(upbeat music) - And welcome back to Family Health Matters.

I'm Shelley Irwin.

With me today are those panelists, Leigh Moerdyke, Prevention and Advocacy Program Director for Arbor Circle.

Dr. Glenn Van Otteren, Pulmonary, Critical Care and Sleep Medicine Physician, and Claire Portinga, Vice President of Program at Gilda's Club.

Always say it, but I mean it, I always get the best.

To thank you all to talk about, oh, a serious topic.

I do begin with you setting the scene on how you spend your day, begin if you would, Claire.

- Sure.

Thank you so much for having us, Shelly.

At Gilda's Club Grand Rapids, we're really here to provide the social and emotional support piece, when people are on a cancer journey or a grief journey, but for this conversation today I'll speak to the cancer side.

So, certainly the medical treatment in Grand Rapids, in the West Michigan area is so wonderful, and we're so lucky to have it here.

The other part is taking care of yourself and receiving support when you're living with cancer.

So during the day, our services are really there to provide education, support, emotional support, learning opportunities, workshops, activities, and social gatherings, so that people are not alone, whether they're the ones diagnosed or their loved ones.

- Thank you for that.

Multiple hats you wear Dr. Van Otteren, and where do you start?

- Yeah.

Thank you again for having us here today.

I am a Pulmonary Critical Care Physician and have been involved in our multidisciplinary lung cancer clinic at Spectrum Health for the last 25 years.

Our focus is to provide a global approach to caring for those patients that are present with suspicious findings, symptoms that might suggest lung cancer, and then bring them through that process of diagnosis into proper treatment, so that they can return to the community.

- And throughout your career, have you watched a few of us sleep?

(Shelley laughs) - Yes.

Yes, certainly have.

- Thank you.

To you, talk about you and yours, Leigh.

- Yeah, so I'm the Prevention and Advocacy Program Director for Arbor Circle.

So, we're a behavioral, health and family support organization, and we, my division really focuses on prevention.

So how do we really build skills for parents, for kids, for our community, to really make sure that we can thrive and prevent some of these risky choices.

- Thank you for that.

Dr. Van Otteren, and let's start with you.

First of all, are you busy?

Are we being diagnosed with lung cancer?

- We're super busy, unfortunately.

There's a reason to be hopeful, but it's a serious problem, lung cancer.

We see a lot here in Western Michigan.

It's a national problem, about 250,000 people will be diagnosed with lung cancer every year and the statistics for lung cancer aren't great, but we're making inroads to improve the mortality statistics by way of screening, earlier detection and then more advanced therapies.

So there's hope, and I'm happy to go into the detail of that, but it's a serious problem and it warrants a lot of effort.

- Yes, let's get this statement out of the way.

Does one have to smoke to get lung cancer?

- No, I mean the honest reality is 85% of those people that are diagnosed with lung cancer have smoked significantly.

So that says a couple things.

It's an identifiable risk factor that we can modify, and so if you're a smoker, I urge you to quit.

About one in nine smokers will develop lung cancer in their lifetime, so that's a powerful statistic.

The other important aspect of that is 15% of patients that will have lung cancer have never smoked, and so how do we identify those patients and decrease their risk and make sure that they're identified and treated as early as possible?

- Stay on the topic of risk, who else, who is at risk besides the smoker?

- Great, so we can identify risk factors, certainly tobacco leads the list, but probably the second most common factor that leads to lung cancer is radon gas exposure, often will have our homes investigated, evaluated for radon gas, that is a odorless gas that emits from the earth, and it can vary from geography to geography.

So, when homes dwellings have a high level radon, that composes significant risk.

Second hand, smoke exposure also probably increases your risk of lung cancer by about 25%, and there are some genetic factors involved too.

So we see families that have unusual incidence, a high incidence of lung cancer as well.

- And clumping my next question into an answer.

What symptoms would you want me to reach out to you?

When is it time?

- It's a great question.

Obviously we wanna be sensitive to symptoms.

The reality is when it comes to symptoms, we're already often too late, water over the bridge, because at that time, 75 to 80% of those patients will have an advanced stage of lung cancer.

So we really want to identify patients before they have symptoms.

Now, if you have symptoms like cough, chest pain, certainly coughing up blood, unexplained weight loss, those are things that clue us in, but those are fairly nonspecific as well.

There could be a variety of reasons why someone might have a cough and it doesn't always mean lung cancer.

