Transcript: Chasing Cancer with Jeffrey Drebin, MD, Noopur Raje, MD & Lisa Ray

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Thank you both so much for joining us today.

DR. DREBIN: Good morning.

DR. RAJE: Good morning, and thank you, Yasmeen.

MS. ABUTALEB: So, Dr. Drebin, I want to start with you. The COVID-19 pandemic has posed enormous challenges to people living with cancer, even those who have gone into remission but still require continued care, follow-up testing. You know, how have you had to adapt during these last several months in treatment for your patients?

DR. DREBIN: I think the whole COVID pandemic has really moved in multiple directions over the course of the last ten months. We started off assuming that cancer care put people at exceptional risk for COVID infection. Early studies from China suggested surgery was particularly dangerous, chemotherapy was dangerous. All that’s been proven to really not be the case. Cancer care is challenging, and COVID is no fun for anyone, but COVID is no worse in a patient who’s just had chemotherapy or had major surgery than it is for a similar age-matched person with their risks.

And so, we’ve basically come back to providing full cancer care without real–with an effort to be as safe as possible, to test all patients before surgery, for example. We were the first hospital in the nation to do that, to test all our patients who are inpatients on a regular basis; to test all our faculty and staff. So, we’re doing many things to be safer, but cancer hasn’t taken a break, and there are still more cancer deaths–even with the surge recently, there’s still more cancer deaths in–every week in the United States than COVID deaths. So, cancer care is our mission and we are continuing.

MS. ABUTALEB: And one thing I want to follow-up on is you’re head of surgery at one of the largest cancer centers in the country. Have you had to postpone surgeries due to the pandemic this year?

DR. DREBIN: Yes. Back in March and April, we closed some operating rooms to convert them to ICU spaces. We had an edict from the government to avoid any nonessential surgeries. And we had limitations on PPE and concerns for safety of our staff and patients.

So, during that time, we dropped down to probably, at the low, close to 20 percent of our normal surgical volume. Now, that was only for a few weeks and we ramped back up relatively quickly, but there was a period of time when we had far fewer available operating rooms, and we had to work very carefully across disciplines with our nurses, our anesthesiologists, our neurosurgeons and all the members of the department of surgery to stratify which patients really could not wait and which could potentially be postponed for weeks or even months.

MS. ABUTALEB: And when you did get back into the operating room and started, you know, scheduling those surgeries again, what have been some of the extra precautions that doctors and patients have had to take?

DR. DREBIN: So, as I mentioned, we are testing all patients before surgeries or any invasive procedure within 48 hours of the procedure. We test all inpatients on a regular basis, currently every three days. We test all staff, those who are in COVID-facing positions, every week; and other staff, every two weeks. And so, we’ve really managed to make the space within our four walls a very safe space from the point of view of COVID. It was always our hope, and I think we achieved it, to make it safer to be in the hospital than it is to be in the grocery store, and we hope to continue that.

MS. ABUTALEB: Dr. Raje, what have been some of the biggest challenges for you in treating your patients this year?

DR. RAJE: So, you know, I would agree with Dr. Drebin. You know, when we first started off, as you know, Yasmeen, the northeast was affected first. And when we–March and April was when we saw the surge to begin with. We had to adapt very quickly and I think, as he’s mentioned, cancer care continues. And we as an institution, we as a cancer center, adapted quite rapidly to the COVID surge, wherein we knew we had to take care of our COVID patients as well as our cancer patients.

And as you know, cancer patients may be at a higher risk for contracting COVID, as well, because of their immunocompromised state. So, what we ended up doing in the hospital setting was triage patients slightly differently. We continued taking care of them, but at the same time, had things in place like isolation procedures, as has been mentioned already. And in certain situations, we did adopt certain visitor policies wherein we did get our patients–come to the hospital, but even today we do not allow for visitors so that we can continue to socially distance our patients while they’re getting their cancer care.

