Bogda Photo

In this episode, I’m talking to Bogda, medical oncologist who shares some great insights if you’re facing cancer right now, or if you’re building a life after cancer.  Bogda breaks down what to expect when you’re talking to your oncologist, advice on dealing with stress, why oncologists are here to guide through the tough times as well as closing the loop with your general practitioner, as well as other specialists you might be dealing with. In this episode, we cover:Bogda Photo

  • Dealing with cancer diagnosis
  • How to prepare for your oncologist visit
  • Why oncologists love informed patients
  • Multi-disciplinary care and how it can help you
  • Why oncologist is your guide and advisor through cancer
  • Resources that support you on your terms
  • When getting professional help to deal with cancer stress
  • Bogda’s survivorship formula


Finding My Way

Bogda’s Academic Profile

Simplify Cancer First Visit Oncologist Checklist

Full Transcript

Joe:                 Bogda, thanks very much for taking the time to do this, I really appreciate it.

Bogda:            Sure.

Joe:                 Bogda, as a medical oncologist, you often have to give people the bad news.  How do you do that?  How do you tell someone that they’ve got cancer?

Bogda:            Sure.  The first thing to say, Joe, is actually medical oncologists don’t do that very often because we don’t diagnose cancer.  Very often surgeons do.  We tend to be the second person who raises the question of cancer, or we might be the person who might see the patient after someone might have said, “This is very likely cancer and you will to see somebody to see the final diagnosis.” Many of our patients are prepared for the bad news when they see us.  It’s not like we deal with issues in a completely unexpected scenario.

What we do quite a lot of is we might be the people who talk to the patients that the status of the cancer has changed.  We might be seeing who we’re treating with the hope that we might cure the cancer and then it becomes apparent that the cancer is no longer curable and growing.  We may need to tell that news and that’s often a very distressing scenario for all involved.  How do you do that?  The first thing to say is that you have to be honest about what you’re trying to tell, and you have to be accurate about your information.  There’s no point talking about something where you really haven’t done your homework.  You need to get your facts right.

You have to have all of your information available.  There’s no point starting the conversation and then saying, “Actually, I’m still waiting for one extra test” because that is really distressing and confusing.  What I tend to do is I tend to try to prepare patients that a difficult conversation is coming.  I will say, “Look, we need to talk about such and such, is it okay if we talk about it now?” That gives a person the option to say, “I really don’t want to talk about it now, or I want somebody else to be with me when we’re talking, or I’m finding it really surprising.” To give themselves some room to deal with things, preparing and warning that something is coming is important.

Secondly, when I talk about what’s happening, I try to keep the language quite simple.  Sometimes in oncology we tend to use very misleading terms, like growth, condition, diseases changing, and you don’t know what that really means.  I think that if you’re really going to say something, try to keep it as accurate and as simple and as brief as you can.  I think cancer is growing is pretty unambiguous, but things are not looking so good could mean anything.  I think you need to be quite precise.  I tend to move onto what can be done quite quickly.  People are interested in not just what happens, but what can be done about it.  That allows them to focus on something positive.

Usually, there is a lot that can be done.  I try to tell what their situation is, identify what can be done and I finish off by trying to draw on strengths of the person I’m dealing with.  Dealing with cancer is not the first stress that people experience.  They will have had lots of stressors and disappointments in their lifetime and they’ve gone through them and managed things.  It’s useful to say, “When you were in a very difficult situation before, how did you cope?  Did you rely on friends or family?

Did you take some time to plan how you’re going to approach it?  Did you get professional help?  What helped you then, because we’re going to use those resources this time because we know they worked for you before and they should help again.” I think there are a number of steps to use, the key issue is honesty, simplicity, and focus on what can be done as opposed to what can’t be done.

