Crystal S. Denlinger Of The National Comprehensive Cancer Network (NCCN)On The 5 Things Everyone Needs To Know About Cancer

An Interview With Savio P. Clemente

It is important to have good social support during cancer treatment, if possible. This could include family members or friends who are able to stay in touch with you in between visits to the cancer center. It may mean finding a support group of other people going through the same cancer diagnosis experience. It may be social workers or mental health professionals at the cancer center who can help you identify resources or provide more structured therapeutic support. It may also mean determining whether you need additional home health care support or referral to rehabilitation services like physical, cognitive, speech, or occupational therapy to ensure that you remain as functional in your life as possible.

Cancer is a horrible and terrifying disease. There is so much great information out there, but sometimes it is very difficult to filter out the noise. What causes cancer? Can it be prevented? How do you detect it? What are the odds of survival today? What are the different forms of cancer? What are the best treatments? And what is the best way to support someone impacted by cancer?

In this interview series called, “5 Things Everyone Needs To Know About Cancer” we are talking to experts about cancer such as oncologists, researchers, and medical directors to address these questions. As a part of this interview series, I had the pleasure of interviewing Dr. Crystal S. Denlinger from the National Comprehensive Cancer Network (NCCN).

Crystal S. Denlinger, MD, FACP, is Senior Vice President, Chief Scientific Officer at the National Comprehensive Cancer Network® (NCCN®) — an alliance of leading cancer centers. Prior to joining NCCN, Dr. Denlinger held several leadership positions with Fox Chase Cancer Center — an NCCN Member Institution — including Chief, Gastrointestinal Medical Oncology; Deputy Director, Early Drug Development Phase 1 Program; Director, Survivorship Program; and Associate Professor, Department of Hematology/Oncology. Dr. Denlinger also served as chair of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Survivorship and as a member of other panels and abstract committees, including the NCCN Guidelines® Panel for Esophageal/Gastric Cancers.

Thank you so much for joining us in this interview series! Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your childhood backstory?

Thank you for the invitation to discuss 5 Things Everyone Needs to Know About Cancer. In terms of my own story, I grew up in New Jersey and have always wanted to be a doctor. In fact, my first grade teacher, Mrs. Keys, will probably tell you that I declared my career direction in that year. Growing up, I was an active American Red Cross first aid, CPR, water safety, and lifeguard certificant and ultimately instructor. My parents’ primary care physician, Dr. Martha Lansing, exemplified what being a good physician meant and served as a great role model for me. When my father was diagnosed with kidney cancer during the summer between my junior and senior year in high school, I began to solidify the direction of my career as I realized that there were few options for someone diagnosed with his type of cancer. By the time I entered medical school, I knew I wanted to pursue a career in cancer medicine.

What or who inspired you to pursue your career? We’d love to hear the story.

Dr. Lansing exemplified what it meant to be a good physician. She took time with her patients, listened to their needs, and holistically treated them with a great bedside manner. I still try and emulate that approach today. My dad inspired me to become an oncologist and ultimately a clinical investigator. My dad was a research engineer and was always pursuing knowledge. When he was faced with his kidney cancer diagnosis, or any medical problem that he or my mother faced over the years, he approached it analytically and tried to learn as much about the diagnosis and treatment options as he could. He lived with kidney cancer for 15 years, ultimately passing away of metastatic disease about 13 years ago. I joked with him that he earned his medical degree the hard way and he once told me that going through this experience of living with and through metastatic cancer with him would make me a better doctor. I hope that I continue to make him proud as I grow as an oncologist and strive to improve cancer therapy daily.

This is not easy work. What is your primary motivation and drive behind the work that you do?

