Episode 21: Young Adult Cancer Caregiver and Oncology Pharmacist, Dr. Laura Cannon

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This is cancer uncovered. An education and empowerment podcast by the live strong cancer institutes.

welcome back to cancer uncovered. This is Kristin Winn, senior administrative program coordinator with the live strong cancer institutes, which is a part of Dell medical school at the university of texas at austin. In early April, there is traditionally a young adult cancer awareness week. So we thought we would take this month to recognize young adult cancer caregiving, shedding light on those that help a young adult, someone between the ages of 13 and 39 through their cancer journey.

A caregiver could be a parent grandparents, sibling close friend, or a spouse. As you may recall earlier this season we heard from our young adult patient advisory board here at the live strong cancer is. An incredible group of individuals who help guide the LCIS best practices for the young adult program with the LCI clinic at UT health Austin, three members of the board talk about their personal cancer journeys as young adults and discuss the importance of this work in episode 16 parts one and two.

Please make sure to go back and take a listen. If you have not. Dr. Laura Cannon, who moderated those conversations is the focus of today’s episode. She was kind enough to take some time to share her personal connection to young adult cancer. And I cannot wait to share our conversation with you all. Dr.

Laura Canon is a clinical assistant professor at the university of Texas at Austin. College of pharmacy and an oncology clinical pharmacist at the university of Texas at Austin Dell medical school live strong cancer institutes clinic with UT health Austin. She received her doctor of pharmacy and master of public health degrees from the university of Kentucky in 2016.

She currently practices a variety of cancer types, including ceramic gynecology. Gastrointestinal and hematologic at the college of pharmacy. Dr. Cannon teaches the pharmacotherapy course and electives mostly focused on oncology, pharmacotherapy and navigating end of life care. Her research interest areas include communication preferences related to patient education, student perceptions of oncology and.

And palliative care issues and topics such as emotional resilience and self-compassion as related to pharmacy students, please help me welcome Dr. Laura Cannon. Well, thank you Laura, for coming on today and coming back, we had you moderate our young adult advisory board episode. And that was super enlightening to hear from them.

And I think it was a natural fit for you to moderate that conversation. So I wanted to take the time to hear your story in regards to. Y you were a part of that young adult conversation and then a little bit about your work in cancer. Thank you so much, Kristin. I was honored to be able to moderate that discussion with rye members and why a specifically hold a special place in my heart as does all of cancer care.

Um, just from my personal experience. And so just to give you a little bit of background on maybe why I was moderating that discussion, I. I am a young adult currently. And I always also young adults during a really difficult time where my husband was diagnosed with a very highly aggressive lymphoma. Um, and so we will touch on this later, but I’m currently an oncology pharmacist and I happen to be in the midst of my training to become an oncology pharmacist during his diagnosis.

And so he was diagnosed at the age of. 30 kind of an ongoing process. We knew something was wrong. We were doing everything that we could to try to find the answers because we just knew he didn’t feel good. He initially got misdiagnosed and we were kind of. Following treatment for that diagnosis and really thinking that any new symptoms that he had were just a flare of that disease or uncontrolled management of that disease.

And, you know, I think I knew in my gut that something was wrong, that something wasn’t right. And I think we both did, but we felt like we had proceeded to get all the answers or all the tests that we needed to make sure that, you know, we had our bases covered. And so, um, that was really earlier on in the summer when those symptoms are happening and then.

About three to four months later, he actually was found to have an 18 by 22 centimeter mass in his abdomen, and then proceeded to be diagnosed with an aggressive lymphoma. And so we had our answers at that point, but it just felt, um, It just felt difficult in the moment knowing that that’s what we had sought out and didn’t necessarily get initially.

So, um, he did ultimately pass away from cancer and it was a pretty short timeframe just in terms of what we were anticipating. He passed away nine months after his diagnosis. So I think the point of me being a WIA, caregiver, being involved in that discussion with the white a board is just knowing the resources that are available, especially at our institution and the things that we’re trying to do to address why a care specifically.

