David Raubach: I want to thank you guys for joining us on today’s episode of the Cancer Project podcast. We have a special return guest with us today, Britney Haynes — of Big Brother, the Amazing Race, and Traitor fame — but also a wealth of knowledge and information on cancer research, cancer care, and famous people who have had cancer. What we want to do today is run through some people that our listeners are going to recognize who have had cancer and talk about the treatments they received and how that might apply to something somebody else is going through today. I’ll just throw out an example: Joe Biden had an aggressive form of prostate cancer and has been going through treatment. We’ll talk about that. So with that introduction, I’ll say hello and welcome, Britney.

Britney Haynes: Hi, thank you for having me. A combination of worlds today because I live for pop culture and also for all things oncology and cancer research, and so we’re really merging the two in today’s episode.

David Raubach: It’s your two specialties — famous people and cancer.

Britney Haynes: Absolutely correct. One of my favorite stories to start off the top has to be Maria Menounos. Her story feels so important because she was diagnosed with pancreatic cancer — a cancer that carries some of the highest death rates of any type, normally very aggressive, found at very late stages because it doesn’t present with a lot of symptoms. When I looked further into it, she was actually doing a completely cash-pay, out-of-pocket scan — not ordered by her physicians — that detected a tumor on her pancreas. It was only stage two at the time it was found, and she was able to just have surgery to have the tumor removed. That is a story that typically comes with a very poor prognosis, but because she did that screening she was able to find it really early and get it taken care of. She has now partnered with a company that offers a blood test — a blood sample that can detect potential precursors or strands of DNA indicating you may have cancer signals from over 50 types of cancer. It’s cash pay, but FSA and HSA eligible, and about $700.

David Raubach: What was the original screening that she did?

Britney Haynes: She did Prouvo, which is one of those full-body MRI services you’re seeing emerge more often. Prouvo is a full-body MRI where a radiologist looks you over from head to toe and sends you a full report. There’s no radiation — there’s no real danger to your body having an MRI. And in this case, it literally saved her life. The Prouvo scan is more expensive out of pocket than the blood test — those run about $3,000 — and they’re only in a handful of major cities across the country. The blood test has great access for everyone even if you don’t live in a major metropolitan area.

David Raubach: Let’s talk a little bit about screening. One thing we do know is that if we catch cancer earlier, we typically have more options to treat it and there tend to be better outcomes. Part of the challenge is that there’s a lot of information out there about when to screen. For breast cancer, the general recommendation is that when you turn 40 you should get a mammogram. And for prostate cancer, you’ll see recommendations to start PSA screening at 50, 55, or 60. But then there’s also the question of when you stop screening — and that comes up when we talk about Joe Biden, because he had actually reached an age where his doctors suggested he didn’t need to continue screening for prostate cancer.

Britney Haynes: I think that the age recommendations change all the time — it’s easy to get lost in what the right age is. And there’s so much to weigh. The blood cancer test sounds really promising. But what do you know about that technology? Is that the future of diagnostics?

David Raubach: Cancer cells often emit chemicals and proteins that can potentially be detected with a blood test. Take prostate cancer: the prostate produces PSA — prostate-specific antigen — and cancer cells produce more of it. You create a baseline the first time you get your blood drawn. If your PSA score was a two and five years later it’s a ten, that 5x increase is an indication that cancer cells may be present. But cancer isn’t one disease — it’s hundreds of diseases — so you have to ask what’s unique about breast cancer cells, liver cancer cells, pancreatic cancer cells, brain cancer cells in terms of what they’re putting into the bloodstream. The holy grail is a simple blood test — low cost, relatively non-invasive, easy access — that can detect cancer across many types at once.

David Raubach: I want to talk about somebody that everybody knows who actually passed away from pancreatic cancer. Britney, do you have an iPhone?

Britney Haynes: I sure am.