Joe:                 That makes so much sense, Bogda.  I’m so glad that you brought up the idea of not using the medical jargon.  I spent a lot of years working in IT and I know that I had to adjust my language when I’m talking to someone who isn’t a specialist in IT, in order for them to really speak the same language.  That’s really important.  Is there a way that you would recommend for people to prepare?  I know from experience that when you go to see your oncologist or another specialist, like you show up, you have no experience what to expect, you’re a wreck, you forget the stuff you wanted to ask, and the other half you forget the minute you walk out the door.  Is there anything people can do to prepare themselves?

Bogda:            One of the very simple strategies is to bring somebody with you.  They know you and they recognize when you’re looking a little bit distressed and you may not necessarily have the courage to start the conversation yourself, but somebody sitting next to you will say, “Hang on a second, we really didn’t understand that bit.  Can we go back and talk about such and such?” Having a person to help you is often a useful idea.  A friend, a family member, somebody that you can bring with you is a useful strategy.

The second thing is to think about what it is that matters to you, what sort of questions would you want to ask.  It’s often useful to have a list.  Many of my patients would have a conversation with me and would say, “Hang on a second, let me look at my list.” They will have a quick look and say, “Okay, we’ve covered everything, but we haven’t covered this, can we go back to that?” When you’re stressed, and your mind tends to wander, and you don’t know whether you’re going to cover everything, think about your list and check against it.  The other thing is don’t be afraid to ask to meet again.  It’s not that the conversation happens only once and it’s very useful to go back and ask, “Could we meet and discuss this again?

Or is there anything I could read about what you’re just describing?  If you’re describing a particular cancer treatment, can I have any written information about it?  If it’s any types of supports, are there any written resources that I could look at in the comfort of my own home?” There are many ways of meeting people’s needs and that doesn’t have to happen in one encounter.

Joe:                 That’s such a fantastic point, Bogda, because sometimes people can feel so powerless that they don’t really have any control and what you’re saying really puts the ball in your court when it comes to dealing with cancer.

Bogda:            I think it’s worth remembering that for an oncologist, it’s helpful to have an informed patient.  It’s in the interest of the oncologist to keep you informed and content that you have all of your needs addressed appropriately, because when people feel like they’re not really well-understood, their needs are not met, they often are more distressed, they often don’t know how to manage the treatment and their condition and they’re more likely to have problems.  Nobody needs problems.  I think it’s in everyone’s interest to make sure that everybody is happy.

Joe:                 Yes, absolutely.  Bogda, do you believe that people with cancer get the support that they need mentally, emotionally, socially?

Bogda:            Not always.  I think that it depends on how good the process of identifying what the needs are.  Sometimes oncologists don’t ask, sometimes patients don’t tell, and sometimes a bit of both.  Oncologists tends to not ask about problems that they feel ill-equipped to manage.  For example, if they’re not very comfortable talking about emotional problems, they’re not going to go there.  Whereas, oncologists who are comfortable about talking about emotions are more likely to say, “How are you doing?”

One example is that I have had stories of doctors, not necessarily oncologists, that would say if they patient is crying in my office, that means that they need to see a health professional because that’s an emergency.  Whereas, there are many of us, including myself, who think, well, my office is a very safe place, so if crying is what you need to do, that’s okay.  It’s not going to tip me off or get me to change the subject.  I think that’s relevant because we know that if we train oncologists to be more skilled in asking the right questions, and listening to the answers, then more issues are uncovered, and those issues are more likely to be addressed.

Sometimes patients often don’t talk, sometimes they talk about things because they’re embarrassed.  For example, a female patient might be uneasy about talking about sexual difficulties with a male doctor and vice versa.  Sometimes patients feel that their concerns are really not on oncologist’s brains.  They might have financial difficulties and they may say it’s not the doctor’s job to fix it, so I’m just not going to mention, I’ll just grin and bear it.  Sometimes they have an inaccurate expectation of what their experience should be like.  50 years ago, having cancer treatment meant that you vomited non-stop.

If a person believes that vomiting is your lot in life, you wouldn’t raise it as an issue, you would just keep on vomiting because that’s what you expect as normal.  Again, this is where preparing patients for what is considered normal and what is not normal can help.  I think that there are lots of reasons why people’s needs may not be met, but we know that they are not always met and there is certainly room to move for all of us.

