Transcript Disclaimer – Please note that the following transcription has been machine generated by an AI software and therefore may include errors and ommissions.

Robin Daly
Hello and welcome to the second series of Cancer Talk, the podcast that explores the benefits of integrative oncology, an approach that brings together standard oncology practice for the raft of lifestyle and complementary approaches in order to provide broader, more holistic care to improve quality of life and outcomes for people with cancer. I’m Robin Daly, founder of Yes to Life, the UK’s integrative cancer care charity, and one of the hosts for the podcast. Series 1 of Cancer Talk was aimed at initiating conversations about integrative oncology and bridging the gap between mainstream and integrative medicine practitioners. And the Series 1 episodes are still available from YestoLife .org .uk forward slash podcasts and major podcast platforms.

Dr Penny Kechagioglou
Hello, I’m Dr Penny Kechagioglou. I’m an NHS Clinical Oncologist and co -host for the broadcast and in addition to treating patients with all the regular modalities in use within healthcare, I have a passion for integrating evidence- supported lifestyle and complementary medicine into patient protocols. I’ve witnessed first have the enormous benefits this can deliver to patients and their carers. So in Series 2 of the broadcast we are planning focused conversations with healthcare professionals, working directly with people with cancer and applying integrative oncology in contemporary clinical practice with the aim of strengthening the clinical voice and evidence for integration, influencing the wider community including academia and research and beating the case for an integrated UK model of care.

Robin Daly
very pleased to be co -hosting another cancer talk today with you

Dr Penny Kechagioglou
Great to see you Robin, it’s a great talk today.

Robin Daly
Yeah, for this episode we’re going to go right around the planet to speak to Professor Judith Lacey in Sydney, Australia. So in your role as co -chair of the BSAO, you were instrumental in inviting Professor Lacey to be a guest speaker at the BSAO conference last year. So I wonder if you’d like to introduce her to us.

Dr Penny Kechagioglou
Absolutely. I’m very pleased to introduce Judith. Judith is an Associate Professor of Supportive and Integrative Oncology in New South Wales and she’s leading the surveys at Crystal Brown Lighthouse and she’s instrumental in setting up research in integrative oncology and she’s also one of the ambassadors of the Society of Integrative Oncology for Australia. So I’m delighted to have you Judith in our cancer talk today. Yeah it’s really lovely to be here.

Robin Daly
Brilliant. So, tons to talk about today as your own journey to get to where you are now and the work you’re doing, it all sounds fascinating. Maybe you want to start off just telling us a little bit about what got you into this whole arena, why were you drawn to it?

Prof Judith Lacey
Yeah, sure. So I started off my career in medicine about 35 years ago now and in, initially in general medicine, but went very quickly into palliative care. And I actually worked as a palliative care specialist for all wants to work as palliative care specialist sometimes depends which house I wear for at least since 2000. So in 2000, I graduated from our quite extensive palliative care training, and was very comfortable working for a short time in hospice care, but I soon felt with the rapid development of cancer care and the improvement in cancer outcomes. I was seeking more and I was looking outside of the box to see how do we really support people to live well and thrive with a cancer diagnosis and there must be more than getting them at the last days of their lives or the last months of their lives.

Prof Judith Lacey
And if we can apply the principles of whole person care from the time of diagnosis, what tools do we need in our toolbox and who’s doing it around the world. So it took me to in 2000 and yeah, about 2007, 2008, we set up a whole person care group and symposium and started researching to understand patients needs. And then in, I started traveling the world a little bit, going spending some time at Memorial Sloan Kettering with the integrative oncology program, spending time with at MD Anderson, with Eduardo Barrera and Lorenzo Cohen and Gabriel Lopez and Richard Lee was there at the time and learned as much as possible from how they set up their program. I spent time with Iran Ben Aria in Israel, Moshe Frankel in Israel. And so it was this gathering of information to see how do you develop a program that can integrate well into a comprehensive cancer service in Australia.

