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The James Cancer-Free World Podcast
53 minutes | Nov 15, 2022
Episode 125: Get to Know David Cohn, MD, Interim CEO of the James
Come on along as we talk to David Cohn, MD, about his journey from the ski slopes of the Pocono mountains to the surgical suites of the James Cancer Hospital. Cohn is the interim CEO of the James, the hospital’s chief medical officer and a gynecologic cancer specialist. In this episode, Cohn talks about growing up in suburban Washington, D.C., his love of skiing and music (he plays the guitar, mandolin and ukulele), how and why he selected a career in medicine over one as an attorney, and the lessons he’s learned from his mentors along the way. His career “was shaped by the people you meet,” Cohn said. “I found people who were committed to their profession, doing this for the right reasons and found joy in what they were doing.” These lessons, and mentors, have shaped Cohn’s professional life and helped him become a leader at the James. His father’s diagnosis with multiple myeloma during his residency “helped shape the way I practice medicine, just to be there for my patients,” he said. Cohn has plans to help the James continue to grow and innovate. “I know where we are today; I know where we can be,” he said. “I think I have a sense of what that path looks like, how you put the pieces along the path so we can walk on it.”
24 minutes | Nov 1, 2022
Episode 124: Injecting the Flu Vaccine Directly into Melanoma Tumors, with Carlo Contreras, MD
In a new James clinical trial, the influenza vaccine is injected directly into the melanoma of a patient. In this episode, Contreras, a James surgical oncologist, explains how he expanded upon a basic concept that has been around for decades to create this clinical trial. The idea is that while the influenza vaccine will not have a direct effect on the melanoma, “it puts the entire immune system on high alert and it is better able to recognize any foreign cells in the body, which in this case are the melanoma cells,” he said. The clinical trial started a few months ago and enrolls patients with both early-stage and later-stage melanomas. For the patients with early-stage melanomas, the vaccine is administered before surgery, with the hope that it will shrink the tumor. For patients with the later stages of this disease, the vaccine is combined with immunotherapy “to augment and further enhance what we’re already doing,” Contreras said. Because the clinical trial is in the early stages, regulations prohibit Contreras from discussing the specific results. However, he said he remains hopeful the influenza vaccine will be an effective form of treatment for patients with melanomas, could see application around the world, especially in poorer countries, and could potentially be used to treat other forms of cancer.
35 minutes | Oct 18, 2022
Episode 123: The James Comprehensive Anal Cancer Screening Center, With Dr. Syed Husain
Although still a rare type of cancer, the number of anal cancer diagnoses are on the rise. “No other cancer has so many factors that prevent patients from seeking care,” said Syed Husain, MBBS, a colorectal cancer and anal cancer specialist at The James, and one of the leaders of The James Comprehensive Anal Cancer Screening Center. In this episode, Husain talks about how “this is a very private area of the body and there are social taboos that prevent patients from talking about issues in this area.” The symptoms of anal cancer (discomfort and bleeding, feeling a lump) are similar to the symptoms of hemorrhoids, which many patients choose to ignore, thinking the problem will go away on its own. These factors often lead to a delayed diagnoses in which the cancer has grown and even metastasized. Husain also discusses the factors that increase the risk factors for anal cancer, the screening process, as well as advances in treatment. The human papillomavirus (HPV) is the primary risk factor, and Husain explains how the HPV vaccine could lead to a significant reduction in the number of anal cancer cases. The James Comprehensive Anal Cancer Screening Center is unique, the only one in Ohio and one of only a handful in the United States. Patients are screened, diagnosed and treated in the center, often all in one visit, “which makes it easier for patients who live further away or may have transportation issues,” Husain said. Screening, especially for people who are at a higher risk, can lead to the detection and removal of pre-cancerous cells, or catching the disease in the early stages when “a minor operation can cure a patient,” Husain said.
