Category Archives: cancer short stories

Cancer Anxiety

Anxiety ( blog) and iheart)

Hi DR Ryan here, medical oncologist AND PROFESSOR AND RETIRED COLONEL AND CANCER SURVIVOR and this is when tumor is the rumor and cancer is the answer.

I am sure you are familiar with our opening song   from chariots  of fire. A man has a plan and in a day it is crushed…… so it is when you have been told you have cancer ,thoughts of loss of control, soul sucking anxiety, what about your family and the list goes on as it hits  you like a ton of bricks.

He rose above it in the film  and so you to will be a hero ………I have seen no exception no matter how afraid you are, and that is what we are going to talk about today …your attitude when first diagnosed and through your course of therapy.. What about ANXIETY

. We will take our time so feel free to write in your questions or comments at and i will try to get to them

Anxiety and fear

it is anxiety that is the killer, NOT FEAR. We humans suffer most when not knowing all that needs known, especially when there is so much to fear. I choose, as do many dictionaries and as have countless great religious leaders and philosophers, to define anxiety as fear of the unknown.

I frequently relate a parable to my patients on this crucial subject. Let us travel back in time to the clan of the proverbial cave man. In one cave, somewhat safe from the elements and huddled about a fire, is a family fraught with anxiety towards the savage carnivores outside. These beasts only know this clan as prey. The clan shrinks under the weight of this knowledge, convinced that the predators will most assuredly find and devour them. The clan huddles all the closer, shaken by every foreign sound and every dimming of the fire. They dare not move. They are not ready to battle for their next meal or to survive. That is the primordial example of paralysis by analysis– as old as man is. That is anxiety.

in the hillside just to the east, another clan of warriors huddle. They know well the dangers that lurk and are ready to pounce as the fire dims and the sounds draw near. Fearful of what they know, and armed, they set forth into what will now be the known. History has shown us that this clan survives. That is the liberating power of fear inciting action.

Both anxiety and fear evoke the same visceral and pressing emotional urgings. However, for the first clan, the unknown fuels their feelings. That is anxiety and that is the end of that clan. However, the second clan knows that the bigger enemy is anxiety, fear of the unknown. It is fear of anxiety that drives them to action. Anxiety is the road to paralysis. Fear can ignite action without guarantee of success, but action nevertheless.

anxiety disorders in patients and their relationship to the quality of life have been the subject of legions of studies in the medical literature. Their conclusion is universal. Anxiety is as much a killer as is living in constant bodily pain. What is life worth, one wonders, when the icy soul sucking grip of the never and forever lie holds you tight to its bosom. This lie screams into your psyche saying, “it will never change and it will forever be the same”.

anxiety is not abnormal and may in fact be an emotion that leads to a positive outcome. Nonetheless, it is almost the kiss of death when it too easily evolves into the loosely defined term morbid anxiety causing panic, irrationality and paralysis. There is little doubt that morbid anxiety has negative consequences in many regards for the cancer patient as well as their family.

Granted, some malignancies with a less ominous prognosis will not elicit as much morbid anxiety. Once again, the key is that the patient knows that the prognosis is less ominous. It is knowledge that is the oncologists’ first and most precious gift to the patient. It is knowledge that the patient and family must demand. Knowledge delivered through teaching that must be thorough, comprehensible, and empathetic. The flow of information must never stop. Physicians must teach patients how to deal with family, friends, sources on the internet, the staging procedures and their meaning, the treatment and the value of second opinions. Patients must learn well that they will not be alone, that thousands have handled this and that others were no less anxious and no braver.

physicians must speak to their patients of the odds of cure, remission and durability of remission. They must not shy away from discussing spirituality, life’s goals, and the effects of treatment on normal bodily function. Common anxiety-laden patient questions, as “what functions or abilities will I lose” as well as “what will I keep” are essential front burner issues. Discussions must be frank regarding the specter that pain, nausea and vomiting often represent to patients. Moreover, physicians will find the more empathetic time spent the greater the patient’s trust and quality of life.

Patients need to know if research studies hold out a realistic promise. Oncologists must explain the amazing armamentarium of medications they have, the psychological assistance patients will be given and potentially, the beautiful role which hospice may play. Most of all, patients must be put in charge by being given repeated slow but thorough helpings of knowledge. That is the key to killing anxiety. Caretakers must indeed take great care to embrace the god given, hero-making emotion of fear, break the paralyzing bonds of anxiety and guide patients and families onward to face the future.

