Dr Doug Flora of St Elizabeth Healthcare On The 5 Things Everyone Needs To Know About Cancer

An Interview With Savio P. Clemente

Cancer is avoidable for many of us, but this requires our active participation. Recent studies have shown that a focus on social determinants of health like access to care, lifestyle changes (more exercise, better diets, less alcohol, etc.) would have prevented nearly 750,000 cases of cancer in 2019 alone. We must focus efforts on improving health literacy, access to healthier food choices, and investments in cancer prevention to win this war on cancer. There is an opportunity here, as some estimates note that our NCI only spends 5% of its budget on prevention efforts. This is shortsighted and correctible IF we refocus our efforts. In this circumstance, prevention is worth a POUND of cure, not an ounce.

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 Doug Flora.

Doug Flora, MD, LSSBB, is the Executive Medical Director of Oncology Services at St. Elizabeth Healthcare. He leads St. Elizabeth’s prevention efforts, recruits associates, and launches innovative treatment programs while providing top-tier healthcare to patients in the Northern Kentucky community. In 2020, Dr. Flora oversaw building a $140 million, state-of-the-art Cancer Center, which offers integrated and holistic care for patients in the region. For his role in bringing the center to life, he received a Healthcare Hero award from the Cincinnati Business Courier. Dr. Flora was also instrumental in developing and launching St. Elizabeth’s Center for Precision Medicine & Genomic Health, a best-in-class genetic testing program that aids cancer prevention.

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?

At around five years old, I knew that I wanted to be a physician of some sort. I loved caring for people, and I was fascinated by the occupation. As I progressed through school, that childhood desire naturally evolved as I discovered that I had a love for science — and I was pretty good at it, too. From then on, I knew that my career would be centered around the medical profession. My other choice was to host Jeopardy!, but that job was already taken.

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

My mother passed away from breast cancer in her 40’s. As a young trainee, I had not completed any rotations on a cancer service until my fourth year in medical school at The Ohio State University. Honestly, I think I avoided it initially because it was too close to home. But, it was my personal experience dealing with cancer and its effects on my family that led me to the field of oncology. I knew I needed to be a cancer fighter alongside the families I help every day. It’s not lost on me now that I spend my days trying to protect families just like mine from feeling like we did.

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

I get a lot of energy helping to empower the talented people around me to be at their best. I am driven to help them recognize that each of us can make a meaningful difference if we work doggedly to bring better outcomes to our region. We all need to work together to realize that cancer care in 2021 is about much more than chemotherapy or CT scans. It starts with health literacy, lifestyle, prevention, and aggressive and intentional screening. The goal here is to reduce the global impact cancer has on our community, and that one is going to take a village.

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

At St. Elizabeth’s new Cancer Center, we focus on prevention, screening, and diagnosis — all under one roof. We build a custom treatment plan tailored to each patient’s exact needs. High-quality, personalized cancer care should be available everywhere, especially when people need it most. I’m so proud that we can provide this for people in the Northern Kentucky community. We want to make this a place where we want our wives or mothers to seek care, which is an exceedingly high standard.

We also offer multidisciplinary lung cancer care where other clinicians and I meet to review the pathology slides, CT scans, and clinically pertinent information to make the best treatment decisions for our patients. By having each expert weigh in from their area of expertise, we can devise plans to approach cancer medically and provide appropriate counseling on treatment plans.

Far too often, doctors are met with patients who haven’t caught the disease early enough. By getting in early and providing screenings, and involving all of our experts, we seek to challenge the status quo and put our time and resources into what matters most: saving people. This commitment to aggressive cancer screening has led to the building of a world-class lung cancer screening program, soon approaching 20,000 scans. It has allowed us to identify hundreds of patients in earlier stages of their cancers and give them a much better chance for longer and happier lives, cancer-free.

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

I’ve spent the better part of the last 20 years dedicating myself to the study of cancer. What began as an eager medical student making rounds at The James in Columbus has evolved into a deep passion and personal mission. I’ve learned along the way from dozens of brilliant and caring mentors and participate actively in research, tumor boards, and symposia. My unique perspectives as a cancer fighter and a cancer patient might set me apart from some of my colleagues. I had my cancer resected about four years ago, and it was terrifying. That experience as a patient myself brought a whole new, almost messianic focus to my efforts to improve access to screening, prevention, and care in our region. I do not want anyone to feel like my wife and I did then. It fuels me every single day.

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?

I describe this to my patients as an uncontrolled growth of abnormal cells in the body. These cells lose their “off switch” and grow unfettered, eventually causing problems in the body when they get to numbers that crowd or block important structures that don’t like being pushed on. Old cells don’t die when they are supposed to and form masses or cloud the blood. We use the word Oncology to describe my field now, but this was derived from the Greek word, Onkos, which loosely translated meant mass or load (or more commonly a burden) to the Greeks. A very fitting term when I think about cancer.

