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 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 and the Amazing Race and The Traitors. But also a wealth of knowledge and information on cancer research, cancer care, famous people who have had cancer. And so I think what we want to do today is we want to run through some people that probably our listeners are going to recognize their names who have had cancer and talk a little bit about the treatments that they’ve had and how that might apply to something that somebody else is going through today. And I’ll just throw out an example. Joe Biden had an aggressive form of prostate cancer and has been going through treatment. And we’ll talk a little bit about the treatments that he’s gone through.

David Raubach: 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 that your two areas of expertise, famous people and cancer.

Britney Haynes: Absolutely. Absolutely correct.

David Raubach: You sent me over actually a bigger list than I even realized in terms of just people that I think we would know who they were that have gone through cancer. So, who’s somebody that stood out to you as you were researching for this episode?

Britney Haynes: Okay. One of my favorite stories, if I’m just going to start off the top, has to be, and this is pretty recent that I believe she came out with it, but it was Maria Menounos. And the reason that her story I feel like is so important is because she was actually diagnosed with pancreatic cancer. And pancreatic cancer, as you know, carries some of the highest death rates of any cancer type. It’s normally very very aggressive. It’s found very late stages because it doesn’t present with a lot of symptoms. And so when I realized that she had pancreatic cancer, one that I associate with poor outcomes, I looked further into it and she actually was doing a completely cash pay out of pocket, not ordered by her physicians scan that found that detected this tumor on her pancreas.

Britney Haynes: So, it was only stage two at the time that it was found and she was able to just have surgery to have the tumor removed. And that is a I think it’s such an important story because that is one that typically comes with a very very poor prognosis. But because she did that screening, she was able to find it really really early and get it taken care of. I think it just kind of speaks to the importance of screenings in general. And she now has partnered with a company that offers a blood test. It’s like a blood sample test that you can have done. It’s cash pay, but it’s FSA/HSA eligible. It’s about $700. And this blood test can detect potential precursors or strands of DNA that indicate that you may have cancer signals from over 50 types of cancer.

Britney Haynes: And some of those are normally go undetected for long periods of time before they present any symptoms or anything that a physician would go looking for. So anyway, I thought that story was really interesting. I now of course am like looking up as you can imagine I’m like about to buy this blood test like right now.

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

Britney Haynes: She did Prenuvo which is one of the it’s you’re seeing these emerge more often. Prenuvo is like the big one that a lot of celebrities use. They also get a lot of influencer endorsements and things. Prenuvo is a full body MRI scan that they have a radiologist look over you from head to toe and they send you a full report. I’ve seen several celebrities who go and get these done, but hers actually did detect a very deadly type of cancer that she was entirely unaware of. So I think that it’s just listen, I think that there’s some debate. I think you would even say, I don’t know about full body preventative MRIs, but it’s no radiation, right? There’s no real danger to your body having an MRI. And in this case, it literally saved her life. I’m all about the all the types of detection.

Britney Haynes: I can be easily convinced of anything.

David Raubach: When did you go on payroll with Prenuvo?

Britney Haynes: I know, right? I should be. I’m waiting on them to offer me my free scan. Now, that the Prenuvo scan is more expensive out of pocket than this blood sample kit. The blood kit was only about $700. A Prenuvo scan, I think those run about $3,000. And you have to be in one of I think they’re only in a handful of major cities across the country. So, not everyone has easy access to those. But, as I was just briefly looking through this because she partners with this company now that does the blood test, I thought that was super interesting and would be, you know, really have great access for everyone, even if you didn’t live in a major metropolitan area to be able to potentially use that resource.

David Raubach: So, let’s talk a little bit about screening.

Britney Haynes: Let’s do it. You brought it up.

David Raubach: I think this is an important topic when it comes to cancer. One thing that we do know is that if we catch cancer earlier, we typically have more options to treat the cancer and or there tends to be better outcomes for that patient, right? So screening is really really important. I think part of the challenge that people have is that there’s a lot of information about there out there about when to screen. So for let’s take breast cancer for example. So kind of the general recommendation is that when you turn 40 coming up for you very soon Britney

Britney Haynes: I was I think that it’s even lower now. I think that they lowered the age.

David Raubach: That’s another thing on the topic of screening is that these things are variable. They change all the time. They’ll change guidelines for screening regularly and it’s easy to kind of get lost in what is the age. So you so so you right so 35 40 45 so kind of general standard is once you turn 40 you should go get a mammogram.

Britney Haynes: Mhm.

David Raubach: Not the most pleasant experience. It can be uncomfortable. It’s invasive. It can be a little bit nerve-wracking. But generally the recommendation is when you turn 40 you should get a mammogram which screens for breast cancer.

Britney Haynes: Mhm.

David Raubach: There are some women depending upon your risk where the recommendation might be 35. It might be as early as 30. Do you have a family history of cancer? Do you have a genetic profile that makes you more predisposed to getting breast cancer? Then let’s take prostate cancer for example. So generally the recommendations are that you start getting a blood test that looks for a protein or an antigen that’s produced by prostate cancer cells at a high level. So this is a PSA test, a blood test. You’ll see recommendations that to start doing PSA screening at 50, you might see 55, you might see 60. But then on the other end of the spectrum, there’s also the question of when do you stop screening?

David Raubach: And that’s going to come up when we talk about Joe Biden because he had actually reached an age where his doctors suggested that he didn’t need to continue screening for prostate cancer. So I think he was 70 years old when he received that recommendation. So then there’s a question of well what about insurance right? Because insurance companies, God love them, they are going to want to try to pay for as few screenings as possible, which I’ll be honest, kind of is a little bit counterintuitive because what that can lead to is detecting cancer at a later stage and then the treatments are a lot more rigorous and you might have to do chemotherapy treatments that cost hundreds of thousands of dollars whereas otherwise you might not have had to do those chemo treatments.