23 minutes | Oct 4, 2022
Episode 122: The Promise of Tumor-Infiltrating Lymphocyte (TIL) Therapy, with Dr. Richard Wu
Richard Wu, MD, PhD, and the James are at the forefront of a new type of cancer treatment in which lymphocytes from a patient’s immune system are removed from a tumor, enhanced in the lab and then returned to the body to better detect and kill cancer cells. It’s called: tumor-infiltrating lymphocyte (TIL) therapy and it is currently being used in clinical trials at the James and other leading cancer centers. Wu explains that the lymphatic system includes T cells and B cells that fight cancer. “In the patients I treat, the cancer has been infiltrated by T cells, but for some reason their tumor doesn’t shrink,” he said. “The cancer cells have found a way to shut off the immune system.” The T cells are removed from within what Wu describes as the “suppressive environment” of the tumor, and these millions of cells are “exposed to a potent stimulus to regrow and regain function.” Millions of T cells become billions and, because they are from the patient’s body, the immune system “can recognize them and maximize their cancer-killing potential.” Still in the early stages, the James TIL clinical trials have focused on melanoma and lung cancer. “We are at the tip of the iceberg,” Wu said. “I see TIL as a platform therapy and we’re only at the beginning and there are multiple ways it is being explored so we can make it work even better … This is what drives me in my daily work, seeing patients who haven’t responded to standard treatment options and coming up with a new approach, never being satisfied with the status quo.”
26 minutes | Sep 20, 2022
Episode 121: The Autoimmune Disease & Immunotherapy Connection in Cancer Treatment, with Dr. Meara
Immunotherapy has proven to be a great leap forward in treating cancer, as these drugs help activate the body’s immune system to better detect and kill the cancerous cells growing and hiding in the body. However, about “30 to 40 percent of the patients [treated with immunotherapy drugs] develop an autoimmune disease and that’s where I come in,” said Alexa Meara, MD, a rheumatologist who specializes in treating autoimmune diseases. “It can happen at any point in the treatment. Although it’s most common in the first three to six months, it can happen a year after a patient is off these drugs.” In this episode, Meara explains the different types of autoimmune diseases cancer patients can suffer from (rheumatoid arthritis and vasculitis are two examples), how they impact patients, and new studies and clinical trials she and other pioneers in this new field are working on to reduce symptoms and increase the quality of life of patients. “This is a really exciting field because it’s so new and it’s so collaborative,” Meara said, adding she believes she is the only rheumatologist employed fulltime in the country working in a cancer hospital. Meara works closely with the James oncologists treating cancer patients who develop autoimmune symptoms, and she is part of an international consortium that shares ideas and results.
26 minutes | Sep 6, 2022
Episode 120: Corrin Steinhauer, the New Chief Nursing Officer of the James
Early in her nursing career, during an internship at a cancer hospital, Corrin Steinhauer, RN, DNP, NEA-BC, CPPS, learned a valuable lesson she’s never forgotten. A wise, experienced nurse taught her “how to build relationships with patients … how to be kind and to be there for your patients,” said the new Chief Nursing Officer of the James. In this episode, Steinhauer describes how she got into nursing, her previous nursing and leadership positions, her connection with her patients, and why she came to the James earlier this year. In her new, leadership role, Steinhauer said her primary job is to be an advocate for the staff of approximately 1,500 James nurses. Steinhauer is also working on a new strategic nursing plan that ties in with the overall strategic plan for the rapidly growing OSUCCC – James. The overall goals of the strategic plan, she said, “are to continue to be one of the top five cancer centers, and that means a lot of leadership, at an informal, staff level, and also at a higher level for all of those with more formal, administrative titles. How do we continue to develop this community of nurses and make sure we remain relevant, up-to-date and are practicing with the best evidence-based guidelines? That’s our goal.”
41 minutes | Aug 16, 2022
Episode 119: Advances in Bone Marrow Transplants and CAR T-Cell Therapy, with Dr. Sumithira Vasu
Advances in genetic analysis, bone marrow transplants and cellular therapies have helped the leukemia specialist at the OSUCCC – James attain better outcomes for patients with blood cancers. “When a patient comes in, we get a sample from their bone marrow to know the genetics of their leukemia,” said Dr. Sumithira Vasu. “We want to know what is causing the leukemia to grow, and cause so much damage, and these genetics help us decide is this leukemia likely to be cured with chemo alone or does it need a bone marrow transplant … or cellular therapy.” In this episode Vasu explains the history and advances that have been made in bone marrow transplants, including the drugs that greatly reduce the effects of Graft-versus-host disease that plagued early transplants. New, cellular therapies, such as chimeric antigen receptor T cell (CAR T-Cell therapy) have shown great promise and the OSUCCC – James is a national leader in this game-changing treatment. “We take stem cells out of the body of a patient or a donor, send them to the lab and super charge them [through genetic modification] and then put them back in the patient’s body,” Vasu explained. These new super-charged T cells found in the body’s immune system can now better detect, target and kill the cancer cells in the blood. These super-charged T cells hunt for CD19, a protein that binds itself to the outside of cancer cells and has tricked the immune system into leaving them alone. “Now, because of the gene modification, they recognize the CD19,” Vasu said. The OSUCCC – James was one of a small group of comprehensive cancer centers that conducted the first clinical trials using CAR T-Cell therapy. And now, Vasu and her colleagues are among the leaders in the next step in the promising process. In the past, the bone marrow taken from patients was sent to a lab across the country for the genetic kick start. “Now, we are one of only a handful of labs in the United States that have the capability of manufacturing these cells in our own lab,” Vasu said, adding OSUCCC – James researchers have also identified two other targets in leukemia cells to attack: CD20 and CD22.