Cancer is difficult to face. It not only affects the person receiving the diagnosis, but also the family and friends around that person. It affects livelihoods, identities, quality of life, functional abilities… yet those diagnosed with cancer and their family and friends are amazingly strong in the face of the diagnosis. I became an oncologist to treat people living with and through the cancer experience because I understood a part of that experience and wanted to do my part to improve it. I became a clinical investigator and cancer researcher because I wanted to make the treatment of cancer and the experience of living with and through it better. I want to provide people living with cancer, and their family and friends, with hope and concrete ways in which they could potentially live better lives.

What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?

In April 2021, I joined NCCN as Senior Vice President, Chief Scientific Officer. In this role, I oversee NCCN’s Oncology Research Program (ORP). This program offers multiple platforms for investigating new and improved ways to treat cancer and deliver cancer care. We work with outside funding organizations to support investigator-initiated interventional and therapeutic research studies that address the treatment of various cancers, as well as quality improvement initiatives that optimize cancer care delivery and guideline concordance and seek to overcome barriers to cancer care. In addition, the NCCN ORP works closely with the philanthropic NCCN Foundation® to support a robust Young Investigator Award program that invests in promising young cancer investigators who are just beginning their careers. In addition to my work with the ORP, I also oversee some of NCCN’s clinical information programs including the NCCN Drugs and Biologics Compendium (NCCN Compendium®), NCCN Biomarkers Compendium®, and NCCN Chemotherapy Order Templates (NCCN Templates®). These efforts help to support clinical decision-making and treatment by providing a library of clinical tools derived from the NCCN Guidelines, defining standards of cancer care, that can be used by clinicians, payers, health information technology companies, health care providers, and policy makers. These clinical tools are mirrored in the NCCN Guidelines for Patients® — companion resources for the general public available for free at nccn.org/patientresources, via the NCCN Patient Guides for Cancer app, or as a printed book for a nominal fee from Amazon.

By supporting various projects and treatment-related efforts that all seek to improve and facilitate quality, effective, efficient, and accessible cancer care through our alliance of leading cancer centers, NCCN is working to define and advance high-quality, high-value, patient-centered cancer care. As Chief Scientific Officer, I am excited to provide the oncology community worldwide with resources that support guideline-concordant cancer care, which has been shown to improve survival and other outcomes in many cancer settings. I am also excited to support cancer research by facilitating the funding of sound scientific investigation while developing the next generation of cancer research leaders.

For the benefit of our readers, can you briefly let us know why you are an authority about the topic of Cancer?

As a medical oncologist and clinical trialist with over fourteen years of clinical experience, I have expertise in the treatment of gastrointestinal cancers and clinical trial design. I have served as an investigator on a number of pharmaceutical, cooperative group, and investigator-initiated early-phase and late-phase clinical trials. I have also developed expertise in survivorship care and phase 1 clinical trials. Prior to joining NCCN, I was a practicing medical oncologist at Fox Chase Cancer Center, and continue to practice in a limited basis there. I have served on a number of national committees, including serving as a member of NCCN Guidelines panels and chairing the NCCN Guidelines for Survivorship panel. I have also served on other guideline advisory groups and as an advisor to various cancer-related entities.

Ok, thank you for all of that. Let’s now shift to the main focus of our interview. Let’s start with some basic definitions so that we are all on the same page. What is exactly cancer?

Cancer, at the very basic level, is an alteration of normal processes, or normal cellular processes gone bad. It is uncontrolled growth and spread of these abnormal cells that ultimately overwhelm the body’s systems and can cause death, if not caught early and removed. Cancer cells have some basic characteristics: abnormal function, instability of cell genes, uncontrolled growth, resistance to normal mechanisms for death, creation of microenvironments to support survival, and invasion of other parts of the body1. How a cancer develops and behaves depends on the organ in which it originates; consequently, the term cancer encompasses many different types of diseases.

What causes cancer?