Prof Judith Lacey
And in 2015, I was given the opportunity to essentially lead and start a center which had the building blocks, the center was actually built, but it was working out a structure of fully integrating the concept of supportive cancer care and integrative oncology into comprehensive cancer care at a very large teaching hospital where I work called Chris O ‘Brien Lighthouse and it’s comprehensive cancer hospital in Sydney, which is a very large city in Australia. And from there, it became history, we have grown developed and a multidisciplinary service and really succeeding, fortunately, in developing this program in our space. And the challenge is how do you develop a program that you can reproduce around the country and around the world and what aspects of integrative oncology and supportive cancer care are easy to cut and paste into other services?

Prof Judith Lacey
And how do you maintain that the concept of equity of access into underfunded services? And how do you develop high level evidence informed and evidence based care in a comprehensive cancer space? So it’s a challenge and I’ve learned from the Masters.

Robin Daly
Fantastic. I mean of course we’re very interested in what you’re talking about because we’re way behind the curve here in Britain and would love some of that over here. So yeah, fascinating to hear your experience. Also I was thinking about this whole arena of palliative care. We have palliative care here of course as well and it’s generally seen as this kind of Cinderella sort of happens at the end as you say to people and you know to me it just looks like good care and I’m very pleased to hear you talk about translating it to the whole of cancer care. I mean I think the whole term palliative care should go personally. I think it’s just you know it’s just describing how we should care for people so you know and dispense with it but

Prof Judith Lacey
So we’ve said actually, in great discussions with the guys from the Christie and other people from the NHS, we actually wrote a paper called, I think the role of supportive oncology, a revolution in cancer care, or some title similar to that, right, suggesting the principles of palliative care can be really helpful, but we need to adapt our skills as palliative care physicians and actually use the skills of taking a very good comprehensive biopsychosocial history and assessment of a patient, but apply it to the complexities of cancer care today with all the side effects and toxicities of different treatments that are available today and training a workforce that ideally would not only be providing supportive cancer care or supportive oncology, but also integrative oncology and that this expanded toolbox should be just a part of supportive oncology. So that’s Biden dream and that’s how there are discussions in with the NHS. I think the NHS has got a few hurdles first.

Dr Penny Kechagioglou
And Judith, you obviously mentioned supportive oncology as being multidisciplinary. Do you want to tell us, you know, what is under the same roof in Chris O ‘Brien Live House? What is, you know, true integration look like?

Prof Judith Lacey
Yeah, so we’re now a mask, the Multinational Association of Supportive Cancer Care Centre of Excellence in Supportive Cancer Care. So we’ve gone through the process of what does good supportive cancer care look like. We have, within our integrative oncology group, we have doctors and a nurse. We did have a nurse practitioner, got a senior nurse, acupuncturists, exercise physiologist, reflexologist, medical oncology massage therapists, mindfulness teachers, yoga therapists. And I feel like I’m missing somebody from my service. And we also run an early lymphedema program, lymphedema assessment and massage program. And we work as a multidisciplinary team, so about 24 of us within this team. But outside of our team and working very, very closely with us are the music therapists, the artist therapy program, psychologists, psycho -oncology service, dieticians, ward. We have a ward -based physiotherapist, occupational therapists, nurses that play a critical role in supportive cancer care, speech therapists.

Prof Judith Lacey
So all that large group of allied health that sit under that umbrella of supportive care. And then you say, well, which components sit comfortably together so that we can work together to develop a holistic care plan? I’d love everybody to work together, but I think we’re still a little bit siloed, but we collaboration. Of course, we have a standalone palliative care team, and I just move back and forth between them. And they refer to us and a pain specialist, geriatrician and all the other specialists. So it’s quite a comprehensive service.