David Raubach: Whatever the case may be, there’s the question of the cost element of screening, right?

Britney Haynes: I would go get an MRI every six months.

David Raubach: Yeah.

Britney Haynes: If I could afford it.

David Raubach: I know you would. Well, you’re now you have free MRIs with your Prenuvo name drop.

Britney Haynes: Yeah. Hopefully. Fingers crossed.

David Raubach: And then so then you’ll hear and I want to bring this up because I think this is important. You will hear some doctors say there is such a thing as over testing because you can get false positives and so then that lead that can lead somebody down a rabbit hole of additional tests that may be more invasive. Also may be costly and so is there such a thing as over testing? I think the point with all of this is it is important to screen for cancer. Everybody needs to make their own decision about when to start that process. It’s important, especially as you get into your 30s and into your 40s. It’s important to understand what the latest recommendations are for when to start screening and what to screen for. It’s also important to understand what tests are out there.

David Raubach: You know, one thing you can get is a PET CT. But with that, you know, a PET scan or a PET CT, you’re actually getting injected with a radioactive drug and that drug goes through your body’s bloodstream. And then the idea with that is that there’s receptors on cancer cells and the molecule that’s that contains the radioactive isotope goes to the receptors on the cancer cells. And I that’s that’s a technical explanation, but the point is that PET CTS can be used to detect cancer, but there’s a cost that comes with that in the sense that you’re exposing your body to this drug that can have side effects. And then if you accompany that with a CT scan, you’re exposing your body to radiation.

David Raubach: So when we talk about screening you also have to there’s a cost thing element that you have to consider and then there’s also the potential side effects that you have to consider as well. So you know there’s there’s a scale there’s there’s pros and cons which I guess gets us back to doing an MRI which usually comes with minimal side effects no exposure to radiation minimal side effects no exposure to radiation but it is pretty costly.

Britney Haynes: Yeah, I mean they’re expensive and normally if you were going to try to go through the typical route of a physician’s referral to get your MRI through a health system, you know, that also includes probably an initial appointment, maybe followed up by a specialist appointment who then maybe is able to order the scan, but a longer time frame as well. So I think yeah, there’s so much to weigh and to balance in it all. I think that the blood cancer test sounds really promising, but what do you know about that type of technology? Is that like the future of diagnostics or are we kind of moving in that direction where kind of like I mean I’m thinking back to Elizabeth Holmes where it’s like is a single drop of blood going to literally tell us everything.

Britney Haynes: What have we learned in recent years that’s kind of led us to developing these tests?

David Raubach: Well, I think so. So, cancer cells, we talked a little bit about this with PET CT. So, cancer cells do often emit or generate chemicals, proteins that potentially can be detected with a blood test. Now, the challenge is that like we’ll go back to prostate cancer. Prostate your prostate is producing PSA, this prostate specific antigen.

Britney Haynes: Mhm.

David Raubach: Cancer cells produce more of it. So if there are cancer cells present in your prostate, the theory is that you can detect an increase in the production of prostate specific antigens. And so what you have to do is you have to create a baseline. And so the first time that you go get a your blood drawn and you score your PSA production, you might get a score of one or two. And that’s an amount that’s associated with an amount of PSA production. Well, let’s say down the five years down the road, you do a PSA test and your PSA score is a 10. Okay. Well, now you have 5x. If you started with a two, now you’re at 10. You have 5x the amount of PSA production. Well, that’s an indication that there could be prostate cancer cells present.

David Raubach: Well, then we think about the fact that cancer isn’t one disease. It’s hundreds of diseases, right? And so then you have to say, okay, well, let’s go to breast cancer. Let’s go to liver cancer. Let’s go to pancreatic cancer. Let’s go to brain cancer. What are what’s unique about those cancer cells in terms of what they’re putting into the bloodstream, producing and putting into the bloodstream? And do you have to have a baseline score for all of those other types of cancer? So, it starts to get really really complicated to say, well, let’s just have a blood test that picks up the fact that you have cancer or don’t have cancer.

David Raubach: Now, what we’ve learned over the years is we have learned a lot more about the types of chemicals or proteins that are produced by other cancers and we’ve also learned how to detect those more efficiently. But I agree with you, the holy grail is to be able to just do a simple blood test, a few drops of blood, and be able to detect that you have cancer.

Britney Haynes: Sounds amazing. It’s low cost. It’s relatively non-invasive. You know, nobody likes a needle, but it is still relatively non-invasive, right? And easy access, too. I mean, yeah, at a fraction of the cost of doing a full body MRI, you know, this is much quicker, easier. You go to your lab, draw off, send it off, and get a report in a couple weeks. It sounds really great. I don’t know much about this specific company. It did say specifically that they did not test for prostate or breast.

David Raubach: Okay. Those both would have to still be independently I would say monitored.

Britney Haynes: But for especially the rare types I think is I think that is what to me is like something that wouldn’t necessarily have easily detectable symptoms is something that I would be more interested in being able to have, you know, occasional screenings for.

David Raubach: Well, you brought up pancreatic cancer, which is a cancer that often is not symptomatic until it presents at a later stage, which is why the mortality for pancreatic cancer can be so high. I want to talk about somebody that everybody knows the name of who had who actually passed away from pancreatic cancer.

Britney Haynes: Okay.

David Raubach: Britney, do you have an iPhone? Are you an Apple fan?

Britney Haynes: I sure am. Yeah.