Cancer is caused by changes or mutations in the DNA or genes of a cell, which can be caused by a variety of things. For a small portion of patients, cancer is caused by a genetic abnormality inherited in the family and is something you are born with. For some patients, cancer develops as a result of lifestyle behaviors including cigarette smoking or excessive alcohol intake that result in gene mutations over time. For others, it develops as a result of exposure to something, such as radiation or a particular type of infection, that results in gene mutations in specific types of cells. Lifestyle factors, such as physical inactivity, can also contribute to the development of certain types of cancers. However, for the vast majority of patients, cancer develops through the interaction of a variety of mechanisms that allow mutations to accumulate over time and may go unrecognized by the body’s usual mechanisms of repair.

What is the difference between the different forms of cancer?

While there are a number of different cells that can cause cancer, there are two main histologic types of cancer — squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma arises from the cells in your body that line or provide coverage of a bodily structure, like your skin. Adenocarcinoma arises from glandular cells, which typically secrete something, in an organ like the colon or breast. There are rarer types of cancer cells as well, for example neuroendocrine cancers and melanoma, which arise from very specific types of cells in soft tissue organs or the skin.

At diagnosis, a cancer is typically “staged”, our way to classify how extensive the tumor is. Staging is done by considering the size and extent of the primary tumor, whether lymph nodes in the region are involved, and whether the cancer has spread to any other areas of the body. Localized cancer is typically confined just to the primary tumor site. Cancer that has spread regionally includes the primary tumor location and involvement of any lymph nodes in the immediate surrounding tissue or area. Metastatic cancer, or advanced cancer, typically denotes the spread of cancer to another organ more distantly located.

Based on the type of cell making up the cancer, and how much the cancer has spread, a cancer can typically be defined as resectable or unresectable. If a cancer is resectable, then it is typically smaller in size and limited in its spread, and can be removed with surgery as part of the treatment plan. If a tumor is unresectable, it typically involves more than one area of the body or a structure that cannot be removed, and treatment most commonly consists of some form of chemotherapy, targeted therapy, and/or immunotherapy. Another general term for these types of treatment is “systemic therapy.”

I know that the next few questions are huge topics, but we’d love to hear your thoughts regardless. How can cancer be prevented?

While not all cancers are preventable, we know that health behaviors related to body weight, physical activity, dietary patterns, and alcohol use account for at least 18% of cancer cases and 15% of cancer deaths in the United States2. Only cigarette smoking accounts for a higher percentage, 24% and 29% of new cancers and cancer deaths, respectively3. Together, these risk factors accounted for 42.5% of new cancer cases and 47.9% of all cancer deaths in 20143. The American Cancer Society has published recommendations regarding health behaviors for the prevention of cancer, which were recently updated in June 20202. A summary of the recommendations is below:

First and foremost, do not smoke. If you currently smoke, work to quit. Find a smoking cessation program or telephone support quitline program, work with your health care provider to determine if nicotine replacement or other medical therapy is appropriate, and set a quit date. Recognize that relapse is not failure; it is just an opportunity to try again.

Second, maintain a healthy body weight throughout life and avoid excess weight gain. Excess body fat has been associated with 13 different types of cancers and 7.8% of all new cancers3,4. If you are overweight, work with your health care team to come up with a weight loss plan that is right for you. If you are underweight, work with your team to identify ways in which you can achieve a healthy body weight.

Third, be physically active. Physical inactivity alone accounts for approximately 3% of all cancers3. Engage in at least 150–300 minutes of moderate-intensity physical activity or 75–150 minutes of vigorous activity weekly. Physical activity could include brisk walking, gardening, biking, or any activity that gets you breathing a little quicker and your pulse a little faster. You should also limit sedentary behavior, including screen-based entertainment. Work with your health care provider to devise a plan of physical activity that is right for you.

Fourth, avoid or significantly limit alcohol intake. Alcohol intake has been associated with 5.6% of all new cancers, and can be additive to other risk factors such as cigarette smoking3. If you choose to drink, limit your intake to no more than 1 drink per day for women and 2 drinks per day for men.