Robin Daly
One particular piece of siloing, which is big time in the UK, I’m interested to hear how you’re getting on with it over there, is that nutrition is still largely seen as just something you deal with kakeksi or something, you know, it’s very narrow definition of what you can do with nutrition. It’s never seen as support or, you know, can actually help the situation in that kind of way. So are you managing to overcome that hurdle?

Prof Judith Lacey
There’s a, I don’t know if you know of Moshe Frankel, who led a paper that many of us contributed, instead of your Catherine, Catherine Zollow. Zollow, yeah. Yeah. And myself and a few of us got together and wrote a paper on the importance of food and talking about nutrition, because people really want to know what they can eat when they’ve got a cancer diagnosis. Our comes to diet for wellbeing or dietary changes to improve, potentially improve or influence cancer outcomes, the gut microbiome, ketogenic diet, other diets, that is more a part of my portfolio. And what we wrote in the paper is that it’s really important that people get a balanced diet and a healthy diet and all the nutrients they need. And often it’s the integrative oncology physician that will have that conversation about the diet and their readings and where the evidence is about different anti -cancer or cancer -supporting diet, like the anti -inflammatory diet.

Prof Judith Lacey
And it’s the dietician that really needs to be involved when somebody is not thriving or if they’re on a diet that is not providing the adequate nutrition they need. And so we work collaboratively.

Robin Daly
Great, great, good to hear it. Yeah, bring it on here please. One of the things that struck me about the Life House was that it was a not -for -profit. Now that is a label. How does that influence what’s delivered, how it’s delivered, what choices are made?

Prof Judith Lacey
Well, we have a tricky model. We have a tricky model of care. And every comprehensive cancer hospital in Australia is slightly different. And this makes it really difficult. So our model of care, we’re actually a private not for profit private hospital that provides cancer therapies and cancer care to both public and private patients. And so the that mixed model allows us to have a lot of flexibility, but it also means we need to bill for our services, or have support from philanthropy. And so the aim isn’t to make a profit, the aim is to continue running a center of excellence. I mean, we’re one of the biggest research hospitals of research units in Australia. And so we depend on research funding, we depend on philanthropic funding, but we also depend on the excellent public health service that we system that we have in Australia called Medicare, as well as private funding. So it is not ideal, but it is far more flexible than a purely public health system.

Robin Daly
Well, I find it very interesting because it’s somewhere in between. We look all the time at the American system and the UK system. And they both have their shortcomings. They’re different. But this is somewhere in the middle there and has a bit of each and it seems. And I can see there could be advances there.

Dr Penny Kechagioglou
Well, yeah, there is. And one of your reasons, Judith, is to reduce health inequalities. Does that model give access to people who otherwise wouldn’t have access to those services?

Prof Judith Lacey
You know, Penny, I think it’s a work in progress, isn’t it? It’s always, it takes good quality evidence to shift health funding models. And I’ll give an example. So ideally every person, we have enough evidence to suggest that every person with cancer diagnosis should receive a personalized exercise program and continue to have access to excellent, guided exercise programs throughout the cancer treatment and have a personalized program to continue into survivorship, or including those living with an advanced cancer diagnosis. The reality is the funding is for five treatments from all allied health services in combination, which gives you one exercise physiologist, one review of a dietitian, and so on over a year. So it doesn’t adequately fund the evidence -based approach. So in order to have equity of access, you need to continue to invest time in research and invest time into developing models of care that are and evaluating the cost -effectiveness of that model of care delivery.

Prof Judith Lacey
And that’s similar with acupuncture. Acupuncture is funded by private health funds. If it’s delivered by a doctor, it’s funded by both the public system as well. But you want the best acupuncturist who practices traditional Chinese medicine techniques and isn’t just dried needling and follows evidence and implements that. And so there is a balance of being able to provide the care, but also embedding research into what you do to enable the future to have improved equity of access.

Dr Penny Kechagioglou
which is what your paper, your white paper in 2022 advocates, isn’t it? Yeah. More education opportunities.

