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					ask
an Expert:     volume 3/winter 2007




coping with
pancreatic
  cancer
 Virginia Cravotta (VC): It must be
 difficult to inform someone of a diagnosis
                                                 and patient to figure out how the patient
                                                 can learn to cope with his or her illness.
                                                                                                                Susan D. Block, M.D.

                                                                                                     when it prevents patients from planning for
                                                                                                     the future, because it gives the impression
 of pancreatic cancer. As a psycho-oncologist,                                                       that patients have all the time in the
 when you’re working with a newly diagnosed      It is important to remember there is no             world, and that they don’t need to take
 pancreatic cancer patient, how do you present   “one prescription” for all patients; rather,        care of their affairs, or face the possibility
 a picture of the future? Do you help patients   clinicians should individualize their               that time could be cut short. Patients
 distinguish between realistic hope and what     approaches to help patients cope with               with unrealistic hope may also receive
 might be considered “false hope?”               their diagnosis and manage expectations             messages from their bodies telling them
                                                 based on their own unique experiences               things may not be as good as they hope
 Dr. Susan Block (DB): Any cancer                and beliefs. Doctors and patients need to           they are. This discrepancy may lead to a
 diagnosis is devastating. People have           discuss how much information the patient            high degree of anxiety. Unrealistic hope
 enough knowledge and experience from            wants; to explore the patient’s ideas about         can also be isolating if patients and their
 our broader culture to view pancreatic          what it means to have a diagnosis of                loved ones have different views about the
 cancer as particularly grim and ominous.        pancreatic cancer; and to discuss how               patient’s condition, which can make it




                                                                                                                                                              THE LUSTGARTEN FOUNDATION FOR PANCREATIC C ANCER RESEARCH
 So, I think that the person who hears           doctor and patient are going to work                difficult to talk openly with each other.
 this diagnosis often has not only the           together as a team to deal with the illness.        So I think there can be real costs to
 weight of cancer, but also cultural images      Setting someone up for “good coping”                maintaining “unrealistic” hope.
 of pancreatic cancer as incurable, painful,     involves an open flow of communication
 lacking in good treatments, and that it is,     between patient and physician.                      On the other hand, there is much uncer-
 in many ways, a death sentence.                                                                     tainty surrounding this diagnosis, and some
                                                 Some patients are able to feel a sense of           patients do remarkably well for long periods
 Therefore, people who know someone with         hope no matter what the circumstances.              of time, living much longer than the
 this disease may come into their diagnosis      We often think about doctors as either              expected average. It is healthy for patients
 with grave expectations. One of the first       “taking away” or “giving” hope. My own              to want to be in the 5% of people who
 and most important things a doctor can          view is that hope resides within the                live with pancreatic cancer longer than
 do is establish a strong relationship with      patient, and is not something that doctors          statistically expected and say, “I’m going
 the patient (what we call a therapeutic         can necessarily give or take away. Rather,          to do everything I can to be in that 5%.”
 alliance), and also with the patient’s family   our job is to help an individual understand         I think we also need to recognize that at
 and/or larger support system. The goal of       what it is that they’re hoping for, and over        some point, some patients start falling out
 a therapeutic alliance is to create a ‘safe     time, help them shape these hopes into              of the 5% category, and those patients
 space’ for the patient and his or her family    goals that are realistic and attainable.            need help dealing with this new reality
 members to share concerns, and for doctor       “False” (unrealistic) hope can be a problem         so they can begin exploring next steps.
*Words in bold are defined in the glossary.                                                                                               (continued)

www.lustgarten.org |                                                                          | 1111 Stewart Avenue • Bethpage, NY 11714 | 516-803-2304   1
    ask
    an Expert:                         coping with pancreatic cancer
    VC: Do most patients have the benefit of
    working with a psycho-oncologist? Pancreatic
    cancer patients may be treated by surgeons,
                                                          “Good” coping includes an open flow of
    medical oncologists, and/or medical radio-         communication between patient and physician.
    logists, but much of what you're talking
    about may not fall within these specialties.
    I’m wondering whether other medical                                                                        — Susan D. Block, M.D.
    specialties take the same approach as you?

