 So, to continue, we're very fortunate to have Matt Lascauzzo here today. Matt, I met when I made my way to City of Hope a number of years ago. And Matt's going to talk to us about what is the best way I can care for myself while living with cancer. And Matt has a very unique position in our country as it relates to the evolving role for how we care for cancer patients. As illustrated by all of you here today, there are many survivors with cancer that have issues. There are many people challenged by cancer. And Matt is the Executive Director of the Supportive Care Medicine at the Sherry and Lesbiller Patient and Family Resource Center at the City of Hope Comprehensive Cancer Center. And it is an expert in helping people understand how to approach their disease and manage their time. Matt, thanks so much for taking the time and coming here. Thank you for having me and thank you for having me in this on a day when there's no traffic. Yay. And I also want to say, most people will say, can you hear me? But up here with this thing, I have to ask, can you see me? I'm not Bob Size physically or intellectually. But the bottom line is why I'm here is because of Dr. Figlin and Nancy Moldauer, who are just such great colleagues and leaders in the field in many, many ways. So what I get to do in my 20 minutes is I get to share with you the bottom line is knowing how to live healthy with cancer. There's nothing different than being a person who hasn't experienced cancer and living healthy. Knowing what to do is easy. Doing it is hard. And for those people who do not accept that it is hard, they never get to do it, OK? So magical thinking doesn't work. So what I'm going to share with you is some clinical experience and also some data, because I think that the data really drives this. We know a lot about what helps people to live healthy lives doing cancer. And I'm going to share some of that. And what you're going to pick up pretty quickly is I am actually a person who still sees patients. So I don't have all the answers. You know, it's only the people who teach have all the answers. Those of us who are in the trenches, we really struggle because we engage people. So this looks like something I should press this thing here. Is it this thing? That I have no clue. OK. Dr. Figlin, can you hear? Oh, really, is it this thing? It is this thing. OK, so then maybe I push this. Oh, this big green button, the one that says forward. Well, I'm sure that it works now. I just wanted you to be close to me. OK, you got the drift of this. Cancer's too serious not to have a lot of laughs. So but really ultimately, why do we care about cancer's survivorship? It's real. I have six siblings. Four of them have had cancer. So I sort of have lived this not only on the professional side, but on the family side. And the bottom line is when you're a family member of someone who has been impacted by cancer, you're a survivor on some level also. And the data consistently shows that caregivers, whether they be women or men, their anxiety is often higher than the patient's. So it's really important that whatever I talk about, I always include support systems along with the cancer patient. People are living longer, which is great because of people like Dr. Figlin. But most always recognize that they have been or impacted by cancer. So very few people just put it out of their mind forever. The big difference, though, and you will know this is in the movies and on television, we talk about cancer. I'm 62 years old. When I first started in this field at Sloan Kettering in 1980, there was still a lot of stigma outside and inside of the actual medical center. People also smoked in the medical center back then. So social change is very powerful. That smoking, a illusion that I made, is really important because it shows you how quickly change happens when it finally happens. But fear and rejection is still very common. I'm sure many of you have been impacted by the reality that once you've told someone that you are a family member, have cancer, they react with the old way of thinking about cancer and fear. And they rapidly tell you what you should be doing, although they know nothing about you. And that's fear, right? And we know that. They are trying to be happy. So we need to have higher aspirational expectations beyond merely surviving. But that's true for really everyone, isn't it? So what really helps people? Well, you know what? A lot of people have had a lot of problems for a lot of years. And ultimately, people transcend their limitations. And they transcend their limitations because they are not their limitations. There are those people who look at what is lost. And there are those people who show up from meetings like this, and you are different than people who don't come, who see what is left to accomplish. What is left in your spirit, in your soul, and in your psyche. So really ultimately, although the world is full of suffering, it's also full of overcoming it. And that's in all of our lives, not just those who have been impacted by a serious illness. But there are three primary trajectories that have been shown everywhere in the world where this has been tested. There are those of us who are impacted by life's experiences. And for some people, that could be losing a job. For some people, that could be a serious illness. For some people, that could be kidney cancer. And they're gonna be impaired for the rest of their lives. That's the reality. Most people, most people are resilient and strong and