Remember it’s ok to tell someone you are not ok

Lets summarize the overview of anxiety

First page


Second page

For example , mindfulness practice during chemotherapy can reduce the blunting of neuroendocrine profiles typically observed in cancer patients, according to a study published in cancer.

Other issues are what some have called scanziety and also the issue of telephone messages.

Scanxiety refers to the fear and worry associated with imaging, both before and after a test is performed, and lasts until the test results are communicated to the patient. As described by cancer survivor Bruce Feiler in a time magazine column, “scans are like revolving doors, emotional roulette wheels that spin us around for a few days and spit us out the other side. Land on red, we’re in for another trip to cancerland; land on black, we have a few more months of freedom.”  The root of this anxiety is  related to the uncertainty of the test results and the amount of time that elapses between when the test is performed and the results known. Not surprisingly, most patients report an escalation of anxiety that correlates with longer wait times.

In an ideal world, scanxiety could be alleviated by immediate test results. However, test results also need someone qualified to interpret them and explain their implications. When scans show no evidence of disease, or a blood test is within normal limits, the phone calls are easy to make. It’s a different story when the scans or tests are abnormal or indicate disease progression. In these cases, face-to-face conversations about treatment options are usually best.

“phone tag” frustration

So, what can healthcare providers do to reduce scanxiety? Some oncology practices schedule patients for a clinic visit on the same day a scan or test is performed or results known. Of course, this approach only works when there is collaboration between the imaging or laboratory department and oncology providers. “the test results are not back yet” are words no patient wants to hear on a follow-up visit.

Patients who have scans and tests performed in their hometowns need to be informed that test results may or may not be available on the same day. These patients should be instructed to call their oncology providers to obtain results rather than wait for a call with the results.

Every oncology facility should have procedures that reduce the likelihood that patients will “fall through the cracks” and not be followed up. This can happen when return calls to patients go unanswered. The resulting “phone tag” is frustrating for patients and healthcare providers alike.

After-hours calls are particularly challenging, as they are often placed or received via personal cell phones. One option is to block or hide personal cell phone numbers; however, patients may ignore or decline these calls since the callers are not identified. Another option is the doximity dialer, an app that allows healthcare providers to call patients without revealing their personal cell phone numbers. Patients see an office or clinic number instead. The app allows healthcare providers to call patients at any US number, choose the caller id that appears, and send return calls to an office or clinic.

The app can be downloaded for iphone at the app store and for android devices at google play.

What else can be done to reduce scanxiety? Cognitive-behavioral therapy may be helpful in dealing with the thoughts that are at the root of the anxiety. This helps by examining possible outcomes. This leads to a reduction in all or nothing, and catastrophic thinking, which in turn reduces anxiety. The bottom line is that there are a number of strategies to help patients reduce scanxiety and cope with its effects . Being diagnosed with cancer is hard enough; we need to do all we can do to make the journey less stressful. –

The physical changes regarding patient;s anxiety are measurable David s. Black, phd, mph, from university of southern California in los Angeles, and colleagues assigned 57 English- or Spanish-speaking colorectal cancer patients to either mindfulness, attention-control, or resting exposure at the start of chemotherapy. Four saliva samples were collected at the start of chemotherapy and at 20-minute intervals during the first 60 minutes of chemotherapy. Self-reported biobehavioral assessments after chemotherapy included distress, fatigue, and mindfulness

Analysis showed a relative increase in cortisol reactivity in the mindfulness group, more than twice as many patients in the mindfulness group displayed a cortisol rise, compared to controls (69 versus 34 percent; Mindfulness scores were inversely correlated with fatigue and distress scores “implications include support for the use of mindfulness practice in integrative oncology,” the authors wrote.


Let’s go back to Yoga

Researchers have put yoga to the scientific test for years, and the results so far have been impressive. The practice has been shown to lower risk for heart disease, type 2 diabetes, depression and hypertension and anxiety.

But yoga can also help those who are already ill feel better. A new study suggests that doing yoga twice a week may improve quality of life for men being treated for prostate cancer and may help reduce the side effects of radiation, which include fatigue, sexual dysfunction and urinary incontinence.

