patients.

Lodging, when you are here, if you've gone through a day of treatment or you are here for an outpatient procedure, the induction of your treatment, and you need to speak to a nutritionist or you don't have transportation, we can get you here.

And how do you stay and where do you stay once you're in Sacramento, if you've traveled 100 miles or 80 miles or 60 miles or you're alone and can't drive?

So there is lodging.

We have HOPE houses, we have vouchers for lodging within our community.

We have transportation.

And someone that can help navigate and fill in the pieces until your clinical team and your support team within our medical communities and systems- - And your organization will provide all that?

- Yes.

And I think what's really important as well is there is an 800 number for the American Cancer Society that you can call 24 hours a day, seven days a week.

- Why don't you tell us what it is?

- It is 1-800-227-2345.

- One more time.

- 1-800-227-2345.

- Okay.

- And you're gonna get a person.

And if the American Cancer Society cannot answer that question and provide the resource you need, there's gonna be someone who's gonna ask you your zip code, who's gonna ask you your age, ask you your diagnosis, and say, "What do you need?

And I'm gonna tell you a little something about the resources in your community."

So I go back to ACS being a collaborator, a convener of resources, and for other cancer organizations in outreach, the American Cancer Society funds outside of our government, and as of last week, more cancer research than any individual organization in the country.

- I actually want to talk about that.

Dr. Cooke, we've had conversations about how the traditional support that's come from places like the National Institutes of Health are at risk of being cut and what that might do to the infrastructure or the progress that places like UC Davis are making in the fight against cancer.

Where is the risk greatest presented by the conversations and the actions that are taking place right now on this topic?

- Yeah.

So first of all, Kelly, I want to thank the American Cancer Society for the resources that you described.

'Cause many of our patients have benefited from those resources.

And Scott, you had mentioned in the beginning, one in two Americans are gonna be diagnosed with cancer.

But if we look at the last 10 to 15 years, the overall death rate from cancer, so patients who are diagnosed with cancer and the rate of not surviving their cancer diagnosis has gone down in this country.

Why is that?

It's because of innovations such as cancer screening, whether it's mammography or lung cancer screening, novel therapeutics, immunotherapy, drugs that boost your immune system to fight cancer, targeted therapy, ability to take your tumor, look at the molecular profile, and provide a medication to treat that tumor based on its molecular profile.

And innovations in surgery, robotic surgery.

Now, if your mother's diagnosed with lung cancer and undergoes robotic lung cancer surgery, or your husband is diagnosed with prostate cancer and undergoes robotic prostate cancer surgery, they potentially could go home the next day after surgery.

Now, all those innovations and techniques and novel therapeutics were made possible by research.

Many of them were brought to the market by the private sector.

But the fundamental research that allows their existence are from academic medical centers such as UC Davis, funded by federal grants, many of which funded by private nonprofits such as the American Cancer Society.

But billions of dollars of federal funding have brought these things to existence, and now they're at risk of all going away.

So I'm concerned about the next generation of therapeutics, next generation of technology, and our community is gonna suffer because of this lack of funding.

- This lack of funding and the access to all of these emerging therapies that you're discussing, generally, I'm not trying to hold you to something, a strict timeline, but between when you're in the discovery process and people are involved with clinical trials and the like, and when things are actually available on a non-experimental basis, what's typically that continuum?

Because things that are probably in late-stage development, we may still see a few of those, but when is it that if funding is cut off, this really starts to bite?

- Well, the crisis is now.

So I personally know researchers who have had their grants canceled now for no reason at all.

And so whatever research that they're doing is now cease and desisting and also the people they employ to support that research apparatus are no longer having positions.

And then you look at the regulatory environment, you look at the FDA.

The FDA has past learned that, "Maybe we need to fast track some of the approval of some of these therapeutics that are saving lives."

And I'm concerned with cuts in that apparatus, are we gonna slow down the ability to bring these novel and lifesaving therapeutics to our patients and the communities that we serve?

So this is not an abstract theoretical crisis.

