Cancer Care w/ Dr. Mary Leung

Episode Information

March 11, 2021

Oncologist and hematologist Dr. Mary Leung talks about her immigration from Hong Kong to America, her journey to becoming an oncologist, her desire to help her patients, the difficulty of losing patients to cancer, and more

Topics Include:

• How patients are scared to go into the hospital because of Covid
• How she decided to become a doctor from a very early age, as she listened to her physician parents discussing their patients at the end of the day
• The sudden loss of her grandmother to cancer and how that paved the way to her becoming an oncologist
• Moving from Hong Kong to America with all of the language and cultural changes that entailed
• The difficulty of not being able to save every patient, the importance an oncologist providing hope and comfort when the patient has terminal cancer
• A little bit about using targeted therapy to treat cancer and stop its progression
• How cancer is caused by multiple factors, as opposed to being caused by just one thing
• How Doctorpedia is almost like a one stop shop for patients and the families to get accurate, concise information and how this knowledge empowers them to really make a more educated decision and be more informed so they know what to ask their doctors when they actually go have the consultation.
• How Doctorpedia helps her to reach so many people globally at the same time.

Highlights

• “I grew up in a physician’s household, both my parents are doctors. I recall just listening to my parents talk about the patients, without the names and just about the challenging cases they would discuss with each other what to do with them and that got me really interested. That’s something that they would think about and really cared about, the patients’ wellbeing, and they really wanted to help. And I think from that point, I’ve always wanted to help people.
• “How I got into oncology was that when I was in college, my grandmother whom I was very close to, just one day out of nowhere, collapsed on the floor, just passed out. And no one knew what happened and she was rushed to the hospital and just thinking back, she actually had lost a lot of weight over probably six months to a year. And no one knew that something was wrong. She was probably not seeing a doctor on a regular basis and this was in Hong Kong. So I happened to be on vacation, visiting her. I was already studying in the United States at that time. And so she was found to have some kind of stage four cancer, and it had spread all over her body and that made her lab values, electrolytes all very abnormal, and eventually she passed away in 10 days. I just remember thinking that had we known sooner that something was wrong, was there a way that we could have helped her sooner and that she could have lived a few years more?”
• “Another thing that I learned that sometimes in life, it’s not easy to let go of some things. And especially as a doctor, of course you want to help people. You want everyone to get better, but at the same time it is not possible for this to happen every single time. There are times that you have to know when to shift your focus to something else, for example, comfort, when a cure is not an option anymore or when the patient cannot tolerate any aggressive treatment.”
• “When I have to tell an individual patient, “Your disease has progressed, you’re not doing well. We really have no more aggressive treatment options for you.” That’s always difficult to say to the patient. Sometimes I tear up and I cry with them too, sometimes we hug each other but I think that’s what humans do, we’re all human beings. So I have emotions. And even though most of the time, I try my best to be objective when I talk about the technology, the medical terminologies, at the end of the day this is real human interaction. And I think what’s important in the doctor-patient relationship is to have that human touch.”
• “I would say that in general, if there are things like unexplained weight loss and it’s not like, “Oh, you’re trying to lose weight’, like you are making no effort in trying to lose weight and you lose more than 10 pounds in six months, that’s not normal. Also other things like unexplained fever that is not related to an infection, night sweats, decreased appetite, decreased energy. Of course, you don’t have to have all of the above, but just even one or two of them may be some warning signs that you should get checked out. More importantly, really keep up with all the health care checks that are appropriate for your age, for example routine colon cancer screening, mammographies and prostate exams.”
• “One of the things I really like about Doctorpedia is almost like a one stop shop in a sense that patients and the families can really go to this one place to get accurate information that is verified by other doctors that are practicing in that particular field. And also the information is very concise – it’s not long and usually if they’re videos, they’re one to two minutes long, and just vital information is included in each clip.”
• “One little thing is I usually like the patients to come with at least one other person, because especially for cancer patients, with the diagnosis and the treatment and you go through potential side effects and all those things – it’s really a lot of information. They’re already overwhelmed with the diagnosis, and to listen to all of this information that sometimes can take an hour or even longer, that is too much for them to remember everything. So it’s always better to have another set of ears to help out and to organize things or be a note taker or something like that.”