So again if you have any of these tell your doctor, there is help

  • Difficulty concentrating and making decisions
  • Heart palpitations, sweating, shaking
  • Shortness of breath, feeling faint
  • Numbness or tingling in the hands or feet
  • Heightened sense of alertness
  • Anticipating feeling anxious or a persistent worry
  • Feelings of guilt, worthlessness, and/or helplessness
  • Feeling of unreality or detachment from oneself
  • Fear of dying or losing control
  • Irritability, restlessness
  • Dry mouth
  • Muscle tension
  • Nausea
  • Sleep difficulties
  • Cold or sweaty hands
  • Loss of interest in activities or hobbies once pleasurable
  • Withdrawal from normal activities and friends (avoidance)
  • Appetite change or weight change (usually loss)
  • Persistent aches or pains, headaches, cramps, or digestive problems

Lets also give a non scholarly but becoming so, nod to smoked cannabis, the psychoactive form in alleviating anxiety- there are some early trials in the 80’s mostly about control of nauseas and vomiting where it was no better than what was then the standard and inferior to what we have now with exceptions existing on a case by case basis. It being a class 1 drug highly controlled by the FDA has made scholarly work hard but there is a growing body of evidence that supports a possible role in alleviating anxiety, besides improving mood , appetite and pain as well as anticipatory nauseas Mostly we are left with it being no better than standard of care but there are some powerful small studies and of course individual anecdotes. Remember ,anecdote does not equal antidote

None of the above is true for any other herbal substance despite what you think or may have heard

Remember anecdote does not equal antidote

Seeing cancer through a sibling’s eyes: what we don’t know can hurt them an article summarized from the ONS

Family-centered care is crucial to the care of children with cancer, whose disease and treatment are both life-threatening and often prolonged over the course of several years, through survivorship or until death. Family-centered care recognizes the stark reality that cancer is disruptive to the family system. And can cause great anxiety in many family members with children being no exception While acknowledging the value of family-centered care to the ill child and parents in clinical practice, we may overlook other family members who would also benefit from family-centered care, most notably the healthy siblings of the child with cancer.

Indeed, healthy siblings have described wanting more information about their ill brother or sister and the illness; parents have described wanting guidance on how to best meet the needs of the siblings when one child has advanced cancer and to do so across the spectrum of life-threatening illness.
Challenges associated with a cancer diagnosis, treatment, and adaptation impact the entire family. Recent research has demonstrated that families experience altered family function and may face an accumulation of risk for mental health and severe emotional problems including anxiety over the course of illness,

other research reports that the experience of cancer increases family cohesion and family resilience. So it can bond as well as break- it is a case by case , family member by family member SITUATION even within the same family

Through the sibling’s eyes

Perceptions of the impact of cancer on the family often come from the parental perspective. BUT NOT ALWAYS. Each member of a family will assess the impact of the illness differently

Some experience feelings of jealousy, neglect, and bitterness. But almost all experience anxiety. Parents may spend less time emotionally and literally with the healthy child

When a child is diagnosed with cancer, the whole family is disrupted and anxiety initially runs rampant and delayed anxiety after a siblings death is all too common.

The nurse’s role

It starts with awareness. Nurses can promote a broadened scope of family-centered care and recognition of sibling needs in advanced disease and other times of turmoil. In doing so, they may mitigate some negative effects of strained or limited communication. Oncology nurses directly impact families through communication and can model open, compassionate, developmentally appropriate communication with siblings. Moreover, coaching and teaching are inherent to nursing care of families. Thus, oncology nurses role can be 2-fold: communicating with siblings across settings to increase their comfort or to provide education and

coaching to parents in discussing sensitive, emotional topics related to the illness.

Teaching parents to keep lines of communication open across the various fronts on which they parent all their children can diminish anxiety.

Although there are many methodological flaws in the following report it stresses the mind body connection which is never to be ignored.

However we are not saying the diagnosis of anxiety or for that matter, depression causes cancer in all , most or a significant minority nor does it mean you will get cancer if you have those diagnoses . Nonetheless, anxiety does have measurable effects on the immune system and that weaves a complex web

So what did they find in England in a study which I remind you has many limitations.