We did have to pivot, as well. And I think one of the biggest things that we have done over the course of this pandemic is really adopted the use of virtual care in a lot of our patients. And by doing so, I think what we have been able to do, really, is provide the care required for patients in the confines of their homes without necessarily exposing them. So, using digital technology to try and facilitate some of the care has been something which we’ve adopted across the board.

MS. ABUTALEB: But even with all those changes and adaptations, have you seen a decrease in the number of people coming in for screenings or consultations this year?

DR. RAJE: So, that certainly is a concern, absolutely, and that’s something we want to reassure the patients. You know, cancer care does not stop because of COVID. We have to continue taking care of our patients. We are continuing with screening programs. We have a lot of affiliates which are not necessarily central to the MGH Cancer Center. We have other places, as well, where patients can go, too.

But one has to continue to seek care as and when required. And I do think we’ve adopted all the policies in place to try and provide safe care to our patients, and we’ve been able to actually accomplish. We are seeing a little bit of fear in patients wherein they do not want to come to the hospital, and we understand that. But at the same time, I think it’s important for us to reassure patients that we are taking all the necessary precautions so that it should not impact their care.

MS. ABUTALEB: Dr. Drebin, I asked Dr. Raje that question because several experts, including Ned Sharpless of the National Cancer Institute predict 10,000 excess deaths this year from cancer due to delayed screenings and consultations. And I wonder if we could get your thoughts on that.

DR. DREBIN: I think that’s entirely correct. And quite honestly, I suspect that’s a low estimate. We know that during the peak period across the country when things shut down in the spring, mammographies, colonoscopies, pap smears, PSA tests all dropped by 80 to 90 percent. And all of those preventive measures have been shown to detect cancer early, and when those types of cancer are detected early, they’re much more curable.

And if one looks at the incredible accomplishments of the last 40 to 540 years in cancer care, we’ve gone from about a 50 percent mortality down to a 30 percent mortality for all patients in the U.S. with cancer. And much of that is due to early identification of cancer with effective screening. And for a number of months, we did not do much screening, and even now we are just barely sort of getting back to it, and people are still frightened, I think, as was mentioned. But again, I think it’s important we reassure people that most institutions are doing everything they can to make the environment safe, and it really is safe to come in and get these important tests.

MS. ABUTALEB: Dr. Raje, you also teach medical students. What are their biggest concerns, especially the fourth years, as they prepare to enter the medical field during this time? What are you advising them; what advice are you giving them; and do you think that pandemic preparedness should be a part of medical school training?

DR. RAJE: This is such an important question, Yasmeen, and I think for our medical students, those who are graduating right now, you know, this has been a year like no other. I don’t think anybody has kind of experienced this pandemic in their lifetime. So, what our medical students are seeing today is something which is absolutely incredible.

What I tell most of my students is take away from this experience. Our medical students were actually on the forefront and helping with the care of the whole COVID surge when it occurred in Massachusetts earlier in the spring and the summer. And I think the experience that they’re going to gain from this is going to be lasting them a lifetime.

I do think it has also impacted them sort of emotionally. The way we are teaching medical students right now is a lot with remote teaching, and that’s not the same as we do with one-on-one teaching. So, they’ve had to adapt a lot, and I think one thing which we’ve tried our best to do is stay in contact with them throughout the whole process of the pandemic and being available to them, because it has been a challenge with respect with how we teach, how we do remote teaching, and so on and so forth, but they’ve really stepped up to the plate, I have to say.

MS. ABUTALEB: One thing I want to ask you both about is, you know, one of the big changes across the medical field throughout the pandemic has been the boom of telemedicine. But I imagine when it comes to cancer care that there are distinct pros and cons in using telemedicine.

Dr. Raje, what have you seen as the pros and cons in telemedicine when it comes to treating cancer patients?

DR. RAJE: Yeah, I’ll start out with the pros. I think, you know, what we have seen is about 20 or 30 percent of our patients we can actually safely take care of with a telemedicine visit. And by doing so, you’re taking care of them in the confines of their home. You’re not exposing them unnecessarily to the risk of infections. Those patients who are on stable medications, oral medications–a lot of our cancer medications are oral medications–they can be followed quite closely as long as we can have local bloodwork done, as long as we can have imaging and things like that discussed on a telemedicine call.

