Transcript generated from the episode’s audio. Speaker names are identified from the context of the conversation rather than from recorded speaker data, and automatic transcription may misspell names and terminology. Please refer to the video for the authoritative version.

David Raubach: I want to welcome you guys to the Cancer Project podcast. We’re really excited today to be joined by Jennifer Watkins. She is the chronic disease coordinator for the Oklahoma Department of Health. And she and her team are leading a broad spectrum of initiatives dealing with things like arthritis, tobacco use, and cancer, and that’s what we’re a lot of what we’re going to talk about today here on the Cancer Project podcast. So, Jennifer, thank you so much for joining us.

Jennifer Watkins: Thank you for having me.

David Raubach: So, first I think we should get to know you as a person. And then Annie, too.

Jennifer Watkins: You have Annie, the star of my show.

David Raubach: Yeah, your English bulldog here. Super cute. Really well behaved, too. So tell us a little bit about just kind of your background and how you ended up working for the Department of Health here in Oklahoma.

Jennifer Watkins: Yeah. So cancer kind of came into my life when I was 11 years old, sitting there waiting for the school bus and I found out my mom was diagnosed with breast cancer. About two years later on July 4th, she passed away.

David Raubach: Oh wow.

Jennifer Watkins: From cancer. So it definitely changed the image of freedom to me. But it gave me a purpose of kind of the rest of my life. So you know I started out working for the American Cancer Society right out of college and then I worked for the National Cancer Institute, MD Anderson, different things. So I really had some really solid cancer connections through that and my goal was just to make sure no one else went through what my family did and that my children would never go through that as well. So that really drove the cancer piece for me. So it’s something I’ve always been in 25 years of professional career. And then you know like we were talking earlier about 10 years ago I lost my dad to colorectal cancer too.

Jennifer Watkins: So just knowing how these families feel when they don’t always know where to get the answers really is what drives my work and everything. And having the opportunity to go back to the health department and make a difference was a great thing for me. And so I’ve been there about 3 years working with the coalition and working with CDC on things.

David Raubach: So and so cancer is one of those things I think as you can attest to that impacts everybody. I mean just about everybody has a friend or a family member or maybe it’s them personally that have gone through cancer. So talk a little bit about if as much as you’re comfortable what it was like for you as a child or a child of now two parents that had gone through cancer. What was it like for you personally?

Jennifer Watkins: I you know back then this was late 80s and we didn’t know what cancer really was. Oddly, I was from a very small town and a couple of other girls whose moms had gone through cancer at the same time. We had a cheerleading coach that was able to connect us and she would have lunch with us about once a month and we would just talk and that was kind of the first connection I had to the support of what families go through outside of my own family in our church. But you so that really kind of helped me understand maybe what some of the families are going to go through.

Jennifer Watkins: So working with ACS and you know I’ve always been that had that patient interaction and so as much as you hate to have gone through it and I hate that my mom went through it knowing a little bit about what a family is going to need I think definitely helped.

David Raubach: Well it sounds like it changed the trajectory of your life because it kind of gave you this career path that you chose. So then what was maybe similar or different as you went through being a caretaker a second time for a parent with your dad?

Jennifer Watkins: It brought up a lot of those old feelings that you didn’t really expect but also kind of knowing a little bit about okay well this is the connection we need to make and this is who I need to talk to. You know, I think that really helped the second time around is knowing what questions to ask and having the resources to be able to ask them was so critical. And you know, like my dad actually went through treatment at the Proton Center and I knew about it from my work with the coalition outside of my dad’s treatment, but getting to see that firsthand and the patient care and the resources was an incredible opportunity as well. Yeah.

David Raubach: Yeah, I think one of the things that we talk about at the proton center and maybe you can comment on this is that we want patients we know we have great technology there. A proton machine is the most sophisticated medical device that’s ever been made. And we so we can do some incredible things clinically, but there’s also this there’s a human element and there’s a psychosocial element and there’s a mental health aspect to going through treatment. And so we want patients that come to the Proton Center to have the best health care experience that they can possibly have even as they navigate something as difficult or traumatic as cancer. So maybe talk a little bit about just the importance of the care that exists outside of just the treatment itself.

Jennifer Watkins: Oh absolutely. You know, and I think it does have to be that holistic approach because your 10 or 15 minutes with your physician, you can’t get all your questions answered. It’s not possible. So, having the big picture approach of having a patient navigator or a social worker or somebody that can help you understand what your insurance options are and what your rights are is incredible. You know, we have kicked off a cancer survivorship series called beyond the diagnosis and yesterday was financial toxicity and we brought in an attorney who specializes in cancer legal matters.