30 minutes | Aug 2, 2022
Episode 118: Finding New Targets in Treating Breast Cancer, with Gina Sizemore, PhD
Gina Sizemore, PhD, and her lab specialize in identifying the causes of metastatic breast cancer at the molecular level. One anomaly they have discovered in the microenvironment that exists in breast tissue is a protein called platelet-derived growth factor-B (PDGFB). In this new episode, Sizemore, an assistant professor in the Department of Radiation Oncology and a member of the Cancer Biology Program, explains that in some women with breast cancer “the PDGFB level is really high compared to a normal [non-cancerous] breast.” Further research found that a high level of PDGFB increases the odds that a patient’s breast cancer will metastasize and travel to the brain. This is an important discovery because “when this happens there is a very poor prognosis, the median survival rate is 10 or 11 months,” Sizemore said. “Something about PDGFB allows the cancer cells to travel to the brain more readily and grow, and if we can figure out why, we can target that and block that from happening or reduce it when it happens.”
24 minutes | Jul 19, 2022
Episode 117: Advances & New Targets in Treating Glioblastomas, with Monica Venere, PhD
Glioblastomas (GBMs) are the most common type of malignant brain tumor and are very aggressive, which means they grow quickly. The current treatment options are limited. “We’re interested in finding the targets that drive the proliferation of these cells, or their resistance to radiotherapy, and then manipulate this to increase the ability of radiotherapy to kill them, or make it so they no longer divide [and grow],” said Monica Venere, PhD, a member of the OSUCCC – James Cancer Biology program and an assistant professor of radiation oncology. In this episode, Venere explains the basics of GBMs: What they are and why they are so aggressive, and the current standard of care. She then describes the work of her lab, which is to identify new targets within the GBM cells to attack through chemotherapy and radiation. She is especially interested in mitosis, which is the final step in the division of cells from one to two. One of the targets that Venere and the members of her lab have identified is KIF11, which is expressed at a high rate in GBMs. “This is an indication the cancer cell is more dependent [on the KIF11],” she said, adding the next step is to target this protein “and see if we can get a higher cell kill.”
61 minutes | Jul 5, 2022
Episode 116: "The Patient Comes First," the Career & Legacy of Dr. William Farrar
Early in his career, William Farrar, MD, learned an important lesson from his mentor, Arthur G. James, MD. “The patient comes first … and I practiced that through my entire career,” said Farrar, who recently retired after a remarkable 46-year career at the OSUCCC – James. In this episode, we spend some time with Farrar, who was CEO of the James Cancer Hospital when he retired. He talks about the impact and legacy of Dr. James and his multi-decade quest to create a cancer hospital in Columbus; the creation of the Stefanie Spielman Comprehensive Breast Center that Farrar led; and the amazing advances in treating cancer patients during his long career. “But we need to keep working and continue to move forward,” Farrar said, echoing another lesson he learned from Dr. James. Farrar was determined to become a surgeon from an early age, and he worked in hospitals in his hometown of Aurora, Illinois during his high school years. He was an outstanding multi-sport athlete and set a record that still stands at Illinois Wesleyan University: five interceptions in one game. He came to Ohio State in 1975 as a surgical resident. A few years later, Farrar was named the hospital’s first oncology surgical fellow. Farrar has performed about 20,000 cancer surgeries over the decades, treating every type of cancer except brain cancer, before he eventually specialized in breast cancer in the early 2000s. “It’s phenomenal to me the advances we’ve made [in treating patients], it’s mind boggling,” Farrar said of the development of advanced radiation therapy, chemotherapy, and immunotherapy. Over the decades, Farrar played an important role at the OSUCCC – James in leading the research, clinical trials and treatments that have helped develop these treatment options and improved the outcome for thousands of patients. He called his career “very gratifying,” adding that “a cancer journey for a patient is also a cancer journey for the doc.”