There are obviously, Yasmeen, certain factors which have–can have negative effects with telemedicine, and some of them are–one is, you know, if you’re having a serious illness conversation with people, it’s very, very, very hard to do it with a Zoom call. You need to do it in person, with a person. There’s so much to be said about holding a patient’s hand and talking about prognosis, talking about the impact of a serious illness on a patient, and also including caregivers. So, the family is such an important part of that discussion. So, that certainly, I think, has been extremely difficult for us to do via Zoom calls.

The other really important factor, I think, is you know, by and large, telemedicine has been effective, but it has also sort of highlighted the digital divide. There is the minorities; there are the disenfranchised people. They are the ones who are at most risk for COVID, have cancer, as well, and don’t necessarily have things like technology, access to the Internet all the time. And in that situation, we’ve run into problems and I do think we have to incorporate not just the tele-visits, but also telephone calls, and so on and so forth.

MS. ABUTALEB: Do you think that telemedicine can help with broadening access to care and reducing some of the cancer backlog?

DR. RAJE: Certainly, I think we’ve been able to do that. And the other thing I will also add is it’s been able to broaden our reach, right? So, we don’t necessarily just have to see the local patients. I, for example, am able to do consultations now nationally and even internationally. So, telemedicine as a platform has certainly helped with the access for patients where they can reach out.

But the down side of it is, in certain sub populations, either we ensure that they have access to broadband, have access to good computer systems. Those are the ones who are at a risk for where this digital divide can even widen further.

MS. ABUTALEB: And Dr. Raje, I want to ask you a question from a member of our audience. Stacey from New York says, “I have stage four colon cancer. Would you say immunotherapy is the most promising cancer treatment today?”

DR. RAJE: Yeah, you know, I don’t think we should get into the details of this treatment specifics, because I don’t know the whole history here. But in general, I will say immunotherapies has come a long way in cancer care. This is the first time we are seeing really impactful outcomes after immunological approaches.

Again, specific to this case, it’s hard to comment, because one needs to know a lot more about the patient, as opposed to just saying that immunotherapy would be the way to go forward.

MS. ABUTALEB: Dr. Drebin, I read a piece recently about how Memorial Sloan Kettering is caring for patients who have both cancer and COVID. Can you tell us a little bit about that and how the hospital has adapted?

DR. DREBIN: Yes, we care for roughly 100,000, maybe 150,000, patients in the region who regard us as a primary source of medical care, even though we really are their cancer care provider. And so, we have cared for both our own patients and our own faculty and staff with COVID. We’ve had separate floors, had separate teams that look after the COVID patients, separate ICUs. So, we’ve done our best to maintain appropriate infection control procedures, and those have been really effective. I think all of us were frightened in the spring, and I think all of us have been reassured that passage of COVID within the hospital almost doesn’t happen. We really have got that part down. But we, at various points, have had a substantial fraction of our beds occupied from our patients who are cancer patients but also had COVID.

I’m happy to say over the summer those numbers went down very low, but they are beginning to creep back up as the pandemic hits New York, along with the rest of the country, now.

MS. ABUTALEB: Well, actually, I want to ask you, I mean, what was Memorial Sloan Kettering like at the height of the virus this spring? And are you worried about a similar second wave happening this winter as we see this really concerning surge of cases across the country?

DR. DREBIN: I think it will be a challenge everywhere, but I think we have learned a lot of lessons. I think we’ve learned how to be safe. We have enough PPE. Our protocols are good. We understand how to–how quickly we were able to do the important things, converting ORs to ICUs. In the spring, we did that ahead of time to be ready. We learned that we can do that very quickly, so we need not cut back critical cancer surgery until we really have to.

So, I think we’ll do a better job the next time. I certainly hope we won’t reach a stage where such a significant fraction of our inpatients are COVID patients, but if we do we’ll be ready.

