Dorothy: [00:00:00] Dr. Chadi Nabhan is an oncologist with over 20 years of experience, and he has helped hundreds of patients. But one thing he noticed during all of this time of providing patient care was that people were confused. People had so much fear. People didn’t know what to expect, and he decided he was going to put himself in the patient’s shoes, in the family’s shoes, and try to come up with something that would help anyone get through this thing called cancer. He wrote The Cancer Journey and wrote it only to empower and inform patients. You know, he says, your health is your wealth. And that is so true. But even when we’re going through a diagnosis of cancer, there are things that we can do to make that journey a little bit easier and a lot less stressful. He gives [00:01:00] us practical advice and narratives, real stories about what you need to talk about when you’re seeing your physicians, what are the questions you should ask, what is it you must know about different treatments, and he offers so much information. He covers a lot of different cancers, not just breast cancer, but any of the chapters in his book you could pick up and read and you would say, uh, I feel better informed.
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I want you to tell our audience, I know you’re an oncologist, but you have written this amazing book. I read it and I’m going back over it, highlighting places, and I just, it’s called The Cancer Journey. It’s from a physician who has certainly dealt with a lot of cancer patients. And first of all, tell us a little bit about you.
Dr. Nabhan: Well, I’m a cancer, I’m a cancer doctor. I’m a cancer specialist. Um, I’ve taken care of patients with cancer for, uh, over 20 years. I’ve done that in various healthcare settings. I’ve done research and written papers and scientific articles and things of that nature. Um, I have transitioned from, uh, [00:03:00] uh, recently and I currently joined an artificial intelligence company that is focused on bringing technology to clinical research operations to help patients, so patients could be enrolled faster in clinical trials and get access to newer drugs. Uh, the company is called Ryght, and I’m the chief medical officer of that company. I’m a podcaster as well. I have a podcast called Healthcare Unfiltered, and I really wanted to use that platform to Interview guests about various topics in healthcare. So I air that every Tuesday morning. And a book author, like you mentioned, I wrote my first book over a year ago called Toxic Exposure was actually on the link between Roundup and non Hodgkin lymphoma, a form of cancer. And, uh, what Monsanto, the manufacturer of Roundup, um, was liable in three trials in the first three trials that I [00:04:00] testified in on behalf of the patients.
So I wrote a book on that experience. The Cancer Journey is my latest book, like you alluded to, and really it’s, uh, it’s a labor of love that took about three years to write. The goal of this book is to really bring to everyone, general audience, all the information related to cancer as we go through this unfortunate journey, but do it in a very easy way, simple way. This is not a textbook. This is not going to make you bored. It’s stories and storytelling to really help people around. So that’s what I do in terms of the professional career and, uh, And, uh, I’m in Chicago. I have, I have twin boys that they’re driving me crazy sometimes.
Dorothy: Well, Hey, that’s, that’s children no matter what. And I’m curious, did you just wake up one day and say, I need to write this book?
Dr. Nabhan: You know, I always wanted to [00:05:00] write this book, frankly, I’ve always, you know, the thing is with, with cancer and the, and what’s going on, there’s, there’s no, there’s no paucity of information out there. Like, you know, I mean, you know, we all have access to the internet and Dr. Google and Dr. Twitter and Dr. Obvious. I mean, we have access, not like we don’t, but when you take a lot, when you take care of so many patients, you realize. Despite the wealth of information, there’s still some confusion and there’s not always clarity, and people struggle separating signal from noise. Like anybody can post anything about anything. I mean, and then anybody could read anything and suddenly you have, yes, there’s information, there’s access to information, but is there access to accurate information? How can we really make sure we help people [00:06:00] during the most vulnerable time of their lives. There’s nothing that replaces health. And if anyone is listening, whether either they’ve had a health scare or they’re dealing with an illness, they would absolutely appreciate that.
So, so, um, I always wanted to do this. I just never knew how I’m going to do it. Like I, I really wanted to explain things. And then what I, I decided, you know what? The way I need to do it, I’m going to put myself in the patient’s chair, and I’m going to go through the process from A to Z. So, first of all, I want to know about cancer and what causes it, that’s general information, and then we talk about screening.