Relevant Links

• Doctorpedia Profile
• Founding Medical Partner Interview

Episode Transcript

Daniel Lobell: (00:00)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only, and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs. Hello, and welcome to the Doctorpedia podcast. I’m Daniel Lobell and I’m honored today to be joined on the line by Dr. Mary Leung. How are you?

Dr. Mary Leung: (00:33)
Hi, good. How’s everything with you?

Daniel Lobell: (00:37)
Everything, that’s such a broad question. [Laughs].

Dr. Mary Leung: (00:40)
[Laughs].

Daniel Lobell: (00:40)
Most things are great.

Dr. Mary Leung: (00:43)
That’s good.

Daniel Lobell: (00:44)
How’s everything with you?

Dr. Mary Leung: (00:46)
So far, so good. I’m just taking things one day at a time. So far 2020 was pretty challenging and I’m just hoping that with 2021, things will be better.

Daniel Lobell: (01:02)
Yeah. I hope so too. I think we’re all hoping that. It’s been rough, especially on your end of things. I imagine COVID has impacted you more than it has the average person being someone who works in health.

Dr. Mary Leung: (01:20)
Sure. Especially that I see a lot of cancer patients and it’s impacted them because a lot of patients are really scared to go to the hospital to seek care. And that has sometimes delayed the diagnosis and treatment.

Daniel Lobell: (01:46)
So in hopes to prevent themselves from getting something that has a pretty good success rate with recovery, many people have put off something that unfortunately doesn’t boast as well a recovery rate. And that is tragic because even when we talk about mental health, I know that so many people are not getting the mental health they need during a very challenging time when depression is creeping in and circumstances are exacerbating it. And I think the suicide rate has gone up as well.

Dr. Mary Leung: (02:25)
Exactly. I think for the most part, my patients who are undergoing systemic treatment, chemotherapy or other treatments, they have been pretty good with keeping up with all the schedules. And of course our facilities make sure that all of the safety precautions are met and make sure that everyone who goes to have the treatment are tested COVID negative days a couple days in advance and also, during the treatment, everyone is a safe distance apart.

Daniel Lobell: (03:06)
Well, I want to hear all about that, with regards to what you do with these treatments and how you got into it. But let’s start at the beginning. As I always say to the doctors, I want to know about you. What were you like as a kid and what made you get into medicine? Where did you grow up? Let’s start there.

Dr. Mary Leung: (03:25)
Sure. I grew up in Hong Kong and so just a little bit further away from where I am right now. [Laughs]. For as long as I can remember, I’ve always wanted to be a doctor. I grew up in a physician’s household, both my parents are doctors -they have since retired about 10 to 15 years ago. I recall just listening to my parents talk about the patients, without the names and just about the challenging cases they would discuss with each other what to do with them and that got me really interested. That’s something that they would think about and really cared about, the patients’ wellbeing, and they really wanted to help.

Dr. Mary Leung: (04:27)
I think from that point, I’ve always wanted to help people. And it’s just this simple thought of helping people. It’s just what I want to do and has become my passion. And I thought that the simplest way to do that was to become a doctor like my parents. So both my parents are internists. My father actually practiced as a pediatric gastroenterologist and my mom practiced as a family physician. So they both have somewhat similar situations, they have patients that they follow and have a really good continuity of care. And when they were practicing, they seemed to actually know the patients very well, not just about their diseases, but they got to know their families and just other things.

Dr. Mary Leung: (05:40)
And that’s kind of what I enjoy also, to know my patients, not just about their diseases but also sometimes what they do or what their family dynamics are like, things like that.

Dr. Mary Leung: (05:58)
So just to backtrack a little bit. How I got into oncology was that when I was in college, my grandmother whom I was very close to, just one day out of nowhere, collapsed on the floor, just passed out. And no one knew what happened and she was rushed to the hospital and just thinking back, she actually had lost a lot of weight over probably six months to a year. And no one knew that something was wrong. She was probably not seeing a doctor on a regular basis and this was in Hong Kong.

Dr. Mary Leung: (06:47)
I happened to be on vacation. I was visiting her. I was already studying in the United States at that time. And so she was found to have some kind of stage four cancer, and it had spread all over her body and that made her lab values, electrolytes all very abnormal, and eventually she passed away in 10 days. I just remember thinking that had we known sooner that something was wrong, was there a way that we could have helped her sooner and that she could have lived a few years more?