David Raubach: Okay.

Jennifer Watkins: And so she was able to walk our participants on and you know we’ll share the recording to access those resources but she was really able to share these are what your rights are and these are the questions you’re allowed to ask and when you’re so worried about the financial aspect of it you know this is what you need to know that you have absolute rights and it shouldn’t be a terrifying experience from every angle because I think it can you know, you’re worried about your own mortality, but you’re also worried about can I put food on the table? Can I feed my kids or my family? Can I do I pay medication or electric bill? So helping address some of those issues was wonderful to have. We’re also looking at some of the social and emotional aspects of physical activity and nutrition.

Jennifer Watkins: What food is going to be the best to help your body heal and make the treatment most effective? How can you get the most physical activity so that your body feels good when it’s at its lowest, right? We’re also doing a session that I’m really excited about because it was kind of the brainchild of a cancer survivor story and it’s uncomfortable questions.

David Raubach: Okay.

Jennifer Watkins: You know, once you’re kind of through treatment and you’re getting back into intimacy again or your body is so different, the bowel movements are different and things that you didn’t think about beforehand. But how to reconnect with your partner and have conversations and again those are some of the things that’s very hard to fit into a treatment protocol but are so healing in the big picture.

David Raubach: So, I want to I want to make sure I get these right because I wrote down the titles of some of these sessions here. So, you have let’s see here. We’ve got financial toxicity, the other side effect. So, that’s the one you just talked about. I do want to talk about that more.

Jennifer Watkins: Absolutely.

David Raubach: Food, fitness, and fighting cancer. Some great alliteration there. The role of lifestyle and cancer treatment. Caring for the mind, suicide prevention, and emotional well-being in cancer. More than survival, the lasting journey of childhood and young adult cancer survivors. And then what you just talked about unspoken questions, intimacy and connection after cancer, right? So going back and so this is just to give people some details. So these are every Wednesday.

Jennifer Watkins: Yes, every Wednesday at noon via Zoom. So and like I said, these will all be recorded. So people that aren’t able to participate, we will have them linked to our website. I’m happy to share those with you as well.

David Raubach: Okay. Yeah, we’ll put the link for those listening. We’ll put the link in the in the comment section.

Jennifer Watkins: Yes, that absolutely works. And so, you know, we’ve got a lot of information on our social media pages for the health department to be able to access that. But yeah, we really kind of through talking to some of our survivors that are helping us really change the narrative.

David Raubach: Yeah.

Jennifer Watkins: We kind of discovered that this is such a needed piece. And the more I talk to people even outside of Oklahoma, we’re actually setting a trend, okay, for other states to be able to do this as well. So I had a conversation with Ohio yesterday and she said, “I never even thought of this.”

David Raubach: Yeah.

Jennifer Watkins: And you know, so we’ve had that opportunity as well. But you know, like I said, the financial toxicity piece was people just need to feel like they have some options and that, you know, it’s not just I can’t even go through cancer treatment because I can’t afford it. That’s such an unfair feeling.

David Raubach: What are some resources that people should think about? So, and I want to step back and kind of lay some groundwork of things that we’ve observed at the Proton Center. I read a stat one time that suggested that over 50% of patients that go through cancer treatment end treatment in some type of debt. And that may be because of the treatment itself. It may be because of their they’re out of work. Caretakers are having to be out of work. Maybe they’re having to travel. There’s certainly a lot of expenses even beyond just the treatment itself that you experience going through something like a cancer diagnosis. And so it is a reality for people and of course there’s the question of is my insurance going to pay for treatment and I’ve got a deductible and then the deductible is going to reset at the end of the year so I have to pay the deductible again.

David Raubach: And that’s a lot to think about. And so as an example, we have a foundation called the Proton Pal Foundation that steps in and helps patients deal with some of those costs that are not covered by insurance. But what are some other resources that people should be thinking about as they’re wondering how do I pay for everything as I’m going through cancer treatment?

Jennifer Watkins: That’s a great question. And you know, finding the actual dollars can be very difficult. But you know the organization that we partnered with yesterday is a national organization called Triage Cancer.

David Raubach: Okay.

