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Dave: Hi folks, this is Dave Bernstein, and welcome to Story of Survival. Today, we’re speaking with Dr. Eric Lubiner, from Florida. He’ll be telling us about his own personal story of survival with patients, how they not only survived cancer, but thrived in its aftermath. Without further ado, let’s go ahead and welcome Dr. Eric Lubiner. Eric, how are you doing, today?
Eric: I’m great Dave, thank you.
Dave: Thanks so much for joining us. I really appreciate it. Tell us a little bit about yourself, your background, your bio, and your credentials.
Eric: I’m a medical oncologist. I did my undergraduate training at Rutgers University Cook College. I then went to medical school at the University of New England College of Osteopathic Medicine, in Biddeford, Maine. I received my D.O. degree in 1994. I did three years of internal medicine residency at Morristown Memorial Hospital, in New Jersey, and three years of hematology and oncology fellowship at Robert Wood Johnson Medical School and the Cancer Institute in New Jersey, in New Brunswick, New Jersey. I then moved to Port Charlotte, Florida, where I’ve been a medical oncologist for the last nine years. That’s where I am, today.
Dave: What is your personal experience working with people with chronic and terminal diseases, specifically cancer patients?
Eric: As I stated; my training in cancer itself was three years and then the nine years that I’ve been in practice, so for the last twelve years I have been treating cancer patients on a day-to-day basis. I see cancer patients five days a week in the clinic, and in the hospitals as well. I also participate in research at our practice.
Dave: No doubt discussing the situation of cancer with patients can be a very stressful thing. Certainly, telling a patient bad news is one of the most difficult things a doctor can do. How do you handle a situation like that? Do you have to protect yourself emotionally?
Eric: I think the most important thing is to have a life separate from the oncology practice. My wife and my fourteen-year old daughter keep me very busy outside of the office. I just keep my work life and my home life separate. This way, it helps me when I have to deal with difficult situations during my practice.
Dave: When you are dealing with patients, what are the initial reactions they go through when they hear the news for the first time? Is there sadness, shock, anger? What do you experience?
Eric: Many times, patients will come to me with the diagnosis already established; however, there are definitely situations where I am the barer of the bad news, especially in the hospital setting when a diagnosis is first made. Many times, a patient has a suspicion already and we discuss all the aspects of the diagnosis, how it was made, what the reports are from either the scans or pathology reports, and what does that mean as far as their overall prognosis.
Many people hear the word cancer and all of a sudden they think they have a terminal illness, which is quite untrue; more than 60% of patients diagnosed with cancer are alive ten years after their diagnosis. We actually do a very good job in handling this disease, now. Therefore, we have to focus on the positive.
Dave: I was just going to ask you about that. Obviously, when you’re dealing with something like cancer, it’s not necessarily terminal. Obviously, they’ve got to overcome the shock and anger. Is there anything else, specifically, that you do to turn this extreme negative into something positive? I’m sure it’s more than just a pep talk; it’s a matter of attitude and everything.
Eric: Absolutely, a patient’s attitude is the most important thing. I try to help that along. Sometimes, a lot of it has to do with the conversation once I’m getting to know the patient. I usually bring a little bit of humor into it as best as I possibly can because a smile or laughter sometimes will really change the entire atmosphere of the conversation. Then, it’s starting with the positive attitude and trying to tell patients that they are going to be part of this fight and that they need help me help them.
Dave: Let’s go ahead and switch topics for a few moments here. What do you think, in general, are the main root causes of cancer?
Eric: Cancer is not just one disease. It’s many diseases and I think that is the first misconception that people have about the word cancer. It represents over a hundred different diseases and every different kind of cancer is treated very differently and has a different prognosis. It’s caused by a change or damage to the DNA or the signal inside cells that tells cells to divide. Normally, all of our cells divide to take the place of cells that are worn out and depending on what cell of your body it is; some of the cells divide faster than others.
Every time a cell divides, there’s a chance that something goes wrong in the cell division and there’s some damage to the DNA. Most of the time, we have mechanisms that can repair that damage, but sometimes that damage persists and the cell starts to grow without control. That’s what cancer is; a cell that’s growing out of control and it doesn’t follow the normal rules that cells in our
bodies do. We never find lung cells in our intestines, but lung cancer cells can travel anywhere.
Dave: How do you help your patients understand exactly where their personal cancer comes from? Are there ways to prevent cancer? How do you ease that realization when they know they do have cancer and there might be something they could do to prevent it in the future, or in the past?
Eric: That’s a very good question because many people do spend a lot of time focusing on how did this happen, or why did this happen to me. One of the major causes of cancer is genetic. It’s your inheritance. Some people are just born with genes that make them more susceptible to developing cancers. There’s really nothing that they can do about that. When they realize that it really wasn’t their fault – the saying goes, “You cannot choose your parents,” and it seems to be that it’s not just something that happened.