Daniel Lobell: (07:47)
I can hear it in your voice, the pain of it to this day that it still affects you and it’s still something.

Dr. Mary Leung: (07:56)
I do miss her a lot. I was very close to her and when my parents were working, she was like a mom to me. And my grandmother used to be a teacher, so she used her teaching skills to teach me. And to this day, it’s like she’s still next to me. So at that time, I think a lot of things were going on that I probably was only seeing a part of. It must have hurt my mom more than anyone else because my mom was very close to her mom also and probably even more. But I saw that when she realized that there was really no way that my grandmother would be cured or would be able to be the same way, I saw how she was able to let go and not hold on to a life that wasn’t going to be meaningful.

Dr. Mary Leung: (09:21)
And so that was also another thing that I learned that sometimes in life, it’s not easy to let go of some things. And especially as a doctor, of course you want to help people. You want everyone to get better, but at the same time it is not possible for this to happen every single time. There are times that you have to know when to shift your focus to something else, for example, comfort, when a cure is not an option anymore or when the patient cannot tolerate any aggressive treatment. So from that point forth, I felt like going into medical oncology was kind of what I wanted to do.

Daniel Lobell: (10:26)
Seems like it was was almost laid out for you, almost a destiny in a way, because it was almost like it was right in front of you. This situation kind of paved the way and it’s like, this is what you need to do with your life. As you mentioned yourself, perhaps if the right treatment was offered to your grandmother, she could have had more years. And it’s almost perfectly laid out for you – I’m somebody who grew up on comic books and it’s like, look at the Spider-Man story. He sees this criminal that comes and he kills his aunt and he knows it’s his job now to save people. That’s what it’s bringing up for me when I hear this story. Because doctors are heroes and they’re not the glorified heroes, unfortunately, of our society though they should be, you had a similar, so to speak origin story where you witnessed this person who was your caretaker die in a way that you feel maybe I could have saved her if I would have stepped into that role. And then ultimately you did step into that role.

Dr. Mary Leung: (11:34)
Yeah, well, I guess I never see myself as a hero and I never want to be. And I just feel like whatever I can do, whatever little part that I can take in helping other people, helping the patients to really undergo that difficult process, because a lot of times with the cancer diagnosis, it’s usually not as sudden as what happened to my grandmother. Usually there’s kind of a timeline – sometimes things can change and then it could be shorter, but usually you have say a few months, or even more, of course, with an early stage cancer diagnosis, there’s even a cure that we can talk about. I just want to be part of that journey for patients and their family to help them out to say, “Hey, there is hope and there’s also a team of people, not just me, but everyone in the office and also others specialists to help you go through this. And you’re never alone in this journey.” And I think if I can achieve that, to me it’s already a reward.

Daniel Lobell: (12:57)
Absolutely. I’d like to hear a little bit more about your childhood in Hong Kong. How old were you when you came over here?

Dr. Mary Leung: (13:04)
So I pretty much grew up in Hong Kong until I finished 11th grade and I came here to study 12th grade and so it was a pretty big transition. When I was growing up in Hong Kong, I learned English, but it was always as a second language. I didn’t really have to speak English outside of English class. We used an English textbook, but we would be speaking in Cantonese. So just the transition from not really speaking much English to speaking all English, that was not the easiest transition. And plus it was the last year of high school. And I was taking a lot of those AP courses. I had no idea what AP meant, I just took them. I signed up and I also had to take American history actually. Usually the American history was taken in 11th grade, I believe, but since I wasn’t in the country in the 11th grade, I was told to take it and plus to apply to colleges. So it was a lot of changes.

Daniel Lobell: (14:36)
Well, what about in terms of culture, what would you say was the most shocking difference growing up in Hong Kong versus moving to, was it to New York that you moved?

