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I am really honored to be joined by Laura today, and Laura is a patient who has experienced lung cancer, and, uh, uh, I'm really grateful to be able to have a conversation with her a little bit about her journey. Um, Laura, thank you so much for, for joining us. I, I wondered if you could maybe start by sharing a little of your story from your first symptoms to your lung cancer diagnosis. Sure. Um, so in 2015, I had just retired from my job and I was about to move across the country from New York to Washington State. And one morning I cleared mucus in my throat, into the sink and there was a tiny thread of blood in it and um I had no other symptoms but since I'm, I was a hypochondriac at that point, I made an appointment with my primary doctor and he sent me to an ENT doctor. So, the ENT doctor uh examined me and told me I had an irritated throat and nasal polyps, but um he also ordered a chest x-ray just to be safe. And by the time I got back from uh home from the chest X-ray, I had a call from the hospital asking me to come in for a CT Scan because they saw a nodule. In my lung in the X-ray and I was then told to follow up with a pulmonologist, which I did. He said, you know, we could watch it. Um, and so I scheduled an appointment with a pulmonologist when I arrived in the Seattle area. Um, and he didn't seem to be too concerned. Um, uh, he thought it was, um, could be a, uh, I think he said an infiltrate or something or, um, Uh, and he said I could, I should continue to get CAT scans every 6 months, but nothing changed, um. And so around July of 2016, I started to get really severe pain in the back of my neck. Um, I got an appointment with a physiatrist who ordered more tests and also prednisone because I was in a lot of pain. Um, and then she told me cause I was worried it was cancer, uh, cause I was always worried about getting cancer for some reason. Um, she told me it wasn't cancer, but that I should see the orthopedist, uh, to make sure if my neck was stable. So when I saw the orthopedist, he said that he believed that the nodule in my lung was cancer and that it had traveled to my C4 bone. Um, I asked him why the physiatrist hadn't told me it was cancer and he, he just said that she didn't have the guts to tell me the bad news or something like that, which was kind of strange. And um, I was really angry. I couldn't believe that he was, you know, that what he was saying and uh, he had to keep telling me, you know, no, it's, uh, uh, I know it is and you know, I know it's a shock, but this, this is the truth and, you know, you have to treat it and so it was pretty shocking. Thinking back to that overwhelming diagnostic period, we've been talking a little bit about biomarkers on our education session today. When did you first learn about biomarker or molecular testing and what was that, what was that like? How was that concept explained to you? So, I vaguely recall, I, I got a, uh, a thoracic oncologist, and I, I vaguely recall him saying something about biomarker testing, but to be honest, I was in such a I was just so Got smacked, is that how you say it? Um, I didn't, it didn't really register with me. Um, but the biopsy did show that I, I had a targetable mutation. So, I really didn't know very much about it, and I, I was in no state to like absorb that information, to be honest. And based on your experience, what advice would you give to community oncology teams about how to best explain the purpose and timing of biomarker tests to a patient who's still processing a new diagnosis? Uh, it's a hard one. So when you're diagnosed with lung cancer, you're so overwhelmed and in shock and worried that you're gonna die soon. It's, it's really hard to take in much information other than how much time do I have left. Um, I would advise an ecology team to first get a newly diagnosed patient to a support group to talk about their fears about mortality, uh, their concerns, um, You know, about how it's gonna affect their families, uh, um, and then point them in the direction of a biomarker group, um, advocacy group. Uh, you know, there's, uh, BRAF group, um, that concentrates on patients with, um, uh, BRAF mutation. Um, they're, you know, on Facebook and they're private groups and they're very active and people really are very supportive. There's a lot of good information in there. Um. And I think it's really important to connect patients with, uh, with, with, with that particular group and also organizations, well, in the United States like Longevity and go to uh Foundation. Um, you know, again, it's a lot of information coming at them at a time when they're really in a tizzy and maybe when they have, um, subsequent visits with the, with the oncology team and it just to settle a little bit more, um, that would be a good time to check in with them on their understanding of their disease. And once your test results were in, how did your care team discuss your first treatment plan with you? What, what did they do or say that gave you confidence in the recommended path? Um, you know, it's all really vague to me cause I was like, you know, an altered state, to be honest. Um. I remember my oncologist setting me up with medi medi medication and saying that, you know, uh I had a special mutation that I, there was this targeted medication for it and um I remember reading about the side effects that, uh, there was a book that they gave me uh with information and it all sounded pretty scary, the side effects. Um, uh, to really be honest, I don't think that they could say anything to, to give me confidence at that point. I knew I was stage 4 and it was incurable and it was cancer. What can a clinical team, the doctor, nurse, pharmacist do to make you. Feel comfortable calling them about new or worsening side effects rather than just toughening it out at home. Yeah. Um, in my particular situation, um, I did develop a nasty rash from the medication and the medical staff communicated that I should stop the medication for a week and see if the rash was better. Um, the skin on my face looked really bad and I was, uh, very self-conscious and embarrassed to be seen. Um, it did resolve, so I was able to resume medication after 10 days with dose reduction. Um, I think at this point, the best thing that the team can do is make sure that they have someone who is very responsible, I'm sorry, responsive and reassuring communication, um, with the patient. Uh, I think, again, to be honest, I don't think many doctors, uh, realize how their staff members treat patients. Uh, I, in my experience, I've, um, Uh, I've felt that they, they're, that they're there to protect the doctor against the patients so that the patients don't bother him, um, or her, and I think that's really not, uh, I don't know if the doctor's aware of that or if that's what he wants them to do, but it's really important to have staff that are compassionate and, um, don't make someone feel, uh, like a pain in the ass basically by calling in about their, their, you know, their side effects or whatever. What do you see as the biggest unmet need or communication gap for patients starting a new targeted therapy in the community setting? So, in, in my opinion, I think the major unmet needs, um, probably psychological, uh, at this point. Um, how do you deal with fear and anxiety? How do you tell your family and kids and friends that, you know, you're Maybe terminal Uh, or you have cancer. I mean, cancer is the This is one of the most scary things uh people could imagine happening to them. Um, I think they need to, uh, they need to clarify their diagnosis in layman's terms and, uh, instead of using, you know, fancy medical terminology, um, and let patients know where to find important information for learning about their disease because I believe that a well-informed patient, uh, and who advocates for him or herself, uh, is gonna live longer and get better care. Uh, access to patient educators like nurse navigators for financial support, palliative care, access to expensive medicine, uh, assistance, medical, uh, medicine assistance or, um, discounts, that's important. Um, many institutions say they work as a team, but they really don't, and patients don't want to be ping ponged to various doctors when they have Uh, either side effects or, you know, problems. They don't know whether it's related to cancer or it's related to something else. Um, so I think that's important, uh, as well. And if you could give one piece of advice to all the healthcare professionals in our audience today, what would be the most important message you'd want them to take back to their clinics? Um, I, I would suggest that they be very kind to their patient, compassionate. Don't speak to them condescendingly. Um, listen to your patient instead of just talking at them and be open-minded and try to use patient-friendly language, not, you know, medical jargon. Um, and most importantly, allowing patients, uh, if they choose to share in decision making about their treatment, um, and allow, you know, time for questions and not rush the visit. Also, I would encourage, um, doctors not to be closed-minded about, um, Complimentary complimentary therapies that, uh, you know, are offered by oncology, naturopaths or other um medical experts.