How To Support Someone Who Has Cancer with Dr. Joel Marcus

Podcast Transcript

Nada Youssef: Hi. Thank you for joining us. I'm your host, Nada Youssef. If someone you know has been diagnosed with cancer you may be wondering how to help or what to say. Caring for a loved one with cancer can be very stressful, which is why we're having this live podcast, so we as caregivers are well-informed and can nurture and empower one another. If you have any questions, please leave them in the comment section below. For today's topic we have with psychosocial oncologist, Dr. Joel Marcus. Thank you so much for being here.

Dr. Joel Marcus: Pleasure.

Nada Youssef: I'll just give you the floor to introduce yourself.

Dr. Joel Marcus: Hi. I'm Dr. Joel Marcus. I'm a psychosocial oncologist. It's kind of a new field, where we're dealing with the emotional side of cancer. As you said, you got to support the loved ones, and it's a package deal.

Nada Youssef: So tell me, what is psychosocial? What do we deal with?

Dr. Joel Marcus: So I love my brethren in the white coats, the radiation, surgery, and medical oncologists, and we kind of cover everything else. It's all the parts that isn't medical.

Nada Youssef: The emotional parts?

Dr. Joel Marcus: Yeah.

Nada Youssef: Okay. Great. Then before we begin, I want to please remind everyone that this is for informational purposes only and not intended to replace your own physician's advice.

Dr. Joel Marcus: Talk to your doctor.

Nada Youssef: Talk to your doctor. We're going to keep saying that all day. First of all, we all know someone who has cancer, affected with cancer. How do we support a loved one? How do we make sure that they maintain a good quality of life?

Dr. Joel Marcus: So I was actually talking with a couple this morning and I told them I was coming on here, and what they wanted people to know is you have to be able to support the emotional roller coaster. It's going to go up. It's going to go down. Having cancer is not a static, just one and done thing. It's always changing, always evolving, not just for the patient, but for the loved ones as well.

Nada Youssef: Yeah. And the caregivers, I mean some of them might even feel scared or distant. How do you make sure you don't give that off?

Dr. Joel Marcus: Well, actually you should.

Nada Youssef: You should? Okay.

Dr. Joel Marcus: Yeah. I mean honesty is so important. It's okay to have those feelings, it's just not okay to stay in it. When you stay in that fear too long, anxiety gets rolling and then you don't want to ... You want to protect from the patient. The patient's going, "What is going on?" So everybody ... It's so important to be clear and declarative about emotions, thoughts, feelings.

Nada Youssef: Yeah. Now when we think about that, as adults we try to maintain our own emotions. What about with kids? When it comes to kids, do you tell them? Do you keep it from them? What do you do?

Dr. Joel Marcus:  Funny you should ask. I was just asked to come meet a woman who had just been diagnosed this morning, and her concern was her two children. What do I say? What do I do? Again, I'm like really, really passionate about being honest, but you have to give it a developmentally appropriate kind of context. Every kid has had a cold, hurt their knee or something, and they got treated, they asked for help, and it got better. So that's the message that has to be given to kids, is yes, I'm sick. To pretend it's not there is kind of a lie.

Nada Youssef:  Is a lie. Yeah. So soften the blow? You can take it ... Soften the message, but make sure they know.

Dr. Joel Marcus: But it has to be appropriate, it has to be ... I mean because if you don't tell them and then they find out later, it's like why didn't you tell me? What else are you not telling me?

Nada Youssef: Right. Right. Exactly.

Dr. Joel Marcus: So it's so important to be clear in a way that kids can understand.

Nada Youssef:  Very good. Okay. Now many can feel angry, sad, upset almost-

Dr. Joel Marcus:  I hope so.

Nada Youssef:  ... at the caregiver. How do you deal with these emotions?

Dr. Joel Marcus:  As a caregiver?

Nada Youssef: Yeah.

Dr. Joel Marcus: You know, lots of caregivers try to-

Nada Youssef:  Act the part?

Dr. Joel Marcus: ... pretend. I'm fine. There's no big deal. No. Put yourself in the cancer patient's place. If you were sick and your loved one didn't get scared or angry, how would you feel?

Nada Youssef:  I would know that they're faking it.

Dr. Joel Marcus: Why don't you care? Why don't ... So having those feelings are really, really appropriate. It's not okay to like take it out on somebody, but to have those feelings, to find the support that you can tell about those feelings, to reality check them with someone, you know?

Nada Youssef: So kind of ride the emotional roller coaster with them, don't make it worse?