Dr. Mary Leung: (14:46)
No, I actually went to a boarding school in New Hampshire and I would say one of the biggest change besides the language was that when I was in Hong Kong, I went to an all girls school and we had to wear a uniform to go to school. So I didn’t really have to think about what to wear to go to school. That was pretty easy and there was a dress code and a certain way to tie your hair and the length of the dress, et cetera. So, coming here, there was no dress code, co-ed and I lived in the dorm. It was quite a different experience. Fortunately I already had a couple friends who happened to be studying in the same school, so that helped out and it was an international school. So I think everyone was very nice and thankfully I didn’t really experience any discrimination of any kind that I can recall. So I think it was really a big learning curve and a great experience. I wouldn’t trade it for anything else.

Daniel Lobell: (16:13)
Tell me a little bit about Hong Kong. From my understanding, it’s a pretty modern city, and I know I have one friend who is from there who grew up very wealthy there. Is there a major divide between those who are wealthy and poor in Hong Kong? Or is there a middle class? What is it like?

Dr. Mary Leung: (16:34)
Yeah, Hong Kong is very densely populated and it used to be a British colony until 1997. So I grew up when it was still a British colony at that time. So the British influence was quite big. And when the pandemic is more calmed down and we can all travel, I highly recommend you going there just to experience it. And most of the places you can go to without having to know any other language other than English, because all the signs, all the roads, most of them are all in Chinese and English. And in terms of the different classes, there are some very, very well off people and there are also some people not so well off, I think in that sense, it’s similar to the United States.

Dr. Mary Leung: (17:50)
I would say that fortunately I grew up not super wealthy, but it was in an environment that I did not have to worry about any financial issues. And I think for people growing up in Hong Kong, most people do okay. I think one of the biggest challenges is the real estate there. It’s very expensive to buy even a small apartment because it’s so densely populated. So most people live in high-rise buildings. Only the really well off people get to live in houses,

Daniel Lobell: (18:39)
Not too dissimilar from Los Angeles where I live. You can’t afford to buy anything here either. It’s become that way unfortunately, but that’s quite an amazing story coming to America and not speaking the language very well, and then absorbing into the culture and then moving on to do what you do in oncology, which is not an easy field from my understanding. And because of your story, I understand why you chose to go into oncology specifically. Is it heart-wrenching, you sound like you’re really a people person, you get to know your patients so well, you get to know their families. How do you deal with the loss if a patient doesn’t pull through?

Dr. Mary Leung: (19:25)
Yeah, so thankfully I don’t deal with it every single day, but it’s never easy. Sometimes when I sit down and just have a little bit of quiet time, sometimes I do think about, the patients who passed away, they kind of pop into my head sometimes in a good way. Of course at the time, especially when I have to tell an individual patient, “Your disease has progressed, you’re not doing well. We really have no more aggressive treatment options for you.” That’s always difficult to say to the patient. I I try to do my best to say it in a way that even though it’s very bad news, hopefully it’s said in a way that they don’t feel worse than it is already.

Dr. Mary Leung: (20:47)
And just really do my best, sometimes I tear up and I cry with them too, sometimes we hug each other but I think that’s what humans do, we’re all human beings. So I have emotions. And even though most of the time, I try my best to be objective when I talk about the technology, the medical terminologies, at the end of the day this is real human interaction. And I think what’s important in the doctor-patient relationship is to have that human touch.

Daniel Lobell: (21:34)
I would agree as the patient on the end of that relationship. I think when I go to a doctor and they seem less clinical and more, let’s just say human, like you did, there’s a huge comfort in that for me. Your job is, as I said earlier, anything but easy, and most of us will never have to deliver that kind of news to someone in our lifetime. So it’s a unique perspective that you have being in that position.

Dr. Mary Leung: (22:07)
Even from the beginning, I always tell my patients that I’m honest with you, but at the same time is, I always do my best to bring in a positive attitude with hope, there’s always hope or hope for a cure. And if that hope for a cure is not an option anymore, than hope for something else, being able to reconcile with your family or hope to be comfortable and not having trouble breathing, things like that. I feel like that really what helps the patients and the families because sometimes I feel like if the patients can have a more positive attitude and I think they have done some studies about that, that you can fight the disease better. And a lot of times it’s when people are stressed out, either physically or emotionally, that’s when they get sick, including cancers.

Daniel Lobell: (23:23)
That’s so interesting. I hear that anecdotally from people, but to hear it from a doctor, it really makes it seem a whole nother level of validity. So really your emotions do play a huge role in your physical health.