David Raubach: Okay. So, you’ve got an iPhone. And I’ve got an iPhone. We all have iPhones. We all So, what many people may not realize is that when the first touchscreen iPhone came out in 2004, Steve Jobs was actually battling pancreatic cancer.

Britney Haynes: Wow.

David Raubach: Now, what’s important to note is that Steve Jobs had what’s called a peanut tumor. Not peanut. Peanut. PNET. It’s an acronym. And what this stands for is pancreatic neuroendocrine tumor. So he had a neuroendocrine tumor that presented in the pancreas and so neuroendocrine tumors can present in other parts of the body as well.

Britney Haynes: I see.

David Raubach: About 5% of pancreatic cancers are neuroendocrine and that the other 95% are adenocarcinomas and adenocarcinomas are the aggressive pancreatic cancer. So neuroendocrine pancreatic cancers don’t tend to be as aggressive. Now, so with so Steve Jobs was diagnosed in 2003 and his doctor recommended surgery, what’s called a Whipple procedure where you go in and you actually cut out part of the pancreas, remove where the cancer cells are. It’s it’s typically very successful. People that have neuroendocrine pancreatic tumors typically have both a good quality of life and a very high cure rate with the cancer. Steve Jobs unfortunately looking back I say unfortunately decided that he did not want to do surgery and instead pursued and I had the list here special diets fruit only diets herbal remedies acupuncture juice fasts and various other alternative therapies.

David Raubach: He told his biographer, Walter Isaacson, that he quote didn’t want my body to be opened, so I tried different diets. Unfortunately, the 9-month delay allowed the cancer cells to spread beyond the pancreas. So then he eventually went in July of 2004 and he had the Whipple procedure at Stanford Medical Center. And the surgeon successfully removed the tumor from the pancreas. Now at the time they didn’t detect the fact that the cancer had spread or metastasized. It was a microscopic cells. But later on in 2008 so this was about four years later well four years later there were obvious signs that Steve Jobs was going through something some medical issue. There was dramatic weight loss. This is a like if you remember those pictures of him where he looked like he weighed under 100 pounds. He was super thin, muscle wasting away. He had hormonal disturbances.

David Raubach: And ultimately what came out was that the cancer had spread to his liver. Now here’s where it also then gets a little bit controversial. So Steve Jobs then received a liver transplant. So he has metastatic cancer spread from the pancreas. Pretty good chance. A lot of doctors think that because he delayed initial treatment nine months doing these alternative therapies that was the reason that the cancer spread. So then he signs up to get a liver transplant and he did something and this comes back to what we’ve talked about with cost and access to care. Because of who he was and the money that he had, he actually got himself listed on wait lists in multiple states.

Britney Haynes: I see.

David Raubach: For a liver in Tennessee had a short wait list for liver transplant. And so he actually ultimately ended up doing a liver transplant in Memphis, Tennessee, even though he lived in California.

Britney Haynes: Oh, interesting.

David Raubach: There’s also some and I’m I don’t know how much I want to dive into this, but there’s also some controversy about doing transplants for metastatic cancer patients because metastatic cancer patients often have not great outcomes or not great prognosis and a lot of times the cancer can actually represent in the transplanted organ, right? Which is what likely happened with Steve Jobs.

Britney Haynes: That’s super interesting because I have heard you know just in general that it’s very very difficult to get organs specifically livers because I think it is one of the organ types that can be transplanted but that there’s a long list of people who suffer from a lot of health conditions that need liver transplant. I had never heard that fact about him getting on multiple lists. So that’s interesting because my takeaway from his cancer and then ultimately his death from cancer was that wow this guy who had the opportunity who had unlimited resources unlimited funds you know there was no barrier to access for him and he still you know couldn’t beat that cancer. So, it’s it’s interesting to hear kind of further details about his specific journey and his deferment of treatment at the beginning and then ultimately the transplant.

Britney Haynes: What do you think about his decision to pursue alternative therapies? I mean, that’s a that’s so rough to hear. Yeah, because I mean then he ultimately ends up metastatic. I actually watched this show on Netflix recently called Apple Cider Vinegar. Have you heard of this show?

David Raubach: I enjoy A Daily Dose of Apple Cider Vinegar. I didn’t know that there was a show about it.

Britney Haynes: Okay, there’s a show on Netflix and it is a it’s a drama, but it’s based off of a true story and it was a girl in Australia who had been diagnosed with cancer and was treating it holistically, but she was presenting because it was kind of her image, her brand. She was presenting as though it was paying off and she was doing great when the truth was she actually was doing much worse like she was declining in her health and ultimately before she passed she kind of came out and said that she wished that she had gone like a more traditional route. So, some similarities there to that specific program and there was another scandal that was involved in the program. But anyway, overall I do think that you hear a lot in medicine in general and in childhood cancer as well.

Britney Haynes: You hear a lot about people who want to kind of engage with those holistic approaches but also are seeking active, you know, treatment through their doctor, through their health care facility as well in addition to and I think that’s a perfectly respectable balance. I hate when I hear an outcome like Steve Jobs who he you know defers treatment altogether to just do the fruits and stuff. I think it can be done in conjunction with and that’s great. Whatever you know makes the patient feel more optimistic and like they’re doing everything they can and they’re un you know turning over every stone I’m in full support of that. But yes, obviously it’s like gh when you hear that they just defer treatment and it leads to this outcome. There have been actually cases because in the United States it’s illegal not to treat your child.

Britney Haynes: It’s actually considered you know child neglect.

David Raubach: Yeah. A crime.

Britney Haynes: Yeah. And so I have heard not verified but I have heard or seen stories where parents move to other countries so they can’t get in trouble for seeking only holistic approaches to for their children when their children are diagnosed. I just think again it’s finding that balance and I think that you can do both and I think that’s great and a great idea but I would personally never advocate for entirely deferring traditional treatments that have been scientifically tested backed and approved.

