Dr. Meera Ravindranathan of OncoHealth On The 5 Things Everyone Needs To Know About Cancer

It’s OK not to share your diagnosis with friends and family until you’re ready: Some people may think they need to tell everyone right away when they receive a cancer diagnosis, but this isn’t true. It is completely fine to take your time, identify who your trusted people are, and share with them first. There is absolutely nothing wrong with that and there is no rule that everyone in the world needs to know you have cancer if you would rather it be private. Every journey is different and doing what feels right to you when it comes to sharing your diagnosis is the most important thing.

Cancer is a horrible and terrifying disease. There is so much great information out there, but sometimes it is very difficult to filter out the noise. What causes cancer? Can it be prevented? How do you detect it? What are the odds of survival today? What are the different forms of cancer? What are the best treatments? And what is the best way to support someone impacted by cancer?

In this interview series called, “5 Things Everyone Needs To Know About Cancer” we are talking to experts about cancer such as oncologists, researchers, and medical directors to address these questions. As a part of this interview series, I had the pleasure of interviewing Dr. Meera Ravindranathan.

Dr. Meera Ravindranathan is a Medical Director at Iris by OncoHealth. Dr. Ravindranathan has more than 15 years of experience treating a wide range of cancers and is a graduate of the Virginia Commonwealth University School of Medicine. She maintains a part-time clinical practice in California and her passion is delivering excellent care and quality improvement in medicine.

Thank you so much for joining us in this interview series! Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your childhood backstory?

I’m the daughter of immigrants and my dad came to the United States during the 1960s to complete his medical training in Chicago and St. Louis. We ended up settling in a rural area of Southern Illinois where I graduated from a very small high school class of 90 students. My mom never had the opportunity to go to college, because in her childhood, the emphasis for women was getting married and starting a family. She always was the one who told me I should dream bigger, and she was ahead of her time back in the 80s and 90s in raising me with this mindset. I have a lot of that spirit in me from her.

What or who inspired you to pursue your career? We’d love to hear the story.

Shortly after my dad immigrated here, his father was diagnosed with a very rare cancer called Sinonasal Undifferentiated Carcinoma — we use the term SNUC now. This was in the late 60s in India and oncology care was only in its infancy. His doctors tried experimental radiation on him, which unfortunately resulted in a lot of pain, facial burning, and other side effects, yet did nothing to control the tumor. He died a very tragic death with no quality of life in a small village without his son, who was the only doctor in the family, there. That story has always touched me and inspired me to pursue my career in oncology. At the beginning of my career, the first patient I ever took care of by myself as an attending physician had the same tumor, which is super rare, as I have only seen two in my whole career. His treatment was successful, and he ended up having a fruitful career as an artist. This full-circle moment affirmed that I had chosen the right career path, and I am proud to help patients like him.

This is not easy work. What is your primary motivation and drive behind the work that you do?

In oncology, you really connect with patients and their families as you’re helping them through such a sensitive and rough time. It can be exhausting, but as Mr. Rogers said, you have to look for the helpers in life, and I feel privileged to be able to help them. Patients and families can be very inspiring in those hard moments, and that’s what keeps me going — that sense of connection and getting to know people and being there for them during those low points.

What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?

I’m still doing clinical practice, but I spend most of my time now working on Iris by OncoHealth. Iris is a digital care management platform that delivers personalized oncology care from trained oncology professionals to support cancer patients and their families as they navigate the emotional challenges and physical symptoms caused by cancer and cancer treatment. Patients can access care delivered by US-based clinical oncology experts from the comfort of their own homes from an easy-to-use smartphone app. In addition to providing support with mental health and symptom management, Iris helps support patients through their cancer experiences with helpful content across cancer types. For example, we’re currently conducting a webinar series on “taboo topics” such as intimacy with cancer and the embarrassing side effects of undergoing cancer treatment. Removing any stigma or embarrassment around these topics is an area I am personally very passionate about.