Dr. Mary Leung: (23:39)
Sure. I mean, not just cancer, I believe in other systemic disease too. And so I think it is very important to just have the healthy mind and healthy body, because we’re all in one together.

Daniel Lobell: (24:00)
I Imagine that that’s something a lot of people don’t realize can cause cancer. What are some other things, while we’re on the topic, that people wouldn’t necessarily be aware of that can cause cancer?

Dr. Mary Leung: (24:12)
There are probably some controversial studies that I can think of, I shouldn’t say controversial, but maybe not very conclusive. Some people may say certain diets may do it, just for example, they used to say that soy may be related to breast cancer, but I’ll just say now that there’s really no conclusive findings. And also, for example, look at the Asian population, most people eat soy, they don’t really have a lot more breast cancer patients. I think there’s a lot of studies that say, “Hey, you know, A can be associated with certain type of cancer or B, C or D.”

Dr. Mary Leung: (25:17)
But at the same time, as we really need more studies to validate that, and or even certain geographic locations, that say, “Hey, you know, somehow Long Island has more breast cancers, why is that?” We definitely need to do more studies on those things. And that’s in the works. I feel like the medical field especially. and oncology has advanced so much that every other day, there’s a new medicine or a medicine that has another use, another indication that is approved by the FDA.

Daniel Lobell: (26:03)
What are some of the most exciting advances that you’ve seen recently in oncology?

Dr. Mary Leung: (26:08)
I feel like one of the biggest things is really the systemic treatment for cancers. So one of the big things is really what we call targeted therapy. Targeted therapy is not quite the same as the traditional chemotherapy in the sense that they’re using the different focus on the particular cancer cells, be it the pathway of certain cancer cells that then have more, or there could be changing the cell cycles of some of these cells, so that they’re more effective in the cancer cells compared to the normal cells. So one of the biggest things these days is called immunotherapy, and that has been developed very widely in different types of cancers in just the past few years. We have probably all heard of at least one immunotherapy commercial on TV.

Dr. Mary Leung: (27:44)
Mainly the Pembrolizumab or Keytruda, and I have no affiliation with them, but they have been indicated in, I think, 15 or 16 different cancers. So what they do, in kind of simple terms, is that they use the patient’s own immune system. They try to be what we call the checkpoint inhibitor. What happens in the normal cells is that there are these immune system cells that usually are kept from attacking other cells in the body. The immune checkpoint inhibitors go into the body and they block that particular immune system cell and that checkpoint. So without that checkpoint, those immune cells start boosting up the immune system, the immune response in the body against cancer cells and this can eventually shrink the tumor and hopefully even get rid of the tumor. That being said, of course it can also potentially affect other normal cells. Sometimes the immune system can be wrapped up so much that you can have side effects, like skin rash or whatever ‘itis’ we call, like pneumonitis or inflammation of the lung, collitis or inflammation of the gut, so on and so forth. But in general, immunotherapy is fairly well tolerated.

Daniel Lobell: (29:55)
That’s interesting. I know that inflammation becomes a big problem when treating cancer.

Dr. Mary Leung: (30:02)
The big problem with our cancer cells is really, they don’t know when to stop growing. So there are different ways that scientists try to really stop them from growing, by using medicines that may stop them from the cell cycle in the vision of the cell cycles. Some of them are blocking the pathways, and some of them are like the one that we talked about, the immunotherapy, is to boost up our own immune system to fight them off. So sometimes what happens is that in someone with cancer, there’s just too many things going on, a lot of inflammation and that probably could be because of a lot of tumor burden, a lot of cancer cells in your body. And sometimes in that situation, no matter what systemic therapy you use, you may not be able to fight the fight. And it’s not something that we want to see, but sometimes it’s what we call it ‘really to the point of no return’ – that sometimes happens.

Daniel Lobell: (31:35)
What role do anti-inflammatories play in trying to stop that? Or at what point do you start using them? Are there any that are proving to be more effective or make you hopeful for the future in combating this?