Fifth, engage in a healthy dietary pattern throughout life. Poor dietary habits, including a diet high in fast food, processed foods, red meat, and refined sugars, has been associated with a number of different cancer types. A healthy dietary pattern limits highly processed foods, refined grain products, sugar-sweetened beverages, and red or processed meats. It also includes a variety of fruits and vegetables, especially whole fruits and fiber-rich legumes in a variety of colors, and whole grains.

Finally, talk to your health care provider about vaccinations which may impact the development of cancer. The human papilloma virus (HPV) vaccine is now recommended for those ages 9–26 and up to age 45 based on shared decision-making between you and your doctor, as HPV has been associated with the development of a number of cancers including cervical, oral, anal, and genital cancers5,6. Vaccination has been associated with lower rates of HPV infection and helps prevent these six types of cancers5.

How can one detect the main forms of cancer?

Unfortunately, not all cancers can be detected. However, many of the most common cancers can be detected through screening tests. In 2021, the five most common cancers were breast cancer, prostate cancer, lung cancer, colorectal cancer, and melanoma6. For each of these cancers, appropriate screening can be used to help diagnose the cancer at an early stage. For all cancers, it is important to try to know of any family history of cancer and discuss this with your health care provider. Patterns of cancers within a family may indicate a higher risk for a specific cancer or group of cancers due to genetic risk. These types of inherited cancers are not common and therefore account for only a minority of cancer occurrences.

The majority of the population will fall into what we consider to be “average risk” for cancer. In this group of people, various professional organizations, including NCCN, have developed screening recommendations. For breast cancers, screening includes undergoing annual mammograms beginning at age 40. Women should also be aware of any changes they see or feel in their breasts, and report any changes to their health care provider promptly7. For colorectal cancer, screening should begin at age 45 years and may be performed in a variety of ways. This includes undergoing colonoscopy or stool-based testing. Again, people should be aware of their bowel habits and report any changes promptly to their health care providers. Cervical cancer screening is also performed routinely in women ages 25–65 and can include a pelvic exam with Pap test every 3 years or a test for the human papilloma virus, or HPV, every 5 years9. We have recently adopted screening for lung cancer in higher-risk individuals. Lung cancer screening includes a discussion about smoking history and annual low-dose chest CT for those over age 50 who have at least a 20 pack-per-year smoking history10. Those at risk for melanoma may undergo annual skin examination and should be familiar with the appearance of their skin and any moles or marks they may have. Prostate cancer screening recommendations are based on a number of factors including age, ancestry, and family history, and may include a prostate examination and bloodwork to check the PSA (prostate-specific antigen)11.

Prior to undergoing any cancer screening test — especially for those considering lung and prostate cancer screening and those older adults with many other medical problems — a person should have a discussion with their health care provider about the risks and benefits of the screening test. Screening for a cancer can lower the risk of dying from that specific cancer but may also include some risk by undergoing the procedure or any subsequent testing that will need to be performed. Thus, an informed decision is one in which a person and their health care provider discuss the reason for the screening test, the potential benefits of getting screened, and the potential risks of the procedure.

Cancer used to almost be a death sentence, but it seems that it has changed today. What are the odds of surviving cancer today?

As of January 2019, more than 16.9 million Americans are living with a history of cancer. The majority of those were diagnosed more than five years prior, and some of them may be a survivor of more than one type of cancer. In general, due to improved early detection or screening as well as better treatments for many cancers, the rate of cancer deaths is declining. This is especially true for the four most common cancer types — breast, prostate, colorectal, and lung. However, there are some cancers in which the incidence and death rates are rising, including liver and pancreatic cancer. Across all types of cancer, the five-year relative survival rate is 67% according to the American Cancer Society’s most recent Cancer Statistics 20216. Survival rates are highest for localized disease, where they may be in the high 90th percentile for cancers of the breast, prostate, colorectal, thyroid, testis, and melanoma of the skin. Once the cancer has metastasized, five-year survivals are significantly lower, and range from 3% for liver and pancreatic cancers to as high as 73% for testicular cancer. Survival is very cancer-specific and is dependent on a number of factors, including the type of cancer and the degree to which it has spread, as well as patient-related factors such as age and other medical problems.