For the benefit of our readers, can you briefly let us know why you are an authority about the topic of Cancer?

I don’t know if anyone can ever be a complete authority in oncology because there’s always so much new research coming out and advancements being made, which is one of the things I love about cancer medicine. In surgery, new procedures may be developed, but in general, once you learn certain things in a specialty that is kind of your wheelhouse. But in oncology, the things I learned in my training are completely different than how we practice today. That being said, I have over 15 years of experience treating a wide range of cancers. After graduating from the Virginia Commonwealth University School of Medicine, I did my residency in Internal Medicine as well as fellowship training in medical oncology at the University of Texas Medical Branch. I still maintain a part-time clinical practice in California in addition to my work with digital health at OncoHealth.

Ok, thank you for all of that. Let’s now shift to the main focus of our interview. Let’s start with some basic definitions so that we are all on the same page. What is exactly cancer?

How I put it simply when people ask this question is that cancer is just a regular cell with bad behavior. Cells in the body should go through a particular life cycle where they grow, replicate, and then die off to make room for new cells. A cancer cell loses that die-off button and just won’t come off the playground and it continues to run around and grow. Since it’s not going through the proper cycle, it starts to take over the normal blood supply of tissues and cells. It’s important to recognize that cancer cells are not an outside entity that comes into your body — it’s a normal part of your body that just is dysregulated.

What causes cancer?

There are a variety of factors that can cause cancer. Certain substances can be a cause, such as carcinogens from cigarette smoking that can lead to lung cancer, and even viruses like the human papillomavirus, which causes cervical cancer. Additionally, people can have genetic mutations that are inherited. The BRCA mutation is one of the most known ones that can make someone more susceptible to breast and ovarian cancer. There’s also a genetic change called Lynch syndrome that makes you more susceptible to some gynecologic cancers and colon cancers.

But then we all know healthy people, like my grandfather, who lived in a village in India, who never drank, never smoked, was a vegetarian, didn’t have access to processed foods, who don’t have the exposures or habits that put them at increased risk of cancer. So how do individuals such as these get cancer? The explanation for that is more in a field called epigenetics, which looks at changes in our genes. There are turned on by the environment and lifestyle factors, so kind of like Homer Simpson once famously said, a little bit of column A, a little bit of column B.

What is the difference between the different forms of cancer?

We generally differentiate cancer by the organ the cancer cells started in. So, for example, lung cancer starts in the lungs. Yet there are different types of lung cancer — there’s something called non-small cell and small cell or adenocarcinoma and squamous cell. So, while all lung cancers start in the lung cells, there are different cells that make up the lung and that’s why there are different types of cancers within an organ. So that’s how we differentiate it — in broad terms by organ and then on a more cellular term by the type of actual cell that has become cancerous.

I know that the next few questions are huge topics, but we’d love to hear your thoughts regardless. How can cancer be prevented?

There’s no 100% guaranteed way to prevent cancer. That being said, eating right is something we can do to lower our risk. That doesn’t mean you can’t eat carbs, or you can’t eat sugar, but what it does mean is eating a diet that’s rich in whole foods like fruits, vegetables, and grains. We all need to have birthday cake sometimes and life isn’t really fun unless you enjoy what you’re eating too. But if we can make up most of our diet with good foods, it keeps our immune system and body healthier, so even if you do get a cancer diagnosis, you’re in a better place to receive treatment. We know exercising regularly also contributes to our overall health, decreases rates of heart disease, and likely decreases the risk of cancer by helping maintain our weight and increasing muscle mass.

How can one detect the main forms of cancer?

The main and most important thing you can do to detect cancer is to get screened. Everyone who is over the age of 45 should have their first colon cancer screening. If you’re a current or a former smoker, you may qualify for a lung cancer screening as well, which is not as widely known. For women, you must get your mammogram every year and make sure you’re up to date on your pap smears. These screenings are like wearing a seatbelt — you could still be in a car crash, but the chance of having a fatal injury is much less. The same analogy applies to cancer: if you get screened, you could still have a cancer diagnosis. However, if you catch it earlier, the higher the chances are of treating it and curing it.