Dr. Mary Leung: (31:55)
For now, those particular anti-inflammatory medications are not really used in treatment of cancers in general, there are a couple exceptions, there are studies that have shown that aspirin may be helpful in certain type of colon cancers. And also part of some cancer treatments, for example certain lymphomas and multiple myeloma, which is also a kind of blood cell cancer, they always include some kind of steroids, which are anti-inflammatory. So for some reason, these cells seem to respond to these steroids better, but at the same time, if you only use steroids, that’s not enough to treat those cancers.

Daniel Lobell: (33:01)
I wonder what it is that makes most of these cancers nonresponsive to the anti-inflammatories. Has there been research done on that?

Dr. Mary Leung: (33:13)
I’m not sure. There are always research clinical trials done and all different things. There’s studies that are done, old cancer drug, new use, you know, that type of thing.

Daniel Lobell: (33:34)
Dust it off, it’s the old cancer drug, but it’s ready to come back.

Dr. Mary Leung: (33:40)
I mean, like for example, thalidomide was an old drug and was used for another reason. And then more recently, it’s used more for multiple myeloma. And there are also other drugs, like another drug that was an old cancer drug, maybe 50 years ago, and now it’s coming back to be used as a part of lymphoma treatments. So I think scientists are always thinking of ways to improve or just find different ways to attack different cancer cells, because they’re so different and really so many changes and so many mutations that we have a lot of things to learn at the same time and who knows, maybe some really old drugs may be good for some future use too. And now, not just with the traditional chemotherapy but also with this targeted therapy, we can do more tests to test individual patients’ cancer cells to see if certain types of targeted therapies are suitable for them. So we’re making cancer treatment more and more individualized. And I think that way, patients in general will be able to withstand the treatment better and hopefully have less side effects.

Daniel Lobell: (35:34)
Yeah, it seems like that should be the way to go for everything in medicine – the more we can specify the treatment to the patient rather than a broad sweeping treatment, that would be, the more beneficial in a general term. Are there apps that are being used now to detect cancer or to help people figure out how to treat cancer?

Dr. Mary Leung: (35:56)
Well, I should say, first of all, I’m not a very tech savvy person, [laughs], so there could be apps that I don’t know about.

Daniel Lobell: (36:06)
It would be kind of a bad app anyway, you’re having a nice day and a little alert comes up on your iPhone, “You have cancer.” Oh man.

Dr. Mary Leung: (36:13)
[Laughs]. Not that I know of.

Daniel Lobell: (36:15)
[Laughs].

Dr. Mary Leung: (36:15)
I know there are apps for your heart rate and of course technology in the medical field is really amazing these days. Even for example, for monitoring blood sugar, now you don’t have to just stick your finger every few hours. They have something that you can temporarily plant on your arm or on your abdomen, and then it can transmit via Bluetooth what your sugar level is. So I anticipate that there may be something similar happening, maybe in a few years, to detect cancer cells even.

Daniel Lobell: (37:04)
I went dark with the app, but it would be good if it says “You can prevent the cancer, you have early signs.” That would be a much better app. It pops up, “You can prevent cancer.” You mentioned earlier with this story with your grandmother, about how she was losing weight rapidly over six months, and you guys should have seen it. What are some of the early common signs of cancer that people usually brush off?

Dr. Mary Leung: (37:29)
Of course, if it’s screaming out cancer, then we won’t miss it. I would say that in general, if there are things like unexplained weight loss and it’s not like, “Oh, you’re trying to lose weight’, it’s like if you are making no effort in trying to lose weight and you lose more than 10 pounds in six months, that’s not normal. Also other things like unexplained fever that is not related to an infection, night sweats, decreased appetite, decreased energy. Of course, you don’t have to have all of the above, but just even one or two of them may be some warning signs that you should get checked out. But I think more importantly, really keep up with all the health care checks that are appropriate for your age, for example routine colon cancer screening, a mammography, prostate exam, things like that.

Dr. Mary Leung: (38:42)
And of course, if there’s any family history of those things, or if you have a family member of younger age with breast cancer or prostate cancer, then you may need to have the screening earlier than the general population. So those are just some of the things that we can do. And of course, for women, including gynecologic exams and because right now not all cancers can be screened. For example, ovarian cancer cannot be screened, but if there’s a family history or if there’s a genetic mutation in the patient or the family, then that’s a different story. But right now really, early detection is the key. And of course, screening tests, as you mentioned, if there’s an App to warn that, “Hey, you may have cancer” or to really give us that information, that would be great.