powerful, and they will cope. And after one year, they will come back to baseline, being optimistic or pessimistic wherever they were. And then there's the third group, you group, you. The people who get up on a Saturday and say, I want to learn. I want to confront. I wanna be with others who have wisdom. And that's the group that thrives. We know a lot about this group that thrives now. We're in the past, we did not. And I'm gonna share with you some of what that is. And I think some of it is going to be counterintuitive. So what really doesn't help? On the negative side, on your left side, is these are the things that don't help. People who have delusions. What's the biggest delusion that we all have? What's the biggest delusion that we all avoid? And that is we are all going to die. I'm not here to boost your spirits. You see that, right? But that delusion is very unhealthy. Two weeks ago, I'm with a couple. It's a mom and a daughter, and the mom is healthy. The mom's about 75, and she says to the daughter, I'm right there, I have a piece of jewelry to give you. I wanna give it to you with a warm hand rather than a cold hand. What does the daughter say? You guessed it, mom, you're gonna live forever. And I'm there, of course, Mr. Happy. And I say, did you just miss that your mother was telling you she loves you? Did you just miss that she recognizes that life is a gift and it's finite? Are you gonna cheat her out of the ability to say I love you? I wanna give you something that's going to last. Delusions are dangerous. Because when we are sleepwalkers, we miss life as it's passing us by. Once you accept this reality, life becomes more full, not less full. So when we think of the typical things that really make us not so functional, they're all on the left side and you could read and I'm not gonna go through them. But the ones on the right side are the ones that really matter. Who are the people who do best, the people who accept life on its own terms? Life is bigger than all of us. Who are the people who thrive? The people who are connected to other people, like the people who come to meetings like this and who are constant learners and growers and say, show me where I'm wrong so the life opens up so I could think of life in a new way. I don't wanna hold on to what I think. I wanna be open to life on its own terms. People who are optimistic. Optimistic doesn't mean delusional. Optimistic means that this is the life that we have and I'm gonna make meaning out of every experience that I have and all of the list on the right side all has data and research that shows these are the people who do better. Even atheists who are deeply spiritual do better. Anyone with a sense of being connected to something bigger than themselves do better. Victor Frankel's work and many other people's work has shown this over and over again. So what really makes healthy self care? Well let's look at some of the challenges which we all face every single day and the number one is we like to be in control. Gee whiz, nice wish to have. Predictability, life is constantly changing. Connection with others, we can control this, we can do this, we can work at this and of course meaning, right? If you have the why, the how's easy. So it works out that all of these things are of course impacted when one is seriously ill and nobody gets through this life unscathed. If anyone who's over 40 has some pill that they are taking, okay, that is the reality. So when you've suffered a great deal in life, each additional pain is both unbearable. Oh no, not one more, but it's also a trifle because I've been through this before. We've all been through it. Now what are some of the things that really help and where do they come from? Motivation, you could have stayed in bed today, you did not, there was something driving you except that you are different than many, many, many people because you are here. If you accept that you are different, it only pushes you to a higher level. It pushes you to a place of courage and thinking, 10 years from now, what am I gonna be saying about how I'm living this moment? The moment you take yourself out of this moment, put on your retrospective scope and look back and say, am I living the life I want to be living or am I living the life I've only inherited? One is being responsible, personally accountable, courageous person, and another one is being passive. And I would bet the passive people are not in this room because you have taken control of that. But we do not live in a vacuum, we live in a world and we're impacted by this world. And it's important that we understand this because the health system, as you know, our health system in many ways is not very healthy. It is not health focused, it doesn't make us easy to get through our systems. But if you have a physician, a nurse, a team, who you trust and who you care about, all of a sudden so much becomes possible. In the opposite setting, where you don't have that, it becomes almost impossible because there's gotta be someone in this life who you trust and you gotta feel they are competent. And that's often crucial and that's why we really help people and we ask them this question, do you have trust and faith in your team? And if you don't, let's talk about that. Is that you or is that the team or is it just communication that isn't hooking up? It can be any of those, but if you're honest and open and non-delusional, you're open to, gee whiz, maybe I have to interact in a slightly different way with my healthcare team. Maybe my