Prof Judith Lacey
Developing a really good workforce, I think the evidence is rapidly developing for the benefit of most of the approach that we take in integrative oncology. I mean, your book, Penny, on integrative oncology and breast cancer advocates for a lot of the therapies that are not accessible to all people. And so it’s evaluating what you can do just through a consultation, lifestyle changes, diet changes. And then what you can do if you have funding, whether it’s philanthropic or research funding to enable access to every person who receives tax sayings, to have acupuncture for their peripheral neuropathy, if they’re responders to it, acupuncture for pop flushes, and so on. So it’s, I think we’re all building, we’re all working towards the same cause. Absolutely.

Robin Daly
Yeah, so yeah, you talk a lot about research. In fact, I noticed on your website, you call it patient -centered research, which I like. Do you want to say a bit about your directional research?

Prof Judith Lacey
Well, first of all, we’re very involved in capturing the patient’s voice, so through co -design in our research and implementation research, research that assists the patient throughout the cancer journey and so that we can collect data but also provide care. And a couple of examples will be our pre -abilitation program for women receiving neoadjuvant chemotherapy for breast cancer. So the research is behind the scenes is the structure of developing a program using patient recorded outcome measures, evaluating the benefits of the therapies, but at the same time the patient receives this structured pre -abilitation program from their time of diagnosis. Same with the acupuncture for symptom clusters in breast cancer survivors or taxane -induced peripheral neuropathy. Our aim is to make sure that there’s a benefit to the patient. In our mindfulness work, there’s a benefit to the patient.

Prof Judith Lacey
It does mean that there’s that challenge when you look at randomized control trials because when you’re providing, conducting research in this space, particularly supportive care space and you’ve got enough evidence to suggest this may help but not enough evidence, you really do need those randomized control trials but the randomized control trials obviously mean that some person is randomized to receive standard care or not receive that treatment. In our randomized work, and one way of getting around that is like in our work with brain cancer patients with a GBM and medicinal cannabis. We use two different types of medicinal cannabis for those patients but it isn’t, you really need a randomized control trial with placebo to really shift the dial. So it is a challenge in this space, isn’t it? In supportive cancer care, it’s a huge challenge in palliative care to provide, to randomize people to a sub, what you think may not be as an effective care but we need it.

Prof Judith Lacey
So it’s patient -centric, we address the patient’s needs and we try and provide therapeutic benefit during the actual or all involved in studies.

Robin Daly
I love that, embedding the patients in the design of the trial in the first place, that’s something, I mean it seems obvious, but I don’t think it really happens here, does it Penny particularly?

Dr Penny Kechagioglou
Not really. No, I mean, we use patience to inform them about what’s happening rather than include them in the design, which is obviously the optimum approach.

Prof Judith Lacey
And and in Australia, it’s almost mandated that patients are that you have the consumer engaged in the consumer voice and the patient advocate involved in research moving forward, because particularly in the support of cancer care and integrative oncology space, you need to know that you’re providing the right care that makes a difference to that person. And there’s no better person to give you that information than the person that you’re providing.

Robin Daly
in the kitchen. I thought it was interesting that the organizational part of there was set up with the blessing of this chap Chris O ‘Brien who obviously was a surgeon but he got brain cancer himself so he did made this move from one side to the other if you like from a carer to patient and I wondered how much influence that had on the direction of the organization, the fact that they’ve gone towards an integrated model that much more closely takes an interest in the patient experience.

Prof Judith Lacey
absolutely huge. In fact, Chris O ‘Brien, Life House, Chris O ‘Brien was the head of cancer services prior to his diagnosis and his dream was to have a comprehensive cancer service all in one spot. We’re across the road literally from New South Wales leading hospital called Royal Prince Alfred Hospital, who is the cancer services that moved over and many people move across and he was head of head and neck cancer and head of cancer services. When he was diagnosed, he moved towards integrative oncology and integrative therapies. He felt that there was more that needed to be provided to him as a patient and so that big shift influenced him and his family.

