Darrin Godin: Well, hello and welcome to Talking Hope. I'm your host, Darrin Godin. Our guest today is Dr. Natalie Johnson. Dr. Johnson is a prominent surgical oncologist specializing in surgery for breast cancer, thyroid cancer, parathyroid disease, and melanoma. Her research focuses on innovative approaches to cancer surgery, as well as research and cancer disparities and the links between environmental factors and cancer. Dr. Johnson practices at City of Hope Orange County, Lennar Foundation Cancer Center, the most advanced comprehensive cancer center in Orange County. Dr. Johnson has been part of the City of Hope family since completing a residency rotation, a surgical oncology fellowship, and a breast surgical oncology fellowship at City of Hope Duarte's campus. We're so pleased that she's here caring for patients in Orange County, and we welcome her to the podcast today. Thank you and welcome, Dr. Johnson.
Dr. Johnson: Thank you, Darrin. It's my honor to work at City of Hope, and pleasure to talk with you today.
Darrin Godin: Well, let's jump right in. A breast cancer diagnosis brings many emotions and many questions. What are the most important things you want your patients to know?
Dr. Johnson: Breast cancer care and care for any cancer is very nuanced and very individualized. So as soon as a patient gets a diagnosis, they're often reading online, talking to friends or family who've had similar problems. And some of that can one support, but some of it can also lead to confusion and more questions. So my hope in meeting with patients and how they can kind of prepare themselves is just knowing that it is very individualized, very nuanced, and so their treatment plan will be essentially customized for them and their cancer and kind of how they can best prepare going into it is just staying optimistic, staying positive, taking good care of themselves as far as their general health, other medical problems, nutrition, exercise, being around supportive family, that sort of thing is kind of the best thing they can do to prepare.
Darrin Godin: Great, thank you. And how can patients know that they've chosen the best place for breast cancer surgery?
Dr. Johnson: Well, I think it's a feeling they get in the place. And I mean, I am biased. I work for City of Hope. I've chosen to work here and have brought my own family members for care here because I think when it comes to cancer, where you get care matters, and at a cancer specific center that as our sole focus, we can really excel in it. It's hard with all the advances in medicine to be a jack of all trades.
So if you're trying to keep up the equipment for the latest in delivering babies and treating heart attacks, then you may not be able to buy all the newest radiation machines and surgical instruments that we need for cancer. And at a cancer center, we also have all the support services and we understand what our patients are going through and can help them navigate those treatments. I think those are really key, and we have hundreds of clinical trials to offer. We don't just keep up with the guidelines. We're actually writing the guidelines, revising them constantly based on new data, new discoveries. So I hope that comes across and instills a sense of confidence in patients when they come to feel that they are at the right place for their cancer treatment.
Darrin Godin: And I think what I hear you saying is that that sense of feeling comes from understanding the depth and breadth of all that City of Hope is. And as you mentioned, our clinical trials, our expertise, our latest innovative equipment and the experts as well that we have access to. You're not a one of one. You are one of 600 plus cancer specialists who are only focusing on cancer. And that team approach that we have here at City of Hope really, really makes a huge difference for a patient...
Dr. Johnson: Absolutely.
Darrin Godin: ... especially when they have a complex type of cancer. So thank you for that.
Dr. Johnson: Yeah, that multidisciplinary approach is critical, so you need to have all the specialists in well-integrated teams.
Darrin Godin: And what are some of the advances in breast cancer surgery that are bringing hope to patients and maybe even exciting you as a surgeon?
Dr. Johnson: Well, a lot. We're doing... Surgery for breast cancer has gotten less and less morbid all the time. I hear from my patients horrifying stories about what their grandparents and aunts went through, and that's not breast cancer surgery today. We do a lot of minimally invasive techniques, hidden scar surgery. Patients who are candidates for lumpectomy can sometimes have a reduction and a lift at the same time. A lot of nipple sparing mastectomy so that if a patient does need a mastectomy, we can preserve their whole skin envelope and nipple and do a reconstruction that really looks very natural shape to the shape and size. Using robotic surgery, we do a lot of direct to implant.
So while a lot of places are still using temporary implants that have to be filled week after week and require second surgery to exchange for implants, we do a lot of direct implant. We do nerve re-innovation to try to preserve sensation, prophylactic surgeries to try to decrease lymphedema, which can be a serious complication from breast cancer surgeries. So a lot of advances.
Darrin Godin: Wow. And has those advances, have we made great strides in a short amount of time or has that been over a long period of time that we've seen those changes?
Dr. Johnson: I would say both. I think the trajectory has been a steady, better and better, but I do think over the last 5 to 10 years probably the slope has increased with some of these advances.