expectations are not where they should be or maybe my healthcare team isn't the team that I personally need, nothing better about them but I may need something different. That's taking control of your life and that's hard. And society has changed so much, I don't have to tell you. In the movies now, on television now, people talk about illness all the time and almost to the point, and I'll have a slide that shows what one of the dangers is, almost to the point that we expect too much from people. We're almost expecting more from them when they get sick rather than helping to say let's transcend the illness and let's get you back on track. So why do we care about all of these? Because if I look at the research and if I look at the data, then this is gonna surprise some of you. And I've never smoked a cigarette in my life so I'm not talking about smoking. But if you have to choose between smoking cigarettes, which will kill you, drinking too much, which will kill you, or being socially isolated. The biggest danger of those three is social isolation. I'll say it again because the original studies happened in Southern California. Social isolation is a killer for both women and men, young and old. There's something about social isolation on a cortical level, on a molecular level, on a social level that keeps you living longer and healthier. Now that may be that people who love you will kick you in the tush, or that may be when you go to the synagogue, people are gonna say, see my doctor. That could be when you go to church. It could be any of those things, but social isolation is not good. And behold, you are here. So on some level you know that because we learn from each other, we thrive on each other's wisdom. And the full biopsychosocial model, one of the pleasures of working with both Dr. Figlin and Nancy was this. We could talk about the bio, the body, the biology. We could talk about the psychological and the social. And I can't imagine anyone in the healthcare field does not know that every time we interact there are biological changes. Every time you cope your brain is changed. Every time you pull up a memory there's a physiological change in your hippocampus. So there is no such thing as biological without psychological. There's no symptom that doesn't have a psychological social impact, be it nausea or constipation or pain or depression. They're all biopsychosocial. Knowing that is great, because you can intervene at any of those levels. So then we have the situation which I'm concerned about is that when people get ill now we expect so much of them. We said, oh, you have to be upbeat, you have to be positive and all of this stuff. Well, you know what? Being optimistic is different than living in a fantasy world. Being optimistic is accepting world as it is and making the best out of that life. That's different than when people are pressured to say be positive because your cancer won't grow faster. There's no data that shows that. And now if you know about some of that data I would love to hear it because I'll open up a clinic very quickly and tell my bad jokes. But we have no data that really shows that. So in this next slide, tragic slide, I remember the day some of you might when the first superman took his own life. Being superman, superwomen is dangerous. Being a human being that has frailties, that has vulnerabilities and can use those to connect with others to gain strength out of it. That is what we human beings are about. Super people are destructive because it's unrealistic. The other thing is how do we engage each other? How do we connect with each other? The number one driver of health are those things that I'll talk about in a second. But if you want to be healthy, surround yourself with people who are mentally healthier than you. If you want to be healthy, find those people who you used to cringe at because they would go walking or they would say, no, I'm not gonna eat that. Or they're gonna say, yes, I'm going back to the doctor. Go back to those people, you miss them. Go get them again, pull them in. You don't have to live with them but associate with them. Merely associating with people who are mentally healthier than you will make you mentally healthy. I don't have to tell you, when I came into this field, again, this is a biggie, cigarette smoking. When I came into this field, many of the surgeons with whom I work smoked. It's hard to find them anymore, thank heavens. And that's social pressure. We knew 300 years ago, not in 1960, when the surgeon general came out with this, 300 years ago, we were opening up people and saying, look at those lungs, that person smoked. We knew this 300 years ago. It wasn't data, it was people saying unacceptable, secondhand smoke kills me, you're not gonna do it anymore. Social pressure really helps. I don't have to tell all of you about racism. Years ago, people were very open about this group or that group and now people just don't do it anymore. Why? Because of social pressure. But social pressure also works healthfully. It gets you to do the right thing. And we know that people who are connected to other living beings do better. Okay, so what are some of the ways that you could do better specifically? One is, take yourself out of the emotional moment when you're feeling stressed and decide to be a wise and healthy person. How do you do that? You say, one day, one week, one year, what am I gonna say about what I'm doing with my life today? This person just got me really irritated. How am I gonna respond to