Darrin Godin: Well, hello and welcome to Talking Hope. I'm Darrin Godin, your host, and today I'm pleased to be joined by Dr. Jessica Cheng. Dr. Cheng is among the nation's few and Orange County's only fellowship-trained experts in cancer rehabilitation medicine. This is a subspecialty of physical medicine and rehabilitation, or PM&R, also known as physiatry. Dr. Cheng is an expert in optimizing function and independence for people with cancer throughout all stages of their journey. She practices at City of Hope Orange County Lennar Foundation Cancer Center, the most advanced comprehensive cancer center in Orange County. Dr. Cheng was recently honored by the American Academy of Physical Medicine and Rehabilitation as a 2024 AAPM&R innovator and influencer for the impact she is making in the field. Welcome, Dr. Cheng. Thank you so much for Talking Hope with us today.
Dr. Jessica Cheng: Of course, thank you so much for having me.
Darrin Godin: So Dr. Cheng, what drew you to become a physician and why did you choose to specialize in cancer rehabilitation?
Dr. Jessica Cheng: Yeah, I started with this sense of awe at the process of healing. That healing isn't just about the mechanisms of a drug or a surgery, and there's so many layers of healing. Emotional, spiritual, practical, functional healing. And so I was drawn to the medical field with that concept.
When I found out about physical medicine and rehabilitation, I loved the musculoskeletal and the neurological system, the practical and creative aspects of marrying all the medical aspects with the rehabilitation practical aspects of available treatments to help a person in a holistic fashion. And so when I found out that cancer rehabilitation medicine is a subspecialty of PM&R, the added layers of complexity, of functional challenges, of emotional, spiritual difficulties and how interweave all those parts are in a person's healing journey really drew me.
And also on top of that, it really broke my heart to hear how underserved the cancer patients are, in terms of having interventions to help with their ability to function in their day-to-day lives.
Darrin Godin: Tell me more about that. What are the benefits that patients receive from this sort of treatment? Or what are the types of challenges or conditions that rehab helps them through?
Dr. Jessica Cheng: So many different types of challenges and conditions, maybe a patient's would be a little bit more telling. This is the patient that I just saw for follow up last week. He's a 69-year-old man, used to be a marathon runner, surfer. Then he got diagnosed with a really rare blood cancer. Then he struggled with heart failure, anemia, blood clot in the leg, severe neuropathy, blood pressure fluctuating when he stands. And with all of those things, he stopped exercising completely. So, former exerciser, stopped completely. And so when I saw him for follow-up, his main update for me was that his stem cell transplant got moved from after the holidays to the end of this month because he was doing so well. So, how was he doing so well? So, the first time I saw him about two and a half months ago, I had him stand up from the chair, but he couldn't do it without his arms. He needed maybe mild to moderate assistance with both arms to get out of the chair. And when I saw him last week, he could get up without his arms easily fast enough, so that he's not even a fall risk. He couldn't walk in line like this, kind of like a sobriety test, at all. He couldn't walk on his toes, walk on in heels. There was no way. But this time he could almost walk in the line, he could walk on his toes, he could walk on his heels. He went back to driving because his fatigue was better, because he had stopped himself out of concern for other people's safety. His leg swelling, it was super swollen and it was down to minimally swollen.
And so in terms of interventions, I like to approach things from a multidisciplinary holistic approach. And so, one of the key things is he worked with our physical therapists on specific balance exercises for the neuropathy, strengthening exercises for the deconditioning, and having that professional guidance so that he can rebuild his confidence to exercise with the different body that he has now compared to before. Occupational therapy helped with compression garments that were custom fit to him. We on my side also, aside from ordering this, reviewing neuropathy diagnostics, expectations and other management options from multiple disciplines.
And so when I saw him for follow-up, also it happened to be because he told me that his stem cell transplant is about a month from now. So I'm like, that is actually perfect. You've already got a heads up, a head start with prehabilitation, meaning getting your body physically and mentally ready, body of mind ready for a huge stressor of a life-saving cancer treatment. And so he's made so much progress in this four week window right before his transplant is really key. And so I was able to give him a entire training program with the support of our multidisciplinary staff already in place to further optimize his exercise and nutrition.
Darrin Godin: I sense your excitement and energy around that, and it's such a great illustration of movement itself being medicine, right?
Dr. Jessica Cheng: Yeah. I'm so excited for him. I was so happy to hear of his already huge increases in his function and that I got to catch him right before his stem cell transplant.