Daniel Lobell: (39:51)
Yeah. That would probably save a lot of lives, take a lot of the guesswork out of things. It is interesting, and there’s so much still to be discovered. I know there’s so many things you’d say this could cause cancer, that could cause cancer. Is there one definitive understanding we have of what causes cancer?

Dr. Mary Leung: (40:17)
The short answer is no, I don’t think so. Because cancer is really the cells that have lost their check and balances and they just start to go haywire and they start to just grow nonstop when they’re supposed to die at some point. So that’s really the simple way of viewing what cancer is, be it the breast, lung or whatever organ system.

Daniel Lobell: (40:48)
Basically the cells are trying to be immortal at the expense of the human being’s mortality.

Dr. Mary Leung: (40:53)
Exactly. With that being said, is there a trigger? Yes. Like Chernobyl, like radiation exposure or orange, things like that. But at the same time, I think it’s also multiple factors, not just one exposure, it could be adding on to a lifestyle, and also a genetic makeup. So it’s not just a one hit wonder, so to speak, it’s really multiple things that add together to form the cancer. Like for example, smoking – what’s in the cigarettes, there are really a lot of different chemicals that are carcinogenic, but not everyone who smokes get cancer. So it’s really different for each individual, not to say that you should smoke. [Laughs].

Daniel Lobell: (42:03)
[Laughs]. Yeah. That’d be a weird takeaway from this interview.

Dr. Mary Leung: (42:06)
[Laughs]. Please don’t smoke.

Daniel Lobell: (42:09)
[Laughs].

Dr. Mary Leung: (42:09)
I always tell my patients when I’m seeing them for something else and they smoke, I always incorporate a smoking cessation, like a little counseling, because I always tell them that I really don’t want to see you for another reason, like lung cancer or some other cancer.

Daniel Lobell: (42:26)
What about the microwave? Should we really be worried about standing near the microwave?

Dr. Mary Leung: (42:32)
[Laughs]. I would say right now there’s no definitive studies to say that we should stay away, but I would still say that if you can, just don’t stand in front of it 24/7.

Daniel Lobell: (42:46)
It is fun to watch the food go around.

Dr. Mary Leung: (42:48)
I do use the microwave quite a bit.

Daniel Lobell: (42:57)
[Laughs]. I know that you said that you’re not a technical or a technological person, but this is a Doctorpedia podcast and we are an online platform. So I am going to ask you a little bit about it. What do you think are some of the things that Doctorpedia should be trying to do with the platform?

Dr. Mary Leung: (43:17)
So I think one of the things I really like about Doctorpedia is almost like a one stop shop in a sense that patients and the families can really go to this one place to get accurate information that is verified by other doctors that are practicing in that particular field. And also the information is very concise – it’s not long and usually if they’re videos, they’re one to two minutes long, so it’s definitely taking into account of people’s attention span and also, just vital information is included in each clip. And also if patients want to learn more about certain things, they can just stay on the website to click on the tabs that they want to look into.

Dr. Mary Leung: (44:29)
So I feel like that’s a really helpful thing for patients. And I feel like for me, seeing patients on a daily basis, I can only help so many patients at the time because I don’t like to rush, I spend the time that I need to spend with each patient. I may need to spend more time with some patients, especially if I’m talking about death or dying. I am only me. I can only help so many people at a time, but with Doctorpedia, I feel like the information is out there and you can really help a lot more people even globally at the same time. So I feel like when patients and their family have that information, they have that knowledge, they’re empowered to really make a more educated decision or at least be more informed so they know what to ask their doctors when they actually go have the consultation.

Daniel Lobell: (45:42)
Right. I think that’s the primary thing that I love about Doctorpedia as well, which is that it takes a lot of the guessing out of things and you don’t really have a resource like that anywhere else on the web where you can really go and get, like you said, concrete, concise information and come in as a better educated patient when you need to be.

Daniel Lobell: (46:01)
What are some of the things that you wish your patients knew before they came in?