I wish I would have had that at the time being so young, trying to navigate. Being newly married, you know, having multiple opinions and being in the health care system and just not really understanding how to utilize it. Cause I’d always been caring for people. I hadn’t necessarily been on the side receiving care and specifically in an area I was interested in.

And so why A’s are very, very special in terms of their needs. They’re uniquely different. And I can speak to that because I experienced it in my role as his caregiver. I appreciate you speaking. So authentically Laura, could you explain to us a little bit about your career and your career trajectory? So I’m currently an oncology pharmacist and also a clinical assistant professor at the college of pharmacy.

Um, I went to undergrad, then I did four years of pharmacy school and knew I wanted to work in oncology. So I followed my pharmacy school with two years of residency. So I did one year of general residency training and then a second year that focus just in oncology and learning how to care for cancer patients and chemotherapy specifically.

Um, with that being said, I get the question all the time as to, you know, did you do oncology because of your husband or did you, was that what prompted your interest? And actually the answer for me is no, it just ended up being that I was interested in it before. He got diagnosed. I probably knew too much about it at the time, in terms of understanding the diagnosis and prognosis.

And then I really had to sit and think like, can I do this? Is this still something that I can do knowing. How impactful. This has been on me and on him and just watching him go through it. And I ultimately obviously chose to continue. So I’m here today as an oncology pharmacist, and I really strongly feel that if we don’t use what we went through, then what was it for?

Um, or if I don’t use that experience and what was it for? And if I struggled as an oncology interested pharmacist, like in the healthcare system to take care of. My husband, how much are other people potentially struggling? And so it’s really where I kind of find fulfillment. It’s definitely equally difficult, but using kind of that experience of what we went through to shape, maybe how I practice now or what I’m even teaching students about the fact that we don’t have control over life.

And we shouldn’t put life on hold for. Education and residency and say, oh, you know, and in a few years we’ll do this, but that’s what I did. And looking back, I didn’t have control over those years, you know, and things can happen in life can happen. So just trying to really make sure that I’m embracing really my experience and using it as a learning point or a teaching opportunity for students and patients and even healthcare team members.

That’s amazing. That is so amazing. What does the day-to-day look like for you? You said every day is a little different. Do you get to interact with patients every day? I know you’re teaching too, right? So can you give us kind of the lowdown on. What your position looks like at LCI and at UT? Yes, absolutely.

So currently I spend half of my time teaching at the college of pharmacy on campus at UT and then half of my time designated to clinical work at UT health Austin. At the college of pharmacy, that it’s pretty straightforward in terms of teaching. So I’m mostly teaching students about oncology, helping with mentorship committee, work, student meetings, organizations, that sort of thing.

I love that part of my job. I love being able to work with students one-on-one and just hear about their experiences, their interests, and hopefully point them in the right direction. Just based off experience. If I was a hundred percent at live strong, I definitely probably would have patient interaction every day.

But in the time that I am there, you know, a lot of people are familiar with pharmacists in the community setting, maybe at their local pharmacy, but not necessarily in my role. So I actually don’t. Work directly with any medications, I don’t dispense medications or administer them or mix them. There are actually aren’t medications in our clinics.

I am strictly with the clinical team, seeing patients and then serving as a direct resource for drug information questions. Problems or toxicity or side effect management. And so really what my day looks like as I help write and dose the chemotherapy orders, what that looks like is taking into account how your kidneys are working and how your liver is working.

So both of those organs are used to kind of process drugs through your body. So making sure everything is dosed appropriately based off that based off patient height and weight, and that goes throughout treatment. So for all patients. When they go through cancer treatment and sometimes they do have side effects and then we need to make adjustments to their doses, whether that’s a side effect of how they feel.

So maybe they’re having a lot of nausea or a lot of tiredness, or as a side effect, we identify in their lab work. So I’m reviewing lab work and then reviewing just tolerability with the team to help manage those dose adjustments as needed throughout their. And then I precept students. So I do have pharmacy students that join me in the clinic to help get them exposed, to care for oncology patients and just really the clinical thought process.

And the other role that’s directly patient facing is. Chemotherapy education. So educating the patients on their medications, what to expect, what the logistics are surrounding treatment, their take-home medications, and then really when to call. So we know that all medications have side effects, but with chemotherapy specifically, because we’re trying to balance like how it’s working and efficacy with side effects, we really need to have.