    SB: There are only a small number of             enjoyable – and to focus on those things.        VC: In addition to depression and sadness,
    psycho-oncologists in the country who            Denial gets a bad name, but can actually         I would imagine that fear may be another
    do this kind of work. However, a lot of          be a useful coping mechanism. Many               emotion experienced by cancer patients.
    oncology practices take a treatment team                                                          In your experience, what do pancreatic
                                                     patients use denial as a way to be able
    approach, which includes social workers                                                           cancer patients most fear?
                                                     to enjoy life – and there’s nothing wrong
    and/or psychologists, either who are on
    staff or who work in collaboration with          with that.                                       SB: Cancer patients in general are often
    the oncology practice. From a patient’s                                                           fearful. Many patients find it helpful to
    point of view, it can be beneficial to have      VC: I think we all imagine that the ability to   articulate feelings about their fears. But we
    somebody other than the oncologist to talk       feel pleasure or joy simply disappears when      must also safeguard a patient’s right to not
    with about these issues. In turn, oncologists                                                     share fears unless, or until, s/he wants to.
                                                     you learn you have a truly life-threatening
    should remain alert to how cancer-related
    emotional issues may play out for a patient.     illness. And you're saying it we can focus on
                                                                                                      Often, patients fear the ‘dying process’
                                                     keeping joy alive?
                                                                                                      and worry about burdening loved ones.
    VC: What about the patient’s family and/or                                                        In my experience, these are the biggest
    caregivers? Do they typically follow the         SB: We hear time and again that one              issues that frighten cancer patients.
    same path of acceptance/denial as the            of the outcomes of cancer is a deeper            Patients worry about experiencing pain;
    patient? I think very often patients feel                                                         about indignities in the dying process;
                                                     appreciation for life. Individuals with
    they have to be optimistic for their loved                                                        about losing control. But they also
    ones, and loved ones feel they have to be        cancer tell us they engage at a deeper level
                                                                                                      intensely worry about the sorrow of loved
    optimistic for the patient. Wouldn’t this        with people they love. These feelings are
                                                                                                      ones who will be left behind, as well as
    place tremendous stress on both parties?         mixed with extraordinarily difficult issues,     what it will be like for a spouse or child to
                                                     such as having a disease like pancreatic         provide concrete physical care for them,
    SB: Absolutely. The tendency to protect          cancer with a poor prognosis. The trick is       and how their loved ones will cope after
    loved ones goes both ways between patient
                                                     to not only acknowledge potential losses,        they are gone.
    and caregiver. Sometimes patient and
    caregiver are on the same page and are           but also find gifts.
                                                                                                      Patients can be reassured about our ability
    able to talk. We have some interesting
                                                                                                      to control pain and relieve suffering.
    data about this issue from our own
                                                                                                      Today more than ever, cancer pain can
    research: One thing that may influence
                                                                                                      be managed, and there are medications
    a patient’s ability to accept the fact that
    they have a serious illness is emotional
    support from caregivers. It’s bleak to face
    a terminal illness alone, so support for
                                                    “able to acknowledge
                                                     Patients need to be                              and other approaches to dealing with even
                                                                                                      the worst pain that can help make cancer
                                                                                                      pain manageable, and allow patients to
    the patient is really important.                                                                  feel whole. An important goal in working
                                                                                                      with someone facing a life-threatening
    At the same time, patients need to be            that they have a                                 illness is to help them to continue to feel
                                                                                                      whole and like themselves throughout
    able to recognize that they have a serious
    illness that might end their life, then                                                           the course of their illness.
    put it aside in the service of living. One       serious illness, then                            VC: A previous issue of Ask An Expert
    of the most important roles of caregiver
    is to acknowledge to the patient how                                                              explored the issue of Depression. Research
    difficult the situation is, but also to          put it aside in the                              has shown that depression sometimes has a
    encourage the patient to “put it aside”                                                           biochemical origin in pancreatic cancer. In



                                                                                            ”
    and instead think about what they want                                                            your experience, are pancreatic cancer
    to do, what’s important to them, what’s          service of living.                               patients depressed?


