October 7, 2020

Cancer: The Journey from Diagnosis to Empowerment: Dr. Paul Anderson

Devastating, there’s no other word to describe the feeling when you or someone you love is diagnosed with cancer. On any given day, you might rotate between feelings of disbelief, anger, and grief. You may even feel like you’ve lost control over your own life.

While your diagnosis may raise any number of negative feelings, here’s the good news–you don’t have to feel lost or confused. In his new book, Cancer: The Journey from Diagnosis to Empowerment, Dr. Paul Anderson clearly outlines what you can expect throughout your cancer journey.

More importantly, he demonstrates how to cultivate the mental outlook that will help you reach your best outcome. When it comes to healing, the mind does matter.

Drew Applebaum: Hey listeners, my name is Drew Applebaum. I’m excited to be here today with Dr. Paul Anderson, author of Cancer. Dr. Andersen, thank you for joining us, welcome to the Author Hour podcast.

Dr. Paul Anderson: Thank you for having me.

Drew Applebaum: You’re welcome, can you kick us off and tell us a little bit about your professional background?

Dr. Paul Anderson: I started in the world of family medicine, a long time ago. Prior to that, I was actually in the world of laboratory medicine as a technician and doing scientific work. All told, I’ve been around medicine since 1976. When I decided to go back and finish medical school, I thought, “Well, I want to be a general practitioner, family doctor,” and that’s what I did to start.

What happened though, in the very early times of doing that was, I started to do what we now would call in medicine, palliative oncology care for people who were going through cancer treatment, or maybe finished cancer treatment. Or were not candidates for standard cancer treatment. They needed quality of life care and maybe recovery from treatment.

I want to make the distinction that my world was palliative oncology, which is all of the care around the person who is going through cancer, not the medical radiation or oncology, which is giving them chemotherapy or dosing the radiation.

That was almost serendipitous, I had some background that made that happen, and what happened was, very early on, many years ago, people started saying, “Well, you can go to Dr. Anderson and he will help you with healing up after chemo or dealing with radiation burns.”

That really started that world and back then, there really wasn’t a lot of palliative oncology done. That set me off into doing a lot more of this and eventually, about 12 years ago, I got involved in the National Institute of Health cancer study, doing this work with people and actually tracking it in a federally funded study. Then I just did more and more of this clinically. That’s the thumbnail sketch.

The Mental and Emotional Space

Drew Applebaum: Now, was there an inspiration for the book? Why was now the time to write it?

Dr. Paul Anderson: Yeah, the book itself really came from one big process. That process was a partner and I wrote a book prior called Outside the Box Cancer Therapy–Dr. Mark Stengler and I. And that book was really focused on, “What are you doing about the cancer process itself?” The focus was on the medical part. In doing that book, I started to look back over about 30 years of patient interactions and see, not just the formal studies that we had done in publications and things which are great but also, I started thinking about, well, are there things beyond the medical treatments that make or break a case for people with cancer?

In other words, are there things that don’t have anything to do with how you’re treating your cancer that make you likely to have a better outcome or worse outcome? As I finished the first book, I started to think beyond the physical part of medicine. I really started to see these themes come out where people who found a way to deal in a better way with the mental and emotional space with this horrible diagnosis of cancer seemed to do better over time with whatever therapies they were doing.

Their quality of life was certainly much better than the people that I saw who got stuck in a particular place, such as confusion or anger, that sort of thing. Mark and I put just a little bit in the other book about this. This is a whole book because everybody who goes through cancer or has a loved one going through it, tackles these issues and so that’s really what led to the book.

Drew Applebaum: Now, who is the book for, is it for patients only, is it for family members of patients, is it for other doctors?

Dr. Paul Anderson: Yeah, I wrote it in a way to target first the patient but really, the patient and any loved one or caregiver that they have. Because what you see is that–let’s take an easy example, it’s your spouse, you don’t have cancer and now they do. You both are going through that experience–the shock and all of the things that you go through.

It’s really written for both the patient and the loved ones. In the pre-publication process, I’ve sent it to a lot of doctors to read and they’re very excited about it as far as a tool to help their patients along. It’s really written for the average person.

Drew Applebaum: Now, we’ll talk about the patients and what you talk about in the book in a moment but I have an interesting question. We know that it’s really hard for the patient to hear a cancer diagnosis but what does the doctor go through when they are telling a patient their diagnosis?