David Raubach: I like the way that you approach that because I think well I’ll just say you know what we tell patients at the Oklahoma Proton Center is we it’s it’s okay to pursue alternatives but we would rarely recommend pursuing a treatment that didn’t have some type of foundational evidence to support its use instead of [snorts] a traditional treatment that we know works.

Britney Haynes: Right.

David Raubach: So, in the case of Steve Jobs, he said he didn’t want to have surgery. He didn’t want to have part of his organ cut out of his body. Nobody wants that. I don’t want that. You don’t want that. Surgery comes with complications. But it was a treatment that at that point in time in the early 2000s that was known to work and his cancer had been caught at an earlier stage. And what’s interesting is that Steve Jobs actually told Walter Isaacson, his biographer, that he regretted not treating the cancer based on the recommendations of his doctors at the Stanford Medical Center. He regretted pursuing this alternative approach to treatment. So now, are there stories of people that take an alternative approach to treatment and their cancer disappears?

David Raubach: Are there stories where people take an alternative approach to treatment and what seems like a fatal cancer disappears or a cancer that’s untreatable disappears?

Britney Haynes: Yes.

David Raubach: Like those stories are out there, but they tend to be the exception, not the rule. And so, yeah, definitely it’s important not to latch on to, well, I heard this story this one time about this one person and read a blog post about it or saw a Tik Tok video about it and so therefore I’m putting all my eggs in that basket and going against the recommendation of my physicians who are saying, “Hey, here’s some options that you have that can work.” so the other thing that I want to talk about with Steve Jobs is that you brought up taking parents taking their kids overseas to go pursue treatment. Steve Jobs went overseas when it so he has the cancer ultimately he has the surgery in 2004. The cancer comes back in 2008. It’s metastasized to his liver. He gets the liver transplant in 2009.

David Raubach: And then he has this noticeable decline in health between 2009 and 2011. And it says here in my notes that he traveled multiple times to University of California, San Francisco, Stanford, and then occasionally Europe for specialized treatments. Now it’s not entirely clear what treatments he was pursuing in Europe but the treatment that people think that he was pursuing was what was called PRRT. So another acronym peptide receptor radionuclide therapy.

Britney Haynes: Okay.

David Raubach: So peptide receptor radionuclide therapy now is regularly used for peanut tumors especially metastatic peanut tumors. And what it is it’s a type of theranostic treatment. And so theranostic is a combination of two words, therapy and diagnostics. And the reason that those two words are combined for this particular type of treatment is that you’re using a common agent or a common molecule both in the imaging of the tumor to identify the tumor and to treat the tumor. And specifically what peptide receptor radionuclide therapy is it’s actually taking a radioactive isotope. So in this so for these types of tumors a lot of times it’s lutetium-177 is the radioactive isotope and attaching it to a molecule that seeks out receptors on neuroendocrine tumors. And neuroendocrine tumors have more receptors. They have a significant increase in receptors versus non-cancerous endocrine cells.

David Raubach: And so think of I’m going to try to use an analogy here. So think of these receptors on neuroendocrine tumors as being like locks and this molecule that’s used to target these receptors as being like a key. And so this key goes to the lock and it unlocks the cell and it triggers the absorption of the radioactive isotope that’s attached to the molecule that targets the receptor.

Britney Haynes: I don’t know. Yes. I don’t even know if I followed it all of that.

David Raubach: But it the point with it is it’s a way to target specifically cancer cells with radioactive isotopes and create a reaction with those cells that causes those cells to absorb the radioactive isotope which then causes DNA damage or kills the cell to the tumor.

Britney Haynes: Yes. There so we talked last time I was on here that my daughter had neuroblastoma. There is a very similar the it’s a similar therapy process. It’s a different isotope but it’s called MIBG that they do that they use for neuroblastoma as well. So same mechanism say same thing. It’s injected and then you remain radioactive until it completely flushes out of your body. But the same thing as what you’re describing.

David Raubach: So is PRRT then is that not available in the United States or was it not at that time? The name of the drug that’s used for neuroendocrine tumors is Lutathera. So there may be people that have heard of this drug. So Lutathera, it was not FDA approved until 2018.

Britney Haynes: Got it.

David Raubach: And this was based on large randomized trials that were published between 2015 and 2017. But there were facilities in Europe in the early 2000s. So the drug was developed and this is specifically this theranostic treatment for neuroendocrine tumors like what Steve Jobs had. That treatment was developed in the late 90s and there were some facilities in Europe that were experimenting with this drug in the early 2000s and mid 2000s around the time when Steve Jobs was traveling to Europe to get treatment. And so there’s some thinking and when I say experimenting what they were trying to figure out was how to get the right dose right of RA because you’re injecting the body with radiation.

David Raubach: So, how do you get the right dose of radiation into the body to kill the cancer cells but not do so much damage to the body and in this case so much damage to the liver that you actually kill the patient? And that’s what that’s the kind of studies that the FDA is looking for before they’re going to give it the stamp of approval to be widely used.

Britney Haynes: Yeah. Yeah.

David Raubach: So yeah so it an interesting story again and I think that probably the takeaway from this is that well two takeaways I would say is that cancer can happen to anybody I mean here’s a guy that was at the top of his field one of the most respected businessmen in the entire world endless access to resources to treatments cancer can happen to anybody it can be fatal for anybody it doesn’t discriminate so that’s one takeaway and then the other takeaway I think is be conscientious or thoughtful about pursuing alternative treatments at the expense of more traditional treatments and each patient.