Conversation throughout their treatment with patients about what they’re experiencing. And then really when the red flag moment is that we need them to reach out to us so that we can jump in and help manage. That’s good. You know why it is so striking to me is that you were a part of the healthcare system and yet.

Knowing what you know about the healthcare system. It still was hard to navigate. It was so hard to get diagnosed. And so that, that is hard to hear because to kind of go back to the why a episode with the board, they were saying, you know, a lot of times it’s the first time you’re interacting with the healthcare system at all.

Can you speak on that a little. Your experience navigating the system as a young couple as a new married couple while you’re going through your residency in cancer. Yes. Yes, absolutely. So I think first of all, I would love to say that I couldn’t have done it without the support that I had. So in my residency, family support being pretty close to home, a lot of friends and colleagues and people that were there to support us, it would not have been possible, but.

I almost wonder looking back if being in the system made it more difficult, just because I knew too much, there could be a potential that being in the system, um, almost puts you at an overexposure to the different avenues and things, but taking that away, there were just some logistical issues. With care in general, think things that were unfamiliar to us.

So things like waiting for biopsies and waiting for pathology results and not really understanding the timelines for any person that’s undergoing a new diagnosis. That’s a life changing event, you know, urgency is what you crave and what you want, and not really understanding how urgent things actually needed to happen.

Right. And putting that trust into the healthcare team. So I think. Some potential there for maybe more communication, just with people that don’t have experience with navigating health peer of just like what’s actually urgent. What’s not, and what are necessary expectations in terms of timeframe? The other thing that I would say to that is sometimes there’s just this hesitancy to accept a cancer diagnosis in young people, especially in situations where.

They do have so much life to live, whether that’s still kids in the future, or maybe they’re engaged to be married or they’re, there’s so many life events that happen when we’re young. And I think it’s hard on the healthcare side to maybe process that emotionally and we try to almost avoid it being the final diagnosis.

Yeah, no, that’s good. I don’t think most people go to work referencing something that was hard and painful and personal every time. Right. How do you walk through that professionally and personally and not, you know, I think I’ve had to learn a lot, so he passed away. It’ll be almost, it was four years this year.

So four years, I think every. Year and has been different in terms of where I’m at in my grief process and where I’m at in terms of processing. So I think one of the biggest things I’ve learned is communication. So a lot of people that work in oncology have some experience personally with it. And I think because of that, we all have this understanding too.

And so knowing my team knows my story, they know. What might be hard for me and knowing my boundaries and knowing my trigger points and trying to anticipate those. So taking PTO on days that I know might be harder, or just being gracious with myself and realizing that like it is a process. It’s okay. If you have bad days, it’s okay to be sad and happy at the same time.

And like recognizing all those emotions, that would be like the first thing that I’ve learned to navigate the second is that there are bits and pieces or times. So my husband had a huge surgery. He had a dream, he had ileostomies. He eventually had nephro SMI tubes. And I don’t think he would care for me to share that just because.

I learned so many skills that I never had as a pharmacist. And so that. Uniquely positions me to be able to speak up for things that like, oh, Hey, we tried this or we did this, right? Like when we would change his ileostomy, we would put Vicks vapor rub under our nose for the smell. When you lose someone, a lot of times grief makes things fuzzy to remember.

And so actually there’s like a happy side of my job, where there are certain things that bring you. Memories that I’m able to almost sit with and reflect on and enjoy and use them to help maybe answer questions for patients or try different strategies based off our experience. So, one thing I also want to point out is that I really did struggle for a few years on, you know, I want to use this.

I want to find fulfillment in what I experienced as a young adult caregiver. And like what I see. Cancer patients going through, but I also am very aware that it’s not appropriate for me to walk into a room and like immediately share with a patient my experience because that’s taking away from their experience.

Right. And so there are things that I recognize or identify with that in my head. Yeah, I know that cause I felt it, but I don’t necessarily share that. And so how do I use it? And so that is really what brought me here to LCI, knowing that we have this access to this wonderful supportive care team, that my role as a caregiver would be recognized and utilized to help improve things that we’re doing on a larger scale for our patients.