Darrin Godin: Great. And as we said earlier, you treat more than breast cancer. You also treat thyroid cancer and melanoma. Is there a connection between these types of cancer?
Dr. Johnson: There are. They tend to occur in similar patient populations or middle-aged women. Having breast cancer puts you at slightly higher risk for getting thyroid cancer later on and vice versa. There are overlapping gene mutations that may put you at higher risk. A lot of people don't realize the BRCA gene mutations also have a higher risk for melanoma. So by treating these different disease sites and combining it, it's a manageable scope of practice where I can really stay at the cutting edge of advances in these three areas, but also offer really comprehensive care to my patients once they're through treatment for one, looking out for other things. And yes, it happens, it does. So that's the reasoning.
Darrin Godin: And Dr. Johnson, I understand you served as a medical volunteer in Uganda and India. Can you tell us about those experiences?
Dr. Johnson: Yeah. So I did. I think for kind of medical volunteerism to be the most sustainable, the best approach is sort of training people. So I chose to do efforts focused on providing direct patient care while there, but also training local people who would be there to provide that care long after we left, and very rewarding experiences, and yeah.
Darrin Godin: That's very cool. As I think about all the doctors that I know here at City of Hope, many of you are very, very humble about your expertise, but I think that speaks to your expertise as you're able to go and train others, and that is sustainable, right? You can either fish for someone or teach them to fish.
Dr. Johnson: Exactly.
Darrin Godin: And it sounds like you've gone there and shared your skill, your expertise, and another way that you and others are having an impact across the world, especially in the area of cancer care. So let me ask you this question. What does the concept of hope mean to you, Dr. Johnson?
Dr. Johnson: That's hard. It's hard to put into words. I think hope is, it's a feeling and it's a culture and it's a state of mind and it's something that we try to focus on at City of Hope in our name. So it's something I feel when I'm there, and I hope to instill in my patients a sense of optimism, a sense that whatever the best possible outcomes for their particular situation could be, can come to fruition. And that there is always reason to kind of see the brighter side and be optimistic about the future, whether that's personally or for the kind of greater good.
Darrin Godin: Yeah. So I'm going to ask you a follow-up question on that. How important do you feel mindset is for patient recovery, patient survival, and just the long-term healing that needs to take place?
Dr. Johnson: I think it's very important. It's hard to quantify, but there have been studies looking at it, and it's something that we try to look at at City of Hope. We're very interested in kind of mind-body connection, making supportive services available to our patients. Everything from psychology, psychiatry, support groups, integrative medicine approaches, yoga, nutrition, and there have been studies looking at better outcomes in patients who stay active through their treatment, that sort of thing. So I do think it's really important. It's hard to quantify, but it's an area interest and focus, and it certainly can't hurt, so.
Darrin Godin: Yeah, absolutely. And as you pointed out, it's certainly a differentiator for City of Hope that we do take this entire person approach and we're not just focused on the cancer that we have in front of us, but the entire person as a whole. So another benefit of coming to City of Hope and City of Hope Orange County. What is the message that you want to leave with our audience today?
Dr. Johnson: I guess I would say if you or a loved one is dealing with a cancer diagnosis or doesn't even have a diagnosis yet, I think City of Hope is a place where you can get the best care. We offer the whole spectrum from screening and diagnosis and expanding imaging modalities for those things to genetic testing and high risk to the latest in treatments, multimodality surgery, radiation, chemotherapy, other types of systemic therapy like immunotherapy. Really tailored approaches looking at genetics of a tumor, how it's responding to treatment, to, in real time, adjust those treatments based on response to really get the best outcomes for our patients.
And we're constantly looking at those outcomes and revising these approaches based on that. So it's really enables kind of to me, I think, the best possible cutting edge treatment and outcomes for patients. And so we're happy to see you and take care of you. Everyone who works here is passionate about our patients and caring for them and their cancer, as you said, like a whole person approach because it's not just about quantity of life, but quality of life and preserving that and minimizing the toxicity and side effects from all of these things as you're going through it. And we understand that.
Darrin Godin: So the outcomes are certainly important, but the process of getting there is also something we focus on. And thank you for sharing that.
Thank you, Dr. Johnson for your time today, for joining us on the podcast. As you know, City of Hope is recognized as top five in the nation for cancer care by U.S. News and World Report. And we are as focused on preventing cancer as we are on treating and curing it.
City of Hope Orange County offers a range of screenings and cancer prevention services, including mammography, colonoscopy, and more. First in research, first in treatment, first in survival. When it comes to cancer, it's hope first. You can visit cityofhope.org/OC to learn more. To make an appointment at any of our Orange County locations, you can call us at 888-333-HOPE. That's 888-333-4673. I'm Darrin Godin. Thank you again for joining us on Talking Hope, and we hope to see you next time. Have a great day.