This is a real-world, happening-now crisis.

- Well, I want to, talking about taking it from the abstract to the real, Kelly, you have a very interesting background in that you started out doing hospice work before hospice was even a thing that most of us even knew about.

- Yes, I did.

- And you've continued this work as a volunteer.

You know, was there an experience or a story or a person to really bring this down to the human level that has inspired or drives you to continue this work?

- There's a story that I tell, I shared this with you previously, and it's a story that I think celebrates my coworkers at UC Davis and the clinical staff and commitment and the community and my passion for ACS.

In working with patients who are end-of-life and how that has all changed, it drives a certain focus, and then your own personal experience, of course.

And so when I was working at the Cancer Center at UC Davis, and this is my go-to in why.

We tell a story always with ACS, what is your why?

And we had a small room that was dedicated as a resource center in the Cancer Center, and we had mostly materials printed by the American Cancer Society available for people to look through, take as they wanted, they could ask questions.

My last year I was working there, I was housed there outside of the trailers at the Cancer Center.

We had a computer for people to use that may not have that access at home.

And I came in one morning, the doors opened when the lights came on in the morning and the doors closed when we all left in the evening.

There was a young couple, younger every day I live, they were about 30, mid 30s.

He was in a wheelchair.

His partner, lady, was with him, and he had a feeding pump that was plugged in and they were on the computer.

So we chatted, we had a conversation, and his story was gutting to me and ended up being celebratory.

He had moved from southern California, had finished a rehab program, had shifted his life in a very healthy good way with a new beginning here with a woman that he loved.

Came to Sacramento to live with his sibling.

He was getting ready to start a new job and had a cardiac event, was transported to UC Davis.

During his hospital stay and open heart surgery, they discovered he had advanced colon cancer.

He was finished with his hospital stay, back to his sister's home, which became a really unsafe and not sober environment for him to be in.

And he and his lady were in their car, discharged from the hospital- - Living?

- Sleeping in our parking garage, the one that we had at the time at the hospital.

He said, "Is it okay if we plug in my feeding pump?"

And we talked more about his circumstance.

He was just beginning his assessment and learning who his team was for his care at the Cancer Center.

And by the end of that day, the resources for the American Cancer Society got them housed, first at our Kiwanis house, then with hotel vouchers for the remainder of his stay.

We got food vouchers so his wife could eat in our cafeteria during that time.

And we were able to facilitate, it was after the beginning of ACA and his hospital stay had initiated this, but we were able to assure that he continued with his Medicaid coverage because he'd established his residency in Sacramento.

For the four to six months after his treatment ended they would come see me periodically and we continued to provide support for them.

And I was able, through resources with ACS, not just with ACS, with our hospital staff and social work staff, to get them housed and safe.

He passed away about six months after, but in that time, he reunited with his son that he had been estranged from, who was also healthy and sober.

He was able to marry his lady love.

And there was a peace and dignity that we were able to provide for both of them.

He was worried about her safety.

That would not have been provided had that conversation not been had, there had not been a space for that conversation, there hadn't been the information, the resources from the American Cancer Society.

The research treated him, the patient services sustained him in the last months of his life.

I don't know a better story.

(laughs) - Well, the thing that leaps out to me about that is there's a term that's used often Dr. Cooke, about patient-centered care.

That story sounds a lot like the best of patient-centered care, where there is the clinical part, and then there is the community and support services part that comes together.

When people are looking at the care that they're receiving and their access to it for cancer, it's a highly emotionally charged time, and sometimes we're not at our best selves when we interact.

Give us some advice on how we as laypeople, as patients, need to engage with people like yourselves and your colleagues as we're trying to just get our legs underneath us and start our own journey through this issue.

- Well, I think the first step is to understand that all the emotions that you're feeling, if you should get a cancer diagnosis or your family or loved one gets a cancer diagnosis, are okay.

It's okay to have anxiety.

It's okay to have fear.