But then I literally put myself in the shoes of a patient. There are signs and symptoms. What are the type of symptoms that I could get? How do I make a diagnosis? If I made a diagnosis What happens until I see that physician, the oncologist for the first time, that first oncology visit, which is really, really challenging.
What [00:07:00] about second opinions? How about staging? How about trials? All of these things. And then I go through every single therapy. What is surgery? What is chemo? What is radiation? All of this in a very easy way. You do not need to be a healthcare professional to read this book at all. But I also wanted to focus on other things, survivorship, caring for the caregiver. You know, this is so important, caring for the caregiver. The person who is caring for the person with cancer sometimes is left forgotten.
Dorothy: Oh, very much so. I love that chapter.
Dr. Nabhan: It is so important.
Dorothy: It is so important. We, we, uh, I love that there’s so much more attention on the caregiver, but not enough, not enough yet.
Dr. Nabhan: And think about the, think about the psychology of the caregiver though. So on one hand, you’re obviously doing every best to help your loved one, but [00:08:00] in inherently, you feel guilty if you’re going to do something for yourself. Like really, it’s, you know, I mean, you’re like, ah, you know, I’m not the one who has the cancer. I’m not the one who’s getting the treatment. Is it fair for me to go to the movies one night?
Dorothy: Or to complain? Or to be, yeah—
Dr. Nabhan: whatever it is.
Dorothy: Yeah.
Dr. Nabhan: I mean, you really, and I saw this so many times in the eyes of the loved ones. I’m like, I have to really write about this because they will really, I will connect with them. So, so I went through the entire process and, and, and I, and then I decided the only way to do this is by sharing stories of my own experience. Because for every single chapter, every single thing, there are so many stories I could tell. And when you read a story, as a reader, you can relate because you start imagining yourself as one of the characters, because we all have been in these [00:09:00] shoes.No one, is going to be immune from, you know, being part of the healthcare system. So, yeah, that’s what happened.
Dorothy: Well, and I love the way that you actually are using the, uh, not just the narrative, but you’re also using the dialogue. You know, I said to the patient, the patient said to me, and I, and I know you know this, but, After I’d read, yeah, you know, a few chapters, I was going, Oh my goodness, I’m seeing these patients. I’m, I’m visualizing them. I, I would never have thought to ask that. That’s, that’s part of the magic of your book is that it’s really giving us that, and I don’t want to say permission, but the words to use.
Dr. Nabhan: Yeah.
Dorothy: And I loved your takeaways at the end of each chapter. Is that what you call them?
Dr. Nabhan: The take home, take home points.
Dorothy: Take home points, right. You know, they were concise. They were, uh, they summed it up well, but it also was like, [00:10:00] okay, yeah, I need to go back and take a look at that again. Because there’ll be some little tidbit in there I kind of, maybe I read over, didn’t catch. The, uh, and I, I want to go back to your questions to ask the doctor, because I had, I had some questions to you about some of those, you know, but, but they were excellent. In fact, we’ve, uh, I’ve shared them with our patient navigators, and, uh, they have many different sources to ask, to have the questions to ask the doctors, but I thought yours were particularly insightful and what the patient really, really wants to know.
So, you know, go back to your caregiving, uh, the caregivers just for a second. Cause you know, our world is breast cancer and most of our patients are women. And I’ve had lots of caregivers on our, Let’s Talk About Your Breasts. Invariably, the husband’s, the spouse, wants to fix it, [00:11:00] and over and over, as they’re talking about what they went through, that has to be, for that, for that spouse, the hardest part. They’re not going to fix it. They’re used to fixing things. You know, and, and what, how do you, when you find a spouse like that, how do you talk to them?
Dr. Nabhan: Well, you have to talk. That is key. In, in fact, just since you mentioned this, there’s a, there’s an entire chapter, probably my longest chapter was, it’s titled Communication, um, because, um, uh, because you have to talk. I think the key is, um, to sit down and try to understand where this is coming from. Um, so, a lot of times when it comes to cancer, and, and, and you know this, because obviously, you know, you do this all the time. We talk a lot, patients and caregivers. Being diagnosed with cancer, [00:12:00] Uh, They — lends itself to loss of control for patients and caregivers because you don’t have a lot in a sense, what, what put yourself in the patient and the caregiver and the spouse shoes, they essentially don’t have a lot of control over the process. So you got to do the surgery, you got to do the chemotherapy, you got to do this, that, this, that. And they feel they don’t have a lot of, they have some input, but they don’t have really the control.