Darrin Godin: Well, let's continue on that same topic. You've used the word multidisciplinary a few times. So, what areas of expertise are involved in the type of multidisciplinary rehab that we offer here at City of Hope Orange County?
Dr. Jessica Cheng: So, the core disciplines of multidisciplinary rehabilitation are physical medicine and rehab, myself, the medical specialty, physical therapy, occupational therapy, and speech therapy. Those are the core rehab disciplines, but truly, the multidisciplinary net kind of incorporates in short, everybody. So, all of the supportive, integrative teams, acupuncture, massage, anything that can help a person function better, I help people determine which one and what priority makes the most sense for them and is doable for them. And so, that's on the rehab supportive symptom management side, but all of this needs to interplay well with what's going on medically.
And so when I say multidisciplinary, it truly means everybody, because I'm often talking with different medical disciplines, the oncology team, the surgeon, just to make sure the whole treatment plan is cohesive and makes sense. So for example, that patient I was just talking about. I was so excited, I talked to my colleague who was going to give him the stem cell transplant, just boasting about how amazing he's done in improving for this and that further improvement is expected.
Darrin Godin: That's incredible. When he's through his treatment, we would love to see if he's willing to come on and tell his story. That sounds like a great story from his perspective as well. Thank you for sharing that. How important is trust in growing a strong doctor-patient relationship with your patients?
Dr. Jessica Cheng: I can't emphasize trust enough. I think without it, I could not do my job. And so that's a huge part of every encounter, is if someone is really scared to move their body for many legitimate reasons, whether it's a bone lesion or this man with all these different medical issues that came up, those are all very legitimate. And so it's my job to build that trust to help them understand where the role of movement is, how movement or exercise might be conceptualized differently. For someone who is a marathon runner, maybe running is not the type of exercise I mean, maybe it's walking slowly. And that's what I mean by intentional exercise.
So, a lot of times it's counseling about people's different conceptions of what exercise or another way to say it is physical activity, what that means to them or looks like to them. And usually I can get some, or usually I say, almost all the time I can get people around. So lots of people, the moment you mention exercise or physical therapy, they're allergic for-
Darrin Godin: The walls go up.
Dr. Jessica Cheng: ... almost everyone. Yeah, yeah, yeah. Like, no, because of this, no, because of that. But I will answer every single question or concern so that there can be no more barriers left besides someone's motivation. And that can be worked on too.
Darrin Godin: You've already shared a patient success story with us, but is there maybe another one that rises to the top for you, or maybe a patient that had goals they accomplished through rehab and maybe gave you a sense of accomplishment as well, in addition to the one you've already shared?
Dr. Jessica Cheng: Oh, yeah. Every time they feel accomplished, I feel accomplished, but it's really when they do the hard work.
And so, another patient that really brought a smile to me was another prehabilitation patient, one of Dr. Josh Cohen's. She had advanced gynecological cancer, and I just had one session with her to introduce the idea of the prehab training for mind and body. And I saw her after her surgery, and her main news for me was, "I did everything you said and I got out of the hospital faster." And me being me, I confirmed with Dr. Josh Cohen, and he said "Yes, yes, she did get out faster than expected." It also gave me an opportunity when following up that she was facing more chemotherapy afterwards. She had concerns about neuropathy. So I was able to set some acupuncture, encourage her to continue exercise, give her some heads up of what that neuropathy path might look like, what the function might look like, kind of moving forward, and just set her up for success, not just the cancer treatment, getting the whole cancer treatment and not having it stop short because of neuropathy. But also the practical, functional daily life aspects of, what is this going look like and mean for you?
So, I truly love being able to walk with someone through their cancer journey from the beginning to wherever that may take you.
Darrin Godin: Let's dig into that just a little bit more as well, because both stories you've told have a bit of a prehab, and you've even used that word, prehab, aspect to it. And then there's also the rehabilitation. So, can you talk to us a little bit more about the difference between prehabilitation and rehabilitation?
Dr. Jessica Cheng: Yes, it's all about timing, the interventions are similar. So, rehabilitation is where the more standard of care is at. What that means is usually rehab, you're rehabbing from something. There was some kind of trauma, injury, pain, or disability that happened, and now we're trying to recover function from that. In prehab, we're applying all of that earlier. So where a lot of people enter the cancer journey already with back pain, neck pain, joint pain, nerve issues, or not exercising optimally. There are already many things to do at the start of the journey, and even if there isn't, there's a role in optimizing people physically, mentally, so that they have less disability afterwards. And so, it's trying to be proactive with their whole cancer care and their whole functional journey.