Dr. Joel Marcus: Exactly. You know, there are very few roller coasters that have only one seat on the ride.

Nada Youssef: That's true. That's very true. Now also psychological effects and body changes that come with this disease, with hair loss, appetite, lack of energy, just like you were talking about mood swings. How do you deal with someone, as a caregiver, when a patient is going through mood swings, how do you deal with someone?

Dr. Joel Marcus: Well, you just asked two separate questions, so we'll do mood swings first. Indeed, that patient I was talking to this morning was riding the roller coaster, knowing that that's going to happen, that is appropriate. The best analogy I have, and I use this frequently, is getting diagnosed with cancer is a large rock being dropped into a small pond. There's a big explosion and then the ripples go out.

So those emotional ripples are going to happen. They're appropriate. They may happen ... I have lots of patients who get cranky. We know they're going to get cranky two days after treatment, when the steroids have worn off and they're feeling kind of depleted. So it's important to say to the loved one, you know, I had treatment and now I'm okay, but tomorrow I'm probably not going to be not so wonderful.

Nada Youssef: So clear, concise communication is also-

Dr. Joel Marcus: Planning, strategic planning, it's really, really important.

Nada Youssef: Excellent. We talked about the psychological effects.

Dr. Joel Marcus:  Psychological effects ... As a health psychologist and as a psychosocial oncologist, we've tried to remove the response of cancer out of the realm of mental health pathology. For a long time, if you had cancer you were considered to have ... And you didn't cope well, you have depression, you have anxiety. Well, yeah, those are normal, natural responses.

So we've tried to move that out of the realm of pathology and normalize them. Once again, having those responses is really okay. It's not okay to stay in them. It's not okay to remain angry so often that it's impossible to have a conversation. When you find life getting disrupted because of those things, whether I'm on the caregiver or the patient side, that's the time to reach out and make sure, hey, I'm being cared for.

Nada Youssef: Okay. Great.

Dr. Joel Marcus: Could we talk about the changes, the body changes?

Nada Youssef: Sure.

Dr. Joel Marcus: So, you know, as I'm fond of saying, there is no fun cancer treatment, there just isn't. There were some studies not too ... Well, yeah, it's getting to be a while ago, that in particular women might find the loss of hair more disturbing than the loss of a breast, because the hair is an outward expression of an inward disease process, and it's more in their face. So it's important for loved ones to acknowledge their cancer patient, to let them know hey, I get it. This is hard for you.

We do a lot of disease group oriented treatment and there is no easy way of getting around some of the treatments we have. Head/neck cancers cause a lot of physical disabilities, a lot of problems with communication, a lot of, for lack of a better term, disfigurement. The loved ones have to be able to care for the patient and be okay with saying, "I'm sorry, I didn't understand. Tell me again."

These are all really, really important things. It's like we were talking before, to pretend it's not happening isn't honest, so it's important that the loved ones be up front and say, "I don't understand."

Nada Youssef: Now when it comes to dating someone with cancer, will they lose interest in romance and sex, and what if they do get turned off by the disease?

Dr. Joel Marcus: Whether who gets turned off by the disease, because that's a very two edged question?

Nada Youssef: The patient. How do you deal with someone that's turned off.

Dr. Joel Marcus: Well, in particular we don't talk about dating and sex enough. It's really an important human function. It's our most intimate way of communicating and it's really, really important. So if the patient is turned off, or in particular the women may have some difficulties with arousal that might have a very easy fix. But they should be talking to their oncologist about this.

I mean it's not unusual for women to be treated for breast cancers and to be having some self-esteem issues, to having body image issues and consequently ... Our largest sexual organ is our brain, so how they think about themselves, how they communicate with their partners, is really, really important.

In the last 20 years or so, we've developed kind of a sub-specialty of adolescent and young adult cancers, and this is a population that is really hit hard by cancer. So asking a young person about reproduction, what do you want to do? Do you want to have children in the future? What does it mean to you? How are you going to date? What do you tell someone? Is that first date conversation? Oh, by the way-

Nada Youssef: By the way, I have cancer. Yeah. Yeah. Right.

Dr. Joel Marcus: So these are really critical issues.

Nada Youssef: Now when we talk about support therapies, besides medicine what can you do? I know like there's art therapy, music. Can we talk about some of the things that are helpful?

Dr. Joel Marcus: No. Yeah, of course we can. Yeah. We, and in particular here, we have a tremendous ... It's like a net. It's this wonderful net that we surround our patients with. We have art therapy, which is a tremendous way of expressing ... And we have a wonderful art therapist who does some really just delightful things even in the treatment setting that allows patients to express themselves in a way that maybe not be verbal.