Dorothy: Control.
Dr. Nabhan: And some of it stems from the fact that I really want to control the process. I want to have some say into what’s actually happening because I want to have my ability to control the narrative and the process. So knowing that allows you to shape the dialogue and the conversation separately and differently. Sometimes I’ve actually asked the permission of the patient and I say, can I talk to [00:13:00] whether your spouse, your boyfriend, your girlfriend, your, your, your partner separately?
Is it okay if I just pick up the phone and talk to him or her? And they say, yes, sure. Because sometimes having this conversation in the absence of a patient might actually gives you insight into what is happening when you say, I want to fix it. Yes. And lastly, I would say it is important to explain to the spouse who you’re sensing this, what they want to do, that you’re actually fixing it.
By being part of the team, you are fixing it. Maybe, maybe your, your feeling of how to fix it is not the right way and let’s just find a common path so we can fix it together. Because I think, I think it’s, I think it’s very key to have the partner or the caregiver, the physician, and the patient on the same page.[00:14:00]
Problems occur when there’s a lot of different views that they’re not aligned, with the patient’s wishes and what the patient is trying to do. And I’ve had these issues and I’ve actually was very, very transparent in the communication chapter about situations where my patients felt I failed them. Um, and, um, I, I think we’re not perfect, but if we really don’t learn from our lessons, we’re never going to get to, to that perfection. And, um, I’ve learned from every single story where I fell short.
Dorothy: That was very brave.
Dr. Nabhan: Well, we have to, you know, I actually, I, I, um, for the most part, thankfully, I think most of the people I have cared for, they were very grateful, very happy, very satisfied, no matter what the outcome is, was. But if any physician tells you they did not have some families [00:15:00] or patients that were somewhat unhappy for one reason or another. They’re not being truthful. We all have had these things and I’ve actually had a folder. I write this in the book I had two folders I had many greeting cards and things of people who are like thanking me and all of these things and I, you always have to read this because it just keeps you motivated, keeps you, it reminds you of what you are doing and why.
But there was another folder where I kept sometimes the letters that were from dissatisfied patients and families and reading those every so often keeps you grounded, keeps you humble and reminds you that you always can do better. And, and that is really, really key.
Dorothy: Yeah, yeah, that’s so insightful. And I, I mean, it, it, it really is just on a everyday level. We need those reminders. We need that grounding. So, Dr. [00:16:00] why’d you get into oncology?
Dr. Nabhan: The first reason was not the science, by the way, was not the advances in technology. I know that sounds more powerful. But I think by reading the book, you know, I’m very, I’m extremely honest and transparent. It was the human element of taking care of patients with cancer.
There is something about the relationship between an oncologist and patients and families diagnosed with cancer that I would believe, I believe it is very different than any other relationship between different specialties and the patient. Nobody wants to be ill or sick, but somehow being diagnosed with cancer specifically leads, it gives us the impression that this is, this is it.
I’ll get cancer and that’s it. It’s a very vulnerable time in the patient’s lives. In the patient, in the family’s lives. And I think [00:17:00] that that relationship, the human element of this is going to be a key. That’s really what drew me. Um, the, the, the first insight for me was really during my internship, 29, 30 years ago, I was at the Loyola University in Chicago, and I was assigned the oncology ward in the fourth month of internship.
And I walked into a room of a 48 year old woman who was diagnosed with stage four ovarian cancer and her daughters were in the room. And, um, to this day, I recall her facial features. She looked absolutely like an angel and she asked me if she would live until Christmas and it was October. And I was an intern. I was clueless. Um, I didn’t know much about the disease. I never been in a difficult conversation like this. And she sensed how uncomfortable I was from my body language [00:18:00] and she smiled and she said, don’t worry about the answer. I just want to see your smile tomorrow morning. She knew I was the intern and that the doc, the attending will come and talk to her.