Joe:                 Absolutely, Bogda.  Is there something in the curriculum, like if you studied to become an oncologist, for want of a better word, is there a subject that you would take as part of your course that would be like emotional side of dealing with patients?

Bogda:            Well, there are a number of curriculum items that relate to it.  The first one is that medical oncologists in Australia are expected to undertake mandatory communication skills training.  That includes breaking bad news and identifying issues and so on.  Oncologists are supposed to develop some skills in communication.  The second issue is that oncology training is a training on the job.  Which means that if your colleagues and your senior colleagues, in particular, notice that your communication skills or your awareness of patients’ needs is poor, then that will be identified as a specific topic to address.

There is a not necessarily new but growing field of psycho-oncology, which allows oncologists to really get interesting and psychosocial needs of patients.  There are some very good training opportunities, as well as research opportunities in this area.  There is no doubt that different doctors have different affinity for the topic, but there is a certain minimum standard that is expected, where oncologists are supposed to develop skills or counter communicate with patients effectively.

Joe:                 That’s great to know, Bogda.  That’s fantastic.  What I want to ask you, as well, when it comes to people who are underprivileged and in terms of the support that they get, again, socially, emotionally, and mentally, as well, what’s your take on that?

Bogda:            I think that’s actually a very important issue because we tend to often talk about cancer care in Australia as this wonderful, high-quality service available to everybody with excellent outcomes.  The truth is that people who come from disadvantaged populations, whether this is socioeconomic, or a geographic disadvantage, their cancer outcomes are inferior, and their needs are more likely not to be met.  That is, again, for a variety of reasons, it is harder to access support in rural areas or in disadvantaged areas.

It is harder to ask because people often feel less entitled.  Sometimes they don’t have the language skills.  Sometimes they don’t have the awareness that they can ask for support.  Clinicians may not necessarily customize the enquiry to those needs.  For example, the majority of patients, it might take 20 minutes to talk about patient’s needs.  For somebody who comes with a language barrier or a particular cultural background, they may need twice that time.  The oncologists need to be aware that that needs to be provided.

In certain cultures, there are particular cultural expectations of how you communicate issues, there are language issues.  There are, again, skills required.  Those skills can be provided and there are ways of bridging the gap through, in particular, through a cancer care coordinator, and patient’s advocates who support patients.  There are ways of addressing this problem.  I think that we actually do have quite a long way to go in addressing the needs of patients from disadvantaged communities.

Joe:                 Well, hopefully, we can do more on that front.  Bogda, if you’re someone with cancer, and I know you’ve obviously seen a lot of folks who go through it, how would someone go out finding better support?  Both from people in their life and from other channels, here in Australia and around the world, are there any resources that are overlooked that people might not know about?

Bogda:            Well, I think that there are a number of resources and I think it’s worth starting by thinking about the fact that there are lots of resources within cancer, but there are also resources outside of the cancer field and are both irrelevant, depending on what the need is.  Within cancer, one of the nice resources that hails from Australia is website.  It’s a very broad website that looks at the support of people who are cancer survivors.  That was developed here in Adelaide.  It provides a lot of information on various aspects of lifestyle.

The Cancer Councils in each state provide excellent resources that are cancer-specific, and those resources are available both online, telephone, and in-person.  Most of the cancer facilities around the country have good awareness of what’s available, both locally and remotely for patients to access that is within cancer.  I also wouldn’t want to discount the non-cancer resources.  They include going to your local library, talking to your local GP, joining in a meditation or relaxation class, learning about journaling, connecting with your peers, meeting your friends for a coffee or going for a walk.

Those are also very important.  Many people who deal with their own cancer journey, often don’t want to spend their entire time talking about cancer.  It’s often very nice to switch off and talk about something else.  I think that in cancer, as health professionals, we often tend to think about the resources available just within the cancer space, but there is a wealth of resources outside of cancer that are just as relevant and just as helpful that could be used, as well.