And that gave me fulfillment in another way. That’s awesome. What do you wish you had as a caregiver that you didn’t? This question is so easy to answer. I’m going to answer it through a story. When I started here, you know, we have the young adult advisory board and they meet regularly. And part of our team is that we all take turns going and introducing ourselves like our role in like meeting them.

And I went for the first time and I. I struggled because I was there as a pharmacist talking about clinic, but I was also there as a young adult caregiver, and I had never been to a support group or I’d never really been in a room with other people my age, that understood. Right. So I left and I was like, I belong in that group.

Not because I work here, but because like I belong there and man, I wish I would’ve had this. I think I gravitated toward a lot of my friends that were oncology pharmacist or in oncology because they understood the logistical side of the health care side. And so we could have very Frank conversations without maybe emotion just about overall.

Prognosis and options and treatment, but I really, really wish I I’m from kind of a smaller town. And I think it was a widows group after he had passed away and I show up and no one was there and I felt very alone. A lot of times, just with, I know that there are people that lose spouses, but the number is even lower for your youngest.

Populations right. Or for your young adult caregivers. And so I wish I would have tapped into like a group or search for that. I didn’t even really know it was in existence. Yeah, absolutely. What were some of the things that sort of came up, you’re going through school and he certainly had a career, right.

And you were newly married. Can you talk about navigating some of those things? Gosh, there’s so much here. And there’s also a lot that I don’t remember or that I wish I’d done differently, to be honest. So, you know, I was very young. I was 27. Really hadn’t been outside of schooling. Right? So graduated pharmacy school transitioned straight into residency, which is really an extension of your education.

Um, I also, I don’t know, it was trying to figure out what I wanted to do with my life and really kind of just in tunnel vision of like, I just need to finish these years and then we’ll have our life, if that makes any sense. I think at the time, you know, again, I had a very supportive program in terms of my residency.

And so I was able to tell, take time off that I needed. They were very gracious and like allowing me to do that. I had some flexibility in rotation schedules in terms of, I took a rotation in the ER, which like the days where three or four days a week, but longer days, but that gave me time around his appointments.

But in terms of like everything else, you know, When someone gets diagnosed with cancer, you have to almost you’re the communicator for everyone. So that gets very overwhelming when you are not only trying to navigate this new part of your life, but also explaining it to everyone else that may be wondering, or may have questions or work or wanting to help, which is wonderful.

And we had so many people in our lives. Be there for us and show up for us. But I think that that was difficult because I felt bad if I didn’t necessarily have the time or energy to get there. And then going into the cycle of, is this normal? How am I supposed to be acting right? That’s where like the Y support group would have been.

Great. I think a lot of your question. So like what your dynamic was in your marriage in terms of roles and responsibilities. Right. And so that’s going to be different for everyone in terms of who kind of does what things and who checks, what boxes, but yeah. Thankfully, he is a very task oriented, get stuff, done person.

And he was still very helpful and able to help with some of those things that are surrounding like his job. You know, we kind of would navigate insurance together. Cause I kind of knew a little bit more about the insurance process and then in terms of like appointments and medications, a lot of that fell to me, but I also think that was part of how I coped looking back.

So I was very much almost like a helicopter mom and. I will be like, are you, are you okay? Do you need anything like all the time? Right. And that wasn’t necessarily what he needed in the moment. And I read this quote after he passed away, it says CS Lewis quote, and it talks about the separation of death actually begins at diagnosis.

And even if death isn’t necessarily the outcome of a cancer diagnosis, it’s still a possibility. And so the separation and preparing for that really begins. At diagnosis, given that what I was preparing was to live without him and what he is preparing is to pass. Right. And so I think that spoke so much to me looking back into the role because I did struggle with, I don’t know how to help.

I feel helpless, but I’m also trying to like prep in case the worst thing possible happens. And he’s just trying to like, get through. I don’t remember the conversations that him and I had about that because we were literally just trying to keep our head above the water and manage everything. And just how more intentional maybe we could have been in our conversations surrounding what we were experiencing.