Prof Judith Lacey
His family are very supportive. Gail O ‘Brien, his wife is the patient advocate and on the board of the hospital and very involved and very supportive and so this hospital was actually built with an integrative oncology department then called the complementary medicine services department called the living room and we changed our name to integrative oncology reflecting where we’re at and so there was this beautiful space developed and built but a model of how best to provide that care and that models evolved over time and very much vision and influenced by his diagnosis.

Robin Daly
It seems that it’s quite often the cases that that move from one side to the other sort of opens the eyes to the part of cancer care that’s missing and those people can become massive advocates for integration as a result.

Prof Judith Lacey
And Robin, is it a move from one side to the other or is it just opening? Sometimes we work in a very blinkered manner in healthcare and maybe it’s just being more open -minded rather than a shift from one side to the other. I see integrative oncology is providing, just allowing healthcare professionals to look outside of the box and look at other traditions of healthcare and other ways to treat more fully and be more open to what else we can do for a whole person. So I don’t see it as a shift from one side to another. I see it as a broadening and a natural progression for anyone that goes into a healing profession. Sorry.

Dr Penny Kechagioglou
like a continuum, isn’t it Judith? But the challenge for me in the UK has been to actually convince my colleagues that this is the right model of care. And you mentioned about one of your strategies is education, is strengthening education. How have you managed to shift that mindset if you have?

Prof Judith Lacey
Well, Penny, I think we’re still shifting the mindset, but I think it’s a work in progress and eventually I’ll retire and hopefully it will be, there’ll be a shift. I think it shifts, doesn’t it? It continues to shift. It’s about collaborating and research. That’s been a really important key. Our breast cancer study had medical oncologists, surgeons, our very superb statistician. We had, as well as our exercise physiologist, other people in the team. Similarly with our peripheral neuropathy study, we’ve got, you know, top medical oncology researchers in that space. And it’s about collaborating in research, but also developing and contributing to the hospital.

Prof Judith Lacey
So we developed the electronic patient recorded outcome measure program and we have implemented it and piloting it. And so we can show our structured approach to care. And I think it is that step by step approach to being strategic in how we move forward, having an integrated electronic patient medical record, I think is therapeutic, providing education and having a very strong workforce. The education piece is hard work. The education piece is a work in progress. I think those that are passionate are not always good educators, having really good educators. And, you know, how lovely would it be to have a workforce of physicians who are working in this space, trained in this space. And I know in Britain, you’re developing a training program for doctors interested in the space. In Australia, we’re looking at that. The Society of Integrative Oncology is looking at that and developing a textbook at the moment.

Prof Judith Lacey
We’re all moving towards it. I think it’s coming. And I think it takes a community of like minded people to move the space forward and being incredibly, people say that I have a very thick skin.

Robin Daly
Nick

Dr Penny Kechagioglou
That’s required, yeah.

Prof Judith Lacey
It is, isn’t it? Because when you know you’re providing really good care, and it’s not quackery, is it? This is good, wholesome, healthy, fantastic medical care. It does take longer. It does.

Dr Penny Kechagioglou
I love that you do. I’m glad you said that. You’re persevering that day, which is great. And I’m looking forward to that textbook, actually, from the SAO. I think that would be really, really key. Have you got any accredited courses that clinicians can join?

Prof Judith Lacey
Not yet, not yet. We have got a credit, sorry, I’ll take that back. Not for physicians as yet. For oncology massage, our oncology massage therapist actually runs the accredited oncology massage program for many years for Australia. A four -part certificate oncology massage program, which is credited. Our acupuncturists run oncology acupuncture courses at various universities. Our exercise physiologists teach at the main universities for exercise physiologists in oncology and exercise. Our lymphedema therapist, lymphedema therapy is very advanced in Australia and early lymphedema therapy. Our reflexologists teach in the natural medicine school. Actually, we do have individual courses, but as a collective, recognized integrative oncology physician training and nursing training, I think we’re waiting to see what everyone else produces so we don’t have to do it ourselves and then we just

Dr Penny Kechagioglou
It is something that I’m very interested in with my colleague Nina, who you know very well. We are trying to create a master’s degree, which again, it’s a sifting slowly that mindset that actually we need that kind of programs accredited by universities, by royal colleges and be embedded within clinician training. That’s the only way that people will be educated, be able to practice it and understand the evidence, isn’t it?