David Raubach: What many people may not realize is that when the first touchscreen iPhone came out, Steve Jobs was actually battling pancreatic cancer. Now, what’s important to note is that Steve Jobs had what’s called a PNET — a pancreatic neuroendocrine tumor. About 5% of pancreatic cancers are neuroendocrine, and the other 95% are adenocarcinomas, which are the aggressive type. Neuroendocrine pancreatic cancers don’t tend to be as aggressive. Steve Jobs was diagnosed in 2003, and his doctor recommended surgery — a Whipple procedure, where you go in and cut out the part of the pancreas where the cancer cells are. It’s typically very successful. People with neuroendocrine pancreatic tumors typically have a high cure rate. Unfortunately, Steve Jobs decided he did not want surgery and instead pursued fruit-only diets, herbal remedies, acupuncture, juice fasts, and various other alternative therapies. He told his biographer Walter Isaacson: “I didn’t want my body to be opened, so I tried different diets.” The nine-month delay allowed the cancer cells to spread beyond the pancreas.

David Raubach: He eventually went in in July of 2004 and had the Whipple procedure at Stanford Medical Center. The surgeon successfully removed the tumor. At the time they didn’t detect that the cancer had spread — it was microscopic cells. But later in 2008, there were obvious signs he was going through something: dramatic weight loss, muscle wasting, hormonal disturbances. What came out was that the cancer had spread to his liver. Then he signed up to get a liver transplant — and because of who he was and the money he had, he got himself listed on wait lists in multiple states. Tennessee had a short wait list, so he ultimately did his liver transplant in Memphis even though he lived in California. There’s also some controversy about doing transplants for metastatic cancer patients because the cancer can represent in the transplanted organ — which is what likely happened with Steve Jobs.

Britney Haynes: My takeaway from his cancer and death was that here was a guy with unlimited resources, unlimited funds — no barrier to access — and he still couldn’t beat that cancer. It’s interesting to hear further details about the deferment of treatment at the beginning and then ultimately the transplant. I actually watched a show on Netflix recently called Apple Cider Vinegar — it’s a drama based on a true story about a girl in Australia who had been diagnosed with cancer and was treating it holistically, presenting as though it was paying off when the truth was she was actually declining. Before she passed she said she wished she had gone the more traditional route. Some similarities there. I think you can engage with holistic approaches in addition to seeking active treatment through your doctor — that’s a perfectly respectable balance. I hate when someone defers treatment altogether to just do fruits and stuff. I would personally never advocate for entirely deferring traditional treatments that have been scientifically tested, backed, and approved.

David Raubach: What we tell patients at the Oklahoma Proton Center is that it’s okay to pursue alternatives, but we would rarely recommend pursuing a treatment that didn’t have some foundational evidence to support its use instead of a traditional treatment that we know works. Steve Jobs actually told Walter Isaacson that he regretted not treating the cancer based on the recommendations of his doctors at Stanford. Now, there are stories of people who take an alternative approach and their cancer disappears — but they tend to be the exception, not the rule. It’s important not to latch on to a blog post or a TikTok video and put all your eggs in that basket against the recommendations of your physicians.

David Raubach: The other thing I want to mention with Steve Jobs is the treatment he was traveling to Europe to receive. After the liver transplant in 2009, he traveled multiple times to the University of California San Francisco, Stanford, and occasionally Europe for specialized treatments. The treatment people think he was pursuing is called PRRT — peptide receptor radionuclide therapy. It’s a type of theranostic treatment — a combination of therapy and diagnostics. You’re using a common molecule both to image the tumor and to treat it. Specifically, it takes a radioactive isotope — lutetium-177 — and attaches it to a molecule that seeks out receptors on neuroendocrine tumors. Think of those receptors as locks and the molecule as a key: the key goes to the lock and triggers the absorption of the radioactive isotope, which causes DNA damage and kills the cell.

Britney Haynes: My daughter had neuroblastoma, and there’s a very similar therapy — MIBG — that uses a different isotope but the same mechanism: it’s injected and you remain radioactive until it flushes out of your body. So is PRRT not available in the United States, or was it not at that time?

David Raubach: The drug used for neuroendocrine tumors is called Lutathera. It was not FDA approved until 2018, based on large randomized trials published between 2015 and 2017. But there were facilities in Europe in the early 2000s that were experimenting with this drug — experimenting in the sense of figuring out the right dose, because you’re injecting the body with radiation. How do you get the right dose to kill the cancer cells without doing so much damage to the liver that you kill the patient? That’s the kind of study the FDA is looking for before giving it a stamp of approval.

Britney Haynes: It’s crazy to think that he started at a point where he didn’t even want a surgery — which is not nothing, but is so much easier to digest — and by the time he was nearing the end of his life he was flying to Europe to have a radioactive compound injected into his body. That’s a complete 180 on his outlook toward medicine. It is interesting to understand more of the details of his journey.

Britney Haynes: Since we are the Oklahoma Proton Center, I wanted to talk about a couple of notable figures who received proton therapy. You may have heard about Michael Strahan’s daughter Isabella, who had a brain tumor and received proton therapy while in college. We recently did a story on Jake Gyllenhaal’s father — a famous director who had prostate cancer and received proton therapy and now speaks very positively about his experience and lack of side effects. And then there was Mark Ralphing, a pro golfer turned golf commentator, who had a stage 4 salivary gland tumor and received proton therapy at MD Anderson. Maintaining his vocal cords was imperative to his job, and he had a great experience — very few side effects, didn’t need a feeding tube, avoided things that would normally be associated with a head and neck traditional radiation route.

David Raubach: Another example is Ron Rivera — football coach of the Panthers and the Redskins — who had a squamous cell carcinoma in his neck and received proton therapy as part of his treatment. He’s spoken very highly of the process and is certain he had fewer side effects than he would have had with traditional radiation. For those who may not be familiar, Britney, why don’t you tell us what we mean by fewer side effects with proton therapy?

Britney Haynes: Proton therapy delivers less radiation to nearby or surrounding healthy tissues and organ structures that you don’t want to damage. Proton therapy also doesn’t have an exit dose — it’s not going to go all the way through the body and harm structures sitting behind the tumor. In a head and neck cancer, for example, you might sometimes need a feeding tube with traditional radiation, or see deterioration to the vocal cords or other important structures. That’s why proton therapy is an ideal choice when the tumor is in a location surrounded by healthy tissue you want to preserve — your heart, your lungs, your vocal cords.

David Raubach: The goal with radiation is to get as much radiation to the tumor as possible with as little to healthy tissue as possible. Because protons can be stopped inside the body, we’re able to target more of the radiation to the tumor than we can with X-ray-based radiation — sometimes called photon radiation — where those photons can’t be stopped inside the body. They hit the tumor and keep traveling. For head and neck cancer, and really any other cancer, that distinction matters enormously. Brain tumors in particular are a great case — your brain contains incredibly sensitive cells. And for younger patients, whether a teenager or a four-year-old, the body is still developing, so radiation damage is exponentially worse than it might be for an older adult. That’s why proton therapy has become the standard of care for pediatric patients.

David Raubach: I want to transition and ask you a little game. We’re going to see how many presidents you can name, working back from the current president.

Britney Haynes: Oh gosh, I’m going to be so bad at this. Okay — Trump, Biden, Trump, Obama, then Bush — W Bush, Clinton, Bush senior… and I’m done. [laughter] Was it Reagan?

David Raubach: Reagan — yes. Good. You needed to at least make it back to when you were born. So, one of those presidents has actually just finished cancer treatment, and that is Joe Biden. He was diagnosed with an aggressive form of prostate cancer about a year ago. One of the controversies is that he was in his early 80s when diagnosed but had stopped PSA screening about ten years earlier. His physician had said, “Once you hit 70, the chance of getting and then dying from prostate cancer is pretty low — screening is really optional at this point.” Unfortunately, because of that gap, by the time the cancer was detected it had spread outside the prostate into the lymph nodes and probably the bones as well. As a result, he’s having to undergo very aggressive treatment including hormone therapy to reduce testosterone that is feeding the cancer cells, followed by radiation at the University of Pennsylvania. He may also need chemotherapy or the theranostic treatment for prostate cancer called Pluvicto, which uses a radioactive drug attached to a molecule that targets metastatic prostate cancer cells.

Britney Haynes: I want to bring up the fact that for prostate cancer, there are so many treatment options even at early stages — active surveillance, surgery, traditional radiation, proton therapy, brachytherapy with radioactive seeds, cryotherapy, ultrasound ablation. You could do a combination. I hope that sounds overwhelming, because it is overwhelming. When you are tasked with these very important decisions and you haven’t woken up that day expecting to educate yourself on cancer later that night, it just comes out of nowhere and you feel very behind the curve. In our case with my daughter, we were working against the clock. Every minute mattered. I chose at the time, for better or for worse, to leave it mostly in the hands of the physicians who knew the disease. In retrospect, with what I know now, I know there were even more options available that we could have pursued. But in that moment, I felt they were capable of making those important decisions, and after the fact is when I really started educating myself.