Britney Haynes: It’s crazy.

David Raubach: Yeah. Go ahead.

Britney Haynes: It’s crazy to think that he got to a point, he started at a point where he didn’t even just want to have a surgery, which listen, a surgery is not nothing, but a surgery is, I think, so so much easier to digest, the thought of a simple surgery versus by the time that he was nearing the end of his life and he’s flying to Europe to have this radioactive dye injected into his body. And I mean the change in his understanding and his mental state from day one until the end, that’s a complete 180 on I think his outlook towards medicine in general.

David Raubach: Yeah. And so it’s Yeah, that’s a really interesting story and interesting for me to kind of understand more of the details on it. So who do you have next on your list, Britney?

Britney Haynes: Who do I have next on my list? Well, I was going to talk about a I mean, since we are the Oklahoma Proton Center, I sort of wanted to talk about a couple notable figures who we know specifically received proton therapy.

David Raubach: Okay.

Britney Haynes: And there are a few you may have heard about Michael Strahan’s daughter, Isabella Strahan, several years ago who had a brain tumor and she received proton therapy for her brain tumor. We recently did a story on Jake Gyllenhaal, the actor. His father is a famous director, and he had prostate cancer, has prostate cancer, but had proton therapy done for his prostate cancer and is kind of an advocate now and speaks very positively about his experience and lack of side effects and those sort of things. And then there was another one that I hadn’t heard of before, but was super interesting to me.

Britney Haynes: It was Mark Rolfing and he was a pro golfer turned he’s like a golf commentator now and he had a salivary gland stage 4 salivary gland tumor that he got proton therapy for at MD Anderson and again he said that it was very important to him throughout treatment that he was able to maintain his vocal cords his vocal health as that’s imperative to him you know doing his job and so that’s why he sought out specifically a proton therapy treatment and he had a great experience. Very few side effects. Didn’t have to have a feeding tube. Things that would normally be associated with a head and neck maybe traditional radiation route he was able to avoid with proton therapy. And so those were a few of the notable proton therapy specific that’s interesting.

Britney Haynes: So, another one I’ll bring up is Ron Rivera, who was a football coach, coach of the Panthers, coach of the Redskins, and he had a squamous cell carcinoma in his neck, and he received proton therapy as part of his treatment. And he’s spoken very highly of just the process and the fact that he is certain that proton he had fewer side effects going through radiation treatment than he otherwise would have had if he did traditional radiation.

David Raubach: So maybe for those listening that maybe are not familiar with when we say that there are fewer side effects with proton therapy Britney why don’t you tell us what we mean by that?

Britney Haynes: Well, proton therapy is going to deliver less radiation to nearby or surrounding tissues, organ structures that are healthy that you don’t want to damage. And proton therapy also doesn’t have the exit dose, so it’s not going to go all the way through the body and harm any of the structures that are sitting behind the tumor. So as such, specifically like in a head and neck cancer, you might sometimes see the need for a feeding tube. You might see some deterioration to all of the structures that are important, imperative for, for example, your vocal cords, your if you’re a speaker or whatever, you know, you want to really keep that all intact.

Britney Haynes: And so that is why they will normally if it’s around a very it’s if it’s in a location that has a lot of healthy tissue around it that is very important, your heart, your lungs, etc. That’s why proton therapy is an ideal choice. It’s an ideal choice for minimizing the side effects to those healthy tissues.

David Raubach: Yeah, I think the so the goal with radiation that was a fantastic summary. So the goal with radiation is to get as much radiation to the tumor as possible with as little radiation to healthy tissue as possible. And because protons can be stopped inside the body, as you said, we’re able to target more of the radiation oftentimes to the tumor than we can with traditional X-ray-based radiation or sometimes you might hear it referred to as photon radiation. Where those photons or those X-rays can’t be stopped inside the body. So, they’ll go and they’ll hit the tumor and they’ll keep traveling. And as you said, for head and neck cancer, and really any other cancer, it’s really important. I think about Michael Strahan’s daughter, and I How old was she when she was treated? Do you know?

Britney Haynes: She was four. She was diagnosed with neuroblastoma. Four is older than average. The average patient who’s diagnosed with neuroblastoma is two years old, 18 months to two. So, she was on the older side. It’s almost unheard of past a certain age, which I think is around 8 to 10. So she was older, which typically will present with a less favorable outcome. I believe that she they spoke widely about the fact that she was originally told 50/50 chance. And she is doing great. She is a healthy teenager today. She went through all of that treatment and is doing very well, which is fantastic. But yes, she was Oh, wait. I’m sorry. I’m now talking about Leah Still. I’m not talking about Isabella Strahan. Isabella Strahan was in college. I’m I was talking about a different child. I’m sorry.

Britney Haynes: Isabella Strahan was in college when she was diagnosed with a brain tumor. Okay. Not neuroblastoma. I was thinking neuroblastoma in my mind. [snorts] Well, yeah. She was a college student who kept having migraines and kept having these debilitating headaches. Went in, got an MRI, and was ultimately diagnosed with a brain tumor and received proton therapy. Especially brain tumors are one scenario where you’re probably going to be recommended proton therapy, I would say, from your physician. Would you agree, David?

David Raubach: Should be I mean that your brain contains obviously incredibly sensitive cells. And for younger patients, whether you’re a teenager or a four-year-old like you talked about that your body is still developing and so the damage that can be caused by radiation is exacerbated. It can be exponentially worse than it might be for somebody who’s an older adult who’s fully developed. That doesn’t mean that there can’t be radiation damage with an older adult. There can be, but it’s even it’s heightened with kids. And that’s why a lot of I mean proton therapy as a form of radiation really has become the standard of care for pediatric patients. There’s very little question that for most pediatric patients if there needs to be radiation especially for brain tumors proton therapy is going to be the choice or on the spine as well.