That being said, cancer is the second leading cause of death in the United States. Heart disease remains the leading cause of death in the United States.

Can you share some of the new cutting-edge treatments for cancer that have recently emerged? What new cancer treatment innovations are you most excited to see come to fruition in the near future?

There are a number of new developments in the field of oncology that are exciting. The first has been the evolving and increasing role of immunotherapy in the treatment of a variety of cancer types. Immunotherapy helps the body’s own immune system recognize cancer cells and attack them, ultimately improving the body’s ability to respond to the development and growth of a cancer. The second development has been the explosion in the identification and therapeutic targeting of biomarkers. Biomarkers are molecular changes in the cancer cell that either drive the cancer cell to grow more or take the breaks off regular cellular mechanisms that inhibit cancer growth. Using a variety of techniques that test tumor tissue from biopsy and surgical specimens, we are now able to test for a wide range of biomarkers that are either based on the expression of proteins on the surface of the cancer cell or are changes in the genetic make-up of the cell, to identify those which are abnormal and likely contributing to the cancer’s growth. This process is called molecular profiling and traditionally has been done on preserved tumor samples that are stored in the lab. We are now starting to see this type of profiling being done in blood-based samples where we are able to identify circulating pieces of tumor DNA and test these pieces for the same biomarkers. By using a blood-based sample, we can perform the test in a safer fashion because we do not need to get a tumor biopsy, and potentially identify changes in tumor DNA and protein expression that occur as a result of treatment, in a sequential manner after tumor growth. The identification of biomarkers has also driven the development of targeted therapy, which is a form of cancer therapy that identifies and targets destruction for only those cells with the biomarker, causing less harm to normal cells. Targeted therapy may focus on the expression of specific proteins on the outside of the cell or a particular genetic process within a cell, and may include the use of monoclonal antibodies or small molecule inhibitors. Recently, combinations of targeted therapies without the inclusion of traditional chemotherapy have demonstrated benefit in some diseases, which could result in less toxic regimens with similar effectiveness against cancer cells.

Healing usually takes place between doctor visits. What have you found to be most beneficial to assist a patient to heal?

For those going through cancer treatment, trying to engage in some form of physical activity can be helpful to combat fatigue and improve or maintain quality of life. This does not mean run out and get a gym membership or buy the latest fitness app for your smartphone. It means engaging in walking, chair-based exercises, or any other activity that gets you moving. You do not need to spend a significant amount of time every day being active, but rather strive for at least 150 minutes of activity weekly. This can be broken into smaller amounts, or exercise “snacks” as Dr. Kathryn Schmitz, past President of the American College of Sport Medicine, likes to call them. Survivors and those undergoing any form of cancer therapy should avoid prolonged amounts of inactivity or sedentary activities. That means scheduling movement breaks if you spend your day at a computer or standing up or moving around during commercials when watching television.

In addition to remaining physically active, it is important to maintain as healthy a diet as possible, focusing on consuming fruits, vegetables, and whole grains. Those undergoing cancer therapy and survivors of cancer should eat a diet that is at least 50% plant-based, and limit their intake of red meats, refined sugars, and processed foods. Finally, minimizing consumption of alcohol is also a good idea during and after treatment. I don’t mean to say you cannot have that cookie, cupcake, or alcoholic beverage during a special occasion. These things should be treats and not staples of the diet.