Prof Judith Lacey
Yeah. And what we’ve done is the Society for Integrative Oncology Clinical Practice Group is we’ve started writing a few papers on just how to establish an integrative oncology service, how to conduct an integrative oncology interview based on our collective knowledge from around the world. And that’s been really, really good actually to, to meet, to discuss and to work together on a document which shows just great similarity in how we approach patients and how we approach patients, how we approach care, how we develop care plans and the fact, and then it’s really how do you implement, and there are these nice training models now on the SIO website for implementing some of the guidelines, the SIO ASCO guidelines that have been written, and just how do you actually put this into practice. So I think all the efforts from around the world, we’re all starting to realize that this is so important in cancer care.

Prof Judith Lacey
And now it’s, if we can get accredited programs and a few universities, I think that would be wonderful.

Robin Daly
Right

Prof Judith Lacey
So keep going, uni. Literally.

Robin Daly
I wonder if I could ask you, you spoke about the change in title of your unit in the hospital there, outgoing from the complementary medicine unit to being integral of cancer care, and an important change of title reflecting, not that we do this stuff as well, but actually it’s part of what we do, and I’d like to hear you describe some of the ways in which it is part of what you do.

Prof Judith Lacey
So a unit is called the Living Room and it’s the home of the Department of Supportive Care and Integrative Oncology. So what you mean by describe what I do, describe what happens at your page?

Robin Daly
No, I’m talking about, yeah, the patient experience of genuine integration, how the different disciplines can play into their journey through your hospital.

Prof Judith Lacey
So perhaps it’s often demonstrated well by the example of a person who’s referred to our service. And if somebody is referred by their medical oncologist, new diagnosis of breast cancer receiving neoadjuvant chemotherapy will be referred to me usually for a one hour holistic consultation. Prior to them coming to see me, we send a referral form which the oncologist will make, say what else, and everybody’s on that referral form. Other therapies, they’re interested for their patient, but also leave it to myself or our nurse practitioner to develop a program. So there’s quite a bit of trust in that group. It’s the patient will come in, they’ll have completed their patient reported outcome measures, which is the Edmonton symptom assessment score and the my core, which is actually developed by a British group.

Prof Judith Lacey
And that will automatically import into the electronic medical records where I have the whole patient’s history, all the surgeries they’ve going to have or have had, their multidisciplinary care notes, their medical oncology notes. And I will spend over an hour taking that comprehensive history, understanding one of the main concerns, why are you here? Where are you at with your treatment? Expectations of care, spend a lot of time on diet. I talk a lot about the gut microbiome, talk about exercise, managing anxiety, managing distress. What are the coping strategies people have in place? What herbs and supplements they’re using or interested in using? And I check them then with our pharmacist for interactions. Prior to giving any advice as a cover for all of us, and that helps the oncologists. And from there, we develop a comprehensive cancer care program.

Prof Judith Lacey
So someone will come into my office and they’ll walk out with a referral to our exercise physiologist for a personalized program. And then to join one of our many exercise programs, we run about 24 a week and fit them with a group that is socially approved to them, maybe to our yoga therapist or our massage therapist, if they’re anxious, if they’ve developed, and depending on their symptoms, other people in the service, depending on their financial distress, I’ll access philanthropic funds that I have for people who score in the Edmonton Sylton Assessment Score, the 17, I include financial distress. And so if you know if somebody has financial distress and you really believe or you really think that this would help them, this program, not everybody needs that, I then access our philanthropic funds.