Jennifer Watkins: And they are incredible. It was founded by two attorneys and they saw the need for cancer patients and survivors and family members to have access to the legal support of cancer. You know one of the we actually so with every session that we do we have a survivor tell their story. So that it kind of gives a face to the story and people can see a connection. And so the man that we had yesterday and he lets me tell his story. So but his name is Curtis and he actually worked in insurance, okay, before he was diagnosed with prostate cancer. And he realized that, you know, like a lot of us, our insurance is tied to our jobs. And when he didn’t have the strength or the stamina to keep up with his job, he lost his job and he lost his insurance just as he was diagnosed with prostate cancer.

David Raubach: Yeah.

Jennifer Watkins: And he said, you know, I had a little bit of savings, but that doesn’t go very far with treatment. And so, you know, he told his story yesterday and it was so impactful because it really is the real life picture of the human side of all of this. So working with Triage Cancer, they have attorneys that you can actually connect with, which is fantastic. There’s a simple form on their website that you can go in and kind of start the conversation and then they connect you. But they also have resources and worksheets and guides to kind of help you walk through the financial side and you know the tips of look at this bill but wait for the EOB and you know have those kinds of things where you’re not well I paid this bill but then I didn’t have to and those different things.

Jennifer Watkins: So it was such a great tool and everybody on the call they were just amazed you know we want to access this and so it was a really great thing to be able to work with them as well and see what’s available and so yeah the one of the things that we talk to our patients about and is don’t be afraid to bring up the fact that you have a financial burden or this financial toxicity.

David Raubach: I think I mean I can probably speak for all of the big cancer centers here in Oklahoma City, SSM Health, Mercy, OU, and ourselves and Integris. All of the all of these cancer centers want to help patients get through treatment. And they all have teams and resources that are designed to help patients. Even if it’s something as simple as, can I have a payment plan for this bill? Or is there a way to possibly have a charitable discount for the bill? A needs-based charitable discount. Those are things that exist, but sometimes it is imperative for the patient to take the first step and ask, but that’s so hard. It’s so hard to just admit that.

Jennifer Watkins: Yeah. And you know, when you’ve just kind of been told one of the biggest life changes, right, then you’re still trying to process your diagnosis and not all of the other things. So, you know, taking a minute and being able to ask those questions of, you know, is there an option? What can I do? And we’ve got some amazing centers here in Oklahoma and resources available. So, feeling like you don’t have to travel to put that extra burden on, I think, is so important, too.

David Raubach: Well, I think the Hope Lodge is a great example of that with the American Cancer Society. Patients traveling into Oklahoma City for treatment can stay there at a significantly discounted or free rate. And so that’s an incredible resource that we have here in Oklahoma City. Not every city has a hope lodge like that.

Jennifer Watkins: Yeah. And I know how hard they worked. A friend of mine was kind of the lead on that and I know everything she went through to get it here and it was phenomenal to see that come to fruition.

David Raubach: So I want to bring up one of these other topics here because I think that this is also something that is it needs to be talked about. So in two weeks you have a topic caring for the mind suicide prevention and emotional well-being in cancer. Talk a little bit about why that is important and why that’s a topic that you guys decided to cover.

Jennifer Watkins: And I think it’s one of those topics that is hard to talk about. So, you know, why don’t we start the conversation was how that one really came about that, you know, there’s such a need and sometimes there’s a stigma on that feeling of mental health and hopelessness. And so, we wanted to start the conversation again, have a survivor tell their story of how difficult it was to kind of come to terms with everything and just the changes that they’re going through. So that was really what kind of created that topic and that was one of the like I guess main topics behind this whole series was this is important and so we want to cover that.

Jennifer Watkins: And so knowing that the risk of suicide because of depression and hopelessness can be so high in cancer patients, survivors, caregivers because they feel alone and they don’t know who to talk to or how to talk about it. The medication may just make their brain feel very foggy and so they’re also not in the best headspace as well. So having an outlet for them to talk to, providing resources for them, I think is going to be so critical to really support them. We have a he’s one of our team members at the health department and he does a great job on the mental health aspect and so he’s going to help us with that series as well.

David Raubach: I’m glad you mentioned caregivers, too, because one of the things that we see is, of course, everybody thinks about the patient and what the patient’s going through. And it there’s going to be dark days, there’s going to be physically challenging days, mentally difficult days, but it also can take a toll on spouses, on kids, on parents. And one of the things you mentioned was just that conversations about intimacy. Well, the mental health and intimacy can kind of go hand in hand. And just getting through as a caregiver some dark times and we’ve just seen too many times where a marriage falls apart or you know, there’s conflict within the family or difficulties within the family because of this catastrophic disruption that can happen with cancer. So, I would say, you know, it’s not what you’re talking about. It’s not just for the patients, it’s for anybody involved in the care.