David Raubach: I mean spinal tumors especially are a great case for proton therapy. But yes, I agree. Generally in pediatrics, it is I would say the standard of care. So, I want to transition and ask you a question that we’re going to play a little game. It’s called

Britney Haynes: Oh, great.

David Raubach: See how many presidents you can name working back from our first president. And we’re going to see how far back you can get.

Britney Haynes: Oh my gosh, I’m going to be so bad at this. This is going to be really embarrassing.

David Raubach: Okay. So, we’ll start with the current president and we’re just going to work back sequentially.

Britney Haynes: What is the point of this game though? Are we talking about the are we only identifying the ones who have had cancer or what are we doing?

David Raubach: There’s there’s going to be you will understand why we’re playing this game in the natural transition that I’m working for here. The segue as they say.

Britney Haynes: Okay. So, you want me to just go backwards?

David Raubach: Yeah.

Britney Haynes: So, we’ll start. So, Donald Trump and back Joe Biden.

David Raubach: Yep.

Britney Haynes: And then Obama.

David Raubach: Yep. Well, Clint, you skipped one.

Britney Haynes: Well, if we’re only naming the name. So, Trump, Biden, Trump.

David Raubach: Correct. Then Obama.

Britney Haynes: Then Obama.

David Raubach: Yep. Okay.

Britney Haynes: Then W. Bush.

David Raubach: Yep.

Britney Haynes: Clinton.

David Raubach: Yep.

Britney Haynes: Bush senior.

David Raubach: Yep.

Britney Haynes: I’m done.

David Raubach: Who was that? This was the president when you were born. You got to get at least one more.

Britney Haynes: I know. When I was born, I don’t know. When was the Kennedy assassination? Was it Kennedy? Was it Reagan?

David Raubach: No, you skipped Who was it? It was Reagan.

Britney Haynes: Yeah, Reagan. Yes.

David Raubach: Okay. So, that was good. So, you made it back to Reagan. You needed to at least make it back to when you were born.

Britney Haynes: Thank you.

David Raubach: So, one of those presidents has actually just finished cancer treatment and that is Mr. Joe Biden.

Britney Haynes: Correct.

David Raubach: And Joe Biden was diagnosed with an aggressive form of prostate cancer about a year ago. And one of the I don’t one of the controversies with his diagnosis was the fact that it came out after he was diagnosed and I can’t remember exactly how old he was, maybe 82ish, early 80s when he was diagnosed, is that he actually had stopped screening for prostate cancer about 10 years earlier. And the reason that he had stopped screening, and again, think about this. This is an individual that has unlimited access to all of the resources that you could possibly want from a healthcare standpoint at no cost to himself. His physician had said, “Well, you know, once my recommendation is that once you hit the age of 70, the chance of getting and then passing away from prostate cancer is pretty low.

David Raubach: You don’t necessarily need to continue with screening. It’s really optional at this point. And he chose to stop doing this blood test this that looks at your PSA score.

Britney Haynes: Mhm.

David Raubach: Unfortunately, what ended up happening is that because of this, by the time the cancer was detected, it had spread outside of the prostate into the lymph nodes and we don’t have all of the details specifically, but probably into the bones as well. So now as a result he’s having to undergo very aggressive treatment that includes hormone therapy. So he had a cancer where the cancer cells grew were fed by testosterone. And so this hormone therapy treatment is intended to reduce the production of testosterone which is feeding the cancer cells. It comes with a lot of side effects. We know that he just finished radiation treatment at UPenn. We don’t know if he got traditional radiation or proton therapy. But he was treated at UPenn. And then it’s likely that he’s having to undergo other treatments. He might have to do chemotherapy.

David Raubach: You might have to do this theranostic treatment that’s available for prostate cancer called Pluvicto which again uses a radioactive drug attached to a molecule that targets metastatic prostate cancer cells so he’s he’s going through it right now and he was relatively healthy otherwise I [snorts] mean obviously there’s some concerns about dementia but in terms of just his physical the health of his body physically he was in pretty good condition and now he’s having to go through this rigorous cancer treatment. And so again, I think that speaks to the importance of screening.

Britney Haynes: Screening.

David Raubach: Yeah. Continued screening. And I think I also I want to bring up the fact that for prostate cancer specifically, you mentioned somebody you said it was Jake Gyllenhaal’s dad who was treated for prostate cancer with proton therapy. So, you know, there’s different stages of prostate cancer. Early stage prostate cancer, low-risk prostate cancer, it is probably true that’s it’s it tends to be very slow growing. And a lot of times patients can put off treatment. So their doctor might recommend what’s called active surveillance where you’re actively monitoring the cancer, but you’re not necessarily undergoing any type of therapeutic treatment. But then if you get to the point where the cancer is aggressive enough that you need to go through treatment, there’s a lot of options. You can do surgery. You can cut the cancer out of the you can cut your prostate out.

David Raubach: You can do traditional radiation. You can do proton therapy. You can do what’s called brachytherapy which is the implantation of little radioactive seeds inside the prostate. You can do cryotherapy where you’re freezing the prostate and killing the cancer cells. That way you can do ultrasound ablation where you’re essentially heating the prostate cancer cells up and killing them. That way you can do this theranostics treatment although that’s typically used for when the cancer spread out of the prostate. So metastatic prostate cancer. And I’m sure that I’ve probably even missed a few options. You can do a combination of those. You can do surgery and then radiation.

Britney Haynes: Mhm.

David Raubach: You could do external beam radiation with proton therapy and internal radiation with brachytherapy. The point with all I hope that sounded overwhelming because it is overwhelming.