Dr. Paul Anderson: Yeah, it’s part of the job, unfortunately. I’ve had to do that a fair amount in my practice and like any other thing in medicine that’s unpleasant to do, it’s part of the job, it’s something that you really have to grow into and of course, when you’re in your training and schooling, people mentor you and you see how they do it.

However, the first time that it happens, it’s you and the patient eyeball to eyeball. The very first time I had to do it on my own, away from training and all that, it was extremely difficult because it was a patient I knew very well from my practice. They were young and had a young child and it hits you very hard and that really doesn’t change. But what changes is your perspective on it. And the perspective that you, for whatever reason, you’re the person giving the information.

This is critical information to give in a caring, in a loving, and inclusive way and it’s part of what we do. So, the best thing to do is to do it in the best way that you can. A lot of that is taking a moment and taking yourself out of the equation because it makes you feel unpleasant, and realizing this is about that person and being there for them. That’s 30 years’ worth of journey there but it never gets easier. But I think you do it better.

Drew Applebaum: Now, let’s flip it around, what usually happens, and what are the emotions that people feel when they get that initial diagnosis?

Dr. Paul Anderson: I tried to set the book up to be very easy to access for anybody at any level of understanding. So, I tried to do is address the most common emotions that come up for people as a launching point. For most people, it’s shock, disbelief, or anger. Those are some of the more common things right at the beginning and they mirror, not exactly, Elisabeth Kübler-Ross’s stages of grief.

Because you’re grieving a diagnosis. They really do follow that though, you start out in some level of shock, disbelief, and probably some anger, those are the big three. What you do from that point, because those are common, that’s a human thing. You get a bad bit of news like this and you’re going to go through that. The most important thing is recognizing that it is normal, and you honor that. But at a point, you have to start working towards a better position to take on this bad diagnosis that you have been given.

Drew Applebaum: Now, you mentioned, when they leave your office or any office after diagnosis, they will have some sort of a road map medical-wise. But how do they make a roadmap for the emotions they’re going to go through in the next six months, twelve months, however long it takes through the recovery?

Dr. Paul Anderson: Yes, that’s really why I wrote the book. Because as I say in the book, your medical team–and normally, when you have a cancer diagnosis, it’s not just one doctor or therapist. There are a lot of people. They’re very good at the medical trajectory and schedule and all of that. Your physical journey with the cancer is going to be very well laid out, for the most part.

The internal-type journey there were not a lot of resources for people. There are some great online things and people might get connected, it depends a lot on your health plan and who you know. You may get connected with a therapist or even a psychiatrist, or psychotherapist who specializes in cancer patients. But most people don’t, and so there’s not a lot of guidance.

There is this two-part thing that happens to people where it is like you get thrown into a strong current with the medical side of things. These lab tests happen, and these treatments happen. And there’s a schedule and you’re feeling not great.

Yet the mental-emotional side, you can actually ignore it because there’s so much medical stuff going on. The purpose of the book, as pointed as it is, is to take you through, regardless of what I’m doing about this cancer diagnosis medically, “How do I get my mind and my body into a place where I’m not just accepting it but I’m actually an empowered patient?”

Being an Empowered Patient

Drew Applebaum: Can you talk to us about what you’ve seen when patients go through treatment with a positive mindset and positive emotions?

Dr. Paul Anderson: Yes, it’s remarkable. Especially when you look back over a number of years’ worth of patients. Because you can always have outliers of people that are very negative and still do well. Or the ones that are very positive and don’t do well. But if you look at the trends, and I bring this up through the book, in the story of two patients, obviously I don’t use their real names and all of that. However, they’re very real experiences and I contrast those things. What I can say is that we never know the length of life with anything outside of cancer. Certainly, with cancer, you can have statistics that say, you’re going to live X amount of time on average. And you might live 10 times as long or half as long.

However, what we see, generally speaking, is that people who become empowered have a much better quality of life through the process. Their friends and family are much more comfortable and able to support them. In many cases, what I’ve seen personally with people is, it appears that they do better with their treatment, and they have often a longer life.

I would talk to patients one-on-one and say, “What’s the most important thing for you?”

The first thing that they’ll ask is, “Can anyone make the cancer go away?” And that’s usually not a part of what you can do, but the next thing that they always get to is that they want the best quality of life they can have.