21 minutes | Jun 21, 2022
Episode 115: Advances in Treating Lung Cancer, With David Carbone
When David Carbone, MD, PhD, began treating lung cancer patients in the 1980s, “it wasn’t clear if anything helped survival.” However, over the past few decades the treatment options and results “have changed dramatically,” said the director of the James Thoracic Oncology Center. In this episode of the James Cancer Free World podcast, Carbone explains the advances made over the years: precision cancer medicine that targets specific mutations, and immunotherapy drugs that “turn on” the body’s own immune system to detect and attack cancer cells that had previously been hiding. “The immune system now sees something it couldn’t see before,” Carbone said. Another promising area of research is cellular therapy in which immune cells are genetically modified to be more powerful “and then infused back into the patient.” Carbone said that new targets and therapies are being discovered in labs at the OSUCCC – James on a regular basis. “It’s important to convey to patients that there is now hope,” he said.
24 minutes | Jun 7, 2022
Episode 114: New James Mobile Lung-Cancer Screening Unit, with David Carbone
David Carbone, MD, PhD, is determined to reduce the number of lung-cancer deaths. “Lung cancer is the number-one cause of cancer deaths for men and for women in this country, and worldwide,” said Carbone, a lung cancer expert and director of the James Thoracic Oncology Center. “That’s why lung-cancer screening is so important.” In this episode, Carbone discusses the new James mobile lung cancer screening unit, which will travel Ohio screening at-risk and underserved people. The goal is to diagnosis lung cancer in the very earliest of stages, when it is more treatable. This will lead to a reduction in the number of lung-cancer related deaths in Ohio. Smoking is the leading cause of lung cancer, leading to about 85 percent of all lung-cancer diagnoses, Carbone said. The at-risk population the mobile unit will screen is defined as people over 50 who have smoked the equivalent of a pack a day for 20 years and have quit smoking less than 15 years ago. “These are the people who are at the highest risk, but we are studying ways to broaden the criteria and screen more people,” Carbone said. Screening at-risk people is vital because a lung-cancer tumor “can reach a reasonable size, a softball size, and the person won’t feel anything, no cough, no symptoms,” Carbone explained, adding that symptoms don’t materialize until the lung cancer has metastasized, spread to other parts of the body and is very difficult to treat.
32 minutes | May 17, 2022
Episode 113: How Healthcare Inequities Impact Cancer Patients, with Dr. Obeng-Gyasi
Where you live, work, play and pray can impact your health. In this episode, Samilia Obeng-Gyasi, MD, MPH, discusses research studies and clinical trials that have shown how the social determinants of health and the healthcare inequities that impact many lower-economic populations can lead to cancer diagnoses in the later stages and poorer outcomes. Obeng-Gyasi is a James surgical oncologist and a researcher who specializes in breast cancer. Her research focuses in on how a person’s income level and access to healthcare, as well as the financial and emotional stress of a cancer diagnosis and treatment, can result in more aggressive cancers, worse outcomes and even higher death rates. These issues are more pronounced in lower-income populations and among many minority groups, such as Black women. For example … “We’ve found that women with no health insurance or Medicaid presented with more advanced stages of breast cancer and had a worse overall mortality rate than patients with private health insurance,” Obeng-Gyasi said. Other areas of her research look at the Allostatic load of breast cancer patients and how it impacts their long-term outcome. Allostatic load is a way to measure the cumulative burden of stress in a patient. “We’ve found that [cancer] patients with a higher Allostatic load have a higher risk of death from their cancer,” Obeng-Gyasi said, adding additional research is trying to determine if a person with a long-term, high Allostatic load would have an increased cancer risk. Another research study found that Black women with breast cancer have a higher rate of what Obeng-Gyasi calls a “rapid relapse.” As a result of these findings, Obeng-Gyasi has worked with Barbara Andersen, PhD, a James psychologist and an expert in reducing stress. “The results of the study are compelling,” Obeng-Gyasi said. “Patients who participated have a better chance of survival and a lower rate of their cancer coming back.”
