Interview with Dr. Betsy O’Donnell, Medical Oncologist

Elizabeth “Betsy” O’Donnell, MD, shares insights on new developments in cancer detection.

More than 1.9 million new cancer cases are expected to be diagnosed in the United States in 2023, according to the American Cancer Society. That’s a scary number, but there’s good news, too: new tests are making it easier for doctors to detect cancer and provide targeted treatments.  

Elizabeth “Betsy” O’Donnell, MD, Director of Early Detection and Prevention of Malignant Conditions at Dana-Farber Cancer Institute, recently spoke with Better Health Advisors about some of these advances. Dr. O’Donnell has been an oncologist for over a decade, and several years ago, while working at Massachusetts General Hospital, she attended the American Society of Clinical Oncology (ASCO)’s annual meeting and saw a presentation about GRAIL’s blood-based cancer detection. She was inspired to build a program to study this type of screening and offer patients this evolving science.

In this interview, Dr. O’Donnell shares updates on the state of cancer detection and treatment and discusses how healthy lifestyle choices can help prevent cancer.

Is blood-based testing the future of early cancer detection?

I think it may be. In terms of patient satisfaction and ease of obtaining, it's certainly the most promising. There are many companies focused on liquid biopsy — liquid being blood-based — but there are breath tests and other types that are also being examined. I like blood-based, because when people have annual physicals, they are already having their blood drawn for other reasons.

Is blood-based testing for cancer happening now?

Yes, but there are no FDA-approved tests. There's a broad range of blood-based biopsies. Some focus on single cancers. Guardant has one that focuses on colon cancer that's being fast tracked for approval at the FDA. Maybe someday you would use that instead of a colonoscopy, or it could complement it.

Then there are multi-cancer detection tests like the GRAIL test, which screens for over 50 types of cancer and is clinically approved. It's a screening test, not a diagnostic test. It’s like when you have a mammogram — if they see anything abnormal, they say you should have an ultrasound or a biopsy. If it has a positive signal, you need further evaluation.

You’re also interested in lifestyle medicine. Can you explain what that means and how it relates to cancer?

The number one leading cause of cancer is smoking, and the second leading cause is obesity. A lot of the things that we know cause cancer are related to our lifestyle. Lifestyle medicine is the evidence-based study and practice of integration of lifestyle considerations, like diet, nutrition, exercise, and sleep, into medical care. I'm very interested in studying things like the microbiome, exercise, and prolonged overnight fasting to see if we can prevent the evolution of cancer or improve outcomes in patients who have cancer.

What steps can people take to help prevent cancer?

Think “healthy lifestyle.” Just going off the American Cancer Society recommendations: smoking cessation, limiting the use of substances like alcohol which are known carcinogens, and trying to have a healthy weight. Eating a plant based diet. Moderate intensity exercise for 150 minutes per week. For women, no more than one alcoholic beverage a day; for men no more than two.

I think people have to feel like they can sustain behavior change to be able to embark on it. Intermittent fasting is pretty challenging, where you're only eating in a three- to four-hour window per day over years and decades, so I'm more interested in things like prolonged overnight fasting, trying to have a window where you don't eat for 13 hours or 14 hours overnight. That's been shown to have cardiovascular benefit. We're studying that in oncology as well — a clinical trial is open right now. We try to design interventions that people can actually do, and that don't cost them a ton of money. Not everybody can afford a private trainer and a lot of the amenities that might make a healthy lifestyle easier.

What do you suggest that patients do when they are initially diagnosed with cancer?

Get an informed opinion. See somebody, if you can, who specializes in the type of cancer that you have. There are different ways in which you can receive your cancer care. You can go to a cancer center. I work at a cancer institute. There are multiple different designated cancer centers within New York City, for example, but then there are also private practices, community hospitals, and community practices.

It depends on what type of cancer you have, what type of treatment you need, and what the demands of that treatment are like — if it's radiation, where you have to go every day for several weeks, or if it's chemotherapy, where you have to go once a week, sometimes there are practical considerations in terms of where you end up getting treated.

But there's benefit, even if you're going to be treated locally, to getting advice from someone who specializes in the cancer type that you have, for two reasons: One, cancer care has evolved so much, and it's so specialized in 2023. And two, because if you have a cancer that exhausts FDA-approved therapies, academic cancer institutes can offer clinical trials that may be a benefit to you.

What’s happening in clinical trials in 2023?

There's so much going on in clinical trials. Just look at the landscape of drugs that we have available versus 10 years ago or 20 years ago. When I first worked at Dana Farber back in 2001, there were just a handful of approved therapies, and we used them in every cancer. Now, if you get treated for cancer, it's very disease-specific with targeted therapies and immunotherapies. Very often our best therapies are available in clinical trials, because they haven't yet moved through the FDA approval process, which takes many years.

Where can people find reliable information online about cancer?

Be very careful when you Google. The landscape of oncology, as I mentioned, has changed so much over the last decade that you need to make sure you're reading things that are up to date. The American Cancer Society is a good resource. They provide references to local and more disease-specific foundations.

There is a lot of expertise involved in understanding a person's stage of cancer and the type of cancer. Unless you really know the details of your cancer, you have to be very careful about how you interpret what you read on the internet.

How does coordination of care impact cancer treatment?

Cancer isn’t isolated. You have a problem, and that problem affects so many different aspects of your life. There's how it affects you, there's what’s required to treat it, and the number of people you need to have on your team. Some cancers are treated with medicine alone, some are treated with surgery, and some are treated with radiation, so you have to have a team.

A lot of people with cancer also have other medical problems. Cancer medicines can affect other conditions like blood pressure or diabetes. I think it's really important to have a cohesive team that is able to correspond with one another and manage the many dimensions of a sick patient, including the social support. 

We’re grateful to Dr. O’Donnell for speaking with us. If you or a loved one is coping with cancer — or any other health issue — and you need support navigating the healthcare system, reach out to an expert health advisor.

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