Joe:                 Absolutely.  I think that a lot of people might be overlooking that.  Probably they’re not using it to the best of their abilities, in terms of being able to open up and talk about these issues.  I’m sure that there are many cancers that are hard to talk about.  Do you notice any patterns, any similarities?  What would you say to someone who is afraid to bring up something personal, something that they feel awkward about?  Whether that’s with a medical specialist, like yourself, or maybe with someone in their life, like a family member or friend?

Bogda:            I think that when we’re talking about patterns, it’s worth remembering that we tend to operate within the patterns we always have.  That means that some of those are very helpful and they work very well, but we also tend to repeat not necessarily helpful patterns.  Examples of it are people who say, “The way I cope with stress is by keeping busy, so there are certain things that I’m just not going to deal with because I’ll just get busier and never go there.” I think it’s worth finding a little bit of time for a bit of self-reflection on how I am travelling on the regular basis.

If you’re travelling great and all is fine with the patterns that you’re using, good for you and keep at it.  If you find that things are not so great, then perhaps the way you’re going about them requires some refreshing, and this is where getting some professional help is often useful because you can count on confidential advice.  You don’t have to feel that you owe the professional anything for providing a service, that’s what they’re there for.  Whereas, with a family member, you cannot be confident that they will always hold the information confidential and you may rely on their generosity to give you time.

Their skills may be variable.  I actually think that when in doubt, seek some professional help.  There are a range of health professionals that could assist.  Many people tend to underestimate the expertise of their GPs and of nurses, both within cancer services as well as general practice nurses.  These are people who are often very happy to help and very astute with regards to what can be done.  They just may not be necessarily aware that there was a need.  Some of us come across as extremely capable and having no worry in the world, when in fact, internally, we might be suffering.  I think it’s worth flagging that there is a need in a trusting health professional.  You might be surprised at how much help you’ll get.

Joe:                 Yes, you’re so right about that because so often we forget that people just can’t read your mind, unless you specifically tell someone what’s going on in your head, people just won’t know.

Bogda:            Exactly.  Yes, sometimes you may wish to talk about issues that are difficult, so you may not necessarily want to spell out what the issue is, but it is worth saying, “Look, I’ve got some concerns that are confidential, could I could to you?” One thing that sometimes people do when they come to my office, they would have this consultation where everything is going really well, and they would reach for the door and say, “By the way, could I just ask you one thing…” and that’s when the interesting stuff really comes up.  It’s useful to ask, because, yes, the crystal ball is usually broken.  We can also look at a person and say, “Do tell.”

Joe:                 Absolutely.  Bogda, you mentioned earlier that it’s okay to make another appointment, to ask more questions, to clarify things, which I think is fantastic because that’s really important.  What if someone has questions in between appointments, or after a procedure or after a treatment?  Is that okay to ask an oncologist, like yourself, for an email address, for example?

Bogda:            Different oncologists have different preferences.   I give my email address to all of my patients, it’s on my business card.  My email address is commonly available because all you need to do is look up my name at Flinders University and it pops out.  That is the case for most oncologists in academic settings.  It’s perfectly reasonable to give patients your email address.  As long as you’re one of those people who access their emails.  I think if you’re one of those people who never answers emails, then you probably shouldn’t offer giving emails to patients because you’re creating an unrealistic expectation.

I quite like responding by email because that allows me a chance to respond outside of my work hours.  Sometimes it’s very hard for me to stop my work to pick up a phone call, but it’s okay to answer emails at the end of the day.  However, not every question should be answered by email.  I’m very happy to receive the emails, but very often, my response to the email would be: We need to meet and talk about it, because certain complex issues are not very easily explained by two sentences in an email.  It’s actually much easier to meet and talk about it face-to-face.  An email is a very good way of organising an appointment, but it shouldn’t be a substitute for an appointment.

Joe:                 That’s a great point.  If you refer your patient to another specialist, like, say, a surgeon, how do you choose that person?  Is that a part of building up your network for a period of time or is there some sort of an online forum?  How does it work?