So our emphasis more recently is to identify those that are at risk, those that have smoked significantly are at a age group that might be a higher prevalence of lung cancer, and then screen them with a CT scan, a low dose CT scan, that's able to identify signs of lung cancer at a very early stage, because there we have a greater impact and certainly can bring about a greater likelihood of survival.

- Yes.

Claire, at what point do we reach out to Gilda's Club, after a diagnosis?

- You can reach out as soon as you feel ready to reach out.

We're here from the first minute onward and we're here for you and we're here for your loved ones and your family and your friends, anyone who's impacted, including children and teens.

We do have a specific lung cancer support group that meets the first Monday of every month at 4:00 PM, and with a lot of our groups, now we offer them, since the pandemic, in hybrid style.

So you can attend in-person at our clubhouse, but you also could attend virtually via Zoom, if you are in the hospital or you don't feel well from treatment or you're concerned about your immune system.

So that option is still there to connect with people who are in that same specific boat with you and realize that you're not alone and get that support.

And I've had the opportunity to facilitate that group a few times and you couldn't meet a more wonderful group of people.

- Yes.

What was discussed at the first visit?

- At the first visit to Gilda's Club, we'll tell you all about the clubhouse and all the different ways you can be involved, whether you want to attend a support group, or you're not sure about that part yet, but you'd like to try an art class or a yoga class, or we have a walking group that gets out for exercise.

We also have a special program called Open to Options, where, if you are faced with some different options of treatment, and you would really like to brainstorm all your questions to take to your doctor, one of our social workers, who's specially trained, will sit down with you and talk through what are your goals, what are your priorities in life, and you will leave with a one-page list of your questions, in your words, to take to your doctor, to facilitate that next appointment in that conversation about treatment options.

So, you can learn about all the different things the first time you come to Gilda's Club and then plug-in to the services and the activities that you're most interested in.

- It's a journey?

- Yes.

- Yes.

- It is a journey and you don't have to be alone.

- Leigh, let's talk, normally I talk about prevention near the end of our conversation.

- Yeah.

But let's get right into how you and Arbor Circle are discussing lung cancer and/or asking us not to vape.

- Yeah, so, with both smoking tobacco cigarettes, and also vaping, there's risk for lung cancer, even though vapes may or may not have as many chemicals as regular tobacco cigarettes, they still have high levels of chemicals, they still have high levels of formaldehyde, and those can be cancer-causing, those be cancer-causing chemicals.

And so we really talk to youth about not starting, and then we talk to parents about, "How do you talk to your kids about this?

How do you understand the risks?

How do you understand what youth are engaged in?"

And then, "How do you talk about that?"

So we have a resource, www.talksooner.org, that has a lot of great information for parents that can really help parents build the conversation at any age.

So I think about parents of young children, we're not talking about the nitty-gritty with them, we're talking about healthy choices and that we wanna make healthy choices and that, you know, it's a healthier choice to not ever start.

And then when we were talking to upper elementary students or our middle school students, one of the things we really can talk about is peer refusal skills and how do we say no?

- Peer?

- Refusal.

- Refusal.

- Skills, yeah.

- Yes.

So it's essentially like how, "If my friend is offering me a cigarette or a vape, how do I say no?

and how do I do it in a way, that isn't condescending, that isn't rude, that doesn't hurt our friendship, but that just really says like, no, thank you, I'm not gonna do that?"

- Well, some adults may need that as well.

Does that - Sometimes we all need those skills.

- Never leave us.

- The earlier we learn them.

Yeah.

- Yes.

Dr. Van Otteren, what's today's treatment for lung cancer?

We have a diagnosis, perhaps it's an early stage, where do we go from here?

- You mentioned it.

It's all about the stage.

So I tell patients, there are really two questions that we have to answer when they present to our clinic.

The first is your lesion, a cancer or something else.

And then if we prove that it is a cancer, it's all about identifying the stage, and the stage really directs our therapy.

So in early stage, malignancy, we wanna do direct control, so that's primarily surgery, sometimes in-patients that can't tolerate surgery, radiotherapy is advanced to the point where it's basically radiation therapy surgical cure, if you will.

So it's a local therapy.

- Can you zone right in, on?

- Yeah, zone right in, the treatments used to be 30 treatments over a month, but now it's like five or six treatments and you're done.

Easy to tolerate for those patients that can't tolerate surgery.

And then if it's a more advanced stage, then we're talking other therapies, typically radiation combined with chemotherapy, or sometimes chemotherapy alone.