A BMJ article addressed how depression and psychological distress can increase the chances of dying from cancer. The study revealed a 32 percent cancer risk due to anxiety and depression. Of course something called multivariant analysis biases this dramatically as stated… just having anxiety  of unrevealed duration and severity does not cause cancer in 30 percent of people…. but this is interesting. The authors are clear to point out that Cause and effect are not established clearly.

The study stresses that the correlation between anxiety, depression, and cancer cannot be treated as evidence. In some cases, people with undiagnosed cancer can get anxious and stressed due to the changes happening in their body despite being aware of their sickness.

An expansion of part of this observation must follow

Up to one in ten people will battle anxiety or depression at some point, and this makes people more likely to smoke and drink, and less likely to take exercise and maintain a good diet. But even accounting for this, anxious and depressed people seem to die in greater numbers from cancer

PERHAPS THIS SHOWS that their unhappiness damages the body’s defense systems against the disease. The chicken and egg argument is self apparent however

Some suggest damages in DNA repair in the severely stressed patient but little good data supports this. What we do know is stress can also put people off from attending screenings which could spot cancer early, or prevent them seeking proper treatment when they do fall ill.


People who are anxious often stop looking after themselves and this could lead to poor diet and lack of exercise both proven to have a role in cancer cause

AGAIN THE LEAD AUTHOR STATES THE flaws are too deep in the English study to walk away thinking if you are depressed or anxious you will get cancer

Finally what about the internet in all this. Rather than recite every nuance and nonsense ( not all is nonsense) that DR Google spouts….. All the following key phrases will take you to links that are self explanatory and say pretty much the same thing as what we have covered  here

fear of getting cancer

anxiety about having cancer

constant fear of getting cancer

fear of cancer diagnosis

fear of cancer

cancer and anxiety attacks

cancer anxiety symptoms

anxiety after cancer

So, anxiety is soul sucking, it has many forms and presentations, it is harmful and it is treatable in cancer patients and families by MANY approaches

This show will be posted both in script form on blog and the book blog reachable through the book web site and the audio will be here as well as on iheart radio in a few days

I urge you to reread and listen critically to what has been said and note what has NOT been said regarding the connection between cancer and anxiety, especially regarding cause and complementary and alternative medicine

Now, as I promised in the first show I would, along the way, read stories I have published independently as well as in the book of actual patients with names changed , to at times illustrate a point. The past few shows have been about attitude- both up and down and what works, Here is a tale of my first and only encounter with a leprechaun…I think you will all get the point

A Leprechauns’ Laser Light Of Life

As I made rounds, lilting laughter punctuated a rag tag vocal ensemble’s singing of “Danny Boy”. It ebbed and flowed from the oncology ward lounge, warmly filling a sterile hallway; but not my heart. It was the twentieth St. Patrick’s Day since small cell lung cancer riddled and devoured my son of Hell’s Kitchen, World War II veteran, tough Irish dad. Although he died during the dreary wet frozen rains of a New England fall, he was etched into my heart’s memory owing to one very magical St. Patrick’s Day.

As I did every St Patrick’s since his death, I was reminiscing a time when I, a newly minted, wet behind everything medical student and a 2nd Lt in the USAF in the Health Professions Scholarship Program, visited my dad at work as  General Electric’s chief labor relations negotiator in Manhattan. The day ended at a midtown Irish bar with me accompanying him on the tavern’s beer soaked upright as he crooned “Danny Boy”. You could feel the century old pub wood weep as a sonorous tenor voice I never knew he had lifted hearts, minds and glasses. Mutually uninhibited but not inebriated, father and son were in tune.

So here I was decades later on another St Patrick’s Day rounding on the Oncology ward, tired and tied to a bittersweet memory. Regaining focus for the duties of the day, I began to thumb through the chart rack. Suddenly, intruding through the funk was the unmistakable sound of a Buck Rogers’s ray gun. It was right behind my left ear, magically mixing with leprechaun like chortling and giggles.

I spun on my heels and was bowled over by the impish grin and theatrical posturing of my toy toting assailant. Hopping and toe dancing as light as a shamrock blown by faerie breath and half naked in hospital regalia with toy cosmic carbine in hand, retired USAF Chief Master Sergeant “O’Reilly” squealed, “Ah-eee, Gotcha Doc”!