my partner, to my spouse, to my physician, to my family in a way that a year from now I'm gonna be really proud of? Rather than just reacting and jumping on them, what if I say, I want you to know that, what you just said really upset me. So let me take a moment to think about what just happened because I want to respond in a way that I'm proud of. The moment you do that, your brain shifts. You then went from the spinal cord and the limbic system, the oldest part of the brain to the cortex, to the speech center. That gives you a higher level of wisdom. Okay, one creates energy and the other one creates effective action. You don't have to know where it happens, but you have to know that it works. So there are a whole host of these brain functions that we're understanding better and better. One that I share with patients all the time is if you're crying, and crying is a very healthy thing. Although in the healthcare system, often if someone cries, they treat it like bleeding. They apply pressure until it stops. That's not a good thing, okay? But sometimes you're trying to communicate and you're crying and you want to stop. If you want to stop, put your finger in your belly button and breathe evenly and slowly and the tears will stop. You'll still feel dreadful, but you'll stop crying and you'll be able to talk. Okay, that's called lateral inhibition. The more we know about biopsychosocial, the more we can help each other, right? Because we're all in this world together. None of us are going to get out alive, but we can live deeply meaningful lives though. And that's what we can do. So we want to understand each other's motivations. Mind reading is magical, it's dangerous. If someone does something, it's better to say, what were you trying to achieve by what you just told me? Rather than thinking what you think that they said and meant. So when men isolate, when women want to talk to them, rather than saying you're avoiding me, you don't love me, you don't care about me, it is you're sitting there when I was trying to talk with you, what are you trying to achieve by cutting off? And you may hear something like, I'm so upset about you being ill, that I don't know what to do and I feel that I'm failing you. Think about the different conversation you could have in that second part when you're not mind reading. When you say to the person, what are you trying to achieve when I tell you I'm really scared and you tell me don't worry about it? Well, I'm trying to protect you. That doesn't protect me, it means that you're shutting me down. So in the three and a half minutes that I have left, one of the big things that people have to do is let go of the past, stay in the present. If you want your relationships to work, just start acting like you have the relationship that you want already and just do that. That works better than years of therapy, the data shows that, okay? Except I'm all for therapy. I'll give you my card later, okay? Professionals really do help people, but generally in relationships, people have the strength to move forward. If they focus on the present and the future and let the past go, right? Focusing on who is right means you both lose. Whenever someone ends up being right, there's a winner and a loser. And you know what loses? The relationship always loses. Use iMessages, be a good listener. Communicate in a way that you'll be proud of later. The moment you think about the future, your present becomes richer because you're seeing the you you want to be rather than you have been. So I'm almost at the end here. These are things that you could take home with you, reach out to others and share your concerns. People think that if they bottle them up and hide them, they'll go away. They won't. They'll appear on your waistline. They'll appear when you get a divorce lawyer. They will appear in other ways. Feelings are only feelings. If you direct them and use them, they give you energy to have a more meaningful life. Share them with others. Surround yourself with those who you love. The research is overwhelming. If you want to be a happy person, all you have to do is this. Do more of what you like doing and less of what you don't like doing. That's it. There is nothing else. We didn't need Freud to tell you that. Okay? The hard part is doing it, right? Do more what you like. See yourself as a much bigger part. The moment we see ourselves as a much bigger part of a social context, all of a sudden healing happens. All of a sudden we feel more deeply connected to other people. Every day, write down two or three different reasons why it's great to be alive. And I don't mean think about writing them now. Literally write them down and look at them. Driving here today, I was looking at the mountains and I was feeling lucky to see Dr. Figlin and Nancy and all of you. I felt lucky to have the experience. I was feeling so different, you know, than if I was thinking about, oh, I'm driving in this car for 40 minutes, whatever. It was a beautiful ride. That's a conscious decision. Attention and intention is under your control. Take it. Don't ever give it back. And then finally, the New York Yankee coach. Oh, I mean the Los Angeles Stodger coach. Joe Tory, as you know, had prostate cancer. But the rest of these people all had kidney diseases. And you know Mozart on the bottom left, he didn't do so bad, did he? And that's Natalie Cole and really Steven Spielberg and that's James Mitchell who died at age 97. You know what? Life is a good thing. It's a pleasure to have met you.