Bogda:            Cancer care is intrinsically multi-disciplinary, so every single one of us works as part of the broader team.  Most of this team is built within the institution we function in.  A medical oncologist would work within a team of medical oncologists and connect with a team of surgeons and team of radiation oncologists and supported by a team of nurses etc.  Within those teams, you get to recognise how people operate.  You would recognise their strengths and sometimes limitation and the best fit for the patient.  For example, I may look at a particular surgeon from the perspective of: Are they very direct and therefore, really a good fit for the patient who likes a lot of very direct information?

Or would they be too blunt for somebody who’s a little bit more anxious and maybe there is a different fit, a better fit for somebody else?  Of course, I get very particular about the skill of the people I work with.  I’m very lucky to work in a wonderful institution where I genuinely trust the skills of the people that I work with and I’ve been doing this for more than 20 years, so I’ve had plenty of track record to learn about it.  I think I often reflect about how sometimes it is challenging for me to verify expertise of let’s say general practitioners that I haven’t worked with, let’s say in a different part of the country, south Australia, and how important it is to verify that they have the interest and the know-how and the dedication to support my patients.

You gather that from telephone conversations, correspondence that you exchange with them, so there are ways of telling whether the person that you’re working with is the person you would want to entrust your patient to.

Joe:                 That makes so much sense.  How often do you get complicated cases, where you perhaps want to take it to a group of experts to get their input, and how does that process work?

Bogda:            Complicated cases happen all the time because every person is complicated and very often, the cancers are complicated.  We routinely review management plan for most of our patients as part of the multi-disciplinary meeting.  That’s often a routine, perhaps not 100 percent, but very close to it, that treatment plan would be reviewed as a group.  For example, in our department, all the new patient’s decisions are discussed once a week, where we say, “We’ve seen this patient, this is the story, this is our plan.” That allows other oncologists to say, “Have you thought of such and such?” It’s a way of ensuring that we really offer the best practice to every patient.

Secondly, sometimes we will have a patient who might have a really complicated situation that required additional expertise and there are groups of clinicians, for example, in Adelaide, the breast oncologist work together as part of a state network.  Not only do I talk to my breast oncology colleagues at Flinders, I can talk to the breast oncologist for the entire state to get advice.  Sometimes there might be a really unusual situation where they’ll be a particular expert in the world for an unusual cancer and I might contact them specifically for a specific case.

We always tell patients that we’ll make contact to discuss the situation of someone else, so they are not surprised.  Oncologists, in general, are very generous with advice and usually honoured to be able to contribute to someone else’s care and very happy to share their expertise.  There’s only a benefit from it, I can’t think of any downsides.

Joe:                 That’s incredibly reassuring to know that there’s such a great process around it.  Bogda, I’m a big fan of self-help.  It’s been so fantastic to read about finding your way, your project that looks into resilience for cancer patients.  Can you talk about what that’s about and what have you discovered?

Bogda:            Sure.  Our team at Flinders, led by Dr.  Lisa Beatty, had developed an online self-help and support resource called: Finding my Way.  It’s available on the website:  It’s freely available and it’s a modular set of resources that support people who are dealing with cancer treated with curative intent.  In a number of areas that include emotional, physical, practical concerns to assist them in better functioning, less distress.  We had tested the website as part of the randomised study.

We enrolled nearly 200 people in a randomised setting to either use the website with our content and sub-practical activities attached to it.  All to have access to the website in a just more limited, less hands-on way, so that you could read the content on the website but not necessarily do exercises that are attached with it.  Both groups had access to the website in some capacity, but we compared the full resource against the more limited resource.  What we had found was that those people who used the full resource had better emotional functioning.  Over time, everyone’s emotional functioning gets better, but those who used the resource actually functioned better in terms of their emotions.