Nada Youssef: Okay.

Dr. Joel Marcus: Right?

Nada Youssef: That's great.

Dr. Joel Marcus: It's very, very cool. If you come into my office I'm going to talk about diet, I'm going to talk about spirituality, I'm going to be talking about physical health and exercise. We have yoga twice a week. Best thing since sliced bread.

Nada Youssef: Love yoga.

Dr. Joel Marcus: It's a mind, body strategy that is wonderful for helping people stay in the moment.

Nada Youssef: How about meditation? We're in the meditation room.

Dr. Joel Marcus: We're in the meditation room. I don't know if you can see it but this is a very chill room. It's very comfortable. Actually in my field of psychosocial oncology mindfulness meditation has really been shown to have a wonderful effect on the immune system, on anxiety, on sleep. You can't make this up. Mindfulness meditation was developed by a guy named Jon Kabat-Zinn.

Dr. Joel Marcus: Out of Harvard. For 25 years now he's been showing us how important staying in the moment, being focused on the body, allowing thoughts to come in, acknowledge them, but not getting too distressed about them.

Nada Youssef: Sure.

Dr. Joel Marcus:  It's showing effects on the immune system. Just all kind of good things.

Nada Youssef:  Amazing. Actually on my way here I saw there was a store that's just for support for cancer patients.

Dr. Joel Marcus: Just down the hall.

Nada Youssef: Blankets ... Yeah. Everything.

Dr. Joel Marcus: Yeah.

Nada Youssef: For skincare too.

Dr. Joel Marcus: Oh, yeah.

Nada Youssef: That's something we don't think about often.

Dr. Joel Marcus: Well, yeah. In this house we do.

Nada Youssef: Right.

Dr. Joel Marcus: Once again there are no fun treatments and the treatments have ripples going outwards, whether it's the skin, the cosmetics, the way you look. Dry mouth. Critically important. It's hard to appreciate a good day when your mouth feels too dry to smile.

Nada Youssef:  Sure. Sure thing. Sure thing. Okay. Now I know you talked about diet. I wanted to ask you about diet. Is there a certain diet that you're supposed to follow that you should be promoting?

Dr. Joel Marcus: We don't want to promote anything but a healthy lifestyle.

Nada Youssef: Okay.

Dr. Joel Marcus: Patients come in and I have several patients who are militant vegan and I support that as long as they're getting their nutritional needs met.

Nada Youssef: Sure.

Dr. Joel Marcus: We have a whole staff of dieticians in the hospital. We have consults that are available if they have questions. "Doctor, can I eat meat?" Well, why not? I don't know. It depends on your disease.

Nada Youssef: Sure.

Dr. Joel Marcus: In all things, my personal philosophy is in all things moderation.

Nada Youssef: Okay.

Dr. Joel Marcus: You know, be healthy. Eat a balanced diet. Should you eat a lot of red meat? No. We have a lot of wonderful data that says a diet rich in grains and other areas of proteins is more healthy.

Nada Youssef: Sure.

Dr. Joel Marcus: It's a quality of life issue.

Nada Youssef: Sure. As long as it's healthy it's good stuff.

Dr. Joel Marcus: Yeah.

Nada Youssef: Okay. Great.

Dr. Joel Marcus:  "I'll never be able to eat sweets." I'm like, "That sounds horrible."

Nada Youssef:  Yeah.

Dr. Joel Marcus:  If they took away my chocolate cake I would be a sad guy. This gets to a quality of life issue.

Nada Youssef: Sure thing.

Dr. Joel Marcus:  We're saving you from the disease but we're making you miserable at the same time? It doesn't sound fair.

Nada Youssef: Right.

Dr. Joel Marcus: The loved ones really have to be aware that this is a whole life changing event.

Nada Youssef: Yes.

Dr. Joel Marcus: Their cancer doesn't exist in a vacuum. When the patient has cancer, the loved ones, the caregivers, don't have cancer themselves but they might as well.

Nada Youssef:  Yeah. They're very affected by it. Sure.

Dr. Joel Marcus: Yeah.

Nada Youssef:  Okay. Well, I'm getting some live questions so I'm going to go to these and then I'll come back. I have Anita, "Is there a right or wrong way to handle the depression?"