MS. ABUTALEB: And one thing I want to ask both of you is, President-elect Joe Biden has put together a coronavirus taskforce full of medical and health experts. What do you think the top line things they should be focusing on to get the virus under control? And Dr. Raje, I’ll ask you first.

DR. RAJE: You know, what we’ve learned with the pandemic, Yasmeen, is the fact that, when we adapt, we can do it quickly and it has to be a unified approach to tackling this pandemic.

And I think what President-elect Biden has done has put in place an incredible team and hopefully we will have a national strategy, because this is–you know, all states, 50 states are affected here and we do need a national strategy to try and counter this pandemic. And unless we have a central strategy, we’re not going to be able to take care of this. So, I’m very hopeful.

We need to start doing the work right now, because we are getting into a very difficult time with winter coming along, with holidays around, where you have the flu season as well as the pandemic. So, it’s really important that we have a unified, national strategy in addition to what every state does. And I’m hoping that, with the help of the president’s administration, as well as with President-elect Joe Biden, we’re going to be able to get that off the ground, here.

MS. ABUTALEB: And Dr. Drebin, I think we have time for one quick thought from you.

DR. DREBIN: You know, I think we were all very excited over the last several weeks with the news on the vaccine. The vaccine is six months to a year away at very best for the majority of people. But we know what we need to do to limit this infection, which is the basic sort of blocking and tackling: Wear masks, wash your hands, socially distance. If everyone would do that, it’s been estimated we would save 100,000 lives between now and the spring, when we will lose several hundred thousand more people if we continue along the current course.

And remember, everyone who dies of COVID between now and the vaccine being available will likely have died unnecessarily, because it appears that the vaccine will largely prevent deaths. So, it’s even more critical now that we do the right thing, and I hope the Biden administration will be able to take the politics out of that, although that seems a very high bar for anything in our country right now, but to sort of get agreement that what we need to do is do the basic public health things that can limit the spread of this election.

MS. ABUTALEB: Well, we are out of time for this segment, but thank you both so much for that fascinating discussion. Dr. Jeffrey Drebin, Dr. Noopur Raje, I really enjoyed it.

We’ll have much more of our program coming up. I’ll be back with actress and author, Lisa Ray, in just a few minutes. So, please stay tuned.

MR. PAUL: Good morning. My name is Chatrick Paul, Senior Vice President and head of U.S. oncology at AstraZeneca. We are delighted to be here today as part of AstraZeneca’s Your Cancer program, which spotlights those change-makers and unsung heroes in the cancer community, working to define a new era in cancer care.

As part of our discussion today, we have the honor of being joined by two of the foremost experts working to improve health and the treatment of cancer: Dr. Debra Patt, Executive Vice President of Policy, Strategic Initiatives at Texas Oncology; and Ellen Miller-Sonet, Chief Strategy and Policy Officer at Cancer Care.

Together, we will explore how the COVID-19 pandemic has disrupted cancer care, and the importance of transforming cancer from one person’s disease into a true community effort that we must address together.

Let me start with you, Dr. Patt. We know that the COVID-19 pandemic has further exposed some of the more persistent challenges to delivering quality cancer care for all patients.

In your view, what are some of the most urgent challenges, and how can interdisciplinary organizations become part of that solution?

DR. PATT: It’s a great question, Chatrick, and first of all, thank you for having me here today.

We are struggling with cancer patients being diagnosed and getting the treatment that they need. We’re observing this in several ways. There was a survey done of Medicare beneficiaries that discussed that over 20 percent of Medicare beneficiaries aren’t getting the care that they need. That’s not even COVID-related. And we’ve certainly observed that as we look at cancer trends. We think that Medicare beneficiaries in particular, to some extent there’s fear of going to the doctor’s office. They may have transportation issues. They may be fearful of going to the doctor’s office. There may not be capacity to see the patient. So, I think there are many issues that are playing a role, but it is clear that medical distancing is going on. We have observed that.

We are working with partners to help and make a difference. We’re working with Cancer Care to try to provide transportation to patients. We’re working with Cancer Care–COA, the Community Oncology Alliance, is working with Cancer Care to help provide a public service announcement to heighten the awareness of screenings.

And then, we’re trying to do what we can to see patients close to home. So, Texas Oncology has launched a robust telemedicine program. We’ve done over 150,000 telemedicine visits to date. By using a dual modality platform to treat patients where they are, you can get them the right treatment at the right time in the right place in a way that they’re really comfortable. So, I think those things have been really important and are sort of a silver lining of the pandemic.

We have observed, Chatrick, that during the pandemic there’s a decrease in new cancer diagnoses. There’s a decrease in screening, biopsies, surgery, and therapeutic interventions, and new cancer patients have been down between 30 to 70 percent every month between March and July. So, I think heightening awareness of these issues and working with our partners, like the Community Oncology Alliance, like Cancer Care, and other philanthropic partners are critical to our success moving forward, for patients to get the treatment that they need so they can live healthy lives from a cancer diagnosis.

MR. PAUL: Thank you, Dr. Patt.

Let me now move to Ellen. What we’ve also seen during this pandemic is that there has been disruption, or, in some cases just elimination of traditional pathways to care for underserved patients. And regrettably, too many patients from minority communities have gone underserved, even before the start of the pandemic.

Ellen, can you share how organizations like Cancer Care are working to improve the cancer journey, specifically access to cancer screens, which help detect and treat cancer in its earliest stages?

MS. MILLER-SONET: Those are great questions because, you know, cancer wreaks havoc in everybody’s lives, but especially for people that don’t have easy access or comfortable access to health care.

We found at Cancer Care that our call volume to our helpline is up 33 percent since March. People are desperate. They have huge financial needs. In fact, they are telling us that they can’t afford food, that they can’t afford utilities, that they can’t afford transportation. If that’s where patients are at, then getting cancer care is going to be lower on the list, I’m sad to say.

As Dr. Patt mentioned, we are collaborating with Community Oncology to provide hygienic transportation for people to their oncology offices. The folks that are reliant on public transportation are loathe to expose themselves to the danger of infection that come with sharing transportation modalities, so, that the extent to which we can provide acceptable transportation modalities, people can continue to get their cancer care. The issues around screening are dire. We work very closely with our clients to provide case management services so that we can help people problem-solve through the logistics of accessing screening and of accessing cancer care. You know, there are so many barriers to reaching clinicians and our social workers are very adept at helping patients overcome these barriers to access there.

MR. PAUL: Thank you. Thank you for sharing your views, Ellen, and Dr. Patt.

Well, due to the impact of COVID-19, we understand that navigating this new normal comes with a unique set of challenges, and we recognize the weight that comes with a cancer diagnosis, and that addressing this takes the full community. This will take the full community, and it’s through programs like Your Cancer, that we can come together to identify solutions that help define a new era in cancer care.

Please join me in thanking Dr. Debra Patt and Ms. Sonet for our inspiring discussion and participation here today, as well as their tireless work on behalf of those living with cancer.

I would now like to turn this over to The Washington Post.

MS. ABUTALEB: Welcome back. If you’re just joining us, I am Yasmeen Abutaleb, a health policy reporter with The Washington Post.

My next guest is Lisa Ray, an actress, model, and author who chronicles her life and career, including her diagnosis with multiple myeloma at age 37, in a new book called, “Close to the Bone.”

Lisa, thank you so much for joining us today.

MS. RAY: Well, thank you for having me, Yasmeen.

MS. ABUTALEB: So, I want to start–you know, you were diagnosed with multiple myeloma at age 37. For people who don’t know your story, can you walk us through that and explain to us how that diagnosis came about?

MS. RAY: Yeah, so, just to give some context, multiple myeloma is what I call one of the more rare orphan blood cancers. It’s a cousin of leukemia but much more rare, and it’s generally diagnosed in people who are 65 and above. So, being diagnosed at 37 is already rather unusual. It–I think it’s one of those cancers, also, that there don’t seem to be any hereditary markers, environmental reasons or, you know, clues as to why one is diagnosed with multiple myeloma.