32 minutes | May 3, 2022
Episode 112: The New James HALT Clinic for Blood Cancers, with Dr. Uma Borate
The new HALT Clinic at the James is improving methods to detect blood cancers, and making earlier diagnoses possible. “The goal is to identify patients or people at higher risk of developing leukemia due to either an inherited genetic mutation or an acquitted genetic mutation,” says Uma Borate, MBBS, co-director of the cutting-edge clinic. In episode, Borate explains how advances in sequencing DNA have allowed scientists and physicians to identify leukemia in the very earliest stages, when it is most treatable. “We’ve also been able to identify patterns of mutations in families and [discover] inherited genetic disorders we weren’t aware of before.” The James, a world leader in researching and treating blood cancers “had all the building blocks in place” to create the Hematologic Abnormalities at risk of Leukemia Transformation (HALT) Clinic, adding that “I helped bring them together under one roof," she explained. Diagnosing a patient with a blood cancer in the early stages is important. “If you had asked me years ago if this would make a difference, I would have said no,” Borate said. “But now, with the advances we’ve made the answer is slowly becoming yes.”
30 minutes | Apr 19, 2022
Episode 111: Advances in Treating Adrenal Cancer, with Dr. Barbra Miller
Adrenal cancer is rare, difficult to detect and is often diagnosed in the later stages when it has metastasized. “That’s why it’s so important to have centers of excellence so patients have access to providers who are experts in treating this disease,” says Barbra Miller, MD, co-director of the James Multidisciplinary Adrenal Clinic, a world leader in treating this type of cancer. The body’s two adrenal glands sit above the kidneys. They are important organs as they produce several different hormones that regulate blood pressure and metabolism “and help other organs work successfully,” Miller said, adding that in most cases only one of the two adrenal glands is cancerous. For patients with metastatic adrenal cancer, the first treatment option is chemotherapy “so we can determine how it responds and how quickly it is growing and determine whether the resection (an adrenalectomy that removes the entire adrenal gland) is advantageous.” An adrenalectomy is a delicate procedure. “The tumor is very fragile and can grow through the capsule of the tumor into the surrounding organs and we don’t want to spread those cells [during surgery],” Miller said. “Once the surgery is completed, we look at the pathology to determine if other treatment is warranted.” A person can function quite well with one adrenal gland, Miller said. Because adrenal cancer is so rare, about 200 cases a year, according to the American Cancer Society, it is hard to attract funding for research. “We are constantly searching for funding, and Pelotonia is key to our program’s success in continuing to research this disease.”
20 minutes | Apr 5, 2022
Episode 110: New Clinical Trial Improves Outcomes For Endometrial-Cancer Patients, with Dr. O'Malley
A new clinical trial led by the James that utilizes immunotherapy is showing great promise in treating women with a recurrence of endometrial cancer (also called uterine cancer). In this episode, David O’Malley, MD, director of the James Division of Gynecologic Oncology and Co-Director of the Gyn Oncology Phase I Program, describes the trial and its great promise. Previously, “we had limited options and they had significant toxicity,” O’Malley said of women who had recurrent or metastatic endometrial cancer. In this new trial, women were treated with pembrolizumab (marketed as Keytruda) an immunotherapy used to treat several types of cancer and targets the cellular receptors cancer cells use to shield themselves from the body’s immune system. Removing these “blockers allows the immune system to identify and attack” the cancer cells,” O’Malley explains. There were 79 patients in the trial “and 48 percent responded markedly and 14 percent had a complete response and their cancer was completely gone,” O’Malley said.
48 minutes | Mar 15, 2022
Episode 109: What Every Man Needs to Know About Prostate Cancer, with Dr. Steven Clinton
“Every man deserves to be treated in a multidisciplinary prostate cancer clinic,” said Steve Clinton, MD, PhD. In this episode, Clinton gives a great overview of what every man needs to know about prostate cancer. This begins with regular screening – and the PSA (prostate-specific antigen) blood test. This test should begin at the age of 40. A significant, year-to-year increase in a patient’s PSA level could warrant a biopsy to determine if there is cancer. If there is, the cancer is “graded” on what’s known as the Gleason Grading System. A higher score indicates a more aggressive prostate cancer and the likelihood of a more aggressive treatment plan, while a lower score could warrant active surveillance. “I don’t like that term,” Clinton said of active surveillance. He prefers “watchful waiting” because “we’re not waiting for something to happen, we’re actively monitoring patients.” This monitoring includes yearly PSA tests, and additional biopsies to determine if the cancer has become more aggressive. He also described advances in treating prostate cancer. The introduction of robotic surgery and improvements in radiation therapy have led to fewer complications and better outcomes. Targeted therapies and immunotherapy drugs have also led to more treatment options and better outcomes. Clinton is one of the leaders of the James Multidisciplinary Prostate Cancer Clinic. “In one afternoon, a patient can see a urologist, radiation therapist and medical oncologist,” he said. “We can give you all the information you need to make your decision” on a treatment plan.