And what's really exciting in the last few years in, in lung cancer care, is this concept of immunotherapy.

So certain tumors have mutations that we can utilize with certain drugs.

So we teach our own immune system to basically recognize those cancers and use our own immune systems to fight that cancer off.

So it basically, the cancer cells are trying to hide from our system and with these newer drugs, in certain situations, we can unmask that hidden cancer and allow our bodies to treat that.

So that's really the concept of immunotherapy, which is new in the last few years, easier than traditional, it's what we call cytotoxic chemotherapy, but unfortunately it's not a tool that we can use in every cancer.

It really depends on what type of cancer we're dealing with, and it's unique mutations.

So therapy has really evolved.

It's gotten better.

It's not perfect.

- Yes.

And what role did, has, and will COVID play in your treatment?

- COVID has thrown a little bit of wrench in just because our access to patients is impeded.

Patients are scared to come to the hospital or the clinic.

Maybe they ignore their symptoms, think that risk of going to get treatment or a test outweighs the concern of their symptoms.

So, basically we've seen a lot of delayed presentations and again, with lung cancer, it's all about where we catch them.

In the earlier stage, we have a far better chance of treating with good results.

An example is if you present at stage one, your likelihood of being alive is about 70 to 80%, at five years, we use five years as sort of the barometer.

If you present at stage four where you've got spread already at the time of diagnosis, that likelihood is less than 5% that you'll be alive at five years.

So, stage is really important.

And that's why screening is such a really important tool for us.

- Right, I'll get back to that in a minute.

Let's turn to mental health with this diagnosis, Claire, both for the patient and the caregiver.

- Yes.

Thank you.

There are a lot of studies, really, that show that people who are diagnosed with cancer, you know, have an outsized effect, they're more likely to experience anxiety, depression, and really a whole host of, it would be hard to call 'em symptoms, but characteristics that are typical once you're diagnosed with cancer, such as existential crisis, "What is the meaning of my life now?

How do I want to live my life now?

What is the meaning of my spirituality and my belief system?

And how is that impacted by being diagnosed with cancer?

How are my relationships impacted?"

And many people tell us that at that moment of diagnosis, you suddenly feel very alone.

You feel very alone, and we can help with that at Gilda's Club, because you will find other people who are walking the same road as you, even if their diagnosis is different, and if you're a caregiver, there are many things that you might not express to your loved one who has cancer, because you're trying to protect them and not wanting to add to their stress your own worries and your anxieties.

So, those caregiver groups are very powerful, because that's where they can support each other and brainstorm with each other about, "how are we going to speak with our loved one?

what's supportive, what's not, and can we just express these things to each other that we can't say to our loved one?"

The other part about Gilda's Club that I am hopeful that everybody would know is that it's, I think people think, "Oh, do I wanna go to a place where everyone has cancer and is talking about that?

That sounds grim."

It is not.

When you walk through our red door and if you haven't been there, I really invite you, it is so warm and welcoming, And our namesake is a comedian, Gilda Radner, there is laughter, there is joy, and there is hope, in all of our groups and all of the community gathering there together.

- Yes.

So that is the best antidote to some of those crises that can come when you're diagnosed with cancer, and when mental health is strained.

- And I know all if not most, most if not all of your programming free to your- - Everything at Gilda's Club is free, that's right.

- Yes.

Fundraising walk coming up around the corner.

- Yes, thank you so much.

- So about that.

Let me turn back to you, if I may, Leigh, again back to, how does a parent begin the conversation and how does a parent, and you touched on this, Glen, how do you stop a habit?

- Yeah, so to begin the conversation as a parent, I think, just asking some open ended questions, like "What do you know?

", especially if you're talking to middle or high school students, right?

Like "What do you know about vaping?

What have you heard?

What is the, what's the talk on the playground, or what's the talk with your friends about it?"

and then just, you know, researching together and researching reputable sites, like talksooner.org or our Substance Abuse Prevention Coalition has a lot of information for parents, and, and then just, having those conversations, talking to your kids about why you don't want them to use, allowing them to use you as a scapegoat to say, "Oh, no, I can't my mom or my dad," or whoever, "my coach wouldn't, wouldn't be done with this."

like, "wouldn't be cool with this."

like, "I'd get in a lot of trouble," like being in your kids' scapegoat.