O’Reilly had whistled and skipped to an easy truce with his sleepy follicular Non Hodgkin’s lymphoma for sixteen years prior to this admission. His blarney charmed the beast called anxiety. His acceptance of the capriciousness of a life filled with the Damocles Sword of a strong probability of an aggressive transformation of his disease was like a therapeutic balm of Gilead for not only himself, but so many patients he befriended and bolstered.

His checkups were always a happy routine rife with fabulous tale spinning, unabashed limerick singing and other sound medical practices. Clinic visits from the sage retired chief leprechaun of the USAF always ended with a pat on my head, a wink at the nurses and his trademark squeezing off of a couple  laser beams of magic from the now infamous toy gun at whomever he thought needed it most.  It never hurt, it often helped and more than once, it seemed more powerful than my prescription pad. An emeritus professor of mirth and mentorship, O’Reilly was one of the wisest men I knew.

Shortly before this final admission, the limber leprechaun interrupted plans to visit family in Ireland because, as he said, “Me shillelagh’s telling me something ain’t right”.  A thorough history and physical revealed nothing. The complete blood count showed a slight drop in his usually robust hemoglobin and his platelet count had fallen considerably. So did my heart when review of the peripheral blood smear suggested what an immediate bone marrow examination confirmed; myelopthisis. His lymphoma had transformed aggressively and was exploding into banshee like furor. It was replacing his bone marrow. Further staging showed broad lymph node, boney, spleen and meningeal dissemination.  An incredibly bright man, he fully understood the limits of therapy and the grave prognosis.  Typically unafraid and more concerned for his family, he was annoyed at the change in travel plans. He sprightly assured me, “I have a few things yet to do, so let’s have a go at it.”

We did. After a rocky course consisting of intensive systemic and intrathecal brain chemotherapy, massive transfusions and considerable assistance from colony stimulating factors to support his white blood cell count and fight infection and erythropoietin to help him make blood, this knobby kneed leprechaun of a man was zapping my dour spirits. Bald and beaming and headed towards a major clinical response,   he was working his magic on this very special St Patrick’s Day.

That was his family in the lounge warming the ward with lilts of laughter. Spying my doleful drudge as I began ward rounds, he left the comfort of family and friends to fire a laser beam of life my way. Clearly unfazed by the enormous odds of a rapid and refractory to treatment recurrence of his cancer, he often grandly showcased his plastic phaser quipping something to the effect of, “If it comes back, we’ll zap me cancer with this thing; it’s better than those poisons, eh?”

O’Reilly was one of the gifts clinical oncologists can garner in decades of clinical practice, if they are open to receive them. He was one of those wonderful “doctor-patients” put in our path to minister magical wisdoms just when we oncologists need those most. Being touched by such patients’ special zest, zeal and wisdoms is one of those easy medicines to swallow. Souls such as these are precious jewels in the growing treasure chest of a clinicians experience and the luster of the clinical pearls they impart are often both illuminating and transformative. So it was with O’Reilly

Unbeknownst to me, he had more things than fighting his cancer on his agenda. He had taken particular notice of one of my young clinic nurses. She was a seemingly emotionally cold and somewhat intense Second Lieutenant nurse that was “too young to act such a tough nut and too talented not to try and crack”, according to O’Reilly. She had requested transfer to the inpatient Oncology service. This coincidentally put her on the ward and in O’Reilly’s service and sights when the aggressive transformation of his lymphoma occurred. Both I and the senior nursing staff were concerned for her, believing her far more fragile than her implacable demeanor might suggest, but our “tough nut” showed no signs of trouble and sadly, few signs of warmth even when O’Reilly’s improbable  clinical remission occurred.