49 minutes | Mar 1, 2022
Episode 108: All About Pelotonia 2022, With Doug Ulman and Joe Apgar
Registration has begun for the 14th Pelotonia, the amazing, fundraising cycling event that has raised $236 million for cancer research at The James. In this episode we talk with Pelotonia CEO Doug Ulman and President Joe Apgar. They describe the new routes, provide some fundraising tips, and give an overview of the new Victoria’s Secret and Pelotonia collaboration to award $8.5 million over the next two years to female cancer scientists around the world working on the most-promising research to beat women’s cancers, such as breast cancer and uterine cancer. Ulman also fills us in on his recent trip to the White House, where President Biden announced a renewed commitment to the Cancer Moonshot Project that was first announced during the final year of the Obama Administration. “The White House has a really aspirational goal, to reduce the number of cancer deaths by 50 percent in the next 25 years,” Ulman said. “That will save hundreds of thousands of lives and put us on the trajectory to ending this disease.” Some of the statewide initiatives for prevention, screening and genetic testing, funded by Pelotonia and implemented by The James, could serve as national models in the years to come, he added.
18 minutes | Feb 15, 2022
Episode 107: Advances in Cervical Cancer Treatment with Immunotherpay, with Dr. David O'Malley
“I like to say that patients at the James have access to tomorrow’s therapies today,” said David O’Malley, MD, the director of the James Division of Gynecologic Oncology and Co-Director of the Gyn Oncology Phase I Program. In this episode, O’Malley describes a new clinical trial that provides “tomorrow’s therapies today” to patients at the James, and beyond. A clinical trial led by O’Malley utilizes two immunotherapy agents to treat women with advanced or recurrent cervical cancer. In the past, there were limited treatment options for these patients. The first drug, balstilimab, allows the immune system of a patient to recognize cancer cells that had previously been able to camouflage themselves and hide from the immune system. The second drug, zalifrelimab helps the body’s tired iimmune cells “reinvigorate themselves to better get to and fight those cancer cells,” O’Malley explains. In a James-led, Phase 2 clinical trial of 125 patients in the United States and beyond “we tripled the response rates,” O’Malley said. “And, not only was there better response rates, but the durability is more pronounced, and when I look at patients two years out, they’re still responding.” The advances made possible by immunotherapy agents and clinical trials are accelerating at a rapid rate. This has O’Malley optimistic about the future. “We’re in an unprecedented time in cancer treatment and drug development,” he said. “I’m seeing things today I really didn’t think I’d live to see,”
31 minutes | Feb 1, 2022
Episode 106: Maintaining Patient-Based Care at the James in the Midst of a Pandemic, with Amy Rettig
The COVID-19 pandemic has created what Amy Rettig calls “a new reality” for healthcare teams. This new reality can be more difficult, but “realizing we are not alone in what we are thinking and feeling, and the knowledge that others are feeling the same way is so supportive,” says Rettig, a James advanced practice registered nurse, who has also earned a Doctor of Nursing Practice degree and a Master of Arts in Lay Ministry. In this episode, Rettig explains how the James philosophy of patient-based care has helped the staff manage during more stressful times. At the core of relationship-based care is “to have a caring relationship with ourselves and with our team so that everyone taking care of every patient are all on the same page.” This in turn leads to better care of patients. Rettig explains several techniques she teaches others at the James to recognize and reduce stress and anxiety, including the brief emotional support concept; and D.E.S.C., which is a way to describe an issue, express your feelings, specify an outcome and discuss consequences. Rettig also shares the breathing techniques she uses to reduce her own stress. “Our team has been able to sustain the James level of providing great care to our patients and their families … our patients know we are here to take care of them,” she said.
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