And then when you do find that your kids might be experimenting with vaping, really trying to intervene as quickly as possible, talking to a behavioral health clinician about tips for quitting vaping.

Talking to your pediatrician is really important as well.

Unfortunately, a lot of our treatments that we might use in the adult population for smoking cessation, just don't have the research behind them, for youth cessation.

And so you really have to talk to your pediatrician, a counselor, to find the best way for your child to really stop smoking.

And, and we're seeing vaping, you know, what we see from our high schoolers are trickles down to our younger kids and we're seeing kids as young as fifth grade vaping, because they believe that there's no harm in it.

And, and we just know that that's just simply not true, and what we do know is that the younger a student starts using something like nicotine, the more likely they are to struggle with addiction at a later stage in life.

- Turning to you.

Thank you for that.

Dr. Van Otteren, I mean, are you seeing young adults coming into your clinic, expand on that and then let's move into some screening.

- Yeah, we see patients of all ages, certainly.

In this situation, with regard to vaping, I'm also a critical care doctor and we've had multiple examples of young patients that present after vaping with lung injuries.

So, while it does contain carcinogens, that we know lead to cancer and also has very powerful inflammatory properties and can lead to respiratory failure, we've had several young patients on ventilators fighting for their lives, because of vaping, so it's a real threat, not lung cancer per se, but certainly something to be mindful of.

And what was your other question?

- Screenings.

- Yeah.

Screenings.

- Yeah.

Where do we start?

- Yeah, very important.

So, about 10 years ago, there was a landmark study that showed, for the first time, if we identify a high risk group, smokers for example, certain age group, and screen them with a low dose CT scan, so CT scan that has about 20% of the radiation dose of a normal CT scan, just enough to get a good quality image of their chest, that we can identify lung cancers very early.

So with an annual screening study for those patients that are eligible, and we define that as age 55 to 80 and have smoked about 30 pack-years, so one pack a day for 30 years or some equivalent to that, that if we screen them, we have a good chance of reducing the likelihood that they'll die from lung cancer.

And it's simply because we identify those lung cancers early and can intervene often with surgery or radiation.

- How are you asking patients to quit smoking?

What are, why are we not quitting?

- Yeah, so all this therapy that we do, all the money that we spend on treatment of lung cancer, is really, it's just a, it's a waste of resources compared to what we should throw at tobacco cessation and those types of efforts, because if we can keep people from quitting, from smoking, and reduce that risk factor, that's far better use of our money, right?

It's a very addictive habit, certainly- - Physically addicted, well, - Yeah, absolutely physically, there are so many ways that it tricks our brain to be dependent on that nicotine, for example.

So, it may be easy to say, well, just quit smoking, it's far more difficult than that.

And it's a multiple pronged approach to get people to have good success.

It's behavioral counseling, it's nicotine replacement therapies, whether it's a patch gum, a nicotine cigarette, sometimes people will allow to vape, because it can be actually a way that you can decrease your utilization, you can actually titrate down, in a gradual fashion, your dependence on that nicotine, and we've had several patients have good success with transitioning to an electronic cigarette, and then be able to quit that exposure entirely.

And then there are medications too, that help serve as mood-stabilizers, so that those withdrawal symptoms are less significant.

So it's a multiple pronged approach, a combination of medicines, nicotine replacement, counseling, and a lot of support.

We can get people to become non-smokers, but it's super difficult.

- Yeah.

Again, back to prevention, Clara, talk to me about the kids of your, adult cancer diagnosis, especially lung cancer, where do we start with keeping them functional and well, happy at all?

Tell me more.

- Yes.

Thank you.

The children can attend Gilda's Club for support and come for groups, and all of these groups are pretty fun and interactive for the kids, but really work on increasing children's emotional vocabulary and allows them a safe place to realize also, they're not the only ones who has a parent with cancer or a grandparent or an aunt or an uncle with cancer.

So we're both letting them speak and teaching them new words and coping skills that they can bring into their life with them into school, into family relationships.

We'll also just have fun social opportunities for the children, like camp sparkle, every summer, a huge, huge Halloween party every year, just to celebrate and be kids and be joyful, because that's a part of life as well.

- What else from your end, Leigh, as far as prevention, the TalkSooner also has an app, I think.

- We used to, or- - We used to, we don't have an app anymore, but we do have a website and it has a lot of great resources.

It even has some resources on, let's say, let's say you smoke and, but you don't want your kids to start, and so it has some really great resources on how do you have that conversation?

How do you talk about that?