Jennifer Watkins: Absolutely. And you know, sometimes, and obviously I’ve only been the caregiver in this situation rather than the patient, but you know, the patient there’s active treatment. There’s active things. And we do hear about once they’re done with treatment, the fear of recurrence because they’re not actively treating it. But for the caregiver, there’s not active treatment. They’re just trying to support. Well, who is supporting them? Who is there for them? And so having that piece too, I’ve had some conversations with people and you know her husband was is the one going through treatment and I said join both of you. I would love to see both of you on there so that you get your own piece.

Jennifer Watkins: And I would love to see this series be able to break out and you know we have kind of a track for survivors and we have a track for the caregivers so that they can talk to in an open space just kind of to people who have been through it with them.

David Raubach: So tell me who are some of the other So you mentioned this triage group that was the presenter for the first episode. What was who were some of the other presenters that you have lined up?

Jennifer Watkins: So next week we will have the YMCA who will kind of handle the fitness piece and then we will have the dietitian oncologist from OU.

David Raubach: Okay.

Jennifer Watkins: And we’re really excited about that because I think that’s one of the least understood aspects of direct treatment is, you know, you don’t feel like eating and you don’t feel like anything. But you’ve got to get enough calories for your body to be strong enough to fight this and work with the medication you’re taking. So just having that, also having the resources of knowing if I’m trying to pay for treatment, I can’t afford good food, right? So where can I access food and what can I do there and how can I find the best you know kind of connection to make my situation as good as possible right

David Raubach: So I want to pivot a little bit and talk about the Oklahoma comprehensive cancer network so more broadly I mean this is an initiative right of that so I’m going to read this is the from the website the purpose of the Oklahoma comprehensive cancer network is to continually develop implement evaluate and update the cancer prevention and control plan for OK for the Oklahoma State Cancer Plan. And when did the Oklahoma State Cancer Plan first get published?

Jennifer Watkins: So, this coalition and kind of the cancer focus actually started it the idea came about in about 2000 and then about 2004 was when efforts really started growing on this. So, it has been around 21 years or 22 years now. And it has just grown. It’s got some amazing partners. We have about 40 organizations, okay, that participate. The ones you typically think of, the health centers and the cancer centers and, you know, American Cancer Society, but we also have local programs, survivorship groups that have joined, just individuals who are interested. So, it’s been a really great thing. Our kind of primary focuses are primary prevention. So, how do we prevent or at least reduce the risk of cancer? Screening and early detection, what cancers can be really screened for and how’s the best way to address that? And then survivorship.

David Raubach: Okay. So then, so we’ll take each of those three.

Jennifer Watkins: Yeah.

David Raubach: So cancer prevention. I mean, that’s something that I think a lot of people would love to know about. So that so you can actually reduce your risk of cancer.

Jennifer Watkins: You can and risk reduction is really the most important piece to it because it’s very hard to totally you know prevent cancer. But by doing the things eating well being physically fit having you know a lower body weight obviously don’t smoke don’t be around commercial tobacco and then also vaccination. So the HPV vaccine is very important as well.

David Raubach: Yeah, I think I think it’s Scotland that has or Ireland, I can’t remember which country, but one of the countries in the UK has almost completely eliminated cervical cancer, right? Or HPV related cervical cancer and that’s one of the most, you know, exciting things.

Jennifer Watkins: We have a doctor at OU who is so passionate about it and sometimes we just stand back and watch her work because she is amazing. But you know, knowing that you really can reduce the risk of preventative cancers such, you know, the ones that are tied to HPV through a vaccine and you know, it can be scary, I know, thinking about a vaccine that you don’t fully understand. But [clears throat] it’s such a great resource to be able to truly reduce cancer risk.

David Raubach: What is the state’s role in this? I mean, why is this why is this an initiative? Because this is taxpayer dollars funding this. Well, yeah. Why is this important for the state?

Jennifer Watkins: It’s actually a cooperative agreement through the CDC. And so, most states across the US have these types of cancer programs and plans. And also a few of the tribes. So, Cherokee Nation also [clears throat] has a cancer plan like this and we partner on pretty much everything with them. But I think it’s really important because it’s really not a competitive thing when we can pull everyone together. You know, everyone wants their patients to succeed and they want their programs to succeed, but if we can pull people together and say, you know, hey, here’s some great things going on in breast cancer, so let’s look at what they’re doing and maybe that evidence translates to another program. So just having everybody on the same page, we’re all speaking the same language. The message is very consistent out there definitely helps.