The focus of prehabilitation is to get the exercise, nutrition, mental health in as much as possible. If it's a mild back pain, that might disappear with the exercise anyways. If there's a barrier to the exercise, then we might address it with medications, injections, to facilitate the participation with physical therapy for focused exercises if there is time for that. But it really depends on the time available, the energy and appointment burden of the patient, and what's feasible, what's practical. So, there's a lot of parts to design the custom prehab training program for each patient.
Darrin Godin: It's kind of mind-blowing to think of all the different aspects that go into treating a patient with cancer. And as I get the chance to interview so many of our physicians, so many of our patients, I learn new dimensions and new aspects that I never even realized. So, when we talk about being a comprehensive cancer center, I think this is what makes us so comprehensive, right? We're coming at it from so many different angles.
To that point, what does the concept of hope mean to you? When you meet with a patient, what are you thinking about when you think hope for that patient?
Dr. Jessica Cheng: Like the multidisciplinary multi-pronged approach, hope is also multi-layered to me. I acknowledge that a lot of times at a cancer hospital, first off, people think of hope as a cancer cure. Now, that is not always realistic for many of my patients. And what I'd like to share is thinking about hope in terms of what is more realistic. In my land, it's focused on hope for meaningful activities. What is meaningful activity to you? What is achievable, and how do we get you there with all the resources that this world has to offer? And so I try to reframe that in the sense that, I am here for you no matter where this cancer journey goes, and meaningful activity applies as long as you have a body that can do some activity. And so, that's one version of hope in my field.
Another version is hope for managing pain and symptoms, because those things, we have many different tools, medications, injections, supportive care, integrative medicine, other subspecialties to help with that aspect no matter what's going on with the cancer. And not to ignore the cancer, of course that's relevant, because that can contribute to all the symptoms, and that's where the multidisciplinary aspect comes into place with communication with the whole team.
And also, I can't ignore the spiritual dimension of hope. That's very important because if someone is struggling with what hope means in their life, then their symptoms, their quality of life, my exercise plan, all of that suffers. And so that's also a very important piece in my care with the patient is, where is their hope currently? Personally, I can say that my hope isn't something that cannot be lost, that is eternal for me, as in Jesus Christ who died and resurrected and gave me life and a hope that is tangible to me. And I wish that everyone can experience this hope, but I also understand that everyone comes from different backgrounds and I need to meet them where they're at and be very respectful of where they are at in their spiritual journey. But I think it's a dimension that is not commonly explored in healthcare, and is definitely something that is so important to so many of my patients. So, I like to at least let them know that this is an important part of their healthcare experience.
Darrin Godin: Yeah, absolutely. I think City of Hope is so focused on treating the patient as a whole person, and that includes their body, that includes their mind, and their spirit. And being the inclusive organization that we are certainly, as you mentioned, we treat all faith backgrounds or no faith backgrounds, but I think it's great that you as a physician can lean on yours as well and bring that to the way that you treat patients as well.
So, what else, Dr. Cheng, would you like to say to our listeners today? What else would you like to leave them with?
Dr. Jessica Cheng: If you have or had or are facing cancer, please start exercising, and if you have any difficulties with that or concerns, please ask your oncologist for a referral to physical medicine and rehabilitation. I know sometimes thinking about functional abilities can be hard to understand, but that's okay, we're used to it. You let us do the thinking, and then we'll work together as a village to help you not only get the cancer treatment, but also get through it as well as you can and survive from it as best as you can.
Darrin Godin: Well, thank you so much, Dr. Cheng. I'm really encouraged by the message that you shared with us today, I think our listeners will be as well. And again, I'm just struck by how much we do for patients to be that comprehensive provider that thinks through all the different aspects of how to give a person the quality of life that they deserve, how to help them to be ready for the treatments that they'll receive, and how to really just thrive afterwards after those treatments, and look back on City of Hope as they really helped me through all aspects of my journey. And you're certainly a big part of that, thank you, Dr. Cheng.
With cancer, you can't pick your battles, but you can choose your warriors. Discoveries made it City of Hope impact more than 100 million lives annually. From diagnosis through survivorship, we are paving the way toward a cure. When cancer and only cancer is the focus, survival happens. We're first in research, first in treatment, and first in survival. Hope First. We hope that you'll visit cityofhope.org/OC to learn more, or to make an appointment at any of our City of Hope Orange County locations, please give us a call at (888) 333-HOPE. That's (888) 333-4673. I'm Darrin Godin, thank you for joining us today on Talking Hope, and we'll see you next time.