Britney Haynes: Yes.

David Raubach: Basically, you have a lot of options.

Britney Haynes: You have a lot of options. So then how do you know what to do?

David Raubach: Well, if you’re President Biden, you just go to the proton center, the nearest proton center. That’s exactly what he did at UPenn. I mean, I guess, you know, speak a little bit cuz you’ve gone through having your daughter diagnosed with cancer and so you went through that point in time where you’re having to try to figure out what to do from a treatment standpoint and then even after the initial treatment, what to do from a follow-up standpoint. Talk about just how overwhelming it can be when you get that cancer diagnosis, especially if you’re presented with a multitude of options. How do you navigate that?

Britney Haynes: Oh my gosh, I know. I even today I would feel so much more equipped to handle something like that. That was cancer was something I had never even considered. Like like I said whenever I was here last time I didn’t even have the awareness that a child re especially a baby could even have cancer. It wasn’t on my radar at all. I knew absolutely nothing. And so yes, right after the time of diagnosis it was so overwhelming. I very much leaned into the idea of just listening to the physicians. I really really trusted her doctor and he gave us options. I mean, we were given options. I kind of went through the process just saying, “What would your recommendation be?” Because we had we were in a situation where we had to start treatment very very quickly.

Britney Haynes: So, there wasn’t a lot of time for me to gather all these facts. In retrospect, with what I know now, I know that there were even more options that actually were available that we could have pursued if we had been knowledgeable about all of them at the time. But I think when you’re in that moment, yes, it’s so overwhelming. There’s so much information. There’s so much that you have to learn and you feel like you have to learn it really, really fast. In our case, we were kind of working against the clock. Every minute mattered. And I chose at the time, for better or for worse, mostly to just leave it in the hands of the physicians who knew the disease, who knew what they were talking about. I was not an expert, but they were.

Britney Haynes: And I felt in that moment that they were, you know, capable of making those important decisions. And then after the fact is when I really started, you know, educating myself and doing the work for her care going forward. Before that initial diagnosis at that time I just chose to trust the doctors.

David Raubach: Yeah. And I think that’s that’s generally speaking that’s the right approach and that’s what patients should do. Listen to your physician. And I know one of the things that you did is you talked to multiple physicians.

Britney Haynes: Yeah. Or you had multiple there were a lot involved. Yes. And her and they had offered the potential for a surgery right at diagnosis that we would have to, you know, fly to go get the surgery done because there wasn’t even anyone here who could do it. And we opted not to do that, but we consulted about that prior to making that decision as well and kind of just got the group consensus on what the best treatment path was moving forward. But it is completely overwhelming when you are tasked with these very very important decisions and you it’s at least in my case I didn’t wake up that day knowing that I was going to have to educate myself on cancer later that night. So it just comes out of nowhere and you feel very behind the curve.

Britney Haynes: And so I think that at least getting through the first initial few days even right after a diagnosis, it is important to trust people who are really educated. And that’s not to say that maybe they stay your provider forever or that you agree with their treatment plan once you have sort of had the time to do some due diligence and talk to other people or whatever. But in that immediate moment, that was the only way that I felt comfortable.

Britney Haynes: So, I have one more famous person.

David Raubach: One more. Do you have another I just assumed if you were going to talk about Joe Biden that you were going to hop across the pond and talk about King Charles, but no.

Britney Haynes: Oh, man. That I mean, that was close. So, I real similar though. My segue question was actually going to be, are you a fan of the royal family?

David Raubach: Are you a Oh, we were thinking the same. We were We Okay. Yeah, we were converging.

Britney Haynes: I just had I am a fan of the royal family. I just had a different member of the royal family.

David Raubach: Oh, you were going to talk about Kate.

Britney Haynes: I was going to talk about Princess Kate.

David Raubach: I think of the members of the royal family that have undergone cancer care. People will be more interested in Princess Kate.

Britney Haynes: Yes, of course.

David Raubach: Or as I was reminded, she is Catherine, right? Whenever we had you had the patient here from the UK.

Britney Haynes: Yeah.

David Raubach: So, what do you know about her cancer treatment?

Britney Haynes: H I feel like they’ve kept it pretty she hasn’t been super vocal about her specific type right or her diagnosis but we know that it was generally I think didn’t they specify she had an abdominal surgery so we know that it pertains somewhat to somewhere in the abdominal region and that’s basically the extent of I think what she has said publicly about it other than she did say that she had gone through I think some treatments and navigating life after cancer and those type of things.

David Raubach: So this is what we do know. That was a good summary. So 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. And then in March of 2024, so two months later, she announced that she was undergoing preventative chemotherapy. And then from June 2024 to autumn 2024, she made some additional statements about her treatment. And then in late 2024, she shared that she had completed chemotherapy and was in recovery, although no specific cancer diagnosis was disclosed. And as you mentioned, it was an abdominal surgery, so you can at least narrow it down to it was some type of cancer within the abdominal region, but we don’t know exactly what it was.

Britney Haynes: Mhm.

David Raubach: One of the things that has stood out to me about her, was the fact that, I mean, one, she wanted to keep as much as possible and as much as you can when you’re, the Princess of Wales, keep everything private.

Britney Haynes: Yeah.

David Raubach: But she also talked about, so I’ve got a couple quotes here that I want to read. So she said, “I am making good progress, but as anyone going through chemotherapy will know, there are good days and there are bad days. On the bad days, you feel weak, tired, and you have to give into your body resting. But on the good days, when you feel stronger, you want to make the most of feeling well.” So then, this is another quote from her. She said, “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.