David Raubach: Because I think one of the things that’s been helpful for us as a provider as a clinical provider at the Proton Center is to just hear what other centers are doing.

Jennifer Watkins: Absolutely.

David Raubach: In a sense, you’re you are serving as this facilitator to bring people together to share ideas.

Jennifer Watkins: Yes. Yeah. And I always think back to you know so many people for a while it felt like okay I was diagnosed with breast cancer I have to go to MD Anderson because everybody knows that and MD Anderson is wonderful but to understand that MD Anderson is communicating with OU and with the proton center and those kinds of things and so these the research and the successes and the survivor stories that are being created across the country come to Oklahoma and Oklahomans get access to that and we are all able to communicate with each other and access as well has been so valuable.

David Raubach: Yeah. We tell patients that come to the proton center, protons are protons whether they’re at MD Anderson or at Oklahoma Proton Center. They’re going to act the same way. They’re going to go in. They’re going to damage DNA. They’re going to stop inside the tumor. We both use a particle accelerators. We use the same treatment planning systems. We use the same treatment protocols. So, you’re right. There’s a lot of I don’t think people realize the caliber of cancer care that we have here in Oklahoma. It’s very high quality. I do want to So despite that though, our cancer mortality rates in Oklahoma are not great. Depending on what year it is and which cancer you’re looking at, we’ve tended to be towards the bottom of the state rankings nationally in terms of cancer mortalities.

David Raubach: Meaning if you get diagnosed with cancer, what how long are you going to live after being diagnosed with that cancer or how quickly are you going to succumb or what percentage of people will pass away because of the cancer? So talk a little bit about why you think that is and maybe what the coalition is doing to help address that.

Jennifer Watkins: I that’s a great question and you know definitely I came like I said from a small town. I grew up in the FFA. I understand that country bootstraps tough. You only go to the doctor when your fingers cut off kind of thing, right? But I think understanding that yes, going to the doctor is scary and you may not get the news that you want, but the sooner you go and you find out this your treatment outcomes are so much better. And so we can tremendously reduce mortality rates by early screenings, by following the guidelines at, you know, No one wants a colonoscopy. It’s not the funnest thing in the world. But if that could stop your cancer right there and you don’t have to go through everything else, take a nap.

Jennifer Watkins: You know, that’s kind of and so we definitely want to encourage the early screenings and the health because in Oklahoma we really are tied to so many strong legacies and you setting those strong examples for your family, for your community really kind of creates that legacy as well. So get the early screenings, talk to the doctor, have the conversations. They’re not always comfortable.

David Raubach: Yeah.

Jennifer Watkins: But finding it early to reduce the long-term effects is so important. And that’s really what will change our mortality rates.

David Raubach: What do you think? So do you think that this the So certainly a lack of screening or lack of early screening is probably the biggest cause of the cancer mortality issue that we have in Oklahoma. What do you think I mean you mentioned kind of a cultural component or element to that. Is there an access issue?

Jennifer Watkins: There definitely is. Absolutely. And one of the great things that we’re seeing are these mobile units that are starting to appear. I there are some of the federally qualified health centers, they have some mobile units. U has mobile units as well. And so we can partner, we can make sure that a community, you know, Gin has access to mammography screening and lung cancer screenings because we can actually take the screening to them and that is so important working with county health departments to understand what resources are there. Oklahoma in the last year and a half created the Oklahoma lung cancer roundtable and they actually have a website and on that website is where you can go be screened for lung cancer and they are all over the state so you know never feel like you have to drive to the city from Idabel or Woodward.

Jennifer Watkins: There are resources and so we really are addressing that access issue because that’s that can be a tough issue or if I don’t have insurance and so there are programs like take charge at the health department or project woman that will actually help with a screening and treatment.

David Raubach: So yeah, Oklahoma Project Woman for breast cancer screening. So we the Oklahoma Proton Center’s partnered with the Premier Breast Health Institute.

Jennifer Watkins: Yes.

David Raubach: Down in South Oklahoma City. And we really love what Oklahoma Project Woman does as far as covering the cost for screening, mammograms and ultrasounds and MRIs or whatever women need to go through breast cancer screening and guys too actually. There’s about 1 to 2% of breast cancers actually present in men. So if so you talked about there’s the lung cancer round table. What are some of the other I guess more prevalent cancers or big cancers that people should be thinking about screening for?