Shortly after that St Patrick’s Day, the probable occurred. O’Reilly was readmitted with signs and symptoms of a rapid recurrence. He was quick to grasp his situation, calmly and confidently summarizing my lengthy delivering of sad news to a family unwilling to believe the unacceptable, saying gently to all, “It’s been a great run, so now, soon, I’ll be with sod and saints”. In his final days of a rapidly progressing malignancy that would not be denied, he had three simple requests; some intimate uninterrupted time with the Mrs., a steady supply of Guinness Stout and “one last shot at some unfinished business”. Curiously, and without any explanation offered, he decreed that the “tough nut” young nurse be assigned to his care and furthermore she was to be the only medical staff he wanted in his room; no one else, no exceptions.  Somewhat bewildered but always admiring of his wisdom, the charge nurse and I warily agreed. On hearing his request, the young lieutenant almost condescendingly agreed seemingly fashioning it as some sort of dramatic last wish. After all, she thoughtlessly quipped, it was “probably (her) turn anyway”. She would be in his service having no idea how true that would prove.

I was shaken upon news of his passing the next morning. However, deeply appreciative of O’Reilly’s gifts, I was both concerned and curious as to the impact, if any, his passing had on the young “ tough nut” nurse. No worries. I no sooner strode onto the ward than she ran up to me glowing, seemingly transformed and weightless, her eyes brimming with tears of joy. Reaching into her pocket she produced our leprechauns’ little laser gun. Smiling, she told how he called her to his room, eschewing all others. She bubbled joyously of how they chatted for hours about secret things, special things about love and the rich life. She was bursting with the pride and surprise as one who had been picked above all others as something special and lovable. Tugging at my white coat like the impatient exuberant child she then was, she announced triumphantly that she was the last target he leveled a final salvo of saving love at. He then bequeathed his other worldly potion in a pistol to her, assuring her that, “I can go now. You’ll know when to use it and when it’s time to pass it on.”

Death is not always so kind, so graceful in its gifts. When we healers and helpers are absorbed in our sorrows, perhaps lost in the fog of sadness over the limits of our skills or other concerns, we may also be most vulnerable to the laser beams of life from those who by all rights should be sorrowful, yet are not.

This is Dr Kevin Ryan author of the book when tumor is the rumor and cancer is the answer, a comprehensive text for newly diagnosed patients and their families signing off radio the cancer support radio program

See you Next Tuesday at noon PST when we will look at depression and cancer

Now for any questions


Even After Head & Neck Surgery Cancer Patients Still Smoke

Oncology Times:
doi: 10.1097/

Even After Head & Neck Surgery Cancer Patients Still Smoke

Susman, Ed

SAN FRANCISCO—When head and neck cancer patients are diagnosed with advanced disease, the majority of them will immediately stop smoking—but nevertheless, 280 days after getting the bad news that they have cancer, 41 percent of the patients are still lighting up, researchers said (Abstract 184).

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The inability to stop smoking may also be linked to depression, said Harsha Vardhan Poola, MD, a fellow in Hematology/Oncology at the John H. Stroger, Jr. Hospital of Cook County in Chicago, in his poster presentation at the ASCO Cancer Survivorship Symposium.

“One of the most important factors for patients to quit was the diagnosis of head and neck cancer,” Poola told OT. “We found that 50 percent of patients diagnosed with stage 3 or stage 4 cancer quit at that diagnosis. But the early stage cancer patients continued to smoke, even through treatment and afterward.

“We had 76.5 percent of the 39 patients in the study smoking when they were diagnosed with advanced cancer. After treatment and 280 days later, 41 percent of those patients were still smoking, so we had about a 50 percent decline in smoking, which was statistically significant (P<0.001),” he said. “We also had high rates of depression, which is not uncommon in head and neck cancer patients. Although smoking rates on diagnosis in our cohort is comparable to literature, our cohort had higher rates of continued smoking and depression.”

There was a trend toward depression among smokers (62%) compared to non-smokers (55%) among the patients with stage 3 and 4 disease, he said, but that difference was not statistically significant.

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“We would like to see if we treat patients—especially African-American patients—for depression whether that would make a difference in their smoking habits,” he said. He also suggested researchers may explore if smoking cessation may be able to prevent depression, especially in underserved communities.

“Continued smoking among head and neck cancer patients is associated with poor prognosis,” he noted. “These patients experience the highest rates of depressive symptoms of all oncology patients.

“Larger studies are needed to address the effects of continued smoking and depression in the quality of life of minority populations,” Poola said. “We are continuing to expand our data with the goal of screening all head and neck cancer patients and to eventually start a smoking cessation program in the ear, nose, and throat/head and neck cancer clinic.”