Prof Judith Lacey
That’s what a boss gets to do, gets to save a bit of money for you. And we continually fundraise for these hardship funds to really improve their care. And from then we then have a, I ask permission for them to be discussed by the patient to discuss in our case conferencing meeting, our weekly multi -disciplinary team meeting where all our team come together and we present more complex patients or new people to the service, and we develop a care plan and discuss what else we can offer them and how then to report that back to them, develop a plan, and then select time points along the way, depending on their therapy, depending on the trajectory, if someone’s receiving immunotherapy versus chemotherapy, if someone’s having surgery and coming, you have to personalise the time of a follow -up depending on the reason they’re seeing you.

Prof Judith Lacey
And usually I see people quite regularly during their treatment, and then maybe a little bit later. And we then have a health coach and when people have finished treatment and we noticed that many people have got similar concerns. So we’ve developed group programs. We have a GP that works with us, GP in integrative medicine with a special interest in survivorship and a health coach and they run group sessions which we’re evaluating and we always throw research in there, so we’re evaluating it, the experience to see if that best assists us in seeing more people and providing more cost -effective approach to empowering people to actually put into action what the recommendations are. And all this continues to be written back and forwarded back to their specialists. And if somebody comes in and I’m really worried about them all, lift the phone to the radiation oncologist or their surgeon or their whoever is required.

Prof Judith Lacey
And so it’s that comprehensive assessment but you’re in this hospital where you’ve got your multidisciplinary team but you also have that broader multidisciplinary team so there’s a great sense of security for people when they come in.

Robin Daly
Sounds amazing. What do you think, Penny?

Dr Penny Kechagioglou
It sounds absolutely amazing.

Robin Daly
fifth. Yeah.

Prof Judith Lacey
And you only see about, we see less than 20% of everyone coming through the hospital. So ideally you want to be able to work out, if you could see everybody, what sort of workforce or if you could screen and identify who would really benefit. And so that’s the next step, isn’t it? Who really would benefit? Rest cancer is easy. I’ve spoken about it a lot, but what about people with colorectal cancer? I just got the lymphoma conference. What about people with blood cancers? I see a lot of brain cancer patients, different cancer groups. People have different needs at different times. And how do we help people access what they need at the right time? And that I think takes a lot of work.

Robin Daly
Hmm, can’t imagine. Yeah, fascinating, fascinating. What we see are the main limiting factors that have been leading to that 20% figure. Is it… Resource? Finance, yeah. Yeah.

Prof Judith Lacey
Imagine if every person with a cancer diagnosis and an assessment at the time of diagnosis and a bundle of care, and that was reviewed on an ongoing basis, that would be the ideal for every cancer patient in the future, but it’s resource driven and resources are also people, spaces, we’ve grown out of our physical space, and I think that another huge barrier is people, many doctors don’t, who are the referrers, don’t really think outside of their own silo.

Robin Daly
Yeah.

Prof Judith Lacey
or see a need. I don’t know if everyone sees a need.

Robin Daly
night.

Prof Judith Lacey
What do you think, Robin? What is a barrier?

Robin Daly
Well, I’m just interested if you had a kind of rough percentage amongst patients of the interest, you know, obviously, it’s not of interest to everybody as a patient. Do you have a feel for how many out of the people who approach are interested in what you do?

Prof Judith Lacey
So I know the people that use our service are all interested, but we haven’t surveyed. And when we surveyed the staff, those that responded to the survey thought it was important. But those who don’t respond to the survey, or those that don’t use the service, or those ones that you really need to understand their needs, it’s a good question, Robin. I don’t know. I think it is…

Robin Daly
I mean, there’s a simple one of the fact that obviously all this stuff is more attractive to women than men, and that’s how it is. I don’t know if it’s any different in Australia, that’s how it is here. And that’s a shame because, of course, men and women, they both have needs. And the men’s ones are often just not being met at all, and they tough it out.