Obviously, when it comes to certain specific malignancies, like lung cancer, and everybody always says, “Lung cancer – the person must have been a smoker; they deserve to get it.” Well, it’s terrible and I never focus on that. If a person was a smoker and they got lung cancer, we need to deal with the cancer.
There, we take the disease, the stage, the treatment, and we focus on the present and the future and we just eliminate the past. The patient understands that they did something that may have contributed to them developing cancer. If it’s something that I feel is very important that they now stop doing, such as smoking, which for most cancers, once you undergo treatment for cancer it is very important that you allow your body to heal. Anything you can do to improve that, such as smoking cessation is going to be very important. We can talk about that in specifics, or discuss it in conjunction with their primary care doctor to get them on a program to stop.
Dave: I’d like to expand on that answer; you brought up a very good point. I think there’s a lot of myths out there that just because someone does have lung cancer that they’re a smoker, or just because they have skin cancer, that they’re laying out in the sun three or four hours a day. Are there any actual percentages? The folks that may have lung cancer, the majority of the folks – are they smokers?
Eric: In lung cancer there is a very strong association; probably about 90% of all lung cancers are smokers or former smokers. The damage may have been done years and years before. I believe that the statistics say that if you quit smoking, however, at about 8 years from when you quit, your risk of lung cancer
approaches that of non-smokers. It never goes away completely, but quitting obviously has excellent benefits.
There are very well-known cases of people who have never smoked and still get lung cancer. Dana Reeves, for instance, Christopher Reeves’ wife passed away from a lung cancer and she never smoked.
Dave: Much has been said about the mind and body connection. Do you believe that cancer is not only a disease of the body, but also of the mind?
Eric: As far as causation, there actually have been studies looking at whether stress does cause cancer or if increased stress causes cancer. There hasn’t been a lot of good evidence showing that it does; however, we do know that once somebody does have the diagnosis of cancer, their attitude means everything. If they are resigned that the cancer is going to cost them their life, then typically the best medicines in the world are not going to do anything because the attitude needs to be as positive as well, and the patient needs to be part of the fight.
Although I don’t know, off the top of my head, any studies that have proven that, in the twelve years I’ve been practicing I’ve seen that dozens of times. The attitude really makes a difference in the prognosis of the patient. I do believe the mind plays an extraordinarily important role in the cancer patient.
Dave: Certainly with attitude, I would think that stress cannot help very much. I’ve talked to a lot of folks and they’ve mentioned they do whatever they can to relieve stress. They become very at peace with what they’re going through. Certainly, it may not be caused by the mind but they can slow down the acceleration; do you feel that’s true?
Eric: Absolutely – meditation, yoga, T’ai Chi, or other practices that calm the mind down are definitely beneficial. Occasionally, it is necessary to use pharmaceutical intervention. There happens to be a lot of antidepressants out there and sometimes they are necessary in our cancer patients. We try not to use them if we don’t have to but occasionally the overwhelming diagnosis and the consequences of the treatment do require something more than the patient can do on their own. As I’m sure you probably know, many people are very good at relaxing themselves and many people are not.
Dave: In the past, it’s well known that chemotherapy not only destroys cancer cells, but unfortunately it also destroys healthy cells. Has this been a concern for your patients? Is it a myth? What other methods of eradication are possible, if so?
Eric: I am a medical oncologist, which means that chemotherapy is what I do on a day-to-day basis. Chemotherapy has come a long, long way. You’re absolutely
right in that chemotherapy goes after cells that are dividing rapidly. There are a lot of normal cells in our body that divide rapidly.
The side effects of chemotherapy that people are very familiar with, such as hair loss, nausea, and vomiting all have to do with the fact that cells, such as the cells of our hair follicles and the cells that line the mouth and gut are all cells that divide very rapidly. They are affected by chemotherapy.
Over the years, we have come up with some excellent medicines to prevent many of the side effects of chemotherapy. We haven’t figured out how to stop the hair loss, but we’re very good at preventing nausea and vomiting, and we’re very good at preventing some of the other side effects.
The most rapidly dividing normal cells in our body are the blood cells in our bone marrow. The white blood cells, which are very important in fighting infections divide and we turn them over three times a day. They have a half life of about 8 hours. They typically will go down every time you get chemotherapy and then you can be at risk for developing infections, but we have medicines now that can help boost those white blood cells and prevent them from going down.
Those are the supportive measures we have for using chemotherapy because chemotherapy is still a very effective and very proven way of treating cancer; however, we still would like something a little bit more targeted. We can do an entire interview on targeted cancer therapies because they’re the latest and the greatest ways of treating cancer. They try to use these approaches that are not as shotgun approach as chemotherapy is. They will look at the actual damage in the cancer cell and address that at a molecular level. Some of these medicines are now given orally as tablets.
I’ll give you a very good example of a rare but what was once a very deadly type of leukemia called Chronic Myeloid Leukemia. There is a medicine called Glivec, or Imatinib is the generic, which actually stops the abnormal protein that’s formed by the genetic mutation that we know causes this disease. Since we know the genetic mutation that causes this disease, we have been able to design this drug to address that particular problem. Patients can take this pill once a day like they’re taking a blood pressure medicine and their cancer is literally cured for life.
