Talking Hope: Connecting spiritual care and cancer research

Talking Hope is brought to you by City of Hope, an NCI-designated comprehensive cancer center and Orange County’s most advanced cancer care. We bring together renowned cancer experts, grateful patients and leaders in the cancer community to share vital conversations, personal journeys and unique insights into the disease that is diagnosed in one in three people during their lifetime and impacts us all.

How do spiritual care and pioneering cancer research intersect? Find out in this fascinating discussion with City of Hope Orange County chaplain-scientist Frank Munoz, Ph.D. In addition to his work as a clinical chaplain, Dr. Munoz is a scientist who integrates spiritual traditions and mind-body medicine into his practice. His research focuses on how mind-body medicine techniques can support coping with stress and how these techniques can be applied on a genetic level. Under the umbrella of integrative medicine, which uses evidence-based, complementary practices in combination with conventional medicine, City of Hope can help patients with cancer regain health and build a lifestyle focused on wellness, part of our holistic approach to patient care.

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Darrin Godin: Hello, I'm Darrin Godin, Chief of staff for City of Hope Orange County, and this is Talking Hope. My guest today is Frank Munoz, who serves as both chaplain and clinical researcher at the City of Hope, Orange County Lennar Foundation Cancer Center. I think it's going to be a really interesting discussion. Welcome to the podcast, Frank.

Frank Munoz: Good morning. Good morning, everyone.

Darrin Godin: Good morning. So chaplain and clinical researcher, spiritual care and mind-body medicine. Your background must be very unique to bring those two together. Can you tell us more about your background and how you were led to this role?

Frank Munoz: Yes. The foundational experience I had was during my Army chaplain training. There is a trauma ministry program where the Army uses their trauma centers to train, basically their medical teams, and they included the chaplains as well. This is battlefield training so on the battlefield, the chaplain joins the medical team to serve the dead, the dying, and the wounded. Our role on the trauma team was to bring a sense of calm, both to the medical team and to the patient. The training happened in San Antonio at Brooke Army Medical Center. We were part of the medical team, and the chaplains had... Their position was right next to the surgeon. We were with the surgeon, we were with the patient, or with the whole team. Out of that foundational experience, I've learned how chaplains bring a sense of calm to kind of decrease the level of stress.

Darrin Godin: How do you do that?

Frank Munoz: How do you do that? Yeah, I think first, our first patient is the chaplain, is ourselves. We learned how to maintain a sense of calm in the midst of all the chaos and distress. That's something definitely takes time. We learn how to do. That's basically what led me eventually, into mind-body medicine. I just had lots of questions. I could see in subsequent experiences, both in pediatric and adult oncology experiences, that how I presented my spiritual care really did have a calming effect to focus first for myself, that I remain calm and centered. That actually had an effect on the patient and their family as well. Of course, this created lots of questions for me. I see I can have a calming effect on patients and families, but what's happening biologically, physically here? That led me to inquire about research training. I received a couple of research training grants with the National Cancer Institute, and that led me to the Mind-Body Medicine program, which the National Cancer Institute actually funded my doctorate in Mind-Body medicine. There, I learned more about the science, about our mind-body connection, and how I-

Darrin Godin: Was this why you were still in the military, or was this something you pursued after discharging?

Frank Munoz: This was after discharging, I would say almost like 15 years later, after lots of experiences at the bedside with patients and families. I think it really opened up just a new frontier. It was easy for me to kind of fold spiritual care into mind-body medicine. So spirituality in religious practices, they're all about seeking peace, meaning, and that folds very neatly into mind-body medicine as well.

Darrin Godin: So tell us a little bit more about mind-body medicine. What exactly does that mean?

Frank Munoz: So mind-body medicine, what we study is how the state of our mind affects the state of our bodies, how our bodies function. There's definitely physical, biological connections. In our thoughts, our feelings definitely affect how our bodies function. The best example is stress. Chronic stress definitely has an effect on how our body works. That led me to another level. Another question I had is how is this affecting our genetic function, our genes, since our genes are kind of like the managers and directors of our bodies? I began to learn that not only does our thoughts, our feelings affect our body functioning, but also affects our gene functioning.

Darrin Godin: So what have you learned in your research?

Frank Munoz: Well, I've learned that stress kind of enables gene expression for inflammation. Inflammation is kind of a healing response in our bodies, and so stress is perceived by our bodies to be kind of form of injury, and our body responds that way. What was meant to be healing though begins to lead to, if it continues chronically, it begins to create other problems for us. Techniques like meditation, prayer, yoga, exercise, those are all techniques that tap into our body's natural resources for healing. That's the other part of mind-body medicine is that we do have... It does identify and articulate our own inner resources for healing, for caring for ourselves.

Darrin Godin: So interesting. Your role here at City of Hope Orange County is both, let's call it bedside or patient side spiritual care, as well as you're continuing this research?

Frank Munoz: Yes, yes. It'll be a busy time, but I think they go hand in hand. I continue to learn from our patients and families how they cope. A lot of my learning comes from them. In fact, all of my learning has come from them. I learn from them how they're coping, how they're dealing with a cancer diagnosis. Then out of my experience, you might say, I learned how to apply what I've learned to support them.