Dr. Joel Marcus:  A right or wrong way to handle the depression? I have patients come in and say, "I think I'm depressed." Well, tell me about it. What is depression? A lot of my patients just have sadness, appropriate sadness. It becomes depression when it affects your ability to participate in life. Does it make you withdraw? Are you so depressed that you sleep too much?

If you find that the signs and symptoms of the depression are impacting your ability to appreciate quality of life metrics or how you appreciate quality of life that's when it's appropriate to reach out, to talk to your loved one. A lot of patients and a lot of loved ones, "I'm fine."

Nada Youssef: Yeah. Of course.

Dr. Joel Marcus:  "I'm not sad. I'm not angry." It's really appropriate to reach out to the loved one and say, "You know, you're looking kind of sad. I haven't seen you smile in a while. What's going on?"

Nada Youssef: Yeah.

Dr. Joel Marcus: Then if it becomes like a real issue we have lots of good professionals.

Nada Youssef: Sure.

Dr. Joel Marcus:  I've got to give a shout out to my social workers. They are unsung heroes.

Nada Youssef: Yes.

Dr. Joel Marcus: They are here at the Cleveland Clinic we have a host of them. They're all licensed to do therapy. There's a whole misconception that they just get bus passes or whatever. Got to give them a shout out.

Nada Youssef: That's amazing. That's amazing. I like what you said, "Appropriate sadness". That's very important.

Dr. Joel Marcus: Yeah.

Nada Youssef: Okay. I have Cindy.

Dr. Joel Marcus:  Hi, Cindy.

Nada Youssef:  "What is your opinion about medical hemp oil for cancer patients fighting this disease both physically and mentally beneficial?"

Dr. Joel Marcus: You said we'd be asked about that.

Nada Youssef:  Yeah. I told you it was going to come up.

Dr. Joel Marcus: The Cleveland Clinic does not endorse the use of CBD oils because at the moment although Ohio has approved medical marijuana we haven't really operationalized it.

Nada Youssef: Okay.

Dr. Joel Marcus: As always, in most things, check with your physician. Make sure they know ... Not just CBD oils but any alternative herbs, supplements, that you may be taking. Clear it with your physician. Can I tell a quick story?

Nada Youssef: Yeah. Of course. All yours.

Dr. Joel Marcus: A long time ago there was a big fad about St. John's Wort. It was supposed to help with depression. People who had depression and were being treated for depression would go out and say, "I'm going to get this and I'm going to take my medicine and the St. John's Wort."

It turns out the St. John's Wort has some of the same active chemicals so they were getting twice as much as they needed. It's so important. Check out with your physician.

Nada Youssef: Yeah.

Dr. Joel Marcus: Right? The CBD oils, check with your physician.

Nada Youssef: Check with your physician. Okay. Sounds good. Now I want to talk a little bit about if I'm going with a patient and she's bringing a chemo bag or he's bringing a chemo bag what to bring?

Dr. Joel Marcus: I got to tell you. I just saw a patient the other day. She had the coolest blanket ever. It was just all soft and fuzzy and had just inspirational words on it. Comfortable clothes.

Nada Youssef: Okay.

Dr. Joel Marcus: If you happen to know that you like a certain Gatorade ... We are not endorsing Gatorade.

Nada Youssef: Yes. We are not.

Dr. Joel Marcus:  A certain beverage that you find particularly good, bring that.

Nada Youssef:  Okay.

Dr. Joel Marcus:  Lots of patients bring those little travel pillows.

Nada Youssef:  Yeah. The ones you can buy in the airport.

Dr. Joel Marcus: You're going to be sitting in a chair for an hour, two hours, three hours. We are in the digital age.

Nada Youssef:  Some entertainment, music.

Dr. Joel Marcus:  Right. We of course are wired up here with WiFi. Go forth and binge watch your favorite thing.

Nada Youssef: Okay. Good. What about for dry mouth?

Dr. Joel Marcus:  Dry mouth, xerostomia is the actual term for that.

Nada Youssef: Oh, I didn't know that. Xerostomia.

Dr. Joel Marcus: You know, once again, talk to your physician. Because I work in head/neck cancers we have a whole ... If you go up to our pod we have a whole list of things that help with dry mouth plus coupons to help purchase them.

Nada Youssef:  Okay. Same with nausea?

Dr. Joel Marcus:  Nausea and vomiting is like a whole other animal. There are some studies that say that the nausea is actually worse than the vomiting. That sense of wanting to throw up.

Nada Youssef:  Always wanting to ...

Dr. Joel Marcus: Yeah.

Nada Youssef: Of course.