Prof Judith Lacey
totally. So we really struggled with reaching men. And then we started a prostate cancer men’s shared exercise program funded by a pharmaceutical company, or few actually, because once one funded all, then everyone else wanted to fund them. And it’s shifted, it’s changed the entire dynamic of our service.

Robin Daly
Well done, well done. That’s an achievement.

Prof Judith Lacey
because we were determined.

Dr Penny Kechagioglou
And as you say, it could be the fact that we need to screen the patients from the beginning and trying to understand what everybody’s needs are, because as you say, not everybody’s needs are the same. So if we had this screening tool at the beginning, we would know what everyone needs and tailor the treatments.

Prof Judith Lacey
I think so too. I don’t know what your thoughts are, Penny, as far as why people are referred. Is it random or is it patient seeking you?

Dr Penny Kechagioglou
I think it’s multifactorial. I think patients are more informed currently of what’s happening and therapies. They read the evidence that the internet has made that more light to them. So they come to the clinicians asking for that care. And of course, we’ve got the forward thinking clinicians, like us, I guess, who practically talk about it. And if you don’t have the combination of the two, that’s probably not going to happen, you say.

Prof Judith Lacey
No. And I think it is, I think times have definitely changed. There’s an expectation that people don’t need to feel bad during their cancer treatment. I started off by saying I’ve been working with cancer patients for quite a while, since 25 years. And during that time, the expectation has shifted. The expectation was, I just want to survive. And why should I suffer? And isn’t there anything else you can do to keep me well? Why do I need to be, you know, we used to tuck people in and say with fatigue, just go and rest. And now we want you to exercise. We have people exercising during chemotherapy. One of our PhD students is getting everyone on the exercise bike in chemotherapy. And that’s perfectly acceptable. And it’s become a norm.

Prof Judith Lacey
You can change things. And it’s changing patients’ perceptions. But you do want to screen and get the concern is people who are from different socioeconomic groups or different culturally and linguistically diverse groups that they don’t have knowledge of what can be done and how we can adapt programs. And so we’re all living in very multicultural communities. So one of our research programs led by two members of our team are actually they actually sat with people from Arab speaking communities and Vietnamese speaking communities, Chinese speaking communities to develop their own supportive care with integrative oncology programs. And all three programs were different. Right. The thread was the same. You know, there were core elements that needed to be included. But the way it was delivered and the pieces to include were very culturally specific.

Prof Judith Lacey
So we need to look outside of, you know, the very predominantly white Western approach to integrative oncology and supportive cancer care and acknowledge the cultural differences and different ways of healing in different cultures. So there’s so much to do. There’s so much more.

Robin Daly
so much to do. Absolutely. Yeah. Well, people are beavering away. Obviously, you are a key figure pushing things over your side of the planet. Very exciting. I think we’re going to end it there, but I loved hearing about what you’ve done over there, and I hope something’s going to rub off over here. I hope somebody’s paying attention to what you’re up to.

Prof Judith Lacey
Oh look, I think that the, I think everybody is, you’ve got leaders in the UK, you’ve got fantastic group at BSIO, the British Society of Integrative Oncology, and the UK Association of Supportive Cancer Care. There are really good people pushing to move this field forward in the UK, so, and we’re here to support. And we’re here to learn. I mean, I’m learning so much all the time. I’m just, I’m just very fortunate to have a space to practice.

Robin Daly
Indeed. Thank you so much to you.

Dr Penny Kechagioglou
Oh, it’s pleasure. Thank you so much.

Robin Daly
Lovely to meet you. Bye.

Prof Judith Lacey
Thanks for watching!

Robin Daly
Thank you for listening to Cancer Talk. Do subscribe and look out for the next edition of our podcast. And if you have friends and colleagues interested in the development of UK Cancer Care, do pass on the details of Cancer Talk. Goodbye.