Darrin Godin: Will there be clinical trials related to this, or is this a different type of research?

Frank Munoz: I think eventually, down the road. I'm working with Dr. Richard Lee, and we have a couple of studies on the launchpad. One dealing with meditation, and the other dealing with aromatherapy. Those are more feasibility studies, studies to see how well they work with our cancer patients. Then once we get results, then we'll be able to build kind of a stronger foundation to build more clinical trials.

Darrin Godin: Very interesting. Is this a unique blend for folks who do chaplain work to also be a researcher?

Frank Munoz: Yes. I would say, I think... Really, be honest with you, I don't know anyone else who's a chaplain I would say, who's doing this kind of work, especially in the genetics part. I actually just completed a post-doctoral fellowship in clinical cancer genomics at the City of Hope Duarte campus. Now I'm at the City of Hope in the Orange County campus, and there I studied with Dr. Stacy Gray, cancer genomics, and her team. I think as far as I know, I'm the only one who's actually delved into this territory, trying to bring everything together. How does spirituality affect our gene expression? I think I'm the only one who might be doing that right now.

Darrin Godin: Very interesting and innovative, and a different skillset that we're bringing to Orange County, and hopefully we'll be able to expand across the broader City of Hope system as well. Let's go back to spiritual care for a moment. We talk about caring for patients as a whole person, body, mind, and spirit. As a chaplain, when you work with families or patients, what are the implications if we don't care for them as a whole person and we only treat, say the illness.

Frank Munoz: Right. Yeah. The implications are, I would say serious. Patients, their approach to their families, their approach is holistic. They're using their spirituality, their religious practices. In healthcare chaplaincy, we believe everyone has a sense of spirituality. That may be their own personal set, a belief system or that may belong to a community of faith, but spirituality and religion are the common denominators. They're all seeking peace, hope, meaning, purpose. As healthcare chaplains, we're there to support that journey and that access to their resources. For the patient and family, they're using everything. They're using a whole person approach. For us not to acknowledge your spirituality is not acknowledging a very significant part of their lives and how they're dealing with their cancer diagnosis.

Darrin Godin: Wonderful. How are we inclusive of so many faith traditions or no faith traditions, in some cases? How are we inclusive, but still able to provide that chaplain support and that spiritual care support?

Frank Munoz: Yes. As a board certified healthcare chaplain, we received training beyond our religious training so there's an extra, at least minimum, a whole nother year of training where we learn how to provide appropriate support for patients, families, and also for staff as well. The focus is not on our belief system, but on the belief system of patients and families. We don't necessarily have to have the same belief system, but we bring... The healthcare chaplains bring a strong emphasis, a strong sense of respect, and admiration, and support, and compassion. We're here to walk alongside them, patients and families, and support them and help them any way we can.

Darrin Godin: You speak about staff, and I want to go back to that in a moment because that's obviously a soft spot for me as Chief of Staff and caring for our team. But walk us through, when does your role get involved with the patient? When a new patient comes to City of Hope Orange County, how soon might you get involved and what does that look like? Is that something that a physician prescribes that you come in and talk to them, or do they have to request it? Walk us through that process.

Frank Munoz: Yeah, generally it's... That's a great question. Generally, the patient or caregiver may raise a question or request that has spiritual or religious connotations, and the provider, that might be a trigger for them to reach out to the chaplain team. I think ideally, we would be part of the initial visit and assessment. I mean, if you're asking me in my opinion, we would definitely be triggered right alongside everyone else just to check in with the patient and family and introduce ourselves. That way they can see us face-to-face, and let them decide if they want to make us part of their care. Obviously, there's still a lot of education and misunderstanding what the roles of the chaplain are. We're not here to push any one perspective. I think a lot of people need that reassurance that we're here to be of support, and that's something we can easily do and we're trained to do as well.

Darrin Godin: So you're literally part of the care team, care model we offer here at Orange County, which is really holistic and inclusive of many different aspects that are beyond just caring for the thing that's in front of us.

Frank Munoz: Exactly. We're in the process... I've actually been here maybe a couple of months. We're in the process of setting everything up where we will be integrated with the care, so physicians and other clinicians will know how to trigger the chaplain services, crucial care services, and we will be involved in every aspect.

Darrin Godin: That's great. So let's go back to the staff piece. You mentioned the staff. I think cancer care is a calling, and we bring in some of the brightest and most caring and loving people to really serve in this area, but it's difficult for some of our staff. There are difficult times. What sort of support do you offer to staff, and what does that look like?

Frank Munoz: Yes, this is great. Thank you. Actually, in my military chaplain training, we learned how to provide support for soldiers and the medical teams. We learned a basic format, which I call kind of a spiritual debriefing. If the medical team is calling on a chaplain to provide some support, if they've had a hard time, difficult time, we come in and maybe open with a very open prayer, and allow the staff to debrief and share about their experiences. Then I may close with a prayer, but the prayer is usually very inclusive and reminding us of just the transcendence of our lives. Usually, if the staff wants the chaplain involved, there's kind of a desire to touch into that sense of transcendence.