Well, the mental and emotional state of moving towards being empowered lets you, every day, meet that with the best quality of life possible. I bring it up in the book. There is a lot of research into, “Does being empowered as a patient improve your outcomes medically?” And the answer is yes. So, we can make that connection to the quality of life as the most important thing.

Drew Applebaum: Now you actually talk in the book about patients adopting a process of empowerment, like you just said, acceptance and maximal emotional mastery. Is there a pathway that you have to get to this level?

Dr. Paul Anderson: Yes, what I layout is, you could think of it as a general group of stepping stones that go in a particular order. And what I am careful to talk about throughout that is, because we all don’t have a cancer diagnosis and then you’ve got 10 people that have a cancer diagnosis tomorrow. The stepping stones may be a very different size for each person. So, some people don’t ever really get angry, but they may be very in disbelief.

Whereas other people immediately become very angry. Either stage is something you have to go on and move to. So, each person pretty much goes in the same order. And as I said, they mirror the stages of grief that Elisabeth Kübler-Ross describes.

There are two phenomena that happen. With some people, denial is very short. Other people, denial is very long, and it is like this big thing they have to deal with and that is okay.

That is fine because the next step is where they are reaching acceptance. They may do that, once they have dealt with their denial or their anger. The next person may move right in there and acceptance is not in their playbook and they have to do a lot of work around that.

The other side of it that happens with people that can be very profound is they can get to a place where they are moving more towards being empowered and ready to deal with things as they come, and something hits–a bit of news or whatever–and it kind of knocks you back and that’s okay too.

The most important thing is every day, moving forward. What I try and layout is not a prescribed, “You have to spend this much time at each step.” But just keep in mind these are the steps your brain is going through and work on moving through them, either on your own or with help, whatever way works best for you.

Drew Applebaum: You’re going through so much here as a patient but there are people around you. How do you suggest handling your relationship with family and friends during a time like this?

Dr. Paul Anderson: It is a very, very critical part of the whole process because almost nobody is an island unto themselves. We reflect the environment we live in and the people we work with and live with. I think the most important thing to remember, of course, is everybody else who loves you and cares about you, maybe even your work colleagues, they don’t want you to have this diagnosis either.

So, they are in shock as well and while it is not the cancer patient’s primary responsibility to take on what other people are going through, it is good to remember that they are going to process this in their own way. What I tried to layout in the book is that there are a couple of trajectories that family and friends go through.

One may be that they don’t like this diagnosis for you and they may process it in their own way. You may not be angry but are trying to gain acceptance. For them, they might be angry. It is important for the cancer patient to have, usually, gentle boundaries with loved ones, just to say, “You know, I understand where you’re at but right now, I can’t have a lot of that sort of energy around me–that sort of mental and emotional energy.” So, you have to have boundaries but also understand that people will progress in their own way as well. This is why I wrote it for families and patients. The important part about it is, though, very rarely do you have people who are truly toxic in your life.

Most people are just grappling with your diagnosis and what that means to them and your relationship. You can all get through it and it all can become very synergistic, very helpful. But what I do mention in the book too that I have seen in cases is that you can have one or two people in your life who you really have to severely limit your amount of exposure to because they can’t get there. They do become, actually, a toxic influence.

So again, that becomes maybe a little harder set of boundaries. But what I wind back to is if you are the primary loved one or loved ones or you are the cancer patient, your job is to take care of the cancer patient and help them be as empowered as possible. So, if there is a toxic element, it just really has to be limited or maybe even removed. It is critical. The people around us can make or break our experience of everything.

A Valuable Resource

Drew Applebaum: There is so much good info in the book. Everything is from yourself, and you are a clear expert in the field. How tough are the first steps to start implementing?

Dr. Paul Anderson: I try to do this through the writing, to take yourself back out and put yourself in the shoes of someone–whether they got diagnosed yesterday or six months ago but they are struggling. The book was very strategically written in a way where a couple of things could happen. One, as we are all very different people, someone might look at the table of contents and say, “I am mostly interested in this family dynamic part.” Or, I am mostly interested in, “How do I deal with a child with cancer?”

So, people can resonate with the chapter and just go right to it, of course, what they’ll see is there is some build-up through each chapter and they can go back. The bottom line is that the book is written in a way where it can draw you in at any point where you need the most help or perspective, and then you can go back through and look at the points as they go.