And so there's, so those web resources are on there, there's links to additional resources, there's all of the newest trends, we do a trend update about quarterly.

We have lots of information on sort of, what is this?

What are, you know, all the drug trends actually, but including nicotine, including cigarettes and vaping.

And then, we actually on our TalkSooner website have a virtual teen room, that shows parents where things might be hidden, that they might not notice.

And then we are having a community forum on September 8th, and so that will be available as well.

- Great.

And I wanna jump back to you.

The walk is like September 17th?

- It is, thank you.

We're really excited about the West Side Walk, it's Saturday, September 17th.

It's a fundraising and community event where we invite people to come, And there's a walk, many fun activities, special times for remembering people we'd loved to have died and also celebrating people who are living with cancer.

And it's, you don't have to fundraise if you don't want, just attend and be part of the community and the celebration, and all that information is available on our website, if you'd like to register and join us.

- Right.

All right, we're winding down final comments.

I will start with you, Clara.

- Well, my greatest comment is thank you, Shelly, because I really believe in everything we have at Gilda's Club, and I just wish everybody knew that we're here, we're here for men, for women, for children, for people impacted by cancer, and for the people who love them.

We have so many resources and we really want to meet the needs of this community and support their emotional health.

- And just to knock on the red door, right?

- That's right.

- Yes.

- Anytime.

- What is your website?

- gildasclubgr.org, and you can become a member by initiating the process on our website, or you can also just call anytime.

- Great.

Thank you for that.

What do you leave us with, Leigh?

More (indistinct) of a Arbor Circle?

- If you need any of these resources, go to talksooner.org, just exactly how it sounds, talksooner.org and it's all right there at your fingertips.

- And remind me again, that parent who is watching, that's saying, "I need to have the talk with little Shelly."

- Yeah.

- Where do we start?

- I would start there.

We have, part of our website is talking tips.

And so start with the website, take a look, go to the talking tips and then just have the use that to start those conversations.

And don't be afraid of those conversations.

The more we have them, have them around the dinner table, have them while you're riding bikes or have them while you're, you know, practicing whatever, whatever sport or whatever activity your kids are involved in, have those conversations and have them often, one time is not enough.

- Yep.

And you'll learn a lot, and also give your kids a lot of wisdom.

- Again, journey in your world.

What's your best website for Arbor Circle?

- Arbor Circle's website is arborcircle.org, and then, and actually, if you go on our website, you can also find the link to TalkSooner.

- Great.

Leaving a couple minutes for you, Dr. Van Otteren.

And I'll start with another kind of big picture question.

How precious are our lungs?

- Oh, extremely precious, that's a vital organ and healthy lungs allow us to do the things we wanna do.

And if those lungs get embarrassed, insulted, afflicted, then it has a lot of consequences.

So again, with regard to lung cancer, there's a modifiable risk factor that we're capable of reducing and that's reducing exposure to tobacco smoke.

So I would just urge everybody to make that a focus and emphasis, because that goes a really long way, and the benefits of quitting smoking start within seconds, they really do.

And then the longer you go without smoking, there are all kinds of improvements in your lung, your heart, your blood vessels, so.

- Yes.

Does sleeping have anything to do with lung cancer?

- Not really.

There's a sort of a separate corollary, bit of a different hat I wear so, but not really.

- But if I were to ask you, "how can I prevent lung cancer?"

You would want me to get my sleep, do my exercise, eat the- - Common sense applies in any case, absolutely.

Good diet, plenty of rest and modest exercise.

- Yes.

Oh, there went my marathon.

(panelists laughing) And again, if a parent has been diagnosed, as a child, should I be screening?

Or worried?

- That by itself is not a risk factor, so it's a great question.

And current recommendations are, genetics enough are not an indication to get screened, but if you'd otherwise satisfy those criteria, have smoked a significant amount in that right age group, I urge you to get screened.

- Great, how do we find out more about you and your services?

- I work at the Spectrum Health Lemmen-Holton Cancer Pavilion, We have resources there.

There's a spectrumhealth.org as well.

- Put you all out of business, but that's not going to happen with reality.

Thank you for sharing, obviously your expertise with us and we'll win this fight, one day.

Thank you very much on behalf of Gilda's, Arbor Circle and Spectrum Health and the work you do, and as always thank you for you, for watching this edition of Family Health Matters Focus on Lung Cancer.

We'll talk again soon.

Thank you for your vision.

Take care.

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