What causes cancer?

We’ve come a long way in our understanding of this over the last few decades. Hundreds of years ago, it was considered an imbalance between blood and “black bile.” We now are better able to characterize the process, which is incredibly complicated. There is no single easy cause, or by now, we would cure more people successfully. It’s the interaction of many factors, including genetic, environmental, or individual constitutional characteristics. Some insult or series of insults leads to genetic changes in a single cell that trigger the loss of the off switch above. This genetic mishap can be acquired or inherited and is akin to having a misspelling in your genetic code that leads to these dangerous alterations. As we age, smoke, etc., we develop more and more misspellings and become less adept at catching and correcting them. When we miss them, cancer is born.

What is the difference between the different forms of cancer?

The process is generally similar, regardless of where cancer starts. That misspelling might be in the code that was supposed to build a white blood cell to fight infections, and instead, it results in the development of leukemia. If the misspelling happens in a breast cell, we now have breast cancer, and so on. It is why lifestyle choices and sound risk reduction can help: fewer insults mean fewer misspellings, and hence, fewer cancers.

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

What’s known about cancer prevention is ever-changing, but we know that there are many ways to approach it. Everyone can practice a healthy lifestyle. That means eating the right things, staying away from tobacco, being physically active, not skimping on sunscreen (skin cancer is one of the most common forms of cancers in the country), and getting the proper vaccinations such as HPV and Hepatitis vaccines. Obesity contributes to the development of thirteen of our cancers and excess alcohol intake, many more. One of the absolute best prevention methods I can recommend is conducting regular self-exams and screenings for the breast, skin, colon, cervix, and other organs. When physicians can catch things early, cancer treatment becomes increasingly more effective.

How can one detect the main forms of cancer?

The best way to check for cancer is self-examinations and routine screenings and imaging tests such as CT, MRI, PET scans, biopsies that directly test the cells themselves, lab tests such as blood and urine tests, and physical exams. Because cancer can show up in so many ways, it’s essential to be thorough and routinely have assessments. The earlier that a physician can detect cancer, the better the chances that treatment works. The next generation of screening is almost ready for primetime here at St. Elizabeth, as we are working to open trials testing circulating tumor DNA in the blood, hopefully detecting the misspellings above long before they can become masses or tumors.

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

This is where there is hope. We’ve seen a steady decline in the proportion of patients dying from cancer over the last few decades. There has never been a better time in history to develop cancer. We are increasingly adept at detecting earlier, performing better operations, and can now provide more tailored and targeted approaches to cancers with our drugs and radiation therapies. In the last few years alone, we are seeing major decreases in cancer deaths, driven largely by exciting gains in lung cancer and melanomas.

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?

We are now evolving from the traditional “bunker buster” approach to chemotherapies to more “smart bombs”. We are using immunotherapy to engage the patient’s own immune system to recognize and attack cancers and are now better able to tailor therapies to an individual patient or tumor than ever before. Next-generation approaches like CAR-T and BiTEs are even better, literally reprogramming the body to attack targets on the surface of a cancer cell. At St. Elizabeth, we’re also increasingly leveraging our Precision Medicine Program, leveraging individuals’ unique genetic markers to tailor treatment based on what will be most effective for them, personally. We are now better able to seek out each cancer’s unique genetic code, and we are getting better at exploiting the weaknesses this exposes. Many cancers have their own Achilles’ Heel, and it’s been encouraging and exciting to see patients surviving better, longer, and stronger as a result.

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

This requires conscious attention to things beyond the CT scans. We need to see our patients as people and commit to treating their emotional and spiritual needs and medical care. Living with cancer is exhausting, and many of the most brutal battles are mental. I fear we fall short supporting these needs, as it always seems like the medical decisions trump the mental ones — but I don’t think you can care for a person without attending to their hopes, fears, and emotional well-being.

I think it all goes back to remembering that each patient wants to be better and cancer-free. I want that, too, so I encourage patients to:

- Slow down and find quiet time for body and mind.

- Make time for things that make them feel fulfilled.

- Eat nourishing foods and have a healthy diet plan.

- Do some light exercise on an approved plan.

- Prioritize sleep. It’s essential for the healing of the body.

- Protect their time. This could mean saying “no” so they don’t stress their body more.

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

Remember the Greek Onkos above? Cancer is a heavy burden, and the best supporter is one who offers support in carrying that burden. Offer to visit often, run errands, keep up good conversations, follow through with tasks, help that person stay organized, make that person feel loved with gifts, and most importantly, your empathy and presence. One hint from a cancer patient himself, too: don’t treat us differently. We are the same people you loved before we got our diagnosis. Love and support us, yes. Pity us; please don’t. That’s not productive.