Dr. Joel Marcus: Symptom management is so, so important in terms of quality of life. This is critically important for the caregivers and the patients. Symptoms are like a big boulder rolling down a hill. They get stronger and bigger and it's harder to stop once that has got momentum.

We always encourage patients, "Stop it at the top. Don't let it get momentum." This is pain, this is nausea. Some of our chemotherapies unfortunately cause neuropathy, a tingling in the hands and feet. We have a tremendous department that has got a bad rep. It's palliation. People think, "Oh, you're talking hospice." No, this is symptom management. This is quality of life.

We have a whole group of really, really talented physicians that can help stop those symptoms before they get momentum. It's important that the loved ones communicate. Once again it goes back to be honest, be clear.

Nada Youssef: Be emotional. It's okay to be emotional.

Nada Youssef: Okay. Good. Now I'm going to go to cancer trials before I go to some more live questions.

Dr. Joel Marcus:  We're trying cancer?

Nada Youssef: No, we're not trying cancer. For cancer trials it almost sounds morbid.

Dr. Joel Marcus: Yeah.

Nada Youssef: I want to clarify.

Dr. Joel Marcus: People think, "Oh, I'm going to be a guinea pig."

Nada Youssef:  Right. Exactly. That's why. Let's clarify to the audience what it's about.

Dr. Joel Marcus: Okay. Every drug that is given has gone through a process of clinical trials.

Nada Youssef: Oh, okay.

Dr. Joel Marcus: Every drug. That's the only way these drugs can be allowed out to the ...

Dr. Joel Marcus: My personal opinion. It is the right thing to do.

Nada Youssef: Okay.

Dr. Joel Marcus:  I had the opportunity of working at a very large trial center that introduced most of the drugs that we knew in the late '90s and 2000s and it was just now, they're commonplace.

Nada Youssef:  Yeah. Right.

Dr. Joel Marcus: Can is say something really ... because people are going to be talking to their physicians about immunotherapies.

Nada Youssef:  Okay.

Dr. Joel Marcus: They're new.

Nada Youssef:  Yeah.

Dr. Joel Marcus: They're really new and they're changing the way we treat cancer. If the physician recommends it, please listen. Talk with them. Yeah. It has changed the face of cancer treatment.

Nada Youssef: That's great. That's very good information. Thank you. Okay, so let's jump on some more live questions.

Dr. Joel Marcus: Okay.

Nada Youssef:  Some live questions. I have Elizabeth. Do you think the Keto diet is a good idea? Are you familiar with the Keto diet?

Dr. Joel Marcus:  Not really, but once again-

Nada Youssef: It's more a no sugar, no carbs, all healthy fats.

Dr. Joel Marcus: All proteins. Once again, talk to your physician. Every disease is going to be different. One of my patients and I were laughing this morning. Her lab work comes back a little bit different because of where her disease is. Her regular physician is, "Oh, we need to give you statins, we need to do ..." No, that's what's going inside me.

The Keto diet might may affect different parts of your body, the way your body utilizes its food. So it's important. Check it out with your physician.

Nada Youssef: Talk to your physician.

Dr. Joel Marcus:  But keep an open mind about any and all.

Nada Youssef: Yes, of course. Open mind is very important. And then Deborah wants to know, is there a right or wrong way to handle anger?

Dr. Joel Marcus: Yes. Don't break stuff.

Nada Youssef: Don't break stuff.

Dr. Joel Marcus: Don't break stuff. Don't hurt anybody.

Nada Youssef: Don't get too emotional.

Dr. Joel Marcus: Well, it's okay to be angry-

Nada Youssef: Anger, the emotion itself sounds-

Dr. Joel Marcus:  Scary?

Nada Youssef: Yeah.

Dr. Joel Marcus:  Well, hey, how do you think you'd feel if somebody said, "You now have cancer and your life as you know it is going to change?" I'm going to be angry.

Nada Youssef: Of course.

Dr. Joel Marcus: Once again, this is that emotional roller coaster. Loved ones need to be on board for this ride. It's going to go up. It's going to go down. Anger is an appropriate response to a life changing disease. It's an appropriate response. "Oh, by the way, you have to come to chemotherapy every three weeks." That'd make me angry.

Nada Youssef: Yeah. So literally, don't break stuff. Be angry.

Dr. Joel Marcus:  Be angry. Talk to people. Don't hurt stuff. Don't break stuff. Don't hurt yourself. Right?