Jennifer Watkins: Well, and the ones that we primarily focus on just based on you know data and everything is the breast cancer, cervical cancer, colorectal cancer, lung and prostate.

David Raubach: Okay.

Jennifer Watkins: So that’s the ones that they’re the highest incidents that we’re seeing. They’re the ones that we can have the biggest effect on. Obviously they’re not the only ones that are important, right? But those are the ones that there are set screening and opportunities to catch it early. There’s some great research going on right now in prostate cancer with at home tests.

David Raubach: Yeah.

Jennifer Watkins: So, men no longer necessarily have to go and have the uncomfortable doctor’s appointment. So they’re working on that. They’re working on some communication things that help men understand how to make that happen. And then obviously the colorectal at home test. Now, if you are high risk, like for instance, I am high risk because of my dad. I still need to go get my colonoscopy, but average risk, you can do an at home test, and that’s a great thing. We’re also seeing that with cervical cancer, they’re about to roll out, and there’s a lot of research happening with an at-home cervical cancer test. So, very exciting things that could really change the dynamics across Oklahoma and make it make it easier for people to be able to do.

David Raubach: I mean there’s a privacy component too with screening. I mean a colonoscopy or a Pap smear a mammogram. None of that is fun personally to go through. What so with lung cancer then what are what are what should people be thinking about with screening? I know you were part of the tobacco settlement trust for a period of time. So maybe talk a little bit about lung cancer and the tobacco trust and just kind of that dynamic in Oklahoma.

Jennifer Watkins: Oh, absolutely. And you know, I think I was around when the tobacco settlement happened and some great things and Oklahoma was one of the only states that did such an amazing job with their tobacco settlement money by creating the tobacco settlement endowment trust.

David Raubach: Okay.

Jennifer Watkins: And they really set aside the money to help Oklahomans change the outcome on health. And so they’ve done a great job with that. They have really, you know, tried to be responsible with that money and everything. They are really looking at how to help, but they established the Oklahoma Tobacco Helpline and so anyone in Oklahoma can access that. They can get counseling. They can get help. There’s different levels of the [snorts] options that they have. But it’s free for everyone. They can get the medication if they want to try the nicotine replacement therapy. So, that’s a great resource. But as far as lung cancer screening, the guidelines basically are 50 to 80 years old and having a 20 year pack-year history. So if you’ve smoked for, you know, more than 20 years, a pack a day and you’re 50 years old or older, then definitely you should talk to your doctor.

Jennifer Watkins: You should see about the screening because again, like everything else, the sooner we can catch it, then the treatment outcomes are so much higher. The side effects aren’t nearly as bad. Had this you know mortality rates and everything.

David Raubach: So go going piggybacking off that we actually do low-dose CT lung screening at the proton center and we started that because we have a CT sim there and of course we treat cancer but that we have this great tool and if and then if somebody ends up being diagnosed with cancer they’re right there in a cancer center. And one of the things that we discovered as we opened up this program three or four years ago was that you would have people come in and maybe they were 55 years old and they had 19 pack years of history instead of 20 pack years of history. So, we established what we think is a very affordable cash pay rate, $250 to get the low-dose CT lung screen. If you don’t because those parameters that you described that does impact insurance coverage too, right?

David Raubach: So insurance companies will say well you have to have these 20 pack years instead of and what and so the definition for that I know you know this but for our listeners a pack year is an average of one pack a day for a year for 365 days. So if you smoke two packs a day for a year that’s actually two pack years.

Jennifer Watkins: Yes.

David Raubach: So if you smoke two packs a day for 10 years, then you are at 20 pack years. And so we think that’s very important and I only bring that up to just let patients know that’s the type of scan that they should be thinking about, these low-dose lung CTs and a lot of facilities offer those. But if you’re if you’re concerned about it and you’re 49 and you have 20 pack years or you’re 52 and you have 19 pack years, don’t necessarily say, “Well, I shouldn’t get the scan.” There’s options out there. And if it’s something that you’re concerned about, there’s a opportunity at the Proton Center and again, there’s other facilities that’ll do it for a reasonable cash pay rate as well. And I think that’s like, you know, again, this all kind of goes hand in hand with what you talked about with financial toxicity because the take-home screening tests.

David Raubach: I think we’re right on the precipice of really being able to do some just incredible things in terms of at-home cancer detection, but those tests are expensive. And a lot of times those tests aren’t covered by insurance. And so that’ll be something to think about as we go forward is how do you create access to that?