It is also important to stay in touch with your treatment team about any side effects or symptoms that you may be experiencing between visits. Many of our cancer therapies have side effects that occur days after the treatment is given by vein or after an oral medication is started. Even though your health care provider may have provided you with a list of side effects that you may experience, you should not suffer alone if those effects happen to you. Talk to your health care provider about medications that can be prescribed as needed to treat some of the most common side effects of treatment, like nausea, constipation, or diarrhea. When a new side effect develops, contact your health care provider to determine whether this requires medical treatment or can be managed with supportive interventions like moisturizers or dietary changes. Know the purpose of medications prescribed, including what medications to use if you have or develop pain, have gastrointestinal tract side effects that could affect your ability or desire to eat, or should be taken to prevent the development of a side effect. Don’t wait until the next visit or suffer in silence. Supportive medications for the treatment of therapy side effects have improved drastically over the years and we can work to prevent these effects from having too significant an impact on quality of life.

Finally, it is important to have good social support during cancer treatment, if possible. This could include family members or friends who are able to stay in touch with you in between visits to the cancer center. It may mean finding a support group of other people going through the same cancer diagnosis experience. It may be social workers or mental health professionals at the cancer center who can help you identify resources or provide more structured therapeutic support. It may also mean determining whether you need additional home health care support or referral to rehabilitation services like physical, cognitive, speech, or occupational therapy to ensure that you remain as functional in your life as possible.

From your experience, what are a few of the best ways to support a loved one, friend, or colleague who is impacted by cancer?

There are a variety of ways you can support someone impacted by cancer, although each person may have different needs. First and foremost, ask what is needed or what might be most helpful to the people living the cancer experience. Understand that they may not know what to ask for or how to ask. You can offer to help with meals, household chores, caregiving responsibilities, or transportation needs. You can offer to run errands or do a task on the “to do” list. You might be able to provide insight on services in the community that could be beneficial. You can be a supportive listener. You can work with your loved one, friend, or colleague to put together a list of questions for the doctor or go with them to a doctor’s appointment to jot down notes. Most importantly, remember that needs may change over time so be flexible. The National Cancer Institute has a wonderful guide for caregivers available on their website, and many advocacy and support groups have caregiver resources available as well. NCCN’s website has a searchable section dedicated to support for patients and caregivers at nccn.org/patientresources.

What are a few of the biggest misconceptions and myths out there about fighting cancer that you would like to dispel?

I think the biggest myth about cancer is that it is always a death sentence. While cancer that has spread to other organs is typically not curable, there are some instances where treatment can result in long-term remission and potential for cure. In addition, new and improving treatments and supportive care interventions have improved long-term outcomes in many cancers such that people diagnosed with advanced or metastatic cancer can live longer with better quality of life than in years past. Overall, we are seeing a decline in cancer deaths in the past few years. This is due to improved early detection with increasing screening and better screening techniques. By finding the cancer at an early stage, when it is small and easy to remove, we increase the chances of surviving the disease. That being said, at this time, not every cancer has a method for early detection and we need to continue to support research for early detection of various cancers.

Another myth I hear often is that eating sugar will make a cancer worse. This is also false, and can deprive people living with cancer from enjoying things like a good dessert. All cells are fueled by glucose, the sugar that the body obtains from foods we eat. However, there are better and worse sugar sources. Better sugar sources include fruits, vegetables, and whole grains. Worse sugar sources are the ones found in sugar-sweetened beverages and fast-food diets. While no studies have demonstrated cancer growth from eating sugar-based foods, there are some data suggesting that those who eat a diet high in fast food and sugary beverages or foods have worse long-term outcomes, including survival, after a diagnosis of certain cancers. This may be due to the diet contributing to excess weight gain or a hallmark of lack of engagement in healthy behaviors, both of which can contribute to the development of certain cancers and poorer survival after a cancer diagnosis. Eating an occasional dessert is not bad; sugary foods and drinks should be treats and not staples of one’s diet.

Thank you so much for all of that. Here is the main question of our interview. Based on your experiences and knowledge, what are your “5 Things Everyone Needs To Know About Cancer? Please share a story or example for each.

First of all, learn about your specific cancer type and the treatment options available to you. There are a number of great resources available online with reliable information that you can use to work with your doctor to define your treatment plan. They include the NCCN Guidelines for Patients based on the NCCN Guidelines used by oncology professionals worldwide to define the standard of care in oncology (free at nccn.org/patientresources).