Dave: That’s fantastic information. I’m glad you shared that. When the patients have been working with you for quite a while, and their treatment is coming to an end, do you normally follow up with patients after their treatments or throughout their treatments?
Eric: Absolutely, as a matter of fact, the American Society of Clinical Oncology, which is the society that most cancer doctors belong to, has now put a very strong emphasis on cancer survivorship and how to treat the survivors. Survivors of cancer need to be followed closely and usually the way they’re followed is very closely for the first couple of years after their diagnosis, and then a little bit less until we get to about five years. Then after five years, usually it’s very unlikely that the cancer comes back, depending on what type of cancer they have.
Personally, I see my patients typically every three months for the first two years, every six months until we get to five years, and once a year after that. I never like to discharge patients completely from my practice because actually seeing survivors out five, seven, ten years is a very important morale booster for me. It helps me treat the patients that aren’t as lucky and don’t have those long-term survivals.
Dave: The title of our interview is Story of Survival. We also talk about thriving after one has been diagnosed with cancer. Have you noticed any amazing things with your patients after they’ve gone through therapy, after you’ve worked with them for a while, some things you thought they’d never do again?
Eric: Oh sure, I mean; patients I had when I was in training as a fellow – there was a woman with a disease called Multiple Myeloma, which I believe Geraldine Ferraro who ran with Walter Mondale has been diagnosed with, as well. Multiple Myeloma is a disease of the bone marrow and immune system. For many years we had very little or very poor treatments for it. It was invariably fatal within one to five years.
A woman who was literally on the brink of hospice care, or end-of-life care was placed on a medicine called Thalidomide. I don’t know if you recall Thalidomide but back in the 1950s and 1960s it was given to pregnant women in the UK and Canada. They unfortunately gave birth to deformed babies with short arms and short legs.
Somebody who had a little more brains than I do took a look at that and said, “Why did that happen?” The reason is Thalidomide is a very potent antigenic drug. It prevents creation of new blood vessels. In the developing baby, they couldn’t develop the blood vessels to make the arms long, but we also know very well that cancer needs the blood vessels to grow.
Somebody who is not pregnant or never going to be pregnant but has a cancerous illness, they may take Thalidomide. It can sometimes make the cancer go away. In this case, this woman not only took this pill and went into remission, but she got out of bed, wrote, directed, and starred in a one-woman
show off Broadway about her experiences. I thought that was pretty amazing. She was literally on her deathbed prior to that.
Dave: That’s fantastic; she absolutely thrived through all the adversity. That’s great news.
Eric: And now we’re a decade later and Thalidomide is hardly used anymore because there’s been another generation of medicines such as Lenalidomide that are even better and have less of the side effects that Thalidomide does. The most exciting thing about practicing oncology in this day and age is that it’s such a vibrant and ever-changing field. There is always something coming out.
Dave: Absolutely, as an obvious expert in your field, what do you think are the most important qualities of an oncologist that cancer patients are seeking?
Eric: A patient needs to be comfortable with their doctor. Cancer is such an emotional and very involved disease, so a patient needs to be able to walk into a doctor’s office and out of the doctor’s office being comfortable that the doctor is not only giving them the best care but also keeping abreast of all of these changes that I just talked about, and that the doctor is also listening to them, being open to their suggestions of therapies or alternatives.
If a patient is not comfortable with their cancer doctor, I think it is imperative that they change because it will change their attitude. Their attitude, a lot of times, comes from their perception of the care that they’re getting.
Dave: I fully agree. We’ve got just a few moments left of our interview. Dr. Lubiner, are there any final thoughts, any words of hope and encouragement you can impart to our listeners?
Eric: First of all, the diagnosis of cancer is not a terminal diagnosis. Even in the late stages of cancer, when it is an incurable illness, many of our treatments now work so well that patients can live many years with the treatment. We are taking cancer and we’re turning it into a chronic illness, such as diabetes or high blood pressure. We never cure those either, but people live with them. Many times, even if it’s a cancer we cannot cure, we can still treat very successfully.
Dave: I think it’s a matter of working hard, keeping the faith, and just knowing that medicine is doing its best. Your doctor is doing his or her best and you need to do your best, as well too.
Eric: Exactly
Dave: No doubt, you’ve been a wealth of information, from someone who has definitely seen true stories of survival firsthand. I definitely want to thank you for joining us on the interview today.
Eric: Thank you so much for having me. You can look at my website at www.flcancer.com, which has a lot of resources for yourself or for patients. There is a lot of excellent resources out there, including the American Cancer Society and the National Cancer Institute, which I would also recommend checking out.
Dave: Absolutely, thank you for mentioning that. I appreciate that. We’ve been speaking with Dr. Eric Lubiner, from Florida. He’s been giving us a candid look at his patients’ own stories of survival. This is Dave Bernstein. I would like to thank you for joining us today. We’ll talk to you soon.