Jennifer Watkins: Yeah. [snorts]

David Raubach: So, what else what else should people know just about the resources available for lung cancer? I mean, you mentioned the helpline or what’s or how are you thinking about dealing with the lung cancer issue in Oklahoma?

Jennifer Watkins: So, [snorts] there’s some amazing things happening right now. The Oklahoma Hospital Association has partnered with some different organizations and have really focused on increasing lung cancer and Kelly Willingham is kind of heading that up and she’s doing a tremendous job. She jokes that she is really not very fun at parties because she’s so focused on lung cancer screening. But, you know, just really getting the message out there and I love that you brought up, you know, the screening rates and ages and guidelines are so important because it does reach the greater population. But if you are concerned and you do have, you know, talk to your doctor, there are, you know, the screening guidelines for colorectal cancer are, you know, they were 45 when I was supposed to get started, but because of family history, my situation changed. My breast cancer screening because of my mom that changed.

Jennifer Watkins: So remember the guidelines are just that they’re kind of guidelines but talk to your doctor always to have the conversation to know what is right for you. Y and I think that definitely makes a difference in outcomes and confidence in the whole process and because we don’t always know and we can definitely help more people when they’re having those conversations.

David Raubach: Talk a little bit about the work that you’re doing with the tribes as well and the partnership with the tribes because I think that’s an important aspect of cancer mortality and cancer screening and cancer survival here in Oklahoma.

Jennifer Watkins: Oh, absolutely. And you know I absolutely love working with so Cherokee Nation is the one that we work with the most.

David Raubach: Okay.

Jennifer Watkins: Because they do have a similar cooperative agreement like we do. They have a cancer plan and so we partner on so many things. So the Cherokee Nation program is called OTAA or Oklahoma Strategic Tribal Alliance for Health and any tribe is really welcome to participate in that. But Cherokee Nation does lead it because of the funding. But they are also focusing on how to improve rates for tribal members and anyone within their jurisdiction. They have some great things going on. And they have the same primary prevention, screening and early detection and survivorship that we do. They have some really strong just events and things that are built within the tribe to get members involved and some things that have been really fun to really work on and they’ve had the grant the same amount of time that we have. And so it’s just kind of been we’ve partnered through the whole way.

Jennifer Watkins: Chickasaw Nation and Choctaw Nation. They’re also members of the Oklahoma Coalition as well.

David Raubach: Okay.

Jennifer Watkins: And so we partner with them. We look at ways that we can help support maybe nutritional pieces for elders who have, you know, nutritional resources but have also had cancer. So how can we increase some of that stuff? [snorts] what and so for so if somebody’s not a member of the Cherokee tribe then they would access some of the resources and things that we’ve talked about that the state Oklahoma Cancer Coalition they definitely could you know they could access perhaps whatever is in you know under their tribal you know medical and health system we will always kind of connect people as we can you know we want the tribe to have the most leadership within their tribe obviously and we just want to be there to support. So we always kind of defer back to what does your tribe have?

Jennifer Watkins: Let’s look or maybe they don’t live in the tribal area so it’s harder to access.

David Raubach: Okay, great.

Jennifer Watkins: Where can we kind of connect you so it’s easiest for you but you know always defer back to the tribe so that they have the biggest say but what’s going to work the best for everyone?

David Raubach: Okay. [clears throat] So, I want to close out today. We’ve talked about prevention. We’ve talked about screening, but survivorship is kind of this third leg of the stool. So, talk a little bit about the importance of survivorship and how you think about it and how patients can think about it and then what are some of the initiatives and programs that the cancer coalition is offering?

Jennifer Watkins: Okay. Yeah, great question. So we have survivorship kind of divided into two areas. We have adult survivorship, but we also have the children and young adult survivorship piece. And you know, I that one has really grown so close to my heart because there’s so many things that we’re learning through this process you know, with adult survivors. We have the sessions that you know we’ve kicked off and are focusing on and they do have kind of the post treatment fear of recurrence and that kind of thing. So we always want to address that but with the childhood and young adult cancers it’s so much bigger. So understanding you know how whatever treatment a child had if they had cancer is going to impact their entire life. Whether it is radiation to the chest and then you know how that could impact them later on.

Jennifer Watkins: We are also working with an organization it’s a national organization called worth the wait and they are actually looking at how to provide education on reproductive rights.

David Raubach: Okay.