What was really a surprise to us, but a very pleasant surprise was that they needed less access to healthcare services elsewhere.  This resource, which you could use in the comfort of your own home for free, improved the wellbeing and allowed people to use less services elsewhere.  Which is very important, especially for those people who have difficulties accessing other services.  We’re very excited about these resources and as a result, it is now available freely in Australia and around the world.  It has been taken up by colleagues around the world in other countries, in the United States, in UK, in Germany, Romania, to adapt it to their local needs.

Joe:                 Yes, that’s fantastic, Bogda.  It’s one of those things, like, for example, like Cancer Connect which I only found out about after my treatment, that I’m going, “Why didn’t I know about this earlier?  You know?

Bogda:            Yes.

Joe:                 Bogda, I know that survivorship is an area that is very close to your heart, so what are some of the challenges that folks typically have after treatment?

Bogda:            It depends a little bit on what treatment and what cancer they had.  It depends on an individual, but broadly speaking, there is a variety of challenges that people face, including physical.  For example, fatigue is a very big problem for many cancer survivors, as well as side effects of various treatments.  That might be physical disability after surgery or heart problems as a result of chemotherapy treatments or others.

There are emotional concerns and fear of cancer recurrence is probably the biggest there.  As well as anxiety, depression, grief.  As well as practical concerns.  Issues relating to return to work, managing financially, sometimes changing your employment status to something different for lots of reasons.  There are a number of issues.  The good news is that for the overwhelming majority of cancer survivors, their concerns diminish with time, and their quality of life improves.  There are many cancer survivors who do very well very early or straight away.

There are plenty of cancer survivors who consider the cancer experience as something that while they would never had wished for it, it also had some enriching qualities to their life.  We do know that there are many needs that need to be addressed and we do need a structural way of addressing them.

Joe:                 Is there such a way?  Is there an integrated way, do you think, that looks at addressing those needs?

Bogda:            Yes, there is.  Clinical oncology society of Australia has issued a model of cancer survivorship.  It’s available on its website.  It outlines all the different elements of survivorship care and that includes assessing the needs, developing treatment summary and a care plan that identifies what the issues are and how best to address them through a variety of resources that might be available.  The next step is really ensuring that cancer services provide and deliver that type of needs assessment and a care plan.  That’s the implementation of it.  It’s really the work that we’re working on at the moment.

Joe:                 Yes, that’s fantastic, Bogda.  I know that you are passionate about shared care.  Can you talk about what that model is like and what do you believe is the best approach?

Bogda:            I believe that we need to start from the premise that it takes more than one person to support a person with cancer.  A person with cancer usually has other needs other than cancer.  Certainly, many people with cancer also have heart conditions, diabetes, lots of other health problems, that oncologists might not necessarily be very well skilled at managing.  It is a given that some of their care needs to be delivered by others, most notably, general practitioners.  If we were to deliver care through a variety of people, that that care needs to be shared somehow between all of those different individuals.  The bit that I am passionate about is that we are explicit about it.

Meaning that we agree that it takes more than one individual to deliver care, and that we are very clear on who is responsible for what aspects of care.  Then that clarity of a plan is also clear to the patient and acceptable to the patient.  Sometimes I find it frustrating that the whole discussion about shared care is just a discussion between the oncologist and a GP, without any consultation with the patient.  Sometimes that there is an assumption that everybody knows what they’re supposed to be doing, but not explicit agreement.  I think shared care can be very useful, can save patients from unnecessary appointments, extra parking that costs them extra money.  I think that to deliver good shared care is a process that involves some investment of time to clarify roles and responsibilities.

Joe:                 Absolutely.  What about integrated care?  Is that something different?

Bogda:            I think integrated care has got a lot of definitions.  Many of us think that we know what integrated care is, but when you really get into the nitty-gritty, different people believe different things.  I think that the term “integrated care” refers to the quality of the overall care that the individual receives from the individual’s perspective.  Very often, what integration means to people is care that is connected and coordinated.

An example of care that is not very well integrated is imagining that the person has got three specialists and a GP.  They see a specialist number one on Monday, specialist number two on Tuesday, specialist number three on Wednesday, the GP on Thursday.  Every single doctor asked the question about what did the other doctors say?  There’s no communication between them.  If you think that that sounds strange, I’m afraid that does happen.