But it’s also, in my opinion–at least in my experience, extremely tricky to diagnose, as well. One of my symptoms, a very generalized symptom, was fatigue. And you know, as I tell everyone, who isn’t tired in this post-human kind of world that we’re living. You know, the pace of life is so, so, so hectic.

So, I think that I had actually been living with a version of it, what they call smoldering myeloma, perhaps for a few years and I simply ignored the symptoms. I was ignoring the signals that my body was giving me. But a generalized kind of fatigue to the extent where I would often be on set or, you know, working in front of the camera, and I would almost fall asleep after lunch, whether in the makeup chair or, you know, perhaps while I was learning my lines or waiting to be called onto the set. And I knew that there was something deeply wrong. Also, I think, intuitively, you kind of understand on a deeper level that something is wrong with your body. But, of course, I did what a lot of people do and I ignored it and I pushed my body beyond its boundaries, swept it aside, until I finally had no choice.

I was actually on a meditation retreat in Kerala, which is a south Indian state, and I was in a yoga class, and at the end of the yoga class, you know, they have a position called Shavasana, which literally means “corpse pose,” where you lie down on your back. And after–you know, after the class had finished, I kind of blinked open my eyes and I realized I had been lying there for the good part of an hour. I simply couldn’t get off the floor.

So, I knew that I couldn’t ignore the signals that my body was sending me anymore, and I went back to Toronto at that point, where I was living, and finally got myself a blood test. And I’ll never forget this one moment where my doctor actually sat me down, called me into the office, to discuss the results of my blood test. And she–actually, when she opened up the papers and looked down, she stood up from behind her desk and she said, “How are you even standing?” Because my red blood cell count had actually dropped to such an alarming degree that I was about to go into cardiac arrest.

So, the first thing she did, of course, was to send me to emergency to top up–to get a top-up of my red blood cells and I did that and then I felt fantastic. But the doctor kind of waggled a finger at me and said, “Now we have to understand why it is that your red blood cell count is dropping at such an alarming rate.”

So, after about three or four months of extensive diagnostic kind of tests, it finally culminated with basically a bone marrow aspiration, which is something that I definitely–you know, is not a very pleasant experience to go through, where you actually drill into my hip to take a sample of my bone marrow. But I knew that, as I said, something was wrong, and at some point, rather than fear and anxiety, I just wanted to understand what was going on in my body. I feel that I have been living with this disease or some version of unwellness for a long time. And the more rational part of my brain just kicked in and said, “I need to know what is wrong.” Once I know what’s wrong, I can do something about it.

And after, as I said, about three or four months of testing I was finally diagnosed with multiple myeloma, and I’ve written about it quite extensively in my book, “Close to the Bone.” And “Close to the Bone,” of course, is a little bit of a play of words on multiple myeloma, which is essentially recognizing as a type of bone cancer. It’s a malignancy of the plasma cells in the bone marrow, and also kind of a choice that I’ve made of living a life that I term as being close to the bone, very raw, and very driven also by impulse and instinct, as well.

MS. ABUTALEB: You know, one thing you mentioned was you were unusually young when you received this diagnosis, and at that time, at age 37, you were at the height of your career. You had been in this critically acclaimed, Academy Award-nominated film. What was it like to receive this diagnosis at that time in your life?

MS. RAY: There were many, many aspects to being diagnosed with cancer for me. I guess, on the surface, Yasmeen, absolutely, I was going–I was on a career high. You know, there were many reasons why being diagnosed with cancer was extremely inconvenient for me professionally.

However, on a personal level, what I wanted to share and what I’ve explored within myself and within the book, and not only reflecting back. Fortunately, I actually chronicled my cancer journey in an online blog called “The Yellow Diaries,” and I’m glad I did that because occasionally when we go through these very big life events, and we look back, we reflect back, we wonder, “Did that actually happen? Did I actually think that way?” So, I’m glad that I chronicled what I was thinking in the moment.