But what did she care about? She cared about a smile and just being able to humanly connect with her when I see her again the next day. And that told me that this the bravery that patients with cancer have is unprecedented. And what they crave is not just science and treatment. They want communication.
They want human connection. They want to know that you care and patients know people can tell right away. Do you actually care? Or you don’t care. And just by simple sitting down, listening, and looking in the eyes, you can show how much you care. That’s really what drew me into oncology in the beginning. And of course [00:19:00] science comes after that and you see the advances and you know how wonderful this is, but. But, ultimately, there’s a human behind all of this.
Dorothy: Really profound. You know, we often say here that your recovery depends on how much you trust your doctor, how much you believe whatever they’re saying to you and, and we say, believe they care about you. I, there’s a healing there that is beyond medicine.
You
Dr. Nabhan: have to trust your doctor because if you, if you don’t have that level of trust, find another doctor. That’s my advice to your listeners. You have to trust the person. And the reason for that is because the cancer journey is going to be filled with bumps along the road.
Dorothy: Absolutely.
Dr. Nabhan: I mean, you deal with breast cancer as an example. Okay, so you had surgery and [00:20:00] you had reconstruction and that didn’t go well. It happens. If you don’t trust the health care team and professionals you’re dealing with, every single bump in the road, it’s going to make you doubt the medical decision and the medical team.
When you trust the The team and you know they’re doing their best. Then you understand that there are bumps and triumphs, but it’s very key to trust the actual team. And that, that, that really allows you to appreciate the journey. And like you said, it’s going to help in the healing process. There’s no question about it. I totally agree with you.
Dorothy: Right, and, and I love that you talk about bumps along the way. You know, so many patients that I’ve talked with have, have come in with their timeline. You know what I’m talking about. This is going to happen. This is going to happen. This is next. This is next. And [00:21:00] invariably, as gently as I can, I say, well, that’s, that’s what we hope.
But you might have a couple of setbacks. I can’t tell you how many times folks have come back to me and said, Thank goodness you warned me. Thank goodness you said. Sometimes it doesn’t always work just like that. And, and I think people can handle anything. When you talk about the courage of survivors, it’s like, where do they find that? Where do they get that? You know, they can handle anything as long as they What is it? Halfway understand? Halfway believe?
Dr. Nabhan: They have to know. They have to know. I think, I think they have to know that you are on their side. You’re doing everything possible, and there’s an element of perseverance, tenacity, you know, just being able to really go through some of these things. I I, I cannot tell you how [00:22:00] many, uh, patients have left me in awe in how they handle things. Um, I think, I think when we are faced with adversity, and this is probably the most adverse thing we’ll ever encounter being diagnosed with cancer, there’s something in us that wakes up. and says you gotta do A, B, and C, sometimes we do it for ourselves, sometimes for our children, sometimes for our family, for our loved ones, um, but certainly that courage and that ability to actually, that you find, uh, in your inner, the inner strength, I would say, is key and critical to get you through this because, um, it’s not going to be easy, but my hope is that you have the right healthcare team with you to make it easier.
And I wrote the book to say, you know, maybe this is a good guide for you. Maybe it’s just something that you can read along the way. Um, a friend of mine, Um, his wife was just diagnosed with breast [00:23:00] cancer just, you know, this week and as you know, the, the, the book came this week and, um, she read it in just one day, um, because, because she, she wanted to consume the information and, uh, she felt she’s going to be armed before she sees the surgeon with all of the information that she needs. So, and that, and that’s when he told me this, I’m like, okay. That’s the purpose of it. If, if she found value in it, even in 20%, that’s the purpose. I armed her with information that’s going to make her more powerful when she goes to the surgeon’s visit.
Dorothy: Absolutely. Oh my gosh. So many things that you included in there. But you know, I want to go back to something you said about if you don’t trust your health care providers, if you don’t trust your team. You’ve been in this long enough to remember there was a time when finding a second opinion, um, was kind of looked down on. I mean, people were very, very afraid to go to [00:24:00] another doctor and say, I need a second opinion. I, I, I think some of the information in your book about that was very, um, encouraging for when we do need to do that. So what, what moved you to include that in there? Cause that’s kind of a, that was a, a good chapter.
