Chadi Nabhan, MD, MBA, FACP
Chadi Nabhan, MD, MBA, FACP
It was her last chemotherapy cycle, and I was beyond elated that my patient was done with her six planned cycles of treatment. She was diagnosed with a form of aggressive lymphoma called diffuse large cell lymphoma, and our goal was to achieve a permanent cure. Indeed, her PET scan turned out negative, and my patient was in complete remission.
I entered the room with a smile, anxious to share the wonderful news that she had completed her treatment and to show her the excellent imaging results. She could finally catch a break from me, the nurses, and everything else associated with the emotional drain of coming to clinic. But as I looked at her, I saw anxiety and nervousness on her face, tears glistening in her eyes. My heart sank, realizing that my joy was perhaps not fully reciprocated
Acknowledging her reaction, I asked, “Are you okay? What happened?”
She hesitated, then replied, “Nothing – I am just very nervous.”
“About what? I can see that you are nervous, and I want to help.” I stated. “You’re done with treatment and are doing great! You don’t even need to come back and see us for another 3 months.”
As if I hit a nerve, I sensed she had become uneasy. “That makes me very nervous. I can’t go that long without seeing all of you. I just can’t”, she countered.
My patient’s anxiety overshadowed the news of her negative PET scan. For nearly 6 months, she was seen almost weekly for blood draws, scans every 6 weeks or so, and numerous assessments by me and the nursing team. Despite telling her that she can leave the office and not return for another 3 months, her reaction was in fact similar to patients I had treated. Some patients have a sense of security when undergoing frequent evaluations and worry when longer time periods pass without being seen. This sense of separation anxiety is heightened early on after finishing therapy but may subside as more time lapses.
“Don’t worry, I understand, I am just a phone call away,” I said, “How about you return to the clinic in 4 weeks to check in instead of 3 months? If all is well, we can extend the frequency to every 2 months then every 3 months. Let’s do that.”
She smiled and nodded in agreement. I heard a sigh of relief as she wiped off a couple of tears.
While published guidelines provide recommendations on how we follow patients once therapy is completed, we often pivot to accommodate every individual case. Every patient is different, and the goal is to assure that the medical team is attuned to individual patient needs. Guidelines are large frameworks but must be personalized.
My patient walked in the exam room accompanied by his wife and two adult children. He was recently diagnosed with diffuse large B cell non-Hodgkin lymphoma. He was referred by the surgeon who removed a right sided groin lymph node, which was discovered by his primary care physician. He had presented with fatigue and weight loss; physical examination revealed palpable lymph nodes, with the groin being the most accessible. He already had a CT and a PET scan done.
“What stage am I in?” he asked. “I hear stages go in numbers, so what number would you give me, Doc?” he continued.
“Do numbers matter though?” I countered. “If we are to talk numbers, it is stage 3 for now, but we need to do a bone marrow biopsy before confirming the final stage.”
I sensed he became anxious. “Not good, I guess.” He mumbled.
“Don’t say that, please.” I told him. “You have a curable disease and our goal is cure. This is what matters. For your case, numbers don’t matter as much, but the goal of treatment does.”
Cancers are staged differently, depending on the type. I find assigning a numerical label to a cancer stage can lead to anxiety. Without context, a higher staging number unfairly increases worry for a patient.
“The best way to stage a cancer is by whether it is curable or controllable. Two stages. There is the curable stage and there is the controllable stage.” I told my anxious patient. “Some cancers can be stage 4 but are still curable. What really matters is whether we can cure it or not.” I said.
“What is a controllable stage?” he asked
“This is when we can control the disease like we do with diabetes and hypertension, but we may not be able to eradicate it.” I answered.
When meeting patients, simplifying the medical terminology is critical. Minimizing anxiety and explaining the goals of treatment are key. I have always felt that staging cancers as either curable or controllable resonates with patients and their loved ones. It is an important tool in helping put the clinical stage into context.
My patient ended up having stage 4 as his bone marrow had lymphoma. He received the treatment and was eventually cured. Most patients would assume that stage 4 is not curable, but this was not the case here. This was a good example of how simplifying the process can help support the patient perspective.
My second book, “The Cancer Journey: Understanding Diagnosis, Treatment, Recovery, and Prevention,” is inspired by the real-life experiences of patients and families I’ve had the privilege to treat over the past twenty years. Through their stories, I explain everything about cancer from A to Z in a simplified manner.
What is cancer? What causes it? What about chemotherapy, radiation, immunotherapy, targeted therapy, bone marrow transplantation, and CAR T therapies? What are complementary and alternative therapies and how do they fit into the care of the patient with cancer? How should we address caregiver fatigue and optimize communication?
These topics and more are covered in my book, presented in a simplified way that is easy for patients, families, and everyone else interested to understand.
The journey of cancer is filled with triumphs and wins, but also with bumps and setbacks.
The journey of cancer is filled with triumphs and wins, but also with bumps and setbacks. My hope is that this book will act as a guide to help those affected by cancer navigate this journey.
The book is dedicated to all of us, the patients of yesterday, today, and tomorrow.
Chadi Nabhan is currently the Chief Medical Officer and Head of Strategy at Ryght.
Dr. Nabhan was previously the Medical Director of the Clinical Cancer Center at the University of Chicago where he was an Associate Professor of Medicine; he also served as the Medical Director for the International Program and worked on quality initiatives in the cancer center. Prior to his tenure at the University of Chicago, Dr. Nabhan was the Director and Chief of the Division of Hematology and Oncology at the Advocate Lutheran General Hospital in Park Ridge, IL where he also held the position of the Cancer Institute Medical Director and the Hematology/Oncology Fellowship Program Director.
Dr. Nabhan has been the primary investigator on many clinical trials (investigator-initiated, cooperative groups, and pharma-sponsored), has over 300 peer-reviewed original articles, abstracts or book chapters, and serves on the editorial board of JAMA-Oncology. He currently hosts his own healthcare podcast named “Healthcare Unfiltered,” which airs weekly with internationally recognized guests. The podcast tackles all and any relevant and timely healthcare topic of interest. Dr. Nabhan has authored two books; the first was released in 2023 “Toxic Exposure: The True Story Behind the Monsanto Trials and the Search for Justice.” The second was released in September 2024 and titled “The Cancer Journey: Understanding Diagnosis, Treatment, Recovery, and Prevention.”