In fact, the three things that patients want in order to have a good experience with their healthcare provider can be confined into three words: fear, trust, and then a phrase, peace of mind, that you alluded to.

They wanna have their fears relieved.

It's normal to be afraid if you're diagnosed with lung cancer.

They wanna be able to trust their provider.

So trust has to be earned.

You have to demonstrate to be trustworthy.

So as clinicians, as providers, we have to demonstrate that you can trust us.

We are trustworthy.

And then peace of mind.

A cancer diagnosis is not a death sentence.

Millions of people are cured of cancer if they get standard-of-care treatment and if they could get access to treatment.

So that cacophony of emotion is understandable with that diagnosis.

And as providers, we have to address that fear, we have to earn that trust, and we have to help establish that peace of mind.

- You know, in hearing Dr. Cooke, and dealing with those three sort of macro issues, there's a component that surprised me about the work of ACS Sacramento, in that you're talking about things that seem a little bit far field.

So you have this new initiative called Cultivate, and it's talking about, you know, food access and food safety and all that.

And help us understand the connection between what Dr. Cooke's talking about in the treatment room and in the treatment protocol, and sort of this push to educate people on some of the things that are not necessarily, at least to the layperson, directly connected to trying to either be cancer free or to address your diagnosis in a way that you are working in partnership with your doctor and the rest of the clinical care team.

- I think what is so brilliant about this, and I so appreciate this question, and Dr. Cooke, I know that you will speak to this because if we know that lifestyle impacts our wellbeing, both our mental wellbeing and our physical wellbeing, our ability to heal or be compliant with a plan, we have to understand that nutrition is a part of that and nutrition is a part of that in every sense.

It is medicine, or it can be a deterrent to wellbeing.

The other thing is when we are talking about a mission to support prevention, food, lifestyle, obesity, nutrition has everything to do with that and often can impact at least half, we think, maybe 40% of your risk of developing cancer, what you eat.

- That much?

- Yes.

What you eat, what you smoke, what you inhale, what you ingest.

So water, food, breath, and all of those things and nutrition and your diet can both prevent and exacerbate a cancer diagnosis.

And not only your risk, but if you've been diagnosed and once you've been diagnosed, how you tolerate your treatment, what your survivorship is like, and what the quality of your life is like throughout treatment.

But once you've recovered, and again, mitigate risk once you've had a diagnosis.

If Dr. Cooke is looking at your unhealthy lungs, but you continue after that diagnosis is treated and you have diabetes or you are obese, and that may not be because of poor choices.

It may be food is not affordable.

It's not, you don't have access and you don't know enough about nutrition.

So nutrition is part of our science.

Nutrition is part of our research.

- I totally agree.

When you look at cancer and how you address cancer, it's not just the cancer's diagnosed and, what's next.

The cancer spectrum is from prevention to survivorship.

Nutrition and food is a big part of every single component as you talk about, it's part of the prevention.

What are a proper nutritional diet to help prevent cancer?

Once you're diagnosed and you're undergo treatment, how can you build the building blocks so your body can withstand treatment better and bounce back better from that treatment?

And then the survivorship that you talk about.

We have a new breast survivorship clinic at UC Davis and nutrition is a big part of that, to maintain that functionality and also the mental health aspect of a proper diet and nutrition and staying in that proper growth mindset as you survive your cancer diagnosis.

And I enjoy the wonderful initiatives that the American Cancer Society has in regards to nutrition and working with our chef Santana Diaz from UC Davis Health.

- He has changed that landscape - And- - He's fantastic.

- We're going to have to leave it there.

I'd like you to repeat one last time that number if we need support immediately.

- It is 1-800-227-2345.

- Thank you both for your work and much success to you all because we all need your help.

- Thank you.

- So thank you.

- Thank you very much.

- Thank you.

- And that's our show.

Thanks to our guest and thanks to you for watching "Studio Sacramento."

I'm Scott Syphax.

See you next time right here on KVIE.

(gentle music) All episodes of "Studio Sacramento," along with other KVIE programs, are available to watch online at kvie.org/video.