Jennifer Watkins: So an 8-year-old that is diagnosed with a cancer they don’t have you know you’re starting treatment that day or the next day. You’re not thinking about the reproductive rights of the child later on. But that’s going to be important to them later on and you want them to have that later on and so how do we look at research and what can we do and how can so there actually are organizations that are focusing on that and we’re trying to provide that education in Oklahoma as well. So those kinds of things have been just incredible to be able to learn and we are hoping in September that we will kick off an event for childhood cancer awareness month that will be just you know whether it’s a day or a month long like we’re doing now.

Jennifer Watkins: But how can we help parents and the children and even young adults who are post childhood cancer treatment but now they’re starting to think about building a family and the long-term effects. So we’re really working on that as well and very excited to see where that goes.

David Raubach: Yeah. That and what’s the what’s your message for survivors that are coming from rural areas because that one of the things that’s challenging is getting to follow up appointments and you know you mentioned some of the smaller towns in Oklahoma and a lot of those patients are having to come to Oklahoma City or Tulsa to access particular treatments. How do how should patients in rural areas think about survivorship and followup?

Jennifer Watkins: You know, access what is available to you, whether it’s at the library or whether it’s online. You know, if there’s a telehealth, I know we’re seeing and soon coming the rural transformation project, okay, that is going to happen. And I really believe it is going to change, you know, the outcomes for rural Oklahoma because of the people involved and because of the opportunities that I think it’s going to give. So I foresee that becoming just even stronger. But access your local networks, whether it’s a church or the library or online. When you see series like we’re providing right now, make sure you connect. And the great thing is these type of series aren’t one health system specific. So you’re getting to connect with people from all across the state and see how they’re handling it.

Jennifer Watkins: So you know just see what’s out there, talk to the American Cancer Society, go online, have conversations, and just really kind of start that for you.

David Raubach: I think that’s a good point is that there’s a lot of resources that are available online. And there’s a lot of great community groups even on social media or other platforms. Reddit is actually another one where a lot of people get on and talk about the experience experiences they’re going through during treatment and then post treatment. So just to wrap up, are there any well, two things. So tell me about a patient that you’ve worked with because you have some incredible patient volunteers that work with the cancer coalition. Tell me about a patient’s story that’s really impacted you personally.

Jennifer Watkins: Oh, that’s such a great question. Wow. You know, one of them, and she didn’t actually become a patient, which makes me so excited, but she was a young mother in her late 20s and she lived in rural Oklahoma.

David Raubach: Okay.

Jennifer Watkins: She had lost her father to colon cancer at a very young age himself. She had a positive fit test and she was terrified. You know, she didn’t have insurance. She had actually just got her green card. So, she didn’t the typical routes that we would send her for the financial assistance weren’t available for her as well. And so, she reached out and [clears throat] you know, just like I said, terrified that what am I going to do? I can’t pay out of pocket. I can’t leave my kid behind. And so we were able to make some connections and she was able to access a clinic and get an actual colonoscopy and she just messaged me and said it was clean. Everything was clean and I’m so excited and I wouldn’t have found it without you. And you know and I’m just lucky to be in the position that I know people. It’s definitely not me.

Jennifer Watkins: I just know who to ask. But for her to know that she has the confidence of I’m going to get to stay with my kid was amazing to me.

David Raubach: Yeah, sometimes those clean scans are the best thing in the world and just having that peace of mind.

Jennifer Watkins: It is absolutely all about the hope that you can provide to someone.

David Raubach: So, if somebody is looking for that type of help, how do they get a hold of you or the of a coordinator or caretaker?

Jennifer Watkins: Yeah. The easiest way to reach us is probably just through our email and it’s occn.gov.

David Raubach: Yeah.

Jennifer Watkins: So, and they can I believe if you kind of type in Oklahoma Comprehensive Cancer Network in a search, you’re going to we’re going to be the first option as well.

David Raubach: Yeah. So, OCCN Oklahoma Comprehensive Cancer Network. That’s the name that people should remember. And there is so many resources out there.

Jennifer Watkins: Absolutely. And if you can’t find the resource, you email me through that OCCN website or email and I will absolutely do everything I can to help.

David Raubach: Yeah. Well, thank you so much for your time, Jennifer. This was great and I’m really excited to get all of this information out published online so people can I know there’s a lot of people out there that are going to appreciate watching or listening to this episode. And again, you guys are doing great work. And really appreciate everything you’re doing personally and the team that you guys have assembled there at the OCCN. It’s fantastic. It’s great for the state. So, thank you.

Jennifer Watkins: Thank you.