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

1. A positive attitude and mentality don’t make it any easier to beat cancer. Treatments take time, and the body responds the best way it can. While it doesn’t have any real physical effects, it can undoubtedly improve the quality of life during the process.
2. The same kind of cancer isn’t treated the same way for everyone. More and more, cancer treatment is being tailored based on genetic testing. Specific changes or mutations in your cancer cells may help guide your treatment. Specific genes may show that a body processes certain therapies and medications differently than someone else’s body.
3. Cancer doesn’t mean stopping the way someone lives entirely. A lot of research has made it easier for people to live more normal lives during their treatment. Drugs are now available to help better control symptoms for treatments, and different kinds of exercise and lifestyle programs are encouraged. The result is that you’re often able to work and stay active during your treatment.

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.

5 Things Everyone Needs To Know About Cancer? Please share a story or example for each.

1) Cancer is avoidable for many of us, but this requires our active participation. Recent studies have shown that a focus on social determinants of health like access to care, lifestyle changes (more exercise, better diets, less alcohol, etc.) would have prevented nearly 750,000 cases of cancer in 2019 alone. We must focus efforts on improving health literacy, access to healthier food choices, and investments in cancer prevention to win this war on cancer. There is an opportunity here, as some estimates note that our NCI only spends 5% of its budget on prevention efforts. This is shortsighted and correctible IF we refocus our efforts. In this circumstance, prevention is worth a POUND of cure, not an ounce.

2) Cancer Screening works. For nearly half of the cancers we see, there is a proven screening method out there that saves lives. If we can get more people screened using these tests, we can better identify cancers in their faintest footsteps, hopefully reducing downstream pain, suffering, and death. This should be front of mind for all of us: early detection is doable IF we make it a priority for each and every patient.

3) Despite notable advances in cancer prevention, screening, and treatment, not all individuals benefit equally from this critical progress. We still see alarming and disappointing disparities in care across the country. Research shows that many of our traditionally marginalized populations (minorities, rural, very elderly, and more) are bearing a disproportionate share of preventable cancer burdens. We need to work as a society to make sure all of us have equal access to lifesaving information and care, not just the lucky ones who can afford it.

4) Cancer is a disease of mutations. As our understanding of the human genome has evolved, so too has our understanding of malignancy. By identifying mutations that cause mutations across families, we can potentially save generations. By identifying mutations in cancers, we can better target our treatments. By identifying things that might repair mutations, we may soon be able to cure cancers in ways that seem cut from the pages of a science fiction novel. Further investment in genetic research and testing will become increasingly important in the coming years and may provide the best avenues to deliver better outcomes for all of us. John Sulston famously asked, “Can an intelligent being comprehend the instructions to make itself?” The answer to this one may guide the next fifty years of significant cancer advances. I think we can.

5) Perhaps the take-home here is straight out of Ted Lasso: we have to BELIEVE. There has never been a better time in human history to survive cancer. The advances in cancer prevention, screening, treatment above mean that we are preventing more, diagnosing earlier, and treating more effectively than ever before. I tell even my incurable cancer patients that “I can’t cure your disease with TODAY’s drugs,” stressing that with ongoing research, cures may soon become possible for thousands of patients we previously felt. This isn’t just me being the unfailing optimist. This is happening every day in the clinic. The science that once seemed like magic is finally catching up to these diseases. I see more patients than ever before, not just surviving their cancers but thriving every day. In this lies hope. This I choose to BELIEVE.

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.

I ask myself this question every single day: “What is the one thing I can do that makes the life of a cancer patient better today.? Our teams hear this often, and we each hopefully come to work every day with this in mind. This drives the passion of the great cancer fighters in this place. My work in the second half of my career seems to be moving me to try and scale these messages to larger and larger audiences. How can I help spread these important messages about new screening tests? How do we reach the most vulnerable? Inequities in access to care and screening are profound and need attention. If I had unlimited resources, this is where they would be best spent: screening and early detection, better health literacy, and access. This provides real value for all of us: providing curative, cost-effective care to early-stage patients is not only good business for payers, hospitals, and doctors, it is the right thing to do and holds the promise of lifting burdens for thousands of our friends and family. Hope lives there. That’s the fuel we burn here every day.

How can our readers further follow your work online?

You can find me and all of the incredible work that St. Elizabeth does at www.stelizabeth.com, and take a look at our new Cancer Center at stelizabeth.com/mycancer.

Thank you for these fantastic insights. We greatly appreciate the time you spent on this.