David Raubach: It’s not smooth like you expect it to be, but the reality is you go through hard times.” And so I think part of what I’ve seen with her is she’s been very transparent and she’s really acknowledged the fact that going through cancer treatment is really really difficult. She talks about in this quote that there’s good days and bad days, especially if you’re going through something as rigorous as chemotherapy and that when you come out on the other end, you actually have to find your new normal. There’s kind of this before cancer and then during cancer treatment and then after where you’re in this survivorship phase or some people will call it their thriving phase which I love but you have to rediscover who you are and you may not actually be entirely the same person as you were before treatment.

David Raubach: So maybe talk about that a little bit.

Britney Haynes: Yeah, I love that message from her and I can appreciate too that she maintains a bit of privacy around it. I think everybody has to sort of do what feels right for them in their journey and some people are maybe less comfortable being public about it than others and I think I completely understand and respect her need to keep it you know so so tight but then to still express that yes it did it was transformative for her. It did change her life. She now has a new understanding of what life is going to be going forward. She also had to go through treatment with young children and you know maintain a stoicism probably not to stoke their anxiety as well and to face you know to also give them a bit of emotional support when she herself was going through this battle.

Britney Haynes: I just love that she’s opening up and talking about it and talking about survivorship because survivorship is something that a lot of people don’t focus on. They focus so intently on the treatment phase and then once the treatment phase is over and it comes to resuming normal life there and there’s not you don’t have someone guiding you along the way anymore. It’s just you on your own now at this point other than your occasional follow-ups with your physician. And so I think that it’s really great that she’s talking about that and making others who have been through the same situation feel seen and feel heard and may maybe they were having an awareness of like, “Oh, I thought I was the only one feeling that way.” And she’s kind of explaining that so beautifully to where they’re like, “Oh, this is normal.”

Britney Haynes: You know, I because people may have an expectation that once you’re done, oh, you’re done. It’s great. Life goes on. And they’re not understanding the long-lasting side effects either from the treatments themselves or mentally, you know, how your mental health might be struggling, how you might be struggling emotionally just coping with what you’ve been through. And so I just think that it’s so wonderful and helpful for her to speak on it. Someone who is so poised and again to your point earlier that this can happen to anyone. She’s a real princess, you know, right? She’s like this gorgeous, poised member of the royal family, but has been through an experience that is so approachable, so relatable to so many people. And so, I just am really glad that she has chosen to speak about the journey that is kind of life after cancer and survivorship.

David Raubach: And she did chemotherapy. And you know, I think I’ve heard some people talk about the fact that well, you know, maybe rich people have access to some secret cocktail of treatments that’s that works differently than traditional care and or the you know, they’re hiding the cure from us, right? Like and I think to a certain it that can be true from a financial standpoint. There’s financial barriers to care. There’s financial sometimes it’s hard to access you know not every patient can travel for treatment not every patient a lot of patients certainly can’t pay out of pocket for treatment but I do think it kind of pulls back the veil on the fact that doctors most oncologists are recommending a treatment for a reason and they’re recommending the treatment because it’s the best treatment for that particular patient.

David Raubach: They’re not recommending the treatment necessarily because well this person’s a member of the royal family and so they get X and but if it was a commoner from the streets they get why. 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. And that’s just it speaks to just the reality of what the cancer journey can look like. And also you talked a little bit about the mental health aspect of cancer treatment. Again, somebody that has access to all of the possible resources that are available, a huge support system, an entire country rooting for her to get through this treatment. And she’s still saying, I have terrible days.

David Raubach: Like I just have these days where I don’t I hardly or as she was going through treatment there I hardly even felt like getting out of bed. I have days now where I don’t know who I am. I’m still figuring that out. I’m still discovering that. And I hope that is in a weird way an encouragement that cancer is that if somebody listening to this is thinking, I have those days that I don’t feel like going getting out of bed. Well, here’s a member of the royal family in England that’s saying the exact same thing, right? I’m two years post-cancer treatment and I still haven’t figured out who I am or who I’m supposed to be. Here’s a member of the royal family in England saying the exact same thing.

David Raubach: And I think it’s important to find your every patient needs to find their support system and their family. And that may be their siblings, it may be their parents, it may be their kids, it may be friends. A lot of times it’s other patients that are walking through the same journey. And I think that’s that’s part of the reason why I wanted to have this conversation with you is to just say, hey, there’s other people out there that are walking through these journeys. That’s why we talk about Joe Biden getting prostate cancer or Maria Menounos getting pancreatic cancer or Steve Jobs getting pancreatic cancer and trying to figure out how to treat it, which is a reality for a lot of patients.

Britney Haynes: Yeah, I think that it’s so true. You know, nobody no one wants to go through this. Like least of all probably Princess Kate who certainly had I’m sure many important things to do on her agenda. But unfortunately it doesn’t discriminate. It doesn’t it’s not something that you can feel sure is not going to happen. You know, you just don’t ever really know. But I think in some sense that is also a bit of a comfort to know that we’re kind of all trying to navigate our health needs as best as we can.

David Raubach: Yeah, there’s there’s it’s that human element which binds us all together. Well, thank you for joining me.

Britney Haynes: Thank you for having me to talk about this. This is really good.

David Raubach: We should do another topic. You know, the history of proton therapy is really interesting. I don’t know if you knew you were I don’t know if you’ve heard it before.

Britney Haynes: You’re going to have to let me know ahead of time because you’re going to ask me 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. We may go back into the 70s and 60s with who was the president when the first proton patient was treated. That’s that’s your question for that podcast.

Britney Haynes: So, okay. Well, thank you for giving me the heads up.

David Raubach: Yeah, of course. Well, thank you, Britney.

Britney Haynes: All right. Thanks, David.