Second, know that clinical trials are an important component of cancer care and are not reserved just for the “end of the road”. Today’s treatments were determined by people participating in yesterday’s clinical trials, and we can only advance our knowledge and develop better therapies through good clinical trials. Clinical trials are a form of cancer treatment, and not all clinical trials include a placebo. When determining what your cancer treatment plan will be, ask your oncologist about clinical trials and whether you might be a candidate for any trials related to your cancer.

Third, recognize the potential benefit of a second opinion at a high-volume cancer center. The best time to get a second opinion is during the period of time when a treatment plan is being decided. Once you begin a treatment, it is likely best to continue on that treatment path until it is determined whether it is effective. But during the days or weeks in which a treatment plan is being established, it is reasonable to consider a second opinion. Most oncologists will not be concerned and may welcome your decision to get another opinion about your care.

Fourth, health behaviors matter. We talked about how health behaviors can help to prevent cancer from developing. These same health behaviors can impact the outcome after a cancer diagnosis in certain cancers. For example, those who currently smoke after a cancer diagnosis have a shorter survival and worse outcome in general. Those who engage in routine physical activity after a cancer diagnosis, adhering to the same recommendations made to prevent cancer, may have lower risks of death after a diagnosis of breast, prostate, and colon cancer. Engaging in a healthy dietary pattern may improve outcomes in colon cancer. Many of the same risk factors that impact cancer risk also impact the risk of developing heart disease. Adhering to as much of a healthy lifestyle as possible can maximize your long-term outcomes and survival after a cancer diagnosis.

Finally, know that living with and through a diagnosis of cancer takes a village. Build your treatment team with health care providers you trust and caregivers on whom you can rely. Do not be afraid to ask for help, whether it be physical assistance, financial or practical support, or emotional care. Ask about what support services are in your area and available through the location in which you are receiving your cancer care. Work with your health care provider to identify reliable sources of knowledge to learn more about your cancer, like NCCN’s resources for patients and others from professional organizations.

You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

Focusing on promotion of cancer prevention and adopting good health behaviors would be the thing I think could do the most good for the largest amount of people. The top two causes of death in the United States are heart disease and cancer, which share a number of modifiable risk factors. These include cigarette smoking, excess body weight, physical inactivity, and poor dietary patterns. Given that a large majority of the U.S. population engage in at least one of these unhealthy lifestyle behaviors, and that these behaviors can impact the development of cancer and cancer-related outcomes in some tumor types, promoting awareness of the recommended behaviors and the importance and impact of these behaviors could be really impactful on both cancer and heart disease incidence and outcomes.

In light of the COVID-19 pandemic, I think the other big movement is just encouraging people to get back to routine medical care. In early 2021, NCCN partnered with the American Cancer Society and leading health care organizations to endorse the safe resumption of cancer screening and treatment during the pandemic. Our “Cancer Won’t Wait and Neither Should You” campaign aimed to combat distressing trends that were seen early in the pandemic when the number of screening mammograms, colonoscopies, and other testing dropped dramatically. As we have developed better knowledge around limiting exposure to coronavirus within health care settings, and now have increasing access to vaccines to lower the risk of serious infection and death from the virus, we must encourage people not to ignore their medical care for other chronic conditions and preventive health recommendations. Cancer, and other medical conditions, will develop regardless of the pandemic and we must encourage people to continue with their routine medical care to ensure that they can continue to live their best lives.

How can our readers further follow your work online?

I work for NCCN, an alliance of 31 leading cancer centers who develop clinical practice guidelines that help define the standards of cancer care. NCCN has a number of resources for health care professionals. In addition, we have a number of resources for patients, including NCCN Guidelines for Patients, patient webinars, recommendations regarding COVID-19, and resources to support patients and caregivers. More information for patients and caregivers can be found at nccn.org/patientresources.

Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.