Dr. Mary Leung: (46:06)
I would say that I don’t really have a lot of expectations. Usually, when I first meet my patients, I ask them, “Do you know why you’re here?” just to clarify, because I don’t just see all oncology patients. So sometimes they’re not cancer patients. They can be blood-related issues because I’m also a hematologist. And so that way I know where to start the discussion with them to see how much they know or don’t know. I would say for the cancer patients in particular, a lot of them are already somewhat informed. They know that they’re referred here by this surgeon because say they need chemotherapy.

Dr. Mary Leung: (47:10)
Just with that knowledge, I’m happy to work with that. Sometimes I get surprised that they say, “I don’t know, my surgeon told me to call here” and then I’ll say, “Okay”, and we go step by step. And sometimes they get really surprised that they need to get chemotherapy. So that could be a challenge, but that doesn’t happen a lot. Usually, the surgeons I work with know the drill, they know what their stage of the cancer needs, what the next step is according to the national guidelines. So I don’t encounter that too much. In short, I don’t really have a lot that I ask from my patients when they come.

Daniel Lobell: (48:04)
Well, it makes it easy to show up, at least, that the expectations are low. I guess that’s good. The pressure is off. I guess you’re going through enough anyway if you have to be showing up to your office, maybe it’s better not to have to know any more than that.

Dr. Mary Leung: (48:20)
I guess just one little thing is I usually like the patients to come with at least one other person, because especially for cancer patients, with the diagnosis and the treatment and you go through potential side effects and all those things – it’s really a lot of information. As you mentioned, they’re already overwhelmed with the diagnosis, and to listen to all of this information that sometimes can take an hour or even longer, that is too much for them to remember everything. So it’s always better to have another set of ears to help out and to organize things or be a note taker or something like that.

Daniel Lobell: (49:02)
I’m sure the support of them being there as well is helpful for them too.

Dr. Mary Leung: (49:07)
Exactly.

Daniel Lobell: (49:08)
Well, Dr. Leung, it’s been a fascinating conversation and I’ve learned a lot and I want to thank you for that.

Dr. Mary Leung: (49:15)
No, I want to thank you so much for having me.

Daniel Lobell: (49:18)
Yeah. It’s been a pleasure. And I ask all the doctors this question at the end of the interview, and I’m going to ask you as well. What are some things that you personally do to stay healthy that you would recommend to the listeners?

Dr. Mary Leung: (49:31)
So even though I work very long hours, I do my best to exercise every day. And it’s not very long exercise, sometimes I may just do 15, 20 minutes, but I always exercise, be it just little runs or stationary runs while I have the TV on but I make sure that I move. The sleeping early part I should do too, but I’m not very good at it just yet. And this should be one of my New Year’s resolutions.

Daniel Lobell: (50:13)
You and me both. I’ve been trying to get that one down for a long time and it’s really hard.

Dr. Mary Leung: (50:19)
But I try to make it up over the weekends when I don’t have to work, but I think exercise is good. I think that’s one of my methods of de-stressing and also, I think it’s healthier for my body and for my heart.

Daniel Lobell: (50:40)
Yeah. I haven’t seen anything to argue with that. I also want to start getting to sleep earlier and making that a big part of my 2021.

Dr. Mary Leung: (50:55)
Yeah, we should do that together.

Daniel Lobell: (50:58)
All right. You’re on. [Laughs].

Dr. Mary Leung: (50:59)
[Laughs]. Okay. Sounds good.

Daniel Lobell: (51:02)
A Doctorpedia challenge begins, let’s see.

Dr. Mary Leung: (51:06)
[Laughs]. We should put that for everybody, right?

Daniel Lobell: (51:08)
Yeah. Thank you so much for doing the show and I’m wishing you and your family a happy, healthy New Year.

Dr. Mary Leung: (51:15)
Yes. Thank you so much. And you too, you and your family and all your pets, right? [Laughs].

Daniel Lobell: (51:21)
[Laughs]. Yeah. You did good research on me.

Dr. Mary Leung: (51:21)
No, I just watched a couple of the YouTube videos. They’re quite funny.

Daniel Lobell: (51:33)
Thank you very much.

Dr. Mary Leung: (51:35)
All right. You take care.

Daniel Lobell: (51:37)
Thanks doctor. All right.

Dr. Mary Leung: (51:38)
Thank you.

Daniel Lobell: (51:50)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only, and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs.