Welcome to “How Healing Works” Season 2: Healing and Cancer

Summary

Welcome to Season 2 of How Healing Works focused on healing and cancer. We are so excited to introduce you to Dr. Alyssa McManamon, who will co-host this season with Dr. Wayne Jonas. For the past year, Dr. McManamon and Dr. Jonas have worked together to write their latest book, "Healing and Cancer," as a way to share their experience and knowledge of how to deliver whole person cancer care.

In season 1 you got to know Dr. Jonas as family physician, researcher and author who strives to share the power of whole person care and understand what matters to your patients. As we begin season 2, we get to know Dr. McManamon who is a triple board-certified hematologist-oncologist. Together they will dive deep into what whole person care looks likes, feels like and should be in oncology. 

Takeaways

• Whole person care is essential in cancer treatment and can improve both the quality and length of life for patients.
• Collaboration and teamwork are crucial in implementing whole person cancer care, with various healthcare professionals playing important roles.
• Examples of whole person cancer care include integrating supportive and integrative services into cancer centers, re-envisioning survivorship programs, and providing resources for patients.
• The book, Healing and Cancer, serves as a comprehensive guide for cancer care teams, providing information, tools, and practical advice on implementing whole person care.
• The podcast series aims to inspire and educate listeners on whole person cancer care, and encourages community and partnership in this area.

Chapters
00:00 Introduction and Background
05:34 The Healer's Art and Whole Person Care
07:54 Understanding Whole Person Care
09:48 Integrative Oncology Leadership Collaborative
12:09 Examples of Whole Person Cancer Care
16:10 Case Study: Inova Life with Cancer
19:53 Case Study: Sidney Kimmel Cancer Center
21:51 Case Study: Ann B. Barshinger Cancer Institute
24:19 Whole Person Care Throughout the Cancer Journey
26:40 The Book: Healing and Cancer
30:43 Conclusion and Call to Action

Resources:

• Primary Care Personal

Check out the book: "Healing and Cancer: A Guide to Whole Person Care"
Visit https://www.healingandcancerbook.com/ for more information.

Connect:
Twitter: @DrWayneJonas
Facebook: Dr. Wayne Jonas
Instagram: @drwaynejonas
LinkedIn: Dr. Wayne Jonas
LinkedIn: Alyssa McManamon

Visit Healing Works Foundation www.healingworksfoundation.org for more information.

Dr. Wayne Jonas is a board-certified physician and Dr. Alyssa McManamon is a triple-board certified hematologist/oncologist. The opinions expressed on this show are those of the hosts and guests and do not necessarily represent the views and opinions of their places of employment, the Department of Veterans Affairs, or the United States government. The opinions expressed on this podcast are meant for entertainment and education and should not be used to diagnose or treat any medical condition nor should they be used as a substitute for medical advice from a qualified, board-certified practicing clinician. Dr. Wayne Jonas and Dr. Alyssa McManamon have no relevant financial disclosures.

Transcript

Please note that this transcript is produced electronically and may not be an accurate representation of what was said. It may not be reproduced, edited, altered or modified in any way without prior written permission. Any use of quotes or excerpts from this interview requires explicit permission from Healing Works Foundation. Please contact us at healing@healingworksfoundation.org if you would like to use any part of this transcript for quotes or other purposes.

“How Healing Works with Dr. Wayne Jonas & Dr. Alyssa McManamon”

Welcome to Season 2 "How Healing Works": Healing and Cancer

Wayne Jonas (00:03.793)

Welcome to the next season of How Healing Works. I'm Dr. Wayne Jonas.

Alyssa McManamon (00:10.448)

and I'm Dr. Alyssa McManamon. In this season of How Healing Works, we'll be covering a range of topics related to cancer care and how to incorporate a whole person approach into your clinical practice.

Wayne Jonas (00:23.182)

This season, I've asked Dr. McManamon to be my co-host. May I call you Alyssa? Please call me Wayne. You know, in case you're new to this podcast, we'd like to provide you with a little bit of background about ourselves. I'm a family physician with over 35 years of experience treating patients, doing research and teaching. Currently, I'm president of the Healing Works Foundation, a foundation focused on making whole person care routine and regular in healthcare delivery. Previously, I ran an Integrative Health Research Institute and before that I was the director of the National Institute of Health's Office of Alternative Medicine and a WHO Research Center.

Alyssa McManamon (01:06.968)

And I'm a practicing triple board certified hematologist oncologist and internist, associate professor of medicine at Wright State University Boonshoft School of Medicine and adjunct associate professor at Uniform Services University's F. Edward A. Baer School of Medicine, where I was previously director of advanced clerkship programs in Bethesda.

Wayne Jonas (01:29.266)

And interestingly, both of us were in the military for a while. I, as a primary care family physician, and Alyssa as an oncologist. And in those experiences, we learned what it's like to do whole person care because in the military, people have to be kept healthy. Both of us then actually began to support veterans and do whole person care in that area with patients that have a lot of pretty chronic and complex illnesses and require more than just simply a pill and procedure approach to heal and get well. So we have that background and we hope we can bring that not only to those who are in those settings, but also to the wider setting from the lessons that we learned there and how to apply whole person care into the cancer.

I'd like to talk a little bit about how you and I got together, Alyssa. I mean, how do we learn about each other? How did we meet? And then how did we go about deciding that we needed to create this initiative, this effort of whole person cancer care in those areas? I know officially we got going in, I think 2019 or something like that.

I was running a whole person care learning collaborative and primary care, and I came and gave a talk about my book called How Healing Works at the Uniformed Services University, and you were there, and that's where we first got to know each other, at least interact, is that right?

Alyssa McManamon (03:14.724)

Yeah, I think it was 2018, of course, in the military, you always know where you were, what year. So that was the year that I moved away from Bethesda to back to Dayton, Ohio. And I did see you speak, I think it was part of the book tour for How Healing Works. And so I was interested in the topic. And I took, you know, there were free copies for people who were at the school. So I took two and gave one away and ended up reading the book. And that brought me later to actually reach out to your team

and it was probably a year later when I reached out. And it's kind of a funny story about why, because at that time I was teaching medical students and still continue to teach medical students, but I had moved, as I said, back to Ohio where I was in a master clinician role, taking care of cancer patients who I had taken care of for seven years before a four-year hiatus to be with medical students. And so...

When I got back to that clinic, I saw how awful our intake form was. It probably was a form that had been used for 11 plus years and multiple pages. And I hate a terrible form. And I said, I'm going to fix this form. And I remembered something that you had shown in your talk called the personal health inventory. And I thought, well, maybe we could use that because no one could find the word document for this form. I couldn't even edit it. I had to recreate a new form.

So that's when I reached out to your team and I said, can I use this personal health inventory in a cancer clinic? And the response I got from somebody on your team was, that's great, we actually are thinking about moving into cancer care. So that's how I ended up connected to speak with you essentially.

Wayne Jonas (04:55.894)

Yeah, that's great. Yeah, we were using it in a general medicine clinic, primary care clinic. A number of groups and other specialties had picked it up, and neurology, for example, cardiology, for example, but you were the first one that actually contacted us and say, hey, what about cancer? And I thought, and my team thought, of course, this is an area where it needs to be applied, but you were oriented towards person-centered care.

A long time before you came across that, weren't you? I mean, you were teaching courses at the medical school on the healer's art and other areas. Can you tell us a little bit about that?

Alyssa McManamon (05:34.18)

Yeah, I think I got, I mean, this goes way back. This goes way back to even when I was in residency and you know, it's just doing medicine, doing nursing, doing social work, none of it is easy. And so I had learned about just courses for people in practice to bolster themselves. And so I had not had the opportunity to take any of those courses, although by the end of residency, I thought I needed to, and I was feeling burned out. This is before workout restrictions.

But it was years later that I heard kind of the founder of the Healer's Art, which is Rachel Remen speak, actually in Dayton, Ohio at a conference. And I then was inspired to bring that course that she was talking about, which I had never taken, called the Healer's Art, to my alma mater, which was Uniformed Services University in Bethesda. So although I lived in Dayton, Ohio and was stationed here, I ended up training in California at Commonweal to learn to be a director of the Healer's Art along with another colleague from Uniform Services and then brought that course together to Uniformed Services University and really hopefully impacted many, many medical students over years. And I personally co-directed for seven years going back and forth from Dayton to Bethesda for the first, you know, three or four of those years and then the rest on campus. But that course has continued there and I remain actually very lucky because I'm involved in the Reman Institute for the Study of Health and Illness here, now based in Dayton, Ohio. That institute moved from Commonweal some years ago to Dayton, Ohio. So I actually do run there.

I should say I am assistant director for the Tending the Flame program, which is really for physicians in practice, which is residents and above, and we've expanded to other parts of the care team. So really we train physical therapists, nurse practitioners, physician assistants. We've had people who are physical, you know, I've mentioned veterinarians is what I was going to say. So we've expanded to who is in practice and who can benefit from this type of programming, which allows you to be a whole person as you care for people.

Alyssa McManamon (07:44.06)

So I've had the interest in how do I be a whole person in caring for people, even when it's hard, which it is. And that started years and years back.

Wayne Jonas (07:54.19)

That's great. We're going to talk about in this series, what is a whole person? What dimensions of mind, body, social connections, mental health, emotional aspects, and spiritual components, why all of those things are important in healthcare, in healing and in the management of disease. This is part of an ongoing broader topic that has been around for a long time in medicine called humanism, right?

And it's been a struggle as we've gotten into more sophisticated knowledge and reductionism where we split people up into different parts to really see the whole person and make sure that the person is held at the center of care. So part of this podcast and video series will be about how do we maintain that view, that perspective, that understanding, that mindset and interaction between the healer and the healee, the clinician and the patient to make sure the whole person is not lost. So thank you for joining me on this. Now, at the time you contacted me, my team was running a whole person learning collaborative in primary care and you took the time to join it, to learn about it, to examine some of the tools we were.

Using in that, it was involved 16 centers around the country that even through COVID were applying these principles, using some of the tools of whole person care, testing them out, collecting data on that, and then finally publishing a number of articles on that. And then you and I got together after that and said, why don't we do something similar in the area of oncology? And so we developed something called the Integrative Oncology Learning Collaborative, IOLC or Leadership Collaborative, I'm sorry, Oncology Leadership Collaborative, where we went out to our networks of oncology teams around the country and invited them to begin to accelerate the effort in these areas to make whole person care more routine and regular. So can we talk a little bit about that? Why did we decide to do that and your involvement in?

Alyssa McManamon (10:17.584)

Yeah, it's interesting the turn of words or phrase because we did talk about doing it as a learning collaborative, but we decided we're not necessarily experts in integrative oncology. I was at that time going through training with University of Michigan's NCI funded integrative oncology scholars program, but didn't consider myself an expert. And...

we decided we're gonna pull from people who may be leaders in integrative oncology, but also who are not leaders, but who are aspiring leaders. And so we changed it actually to be called integrative oncology leadership collaborative instead of a learning collaborative, because we were gonna learn together as leaders. That was really the idea, that we were gonna have a community of practice of people who are willing to try things out that had been developed in primary care, but to adapt them to work on them to see how they could actually work in oncology. And like I said, be willing to make those mistakes to really be able to be in practice together. And that was the leadership aspect. Whether you were an expert or not, you were willing to try. And so we contacted, as you said, a number of groups. We came out with 15 different sites. Maybe 13 of those were cancer centers, great and small, academic and community. And then we did have some individual participants one from the NCI and one from an Osher Center. And we'll hopefully meet them at another time in a different podcast for guests that may come. But I think that it was a great group of community and we met monthly to twice monthly from April, 2021 through December of 2022, anywhere from 60 to 90 minutes at a stretch. And through that, I think people really did make a contribution to the larger possibility of whole person cancer care, you know, for this country and hopefully others.

Wayne Jonas (12:09.502)

Yeah, well, you taught me in that process what a community of practice was and how the holding of a space for people to talk and really do deep dives into the kind of care that they wanna provide and how they can do it better really helped them bond and they continue to interact. They continue to learn from each other and they continue to be leadership in these areas. 

I want to point out that part of what happened during that leadership collaborative is that we moved beyond what is commonly known as integrative oncology to whole person care. And you'll hear that term a lot during this podcast series. And the reason is it's more than just what is traditionally known as the integration of so-called complementary and alternative medicine to really paying attention to the person at the center of the care and bringing the person and the cancer care together and integrating that.

Now there have been many attempts at doing this. There's two National Academy of Medicine reports over the years that have talked about high quality cancer care, that have talked about the importance of the person in the center. And the biology of cancer has reinforced the need to pay attention to the person. We know now, for example, that the engagement of the patient and their behavior, sleep, nutrition, physical exercise, stress and stress management, social support, all improve both the quality and the length of life. And so need to be integrated into the treatment of the cancer and can actually make the treatment of the cancer better. And so that was part of the shift that occurred in oncology and why we call it whole person cancer care in these fields.

Alyssa McManamon (13:55.4)

Yeah, that was an evolution kind of. I mean, I think that, you know, it was, it makes it more accessible because again, not everybody has time to go do a fellowship as much as they might be interested in the term integrative oncology. It's not for everyone for various reasons, you know, time, finances, whatever. And so, but anybody can deliver whole person cancer care. Anybody can meet another person as a whole person.

And I would submit you have to be in some level of wholeness yourself to really even go there. And so it is less of a separation between you and the person you're serving when you're kind of meeting them where they are. And I think anyone can do that. So that was an evolution of terms over time, but I hope it makes it seem more possible.

Wayne Jonas (14:43.894)

I think it does and it also touches a number of movements that have occurred in medicine in general and in oncology specifically that are attempting to do whole person care. I mean, they are cancer care teams and patients that are listening to this will be familiar with things like supportive care, integrative care, palliative care, psycho-oncology, nutrition, survivorship and social support, all of which are there, somewhere in cancer care, but are often disorganized and not effectively delivered. And the goal of this Leadership Collaborative and the goal of this podcast is to highlight how those are being implemented in cancer care more effectively. And we're gonna talk about cases from around the country, some of which were in the Leadership Collaborative and some of which are not, but are out there doing great things in the area of whole person cancer care, so that those who are involved in the care of the cancer, whether they be the patient themselves or the cancer team, can see actually how to do it and hopefully get inspired on doing it in their own settings. So can we talk a little bit about a couple of the cases that we're gonna be highlighting? These are just a few samples for those that are listening to this introduction to the series to highlight.

I'll talk about one that I have a lot of experience with and it's called, it's part of the Schar Inova Cancer Institute in Northern Virginia here where I live. And, you know, unfortunately, and in some ways fortunately, I've had a lot of interaction with that center. My wife said, you know, cancer's over many years of different types. And so we've had to engage with that cancer center. When we first started going and getting care there, we didn't even know that they had a Life with Cancer Center that offered over 200 supportive and integrative services for cancer patients and their families into the region. Nobody spoke of it at the most. You might see a brochure sitting around somewhere. But over the years, we've seen this more penetrating into the heart of the Schar Cancer Center. In fact, Life with Cancer is now at the very center

Wayne Jonas (17:06.539)

of the cancer center there. And we've seen those services being offered increasingly in those areas, embedding it into the new cancer center. And I think this is an example of what a large center can do when they put their mind to it.

Alyssa McManamon (17:22.672)

Yeah, they were an interest, I mean, really wonderful contributor to the leadership collaborative. But the interesting part was, although they had, you know, all those, that menu of services, like you said, it was the integration piece of getting it into the cancer center over time. And really interesting what they were able to do. First, they identified, you know, the two members that came regularly to the collaborative were a social worker.

Jennifer Bires and a GI oncologist, Ray Wadlow. And really, I think they identified that, you know, strengthening their team by being a duo, right? That the oncologist was really behind this effort of bringing these services more into their clinic. And so that working together, but really having the buy-in from who we still sometimes think of as the kind of team head or the oncologist that made a big difference in the way that they were able to integrate services, particularly to the GI clinic. So they piloted doing that within the GI clinic first. And I just think they were able to really say, it takes the oncologist buy-in, it really takes a team, and then they doubled down on also their group programs, which they've offered for a long time. But I do want to put a plug-in if people are listening, because Inova's Life with Cancer, they offer programming online that's available to anyone and for free of charge. So this is a philanthropically based program and it's amazing. I have started to refer patients because, they have great offerings and you don't have to be a patient in Virginia to take advantage. So just to be aware.

Wayne Jonas (18:56.542)

Yeah, one of the benefits of the post-COVID virtual world, isn't it? You mentioned something really important about this center, which we also saw repeated in other groups, and we're going to talk about and talk with some of those folks so that our listeners can see some of the details about how it's done. But that is the team. And it is often the team that is leading this and not always the oncologist.

Now, the oncologist, it's important for the oncologist to understand it, to be involved and to support it, but it was social workers, it was advanced practitioners, nurses, health coaches, nutritionists, physical therapists, and a number of others that were key in terms of both providing this kind of care and leading their organizations in those areas. One of the other examples we saw was at the Jefferson University Sidney Kimmel Cancer there which provides really robust evidence-based programs to a variety of types of patients.

Alyssa McManamon (20:01.892)

Yeah, I think that's another thing that we personally probably learned going through this process is that, you know, some of the most active members are the people who have known for a long time that this needs to be happening and have expertise in doing it, which would be social workers, as you've already mentioned, you know, same thing with Jefferson. Like, it was important that they came as a group of physicians and social workers together, and there were multiple of each who came. And I think it was instructive to us, especially if you've worked at a place where you know, maybe there's only one social worker to see some, some teams that maybe have more than one deep and how much more they can get done, but also to be inspired by those teams that really do have some depth to them and, and some breadth to them.

Wayne Jonas (20:46.238)

Yeah, one of the unique features at Jefferson is they actually have, I think, one of the only departments of integrative medicine at an academic medical center in the country that's very strong. And the interaction between the cancer center and the integrative center really provided more whole person cancer care. And in fact, some of the oncologists there were working over there or certainly providing services to cancer patients.

We saw a similar thing going on at the University of California, Irvine, that was part of this, where they have an Institute for Integrative Health that is developing new efforts, reaching out and providing care to cancer patients in their Comprehensive Cancer Center there also. So an example of that kind of cross-department work and cross-institute work was there. I think another example that we'll just mention on this introduction.

is that at the Barsheeg, or how do you pronounce it again? I'm sorry.

Alyssa McManamon (21:46.212)

I think it's Ann B, Barshinger Cancer Institute. Barshinger.

Wayne Jonas (21:51.392)

Barshinger Cancer Institute at Penn Med. And there it really came in some ways from the top down, a really long-term supporter of person-centered oncology care, Randy Oyer, who leads that cancer center, really got it. He understood it, he was doing it in those areas. And they came to the table and really started embedding it into their survivorship program and shifted their survivorship program significantly to more whole person care. Isn't that correct?

Alyssa McManamon (22:26.156)

Yeah, I think it was, and a lot of this comes down to languaging, so it's really interesting. They might not have used the term whole person care or whole person cancer care, but they re-envisioned their survivorship to kind of survivorship and wellness. So it's like, it's still their survivorship program, but they changed the focus. They started asking people, what does wellness look like to you? So maybe, you know, maybe not the exact question that came off of the personal health inventory, but they used a question that really was inviting the patient voice into what does wellness look like to you and how do we get you there? How do we provide you the link to the next service in the community or here at Barshinger that can do that? And so they built out kind of an electronic resource that could be available to any of their providers of what resources are available in the community and or here at our center that can get people to what they say looks like wellness for them. And I think just some of those nuts and bolts, they really got into starting to integrate things into the EHR.

I'm trying to figure out the workflow, who's responsible for what when it comes to different diagnoses and making sure that everybody who's in the survivorship sphere has access, whether you got surgery only, whether you got radiation after surgery only and no chemo or whether you got chemo and immunotherapy, could everybody get same access to this survivorship and wellness program. So, they were a great example based on, again, a leader who really took it forth but broadened his team to allow them to do it.

Wayne Jonas (23:52.306)

Yeah, I think, you know, obviously after cancer has been treated and that's when most people think about survivorship and how do I make sure I have health and well-being for the rest of my life. But that doesn't just apply after the cancer treatment. We found in the leadership group that whole person care was essential throughout the entire cancer journey from the time of initial diagnosis even to the end of life if the cancer itself couldn't be eliminated in enhancing well-being and important transition at the end of life. And so the leadership group worked with us and helped us take some of the resources that were in primary care and specifically translate them into cancer care so that they would be available to those in oncology that wanted to do this. And we call these resources, one of these resources, the pocket guides, which are simple, easy to access, and free on the Healing Works Foundation website, so that anybody anywhere, even if they don't have a big robust Life with Cancer Center like at Inova, can begin to do this on a day-to-day basis with patients. And you were helpful in working that, working with the oncology groups to create those pocket guides and resources in those areas.

Alyssa McManamon (25:20.616)

There's a lot of team members doing a lot of work in the back, backside to get those out there, I would say. And really, we did lean on members, subject matter experts in the leadership collaborative to be interviewed, to be quoted, to review them, and to make sure that they were as evidence-based as possible. I think we're up to 19 pocket guides now. And the...

thing that people should know is that they can be rebranded. They're all available through Creative Commons. So, you know, if you contact the Healing Works Foundation team, it's possible to rebrand the pocket guides under your own cancer centers, you know, or whatever clinics, you know, nomenclature. And I know at least one center chose to do that from the Leadership Collaborative to really adopt the pocket guides, but under their own branding.

Wayne Jonas (26:06.422)

That's great. Well, we got a lot of questions as we were going through this and we continue to get questions from those with cancer and teams taking care of people with cancer about, well, what is whole person cancer care? What do you mean by that? Is it integrative care? Is it supportive care? Is it psycho-oncology? What is it? And so you and I decided we would try to put this all together into a book called Healing and Cancer. Can you talk a little bit about that and sort of what the goal and the reason that we wrote that?

Alyssa McManamon (26:40.356)

Yeah, I mean, I think the book is, and thank you for inviting me to co-author, I mean, The book is really a compendium of kind of our learnings from being with these teams over the course of that period of time and all in a way to kind of give a guide to cancer care teams. How to do this, how to make it routine and regular, how to get started.

And of course the why behind it, you know, and I think that partly is evidence and partly is just what we already know, which is that this is the kind of care we're all trying to give. I look at colleagues at all the places I've worked and I think that everybody strives to give whole person cancer care. And this is just bringing it together in one place for care teams. We're not just speaking to the oncologist, we're not just speaking to the infusion room nurse, we're trying to speak to the team as a whole and say, we know you all wanna do this and here's more and better kind of information to be able to do it. That's the hope. So it's a book that's really, I think when we wrote it, the audience was for care teams.

Wayne Jonas (27:45.294)

Yeah, that's great. Define, describe, and show, and then provide practical tools so people can do this. People often ask, well, there's a lot of cancer books out there, a lot of cancer guides, there's guidelines in these areas, and how is this different? And I would say, and not just me, we've gotten a lot of endorsements from this that have said the same thing, that this really is the first comprehensive action guide on whole person cancer care to come out. 

It describes, as you said, the why, including the science and the importance of it to people. It describes the how with a number of examples, a few of which we've touched on in this introduction. And then it gives you tools to actually do it and to implement it and embed it in your own practice in those areas. And so we hope that it inspires people, it helps them learn to do it, and it encourages them to meet with their colleagues, meet with the teams and say, hey, let's begin to implement more whole person care in our own practices. 

And really the goal and the hope of this podcast is that we can expand on those areas so that individuals listening to it during this second season of how healing works and that are interested in whole person cancer care can get some details about how to make that happen in their own settings. And we are open and welcome any feedback, comments, interactions, as we move through this series on whole person cancer care. So thank you for joining me, Alyssa. Can you, you wanna add anything more about either the book or the podcast itself?

Alyssa McManamon (29:33.82)

No, well, what I would add is that, you know, this idea of community, I mean, you know, if you're listening and this is something that speaks to you, like, that's the whole thing. Like, this is, you know, we're just, we're a community of practice, we're trying, you know, and we're learning and we wanna learn from you too. So I think that, you know, just knowing that there's not one way to do something is really powerful and you only find that out by talking to other people. So I think it's really useful to kind of open up to other people and learn from each other.

Wayne Jonas (30:05.13)

I think that's correct. And we're always looking for partnerships in this area. This is only part of an initiative that Healing Works Foundation is launching next year that we hope will provide tools to a number of national cancer and patient resource organizations that'll make it available. And so Alyssa and I really look forward to sharing this information with you and hearing from you as we move forward to make whole person cancer care routine and regular.

Alyssa McManamon (30:43.613)

Thank you.

Wayne Jonas (30:44.766)

Thank you.