Darrin Godin: Very cool. Well, it's great to have you on the team, and I look forward to seeing the great things that you do, definitely. You're collaborating on research in the realm of integrative medicine. What other studies are you helping with?

Frank Munoz: Well, I think, what I'd love to do in the future is I've done a couple of studies where I use the mind-body intervention to measure the effects on gene expression, usually genes involved with inflammatory response, tumor suppression or cognitive functioning. So I hope to return to that and in near future and also begin studies along those lines. I know usually in my experience, the patients are really jazzed and interested. They want to get involved. They want to learn more about what's happening within their bodies. Even in my postdoc experiences, patients were always really keen and interested in learning more about genes and genomic education. That's something I also hope to provide as well. I've had some training as well, so I can speak on their level because I am at their level, and it's easy to lay down a basic foundation.

Darrin Godin: Excellent. You share very plainly. I know some researchers could speak so high level that people can't quite understand what they're talking about, but I get the connection you're making. Are there misconceptions about the role of chaplains in healthcare, and how can chaplains work to make spiritual care more accessible to patients?

Frank Munoz: Yes, definitely. I think on the chaplain side of things, we need to do better of what kind of skillset we bring to healthcare. That's something on the chaplain side of things as a discipline we're working on. I think I mentioned earlier, bring reassurance to patients and families that our role is supportive. We're not here to teach them what to believe or how to practice, but we're actually more the students. They're the teachers. We learn from them. For a lot of people, it's there, but they've never really articulated it. We have that training and that skillset to help people become more aware of what their spirituality means and what that looks like. For that, teach them to learn how to access. Any teaching that we do is just helping them to redirect inwardly where their strength and inner resources are because they're there, and they're using them already in many ways.

Darrin Godin: What about outcomes? What have you seen with outcomes? Just when a chaplain is involved with a patient's journey with cancer, a patient's family with cancer, what have you seen the outcome kind of be when the chaplains are involved?

Frank Munoz: My experience is it's just some things that patients have shared with me as things like, "I don't know how I could have gone through this without you." Again, it's like some patients have shared, "It's not so much what you say. It's just who you are." One person was telling me, "I pay a psychotherapist $250 an hour, but when I'm with you, it's just a totally different feeling." They said, "So maybe you should be a psychotherapist." I think it was more about that presence that we bring with the patients and family. We're not the answer people. We don't bring answers, but we do bring a presence and a support to help them find their own answers in their own meaning and purpose.

Darrin Godin: That's great. I teach our OC orientation class, and one of the things I like to share is a personal experience I had when I was in the hospital a few years ago in that I really felt like I experienced the presence of God whenever the caregivers were in the room. Didn't know what their faith tradition was or if it aligned with mine, but something about the fact that they were there, and present, and offering me the care that I needed at that time... Of course, it was during Covid and I was all alone, but it was very clear to me that there was a presence there with them, whether they knew it or not. I like to share that with our team as well, that the work we're doing, especially with our patients with cancer, is in a way, it's very sacred work. Being open to that, even if you're the MA rooming a patient or walking somebody from the front door to the elevator, that little bit of time, that little bit of presence can make all the difference in the world for somebody who's facing the challenge in their life.

Frank Munoz: Completely agree. I've had nurses ask me, "Frank, can you teach me what to say when I'm working with my patients?" I say, "Well, I think when you display compassion and care as you're treating your patient, when you touch them gently, that is powerful spirituality," just like you're saying, they feel-

Darrin Godin: Fully present for that moment. Even if it's the 30 seconds of showing them to their next location or something, being fully present and being aware of them and seeing them, I think is a huge thing. Right.

Frank Munoz: We feel compassion and respect. That has a powerful healing effect on us.

Darrin Godin: Very much so. Touches you at the very core of who you are. You're seen as a human, and your dignity is kind of honored. Yeah, absolutely. I think I may have said this earlier. We have this saying, "When we take a patient's hand, we never let go." What does that mean to you as a chaplain?

Frank Munoz: For me, I would say it's about being able to impart what I've learned in their journey, the support. I definitely see my role as a companion, and that what I have learned that I'll be able to pass on to them, and that I'll be able to facilitate their integration. Through my own religious academic training, I actually know how to read Hebrew and Greek and so for me, the biblical meaning of hope is about presence. It's not so much of an expectation. It's more of a confidence in the present, and for the patient and family to know that I am there for them, and I'm behind them 100%. They can depend on me to always come through.

Darrin Godin: Thank you for sharing that. On the heels of that, so what does hope mean to you as well?

Frank Munoz: Yeah, hope, for me is that not so much... Not a future tense, but it's a present tense. It's a presence of companionship that we will share each other's burdens. I will be there to carry their burdens any way I can, and they will know that that I am there for them, 100%.

Darrin Godin: That's beautiful. It's beautiful. Well, thank you so much. Frank Munoz, our chaplain at City of Hope, Orange County Lennar Foundation Cancer Center. Thank you for talking hope with us today. It's been a pleasure getting to know you and the work you're doing, and thank you all for listening. I hope you'll join us next time for our next episode. I'm Darrin Godin, and this is Talking Hope.

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