Dr. Nabhan: Yeah, and it’s really important. I wanted to take away this, demystify the second opinion thing. So two things. Number one, patients and families feel sometimes uncomfortable Requesting a second opinion because they may hurt the feelings of their doctor. Uh, you know, I mean, they may hurt that as if it applies that they don’t really trust the person. And I gave stories in that chapter, if you recall, about when people I cared for, they wanted to go for a second opinion and people who came to see me for a second opinion.
It is very important [00:25:00] to be empowered to feel that you can get a second opinion. What does a second opinion do for you? Number one, if you are getting the recommendation from Dr. A and you get the same recommendation from Dr. B, that reinforces that you’re getting the proper care and you feel comfortable.
There’s an ease that, okay, I’m getting really the right things to do. If there’s some discrepancy in the recommendations or diagnosis, you owe it to yourself to know. This is your health. This is the most precious thing that you have that you need to owe it to yourself. And I think it’s really key to understand we as physicians are used for second opinions.
So we have seen people for second opinions. I have referred for second opinions. I literally, every single new patient I’ve seen. Every single one in my career, I’ve always ended the visit by me taking away the burden from them by telling them. [00:26:00] And by the way, I know that you may want to see a second opinion to know about this disease and what to do. And I tell them, that’s totally fine. That’s totally acceptable. If you want to do that, let me tell you who I would see in the city of Chicago and things like that. So suddenly you take the burden off them. Like, Oh my gosh, okay. He’s fine with it. He’s not going to be upset with it. This is really key. My last comment, if a physician, Uh, you know, whoever is listening to this, if a physician feels uncomfortable about you getting a second opinion, that’s your cue to find another physician, period.
I do not believe any physician should look down upon second opinions. Why? Why would, you know, you know, I mean, I don’t want to downplay this, but if you’re going to go buy a car. [00:27:00] You sometimes go to four dealers, don’t you? I mean, you go to four dealers and you go, and like, well, it’s a car you can live without, frankly, it’s not life or death.
So you’re now faced with cancer and you’re afraid of going to ask another person something. You should never be afraid of this. And if somebody is making you feel bad about it, It’s probably your cue that this is probably not the right team for you.
Dorothy: Wow, great advice. I, again, want to go back to your questions to ask your doctor, your oncologist, your surgeon, things to know. One of the things you said in there was, ask your doctor, let me see if I can get it right, you know, if the anesthesia, the surgeon, if that anesthesiologist is going to be covered. Now do, do you really, do you know that?
Dr. Nabhan: You don’t. It’s, it’s, it’s actually, um, it’s actually an issue because, um, what happens is you go and see the [00:28:00] surgeon who is in your network, but there’s a different anesthesia group.
That may not be in your network. And the last thing you want to be, you know, you know, you’re being covered, putting, paying your premiums and everything, and you get like thousands of dollars in bills when you’re really trying to save money. So I think it’s fair. It’s fair. Uh, the physician may not know, the surgeon may not know, but they have people in the staff.
In their office to know, because you just want to know what your financial responsibility is. So, uh, patients may not know, and the physician usually will tell them, this is the anesthesia group I deal with. So you can call the insurance company and ask, are they in my network? Or you can have the office staff of the surgeon and say, can you please check for me what we might co pay for somebody like this?
Because essentially, the surgeon is your network. But, remember, The surgeon is only doing the surgery, the anesthesia team. There’s also a pathologist who’s going to read the report and other things. [00:29:00] And I guess my advice was talk to the financial, talk to the office manager or the folks in the, in the office to make sure that they help you with this. So just, you don’t have any surprises. Uh, that’s really key.
Dorothy: That is very key because it happens over and over again. And, and if that anesthesiologist group is not in your network, then do you have the right or whatever to ask for another?
Dr. Nabhan: I mean, you would have to tell the, the surgeon, is there another anesthesia group that I actually can deal with?
Do you operate at a different hospital or hospital aid? Do you go to a different hospital or somebody like this? I mean, somebody’s going to be in your network. Uh, it’s unlikely you’re going to have no one, but maybe you have to maneuver this a little bit. And, um, but it’s really key. And look, if all said and done, somehow your plan doesn’t have anybody who’s anesthesia. [00:30:00] At least, you know, you can call the office of anesthesia and say, I’m not covered. Is there a payment plan? Is there something you can work with me on? But being knowledgeable, always: knowledge is power. Whatever it is, whether about your money, about your health, whatever it is, it’s important.