The other thing is cancer is such an ominous thing. The book could have been easily five or ten times longer than it is, but my goal was that this is for someone who’s hurting, whether a loved one or a cancer patient. And I want them to get to the meat of it quickly. For instance, if someone is really struggling in the family dynamic area or they really want to employ some family dynamic tools, I give them places they can go and get all of the information they want.

Then we don’t have to redo that in the book. So, I try to make the book very user-friendly, very to the point, and then lead you to more information, should you need it.

Drew Applebaum: Can you tell us about some of the amazing stories and the FAQ, from real patients at the end of the book? That is a very powerful section.

Dr. Paul Anderson: Yes, something that I was just so pleased that people said yes to do was allowing me to interview them. You could have a whole book of interviews with people with cancer or supporting people with cancer. And it would do almost the same thing because you are getting everyone’s perspective. However, what I decided to do was to pick different perspectives that we could highlight. These were all people who either I was their doctor or one of their doctors or I was involved in the support of their loved one.

Wo, what they did, which was very brave and very, I would say, typical of a lot of cancer patients and families, once they get past that shock and they truly reach an empowered state, is that they want to help other people. That is one of the biggest joys in life is helping other people and the fact that these people did the interviews, that was their motivation. They wanted to help others.

For example, I have a young woman who had an extremely rare type of cancer and it came on her out of the blue. It broke all of the rules around cancer and her perspective around being the outlier in the world of cancer, she was super healthy, took great care of herself and she still got this very, very unusual cancer. What she talks about was extremely good from the point of view of what is the better and worst way to interact with a cancer patient? Things like, “What are they going to be sensitive to? What are their feelings, what is their point of view?”

I had a man who was the primary caregiver of his father, who went through a diagnosis of a brain tumor and eventually passed away from it, and he was with his father every day and they were extremely close. He had some really great insights into the process as a caregiver and as someone who is extremely close to the patient. It is a different perspective than being the patient.

Then we have two families of children who had cancer, who had both been my patients in the past. They had two very different experiences. One was a young child who had a, not unusual cancer of young children. They are still surviving to this day. They have done very well. The family became a resource for parents around the world with cancer and they share a lot of insight.

The other was the family of a little girl who was born with some genes that are rare. They are known to essentially trigger a cancer, which is so unfortunate. She lived longer than anyone expected but she did pass away. So that family had a very different experience. Their insights, you couldn’t ever read enough research to hone into the insights that these patient’s family members can give you.

I am just so grateful to them for doing it. It is one of my favorite parts of the book and also it is good reading, but it is a little tough reading sometimes.

Drew Applebaum: Yeah, it definitely makes it a must-read for anyone in this situation. The feelings and emotions are so raw but also so helpful.

Dr. Paul Anderson: Yeah. We worked on that in the editorial part to really keep their feelings. We didn’t edit their tone. I felt that was important.

Drew Applebaum: Dr. Anderson, writing a book, especially like this one, which will help so many people, is no small feat. Congratulations on finishing.

Dr. Paul Anderson: Thank you.

Drew Applebaum: And if readers could take away one thing from your book, what would it be?

Dr. Paul Anderson: I think that my goal is to show people, through all of the different chapters and topics and everything in the book, that whether you are a loved one, caregiver, or friend of a patient who has cancer or the patient themselves, there is a pathway you can take to go from this very shocking, horrible diagnosis and take it to a place where it is no less of an unfortunate diagnosis, but you or the patient are empowered in a way to really improve your quality of life and probably your quantity of life. That’s really the most important thing to do when you have cancer.

Drew Applebaum: Dr. Anderson again, this has been a pleasure and I am excited for people to check out this book. Everyone, the book is called, Cancer: The Journey from Diagnosis to Empowerment, and you can find it on Amazon. Dr. Anderson, besides checking out the book, where can people find you?

Dr. Paul Anderson: Yes, there is a website, drabooks.com. There is information there. There are also my two biggest outlets where I post things constantly is on Instagram @draonline and then on Facebook @dr.aonline. They have all of the connections to find me.

Drew Applebaum: Thank you so much Dr. Anderson. Thanks for coming on the show today.

Dr. Paul Anderson: Thank you very much.