The healthcare providers should have a clear plan of how they work together, how they communicate their findings, who’s in charge for what, how do you tell that the care is simple, not excessive, flows smoothly and seamlessly, it’s not an easy task to achieve but I think it’s a very reasonable aspiration to have.

Joe:                 Absolutely, and I think that really ties into what you mentioned earlier about defining roles and responsibilities.  What do you think is a practical way?  How do you define those responsibilities?  Is it like a centralised thing or is it down to each individual person, like yourself, talking to a general practitioner and having that two-way communication?  How would that work?

Bogda:            Well, I think that this is where the patient is the key because ultimately, it has to be acceptable to them.  For example, I sometimes have patients who really need to share their care with the general practitioner.  The patient says, I don’t like my GP and I don’t have another one.  Well, I have to start by negotiating with the patient about getting a GP because it has to be acceptable to them.  I really see that empowering the patients to be a deal breaker with regards to what is acceptable to them is a very good start.  They will identify who their team is, and they will tell me who they see as the most relevant lead to lead the team for a particular purpose.

I think that those basic building blocks and be started with.  We have figured out in oncology how to bring together medical oncologists, surgeons, radiation oncologists, and we do it quite smoothly.  I think we need to broaden our horizons and we need to start bringing in GPs and cardiologists and rehab specialists.  People who are just as important but often don’t sit at the table in cancer care.  They’re a little bit invisible these days.  I think that we need to make them a little bit more visible.  We can, again, draw from the experiences that we’ve had in doing that for the more traditional cancer disciplines 20 years ago.

Joe:                 Absolutely.  I think that just needs to be in place.  I know that I was lucky that I had a fantastic GP and a fantastic urologist and really incredible oncologist, but I’m not sure that they ever really talked to each other.

Bogda:            Yes, exactly.  I can tell you that one of the highlights of my last year of work was I convened a multi-disciplinary meeting between a cardiologist and an endocrinologist, palliative care physician and myself for a patient who had a lot of general medical problems, as well as cancer.  We needed to figure out a clear plan for her that actually was not terrible relevant to cancer, because cancer was the least of her problems, but it was very relevant to her wellbeing.  We basically organized a teleconference because we were all in a different part of the city.

We talked for an hour about what we collectively can do and identified who would be responsible for what.  One of us met with the patient and said, collectively, this is what we can do, and this is that we can’t do.  That meant that she had one consultation and advice from all of us and we were very clear of our respective strengths and limitations.  I know that is can be done, it was me testing the waters and I’m certainly hoping to do more of it.

Joe:                 Yes, that’s fantastic, Bogda.  I know you’re so passionate about finding better ways to do things and improve outcomes for people.  How hard is it to incorporate research that you do into your practice?

Bogda:            It’s not very hard at all because my research originates from the clinical problems that I experience when I see patients.  The research needs and the need for research solutions are right there in my face every day of my working life.  At the same time, there’s not enough hours in the day.  There are just so many things that one could do and so little time.  It’s hard and easy all at the same time.

Joe:                 Bogda, when it comes to someone who made it past cancer and now, if they want to move forward and have the life that they want, what advice can you give them?

Bogda:            I actually think that the advice that you give to somebody that had survived cancer is the same as advice that you give to anybody for a rich and fulfilling life.  I have a little acronym called: READY, which stands for: Relationships, exercise, active mind, diet that’s healthy, and yearning.  What I mean by yearning is a passion and purpose in life.  I think that if you can focus on those five things in your life, we know that all of them have a role to play in keeping you well and cancer free.  They are also very important in general lifestyle, which really means that cancer is not that unique in the issues of health and wellbeing.  The directions for happy and healthy life are very much similar in cancer and life in general.

Joe:                 Wow, READY, is a fantastic framework.  Thank you so much, Bogda.  This has been some great advice and thank you so much for your time.  I really appreciate it.

Bogda:            It’s a pleasure.  Lovely talking with you.