Dorothy: And so we should never hesitate to even talk about that with our doctor. He/ she doesn’t know, they can certainly direct you somewhere else. It, you know, cancer is expensive. No matter what, it, it’s a lot, it’s lots of bills. How do you, how do you handle— now, remember what we do is a lot of uninsured patients. How in your practice do you handle those patients?
Dr. Nabhan: Yeah, so there are a lot of charities out there, patient support groups and charities and there are many, for example, Breast Cancer Foundations, as you know, that do That helps them provide charity care. Hospitals also have charity care for a lot of patients. I mean, in fact, it’s part of their negotiations [00:31:00] with Medicare and Medicaid and things like that. The way I handle this is whenever there’s a patient who is uninsured, the best thing you could do is immediately hook them up with a social worker in your office or in the hospital because there’s a way that they can apply for public aid, state, whatever it is, or charity care. That is the best that you could do.
And I think as long as there’s an application that is actually there, then the patient now is feeling comfortable that everything is fine and you can proceed with your medical care.
Dorothy: Right.
Dr. Nabhan: But you have to put resources. Physicians can always waive their own fees, but you can’t really waive a hospital fee. You have no jurisdiction over that. I think social work has been very good. Patient Foundation, Support Group, Philanthropy, a lot of these folks have been very helpful for patients.
Dorothy: But you know, you touched upon something there, we have a lot more physicians willing to help than we do hospitals or any of the other professionals and we are so grateful for them. We, we call them our heroes [00:32:00] because sometimes that person needs someone that can just give us a little help at that time. So do you, and I know you get asked this all the time but I would be remiss if I didn’t, do you think we will ever have a cure for cancer?
Dr. Nabhan: Well, I do get asked a lot. Actually, it’s in my introduction when I met that fellow on the plane and he was asking about this. I think, I think it’s a bit of an unfair question because I think it lumps all cancers in one category. When you say, are we going to cure cancer? Because, As you know, we cure way more breast cancers than ever before, ever, but we don’t cure as many pancreatic cancers or brain cancers. So the problem is the reason we can’t answer this question accurately is because every cancer is different.
Not all cancers are the same. And I would say we cure today way more cancers than ever before. [00:33:00] We have close to 2 million new cancer cases diagnosed in the United States a year. And according to the American Cancer Society, a bit over two thirds of these 2 million patients who are newly diagnosed are still alive and well five years after their diagnosis. That is very different than 30 years ago, and I actually cover, cover some of these statistics in my survivorship chapter.
Dorothy: Absolutely. That’s different.
Dr. Nabhan: We talk about survivorship. So the answer is, I think we are going to cure more cancers of the ones we are already curing. And we are gonna cure more of the cancers that we are currently not curing as much of because we know more about what’s causing cancer. And when you know the cause, you can design treatment against them, but I just think we can’t ask the question broadly for cancer as an entity as a whole.
Dorothy: It has been an incredible pleasure to talk with you. Thank you so much for taking this time. [00:34:00] And I sincerely recommend the book, The Cancer Journey, uh, to anyone who’s facing this or any caregiver, or it’s just chocked full of all kind of information. I don’t know if we’re going to be able to see it, Freddie, but there you go.
Dr. Nabhan: Who needs my face?
Dorothy: He is, he is used to doing that again. Thank you so much, doctor. We hope we can talk with you again.
Dr. Nabhan: Anytime. More than happy to come back on the show anytime.
Post-Credits: Thank you for joining us today on Let’s Talk About Your Breasts. This podcast is produced by Speke Podcasting and brought to you by The Rose. Visit therose.org to learn more about our organization. Subscribe to our podcast. Share episodes with friends and join the conversation on social media using #LetsTalkAboutYourBreasts. We welcome your feedback and suggestions. Consider supporting The Rose. Your gift can make the difference to a person [00:35:00] in need. And remember, self care is not selfish, it’s essential.