But I was also suffering from I think what is a very modern disease, and that is the disease of busyness. That is sort of a disease of denial, a disease of not listening to my body. And as I term it, sort of living at a post-human pace. So, there was an aspect of myself that was searching or seeking a kind of a more balanced lifestyle, that was seeking reprieve, that was seeking solace, that was looking to slow down. And I guess it–you know, the case was that my more rational mind wasn’t allowing that, you know? It was all, well, now you’re riding sort of a wave of success, so go, go, go. And it had become a pattern in my life.

You know, I actually entered the Indian entertainment industry at 16, and I knew nothing but how to push myself against my–or, you know, push into my body’s limits, because that’s what I was trained to do, you know, working for 16, 17 hours on sets. If I was sick, a doctor would be called on the set, would give me an injection, and you continue. And we are applauded for this in the world, as well, Yasmeen. You know, we are applauded always for pushing ourselves, for showing up even when we’re sick, for not allowing our body to express its sort of natural healing cycles, you know?

There’s another aspect, as well, of healing and disease and unwellness that we don’t discuss, and that’s actually convalescence. And that was also something that I found out even during my cancer journey, that–so, in a strange way, I don’t advocate being diagnosed with cancer for anyone else, but I welcomed it in my case because it was a very clear signal for me to, like, stop, and obviously heal. And I had an opportunity to reinvent myself and reinvent my lifestyle and make some very, very big choices and decisions in how I wanted to lead my life.

And as I said, convalescence also was an aspect of that, that, you know, I would love to discuss later.

MS. ABUTALEB: Well, one thing I want to discuss is what were your treatment options at the time? My understanding is that you ended up doing chemotherapy and getting a stem cell transplant.

MS. RAY: Yes. So, I was diagnosed in 2009 and I was very fortunate because I chose to make my diagnosis very public. I wanted to also highlight one little–one little thing which is that often people in the South Asian community tend to believe that certain–talking about certain serious diseases is taboo. And I sort of chose to turn that on its head and I announced my diagnosis from the red carpet at the Toronto International Film Festival. And at the time, I was about two months into my diagnosis. I hadn’t made any sort of public announcement.

And I–part of my protocol, was steroids, very heavy steroids. So, I bloated up to–I was about 40 pounds more than my normal weight. So, obviously, I had changed physically, and radically so. So, instead of hiding, I chose to take that very, very public moment and subvert a very glamorous moment and discuss this cancer that I was going through. And in that way, in my own small little way, highlight my multiple myeloma and also perhaps challenge this idea that we’re meant to, in some way, hide or feel shameful about being diagnosed with a potentially life-threatening disease.

So, that really changed a lot of things for me. However, in terms of my protocol, in 2009, I was put on very heavy steroids, dexamethasone, which also essentially made me crazy for about four days a week, that I’ve also written about in “Close to the Bone.”

And also, at that time, it was considered a radically new form of chemo that was just a five-minute dose. And so, the chemo wasn’t so problematic as much as the steroids at that moment of time. But all of this protocol of four months was meant to push me to remission and prepare me for a stem cell transplant.

Now, stem cell transplant, I know there’s a lot of strange connotations around stem cells and discussions, particularly in the States, but a stem cell transplant is considered not curative but definitely buys you a lot of time for a multiple myeloma patient. And so, I was fortunate that I was able to take stem cell transplant.

MS. ABUTALEB: You also reveal in your book that you had a relapse in 2012 and that came about a month after you had gotten married, and you wrote that this was the lowest low of your cancer journey. What was it like to go through this with someone at the time, as opposed to, you know, in 2009, when you had to go at it alone?

MS. ABUTALEB: We’re having some technical difficulties connecting to Lisa Ray. We’re working to get the connection back up, so, please stay with us.

MS. ABUTALEB: We’re unfortunately having some difficulty getting Lisa back on. That’s life in the work-from-home era, but we got to have a fascinating discussion before we lost her. Thank you so much for joining us.

My colleague, Robin Givhan, will be back here at 3:00 to 3:30 p.m. Eastern to speak with the president of Shopify, Harley Finkelstein. Thank you so much.

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