Nada Youssef:  Okay, great. I now have Amina. How can you reduce anxiety for a cancer patient with generalized anxiety disorder, cannot have a sedative due to dyspnea?

Dr. Joel Marcus:  Dyspnea. Dyspnea?

Nada Youssef: D-Y-S-P-N-E-A.

Dr. Joel Marcus: Dyspnea. We're giving you all kind of new words. So dyspnea is problems with breathing. With a generalized anxiety disorder, this goes back to mindfulness meditation. These mind body strategies are really, really good for this. It starts with focused breathing, paying attention. Because anxiety disorders are all about brains thinking too fast and giving us bad messages. Once you focus on the breathing, settle into a calm space, it really can help. The other thing we do is cognitive behavioral therapy. Cognitive behavioral therapy helps to identify thoughts that cause the anxiety. This is really, really common. Fear of recurrence.

People worry and it can be debilitating. Learning that some of these thoughts are knee jerk reactions and that there is a way of dealing with them, learning some very specific techniques. Diaphragmatic breathing. The person with dyspnea might have some difficulty with that. Learning to stay in the moment is really, really important. Not being able to take a sedative, I'm not quite sure I understand it. Because our medicines come in a whole bunch of different varieties. Anxiolytics are typical anti-anxiety medicines can be useful. But antidepressants, SSRIs, also have a really good effectiveness in the literature on anxiety. This is something to talk to the physician about. "Hey doc, I'm worried all the time."

Nada Youssef:  Yeah, okay.

Dr. Joel Marcus:  Hope that helped.

Nada Youssef:  Yeah. I'm sure it did. Can we talk about chemo brain.

Dr. Joel Marcus:  Chemo brain? I forgot, what is that?

Nada Youssef:  What is that? Chemo brain.

Dr. Joel Marcus:  Chemo brain, really common. My field of psychosocial oncology is relatively new and 20, 30 years ago if you came to your doctor and said, "Hey, doc, I can't remember things." They would've said, "It's all in your head, dear."

We're finding out more and more that this is a real, honest-to-goodness, documented phenomena. It really bothers people. Am I going crazy? Why can't I ... and that just increases the anxiety.

Nada Youssef: Sure.

Dr. Joel Marcus: So, chemo brain is a real thing. I encourage patients to stay in the moment, to breathe, to relax, because it's kind of like, you know how you forget a word and the more you try to find it the harder it is to reach. So when you relax, what happens?

Nada Youssef: It comes back.

Dr. Joel Marcus: Also, there's a whole bunch of structured activities that can be done. I encourage things like, playing chess, because that makes you think in a sequence, forward looking manner. Sudoku, that challenges you think a little differently. All these things are real.

Nada Youssef:  It stimulates the brain.

Dr. Joel Marcus: They do.

Nada Youssef:  How about group therapy?

Dr. Joel Marcus:  Group therapy. I think group therapy is one of the best things since sliced bread, but it has to be done right. It has to be done by professional. There's support groups which are completely different from group therapy.

Nada Youssef:  So is 4th Angel a support group?

Dr. Joel Marcus: 4th Angel is a remarkable program that links cancer patients to, almost like a mentor, who has been through exactly what you've been. I know a lot about this stuff. I know a lot, but I'll never know. And 4th Angel allows that connection. Is it a support group? No, it's more like a mentoring support activity. They link patients up to patients who have had the exact same diagnoses, treatment. They really go out of their way to link people up.

Nada Youssef: That's amazing. That's great. It looks like we are running out of time.

Dr. Joel Marcus:  Get out.

Nada Youssef:  No. But before I let you go, anything else you want to tell our viewers that maybe we haven't talked about.

Dr. Joel Marcus: There is a human side to cancer. There really is. It's not just a disease of the body. If you come into my office, we're going to talk about how you think, how you feel. We're going to talk about what you're eating. What is your spiritual connection? In my office I don't care what spiritual restaurant you go to, as long as you're getting fed.

Nada Youssef: I like that.

Dr. Joel Marcus: Please, please, please, check it out with your physician. That's not to say that the diet you want isn't a good thing.

Nada Youssef:  Right, right. I'll also let them know about the clinical trials for Cleveland Clinic. If you want more you can go to clevelandclinic.org/cancerclinicaltrials. And thank you so much for this.

Dr. Joel Marcus: Thank you. This was actually fun.

Nada Youssef:  This was great. And then for more information on cancer support and everything we talked about today, please go to clevelandclinic.org/cancersupport for more information, and for more health news and information, keep following us on Facebook, Twitter, Snapchat and Instagram.