Cancer used to almost be a death sentence, but it seems that it has changed today. What are the odds of surviving cancer today?

The earlier cancer is detected, the better chances of survival, which is why cancer screenings are so important and lifesaving. Even for patients who are diagnosed with later-stage cancers, people are living longer due to new therapies and treatments. When I was in training, there were maybe two drugs to treat a blood cancer such as multiple myeloma, and now there are such a wide variety of different treatments. If you get a cancer diagnosis, no matter what your age is, you should talk to an oncologist to develop the best treatment plan. We’re fortunate that cancer is no longer a death sentence, and there are really good therapies out there that don’t have a lot of side effects and can help you live longer and preserve your quality of life.

Can you share some of the new cutting-edge treatments for cancer that have recently emerged? What new cancer treatment innovations are you most excited to see come to fruition in the near future?

The big one right now is immunotherapy, which is like revving up your own immune system to get it to start recognizing cancer cells as bad. Traditional chemotherapy works to kill off the cancer cells, but unfortunately, it kills good cells along with it since the chemotherapy doesn’t know how to differentiate one from the other. It’s taking everything out, which is why patients experience symptoms such as low blood counts, nausea, and hair loss. Immunotherapy is more directed since it can tell your own immune system to start recognizing cancer cells as dangerous and eliminate them. While it does have some side effects, they’re not as harsh, and a lot of times it works better than chemotherapy. I’m really excited to see the advancements we’re making in this area.

Another exciting innovation is something called genomic testing. We use this a lot in breast cancer where we are testing cancer cells to determine the likelihood of the cancer cell recurring. We’ve always known that we over-treat certain people with cancer and sometimes give chemo to people who may not benefit, but we don’t want to undertreat them either. Now that we are beginning to have a better understanding of tumors, we can make a patient’s treatment regimen more personalized to them and their genes to improve patient outcomes and decrease harmful side effects.

Healing usually takes place between doctor visits. What have you found to be most beneficial to assist a patient to heal?

Leveraging a digital app such as Iris that bridges the gap between office visits is a great way to ensure patients are managing any side effects from treatment and have access to the resources they need. It’s very common to leave your doctor’s office and be like, oh, I forgot to ask this question, or I’m having that side effect that I wish I told them about. Having oncologists at your fingertips with an easy-to-use mobile app helps to make sure no questions are left unanswered in between treatments and can ensure better care overall.

From your experience, what are a few of the best ways to support a loved one, friend, or colleague who is impacted by cancer?

If they have children, one big thing you can do is help with childcare. Be super intentional and plan a day where you take their kids to the movies or the park to help give that loved one a break. Otherwise, assisting them with chores or everyday tasks such as their laundry or yardwork, is also a great way to show support. In terms of meals, people with cancer typically get bombarded with food from others hoping to help, and while the intentions are always good, you just don’t know what kind of food that person is going to be able to tolerate after chemo. A better option would be a gift card to Uber Eats or Grub Hub where they can choose what they want to eat themselves and have it delivered.

What are a few of the biggest misconceptions and myths out there about fighting cancer that you would like to dispel?

One of my pet peeves is the term “fighting cancer,” and the analogy of cancer being a war or a battle. This terminology infers that there is a winner and a loser. There are some people who can finish their treatment and do not have cancer anymore and there are other people whose lives will ultimately be lost to cancer — but this does not make them a “loser” or mean they are any less of a fighter. As far as common myths, there is a misconception that the side effects of chemo are all the same, but it is not always nausea, vomiting, or hair loss. There are different types of chemo and lots of different side effects, so be sure to talk to your oncologist about what to expect before receiving treatment.

Thank you so much for all of that. Here is the main question of our interview. Based on your experiences and knowledge, what are your “5 Things Everyone Needs To Know About Cancer? Please share a story or example for each.