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Smoking Prevention

The overarching problem is nicotine and its addictive effects on smokers, said Dennis H. Kraus, MD, Director of the Center for Head & Neck Oncology at New York Head & Neck Institute, Northwell Health Cancer Institute at Lenox Hill Hospital, New York City.

“Tobacco is an addiction. For anyone who is depressed, the effects of addiction are additive if not exponential,” Kraus told OT in commenting on the study. “I don’t believe it is any easier or more difficult based on an underlying disease. If anything, folks undergoing radiation-based therapy often describe how bad the tobacco tastes during that therapy.”

He said getting people to quit smoking is not just saying no. “Quitting is best facilitated by a host of factors, including a motivated patient, coupled with a patient-centric support system,” Kraus said. “Literature shows that patients who receive services such as counseling, positive reinforcement, and tobacco replacement such as patches are likely to have the best outcome. A patient-centric support system can mean the difference between success and failure.”

Kraus said the best way to stop patients from smoking is to prevent them from becoming addicted in the first place. “For starters, we need to prevent addiction,” he said. “We don’t provide minors and young impressionable adults access to needles and heroin, and then ask them to quit.”

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Study Stats

In Poola’s study, the patients’ mean age at diagnosis was 55.84 years. Eighty-two percent of the patients with stage 3 and stage 4 head and neck cancer who smoked were men. Seventy-four percent of the entire cohort had stage 4 disease at diagnosis. Forty-six percent of the smokers were African-American, while 36 percent were Caucasian. He said the smoking patterns and depression in the prospective cohort of head and neck cancer patients was evaluated by through surveys and chart review.

Depression was assessed using the Patient Health Questionnaire (PHQ-9). Head and neck cancer patients were stratified as non-smokers; ex-smokers—defined as those who had quit at least six months prior to their assessment; recent smokers—those who had quit for less than 6 months; and current smokers—individuals who had smoked within the last week. The patients’ electronic medical records were reviewed for sociodemographic variables, cancer stage, date of diagnosis, and modality of treatment. The cohort was followed through July 2015 to assess for recurrence of disease and survival.

Poola noted persistence of smoking after diagnosis was seen significantly more in the Caucasian population compared to the rest of the ethnicities (P=0.038). Complete response to treatment was seen in 82 percent of the patients and recurrence occurred in 20.5 percent of the patients.



Well  my lungs still have not  cleared up ” It’s just a little pneumonia”,  as us Docs like to self diagnose  while hacking  up “indelicates”  and   placing no lower than third in any self respecting hollering contest

On many levels , I  thought  I had proved my stupidity once again,  and went out in the colder air to a neighbors memorial  and funeral. I never met the man. My loss.  Once again, HE was right  and I was wrong. Like the overflow crowd there, there were thousands of reasons to just get  up , shut up and get lifted up. Yup, I cried quietly in the back because of the  man I  learned he was. Heh, we all carry baggage .In this trip let’s just say it was more than an overnight bag, more  in Queen Mary transatlantic genre.  I only barely knew his saintly wife briefly .You could tell when she had been around as these paranormal, billowy white feathers seemed to trace her track of her 50 and just as often 100 mile runs. She is somewhere in her  seventies. ( God save  me from having publically revealed even a woman’s age  range) Pam, my wife , the other saint, spent two hours alternatively crying and listening at her house as she talked about a lot and mentioned forlornly how  the depression from her beloved’s  death only let her get in a 50 mile jaunt.

The memorial stories were amazing, What a Father, leader  and friend and so so much more

Cancer  killed him. I am an Oncologist. I am not clear and do not need to be , except that bone spread was probably widely involved..Of course this  sort of man eclipses  mere clinical diagnosis  as he lives  on interminably in the thousands of heart minds and souls he lovingly caressed

The stories were not really  eulogies, they were facts and plot points in the arc of a story  of a self made man who took care of family and friends  and was broadly loved. I might (-check that- )hope that I would have been able to learn a lot about a lot of the most important things in life if I was lucky  enough to have been his doc for a while. You can do that if you thank them for selecting you , introduce your team looking him square in the eye, throw out that right first question and sit down , shut up and begin, sometimes if you’re lucky, to learn…like you could from Vern.