David Raubach: And I think that’s generally the right approach — listen to your physician. I know one of the things you did is you talked to multiple physicians and got a group consensus on the best treatment path. I was going to ask: are you a fan of the royal family?

Britney Haynes: I am a fan of the royal family! I was going to bring up King Charles, but I think I was going to talk about Princess Kate. I think of the members of the royal family who have undergone cancer care, people will be more interested in Princess Catherine. I feel like they’ve kept it pretty private — she hasn’t been super vocal about her specific type, but we know she had an abdominal surgery and has said that she went through some treatments and is navigating life after cancer.

David Raubach: In January of 2024 she underwent major abdominal surgery in London. At that time the condition was believed not to be cancer, but tests after the surgery revealed that cancer had been present. Then in March of 2024, she announced she was undergoing preventative chemotherapy. From June through autumn of 2024 she made additional statements about her treatment, and in late 2024 she shared that she had completed chemotherapy and was in recovery, although no specific cancer diagnosis was disclosed. I’ve got a couple of quotes from her. She said: “I am making good progress, but as anyone going through chemotherapy will know, there are good days and bad days. On the bad days you feel weak, tired, and you have to give in to your body resting. But on the good days, when you feel stronger, you want to make the most of feeling well.” And another: “You put on a sort of brave face, stoicism through treatment — treatment’s done, then it’s like I can crack on, get back to normal. But actually, the phase afterwards is really, really difficult. You have to find your new normal, and that takes time. It’s a roller coaster.”

Britney Haynes: I love that message from her, and I can appreciate that she maintains a bit of privacy. Everyone has to do what feels right for them in their journey. But I love that she’s opening up and talking about survivorship, because survivorship is something a lot of people don’t focus on. They focus so intently on the treatment phase, and then once treatment ends and it comes to resuming normal life, there’s no one guiding you along the way anymore. I think it’s really great that she’s talking about this and making others who have been through the same situation feel seen and heard — maybe thinking, “Oh, I thought I was the only one feeling that way.” People may have an expectation that once you’re done, life goes on. They’re not understanding the long-lasting side effects either from the treatments themselves or mentally — how your mental health might be struggling, how you might be coping emotionally with what you’ve been through. She’s a real princess, gorgeous and poised, and yet she’s been through an experience that is so approachable and relatable to so many people. She went through chemotherapy — we hate chemotherapy, chemotherapy is terrible — but she had access to every possible treatment in the world and this was still what she had to go through. It pulls back the veil on the fact that most oncologists are recommending a treatment for a reason: because it’s the best treatment for that particular patient.

David Raubach: She also talked about the mental health aspect of cancer treatment. Somebody with access to all possible resources, a huge support system, an entire country rooting for her — and she’s still saying she has terrible days, days she hardly felt like getting out of bed during treatment, and days now where she doesn’t know who she is. I hope that is, in a weird way, an encouragement: if somebody listening is thinking, “I have days where I don’t feel like getting out of bed,” here is a member of the royal family saying the exact same thing. And I think it’s important for every patient to find their support system — siblings, parents, kids, friends — and a lot of times it’s other patients walking through the same journey. That’s part of the reason I wanted to have this conversation: to say that there are other people out there walking through these journeys. That’s why we talk about Joe Biden getting prostate cancer, Maria Menounos getting pancreatic cancer, Steve Jobs battling a PNET — because these are realities for a lot of patients.

Britney Haynes: It’s so true. Nobody wants to go through this — least of all Princess Catherine, who certainly had many important things on her agenda. But it doesn’t discriminate. It’s not something you can feel sure is not going to happen to you. And in some sense that is also a bit of a comfort — we’re all trying to navigate our health needs as best we can.

David Raubach: There’s that human element that binds us all together. Well, thank you for joining me. This was really good. We should do another topic — the history of proton therapy is really interesting. Your homework is to know who was president when the first proton patient was treated. That’s your question for the next podcast.

Britney Haynes: You’re going to have to let me know ahead of time because you’re going to give me a quiz and if I don’t pass the quiz I will be beside myself. So let me know in advance!

David Raubach: There’ll be lots of quiz questions. Thank you, Britney.

Britney Haynes: Thanks, David.