What he wanted for me was to like, keep up with residency and not be delayed. We wanted normal or what our new normal was as best we could. And I think that’s what we. Really strove to try to create was almost as much as we could a sense of normalcy. And that really meant me trying to go about my life. I don’t know if I would have in his shoes behaved in as gracious of a way as he did what a way to honor me and our life and each other, and like our commitment to each other, really to the end.

But like, man, I wish we would’ve talked about it and I really think we could have. We’d been prompted to, or really had those resources to guide us in those weights. We always ask people that come on. What do you want students to know about working in cancer? I would say first of all, I would encourage students that don’t.

Limit yourself because you think it might be too sad. So when I talk about it with pharmacy students, one of the most common questions I get is Dr. Keenan, how do you handle it? Like it’s sad, right? It’s emotional. And it’s real cancer is a reality in so many of our lives, whether it’s direct experience like a friend or a parent, or just a neighbor or a loved one, you know, like we’re all gonna experience it.

And it’s a reality. That doesn’t mean we have to avoid it. And my answer to them as, yes, it’s hard, but you know what? It’s gonna be hard for that patient. It’s going to be hard for that person, whether I’m involved or not. And I can make it maybe hopefully a little bit better. And the same is true for you.

If you want to do oncology, you can come in and you can make it a little bit better. And yeah, there are hard days, but man, it’s also full of a lot of wins and love. And even if it’s not. The outcome that you hope for. There’s still something special about having someone die in the way in which they want and empowering them to really make the most of their end of life and feel the best and feel like they had a choice and say over that, even if the outcome isn’t a cure, it can still be dying with dignity.

I try to just flip my perspective and not focus on how hard it can be, but how fulfilling it can be in terms of like, it might be. Difficult for patients, no matter what, but if we can make it a little bit better, there’s always going to be the opportunity in oncology. So if you’re a student interested, even in research or trying to discover new jugs, this is a really great field for that.

You know, you have a lot of new drugs coming out and being developed. So that creates a very unique opportunity. Not only for me as a pharmacist, but for our medical oncologists for potential for clinical trials, I had the experience of navigating. Uh, clinical trial on the side of being the patient or being the caregiver.

And so there’s a huge opportunity for improvement in that process in terms of access to clinical trials. A lot of times it depends on where spots are open across the country and there’s coordination of care. And so, you know, as a student in high school or undergrad, that is like, what are some opportunities available to me to be innovative or to really improve the system?

There are a lot of ways that can be done in cancer care. If you have people in your life that are navigating the cancer journey or cancer care, making sure that your. Encouraging people to seek support so they can receive the validation and support. They need to be able to be the best caregiver they can for the people in their lives that are, are struggling.

Cause you can’t, you really, really, really can’t take care of other people unless you’re taking care of yourself to the best of your ability. And that is something I had to learn. Kind of the hard way, and I’m still learning that even in my job, I learned it as a caregiver and then I’m learning it as I care for oncology patients that if I’m not doing okay mentally or physically or emotionally, then I’m not going to care for my patients as best I can.

And that it’s really something I would encourage students to start working on. Even in their studies is don’t forget to take care of yourself. Thank you for taking this on. Thank you for being so honest and so easy to talk to. And so giving as far as, you know, being an educator and being an advocate for patients and the work that you do.

So lucky to have you as part of LCI and part of UT Austin. So thank you for your work. Absolutely. Thank you. And it’s really an honor to be able to share some of the story. I really haven’t taken a lot of opportunity to do that much unless you’re real working on the ground with me. I appreciate it. And just hope that it can be helpful.

To anyone that needs to hear it or that they can take something away from it. If you have questions for us or an idea about a future episode, please email us at livestrongcancerinstitutes@dellmed.utexas.edu. To find out more about the live strong cancer institutes, please visit Dell.utexas.edu.

Please also follow our department chair, Dr. Gale Eckhardt on Twitter at S Gale at cart at cart is spelled E C K H a R D T. This is Kristin when with the live strong cancer institutes and cancer uncovered and education and empowerment podcast, challenging you to keep asking questions and to stay. Thank you for listening and learning with us.

We’ll see you next month.