This was a man you heard and felt , not just saw his imposing yet somehow gentle frame. Yesiree. a depression Oakie farmer right out of a novel. Middle or so of a big family. Tall and handsome.  No, this is NOT that kind of man crush thing- ( there were a LOT of photos). Again I erred, thinking “God knows what more  that Oakie kid  would have done if he had more than one maybe reasonable meal a day, yesterdays papers to sell as a kid down by the boat yards, a crane aerial- automobiles and some six-inch pipe caper …and my favorite, a dead cow” (all great stories there)

Ill as hell, to die in 72 hours or so , he was still working for the  benefit of others diagnosed  with lethal mesothelioma (incurable cancer of the lung linings about always due to inhalation  of types of asbestos)  by giving a deposition on their behalf with his unfathomable memory and eidetic recollection abilities  to see the past  as it  was, close to 80 years later, not just as he might reminisce  it  probably was. In that final deposition, he spoke in exquisite unassailable detail of another man’s lethal exposure , as he lay in bed  in bed  and  doing so at his insistence. (It was deposition#1000.  )  Apparently he became the gold standard honest go to man in court with the killer memory that finally and rightfully  landed one of the biggest volume of suits about asbestos, unsafe working conditions and mesothelioma .His words as  a “Union Man” set the standard for the billion dollar fund now in existence by law. He did not get that disease yet he inhaled as much as any. God had more important work. He was where HE wanted him.  Maybe that is why despite his “ bone cancer” that crippled him for 2 years , he would still go help the attorneys constantly and would not take pain meds except over the counter meds–like candy- worthless alone for this and have a limit per day anyway. Oh My God, I know the  agony he had to be in but for him LIFE was his wife and helping those men, his brothers;  some living, some dying, some dead- and he was going to make it  to the next one. He  died 72 hours or so later . OK, so now I am crying again.

God puts such men in the path of so many unwitting and all that special man has to do is be themselves, again and again as the tapestry changes but all the colors are all still there and unfazed and the effect  on most, soon or in time is  deep, exponential , immemorial and as I heard, very often passed on by initially mimicking  and soon heart and head wise knowing – from  “Vern-Ing” the right thing to do.

In over three decades of practice, every time I took care ( wait, reverse that)  of men from that era, something deep and special stirred. I’ll spare the many  metaphors as to what it was like– just it was many  of the things I needed. Still do. Don’t go thinking that are only a few who do too. There were many of those” Special men”  in that day,. Maybe that’s all hyperbole or maybe,  we look at those men as we might now at  the Founding  Fathers  and say  of both “These were men” I will let history write that report card; but those Oakies who made it, and others; well they’re just something special; . Dead cow and all

I tried many times, but I just could not put one of the stories of such a man  in my book on Cancer   I really tried. So I assumed they were sent and meant just for us. I was wrong. The story is now  on the website of my book  ( above) and Facebook Widget) –left bottom of book web page on the  also on the blog . I think that will ensure  thousands  will …”Know What Ya Mean, Vern”.

This was my  first outing since pneumonia and then back up into the colder air. Stupid? Nope! It would have been truly  stupid NOT to go and it was worth every spleen splitting cow calling  coughing fit holler. Cars filled the parking lot and 1/2 mile up either end of street . Folks were standing anywhere they could. Stories were wonderful and tearful if you had any heart. My loss in not knowing him.

OK OK …the “ Dead Cow”   story . But that is the only story I’ll just pass on to you fellow wranglers and rail men and those of our greatest generation. The rest of the stories were part of the price of my admission to something very holy. Vern’s family was durt poor, that’s worse than its neighbor of dirt poor in 1930’s in Oakie-Land…..

Well, just one part of this story is almost  straight from Samuel  Clemens pen. The cow was already dead and the  tale is  how , unseen by any , they would drag the same dead cow across the railroad tracks just a skip ( although not for a dead cow) away . Let’s just say  they lived off the settlements as long as that  sadly alleged  railroad hit cow could hold up its end…and more, so to speak

I will miss you Vernon.

I pray it’s for not too long . Yesiree, you can do that if you know where they are and it is  just where you hope to be

Kevin P Ryan MMM MD FACP

Internist, Hematologist, Oncologist, Palliative Medicine

Colonel USAF (ret) USAF

Professor of Medicine UC Davis (ret)

Cancer Survivor