Not all cancers are treated the same way: Even if you get diagnosed with a more common cancer, such as breast cancer, your breast cancer may be treated differently than someone else’s. Some people need chemo, some are told to take pills for five years, and the list goes on. Try not to compare your experience to another person, but instead focus on asking your doctor questions that will help you understand the rationale for your care. It’s important to talk to your doctor about your treatment and understand why they’re recommending that specific treatment rather than comparing yourself to others.

Mental health therapy is helpful for most patients with a cancer diagnosis: Seeking mental health can improve your quality of life and help you manage the emotions that come along with that cancer diagnosis. It can also help you communicate better with your friends and family. One example we have from Iris is there was a 19-year-old man who was recently diagnosed with terminal brain cancer. Our Iris mental health professional helped him figure out how to talk to his doctor about his depression and get on an SSRI. She also helped him have difficult conversations with his friends and his family members about his diagnosis. Just because you seek out therapy, does not mean there is anything wrong with you, and addressing that mental health piece is so important when dealing with the accompanying emotions from a cancer diagnosis.

A nutritionist can provide needed insight while going through treatment: Cancer nutrition is a specialized field and connecting with a licensed nutritionist can help you sort out confusion around food. For example, some people tell you fasting on the day of receiving chemotherapy can make your chemo more effective, when in fact, we know that not eating can lead to muscle loss, increased nausea, increased fatigue, and worsen your side effects. A licensed dietitian can help you understand how to optimize your nutrition while still enjoying food while going through cancer treatment.

Palliative care does not equal hospice: Although there is a lot of confusion between the two, palliative care is a medical specialty that helps patients manage the symptoms related to cancer and the side effects of therapy, while hospice focuses on care and comfort as a patient approaches the end of life. Hospice does provide palliative care at the end of life, but not all palliative care involves hospice. Studies prove that patients who get palliative care early on in their cancer diagnosis live longer and have a better quality of life. So, if your oncologist mentions getting a palliative care team involved, don’t be alarmed — they are simply hoping to address your symptoms regardless of the cancer stage.

It’s OK not to share your diagnosis with friends and family until you’re ready: Some people may think they need to tell everyone right away when they receive a cancer diagnosis, but this isn’t true. It is completely fine to take your time, identify who your trusted people are, and share with them first. There is absolutely nothing wrong with that and there is no rule that everyone in the world needs to know you have cancer if you would rather it be private. Every journey is different and doing what feels right to you when it comes to sharing your diagnosis is the most important thing.

You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

A lot of the chemotherapy drugs that serve as the backbone of treatment for common cancers, such as breast, lung, and colorectal cancer, are currently in short supply. From adults to children, the whole community is suffering because of these shortages. I’d love to see a coalition that oversees drug manufacturing and ensures that even though these drugs are older, and they don’t make a lot of money, they need to always be available to oncologists and patients. We can have all the best treatments in the world, but if we don’t have the right drugs, then we can’t provide patients with the care they deserve.

How can our readers further follow your work online?

Stay up to date with OncoHealth by following us on LinkedIn.

Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.

About The Interviewer: Savio P. Clemente coaches cancer survivors to overcome the confusion and gain the clarity needed to get busy living in mind, body, and spirit. He inspires health and wellness seekers to find meaning in the “why” and cultivate resilience in their mindset. Savio is a Board Certified Wellness Coach (NBC-HWC, ACC), #1 best-selling author, syndicated columnist, podcaster, stage 3 cancer survivor, and founder of The Human Resolve LLC. He has interviewed notable celebrities and TV personalities and has been featured on Fox News, The Wrap, and has worked with Authority Magazine, Thrive Global, BuzzFeed, Food Network, WW and Bloomberg. Savio has been invited to cover numerous industry events throughout the U.S. and abroad. His mission is to provide clients, listeners, and viewers alike with tangible takeaways on how to lead a truly healthy, wealthy, and wise lifestyle.