2   www.lustgarten.org |                                                                                                  THE LUSTGARTEN FOUNDATION FOR
        SB: There is a subset of patients with            It’s really important that clinicians caring      Although chemotherapy is increasingly
        pancreatic cancer who become severely             for people from different backgrounds             being used later into the course of cancer,
        depressed, and this may have a biochemical        adopt the role of “student” and allow             often as the disease progresses, so do the
        cause. This is an area where the oncology         patients to teach them what they need,            symptoms. At that point, palliative care
        clinicians need to be proactive and               rather than try to impose their views and         plays a larger role. As a clinician, the
        conduct screening. These patients may             beliefs onto patients.                            advantage of starting palliative care early
        require treatment with antidepressants                                                              is that you can develop a relationship
        and psychotherapy, the “gold standards”           Cancer is an individual experience, and           with the patient and get to know him or
        for treating depression. But most patients        our job as clinicians is to individualize         her as an individual, and there’s also an
        with pancreatic cancer – in fact, the over-       treatment to meet the patient’s needs.            opportunity for the patient to develop
        whelming majority – are not depressed.            The patient’s job is to tell us what these        trust with the palliative care team.
        They may experience moments of sadness            needs are. Needs may be very different
        and crying, but they can also be lifted out       among people with different cultures and          Palliative care clinicians are expert in
        of those dark places by being with people         backgrounds. Cultural differences may be          sensitively exploring end-of-life issues,
        they love, and by doing things they enjoy.        particularly important at the end of life,        including desires for care at the end-of-life,
        I think it’s important to recognize the           since different cultures deal with death          fears, and illness-related feelings. Many
        resilience of most people – even in the           and dying differently. It is very important       times, people have concerns about being
        face of serious illness.                          for us to be aware of our own biases and          kept alive on machines and want to share
                                                          prejudices, and to remain open to the             end-of-life wishes so that if they become
        VC: How do our personal beliefs and atti-         patient’s perspective.                            very ill, family members won’t be burdened
        tudes influence our overall style of coping                                                         with difficult decisions. As patients get
        with cancer? Do cultural values and mores         VC: Palliative care is about maintaining          sicker and more symptoms appear, they
        affect coping style?                              dignity, but I think a lot of people see it       may become discouraged – and this may
                                                          solely as pain management. How does               be stressful for the family. Patients may also
        SB: Certainly, cancer doesn’t change who          changing the focus from active treatment to       find themselves struggling with questions
        you are. Patients often bring past personal       palliative care enhance the coping process?       about spiritual or religious beliefs. Palliative
        experiences pertaining to loss, which have        Do people think of palliative care and/or         care clinicians are trained in helping people
        a significant impact on how they perceive         hospice as “giving up?”                           navigate these kinds of issues.
        their own cancer. For example, someone who


                                                         “Our job as clinicians is
        watched a parent die a difficult death is more
        likely to be afraid for him or herself than if
        s/he watched someone slip away gently, and
        this certainly affects what people are afraid
        of and how they deal with illness. We all
        have vulnerabilities as well as strengths,
                                                          to individualize treatment
        and these play a big role in how we cope.
                                                          to the patient’s needs;
        Somebody with a history of depression is
        probably more vulnerable to depression
        with pancreatic cancer. Also, those lacking
                                                          the patient’s job is to teach
        good support systems are going to have a
        harder time managing challenges surrounding
        illness. Younger people dealing with
                                                          us what these needs are.”
        pancreatic cancer may struggle with the           SB: My own view is that palliative care           Traditionally, hospice has often been
        feeling that they haven’t yet started their       for patients with pancreatic cancer should        seen as the “end of the line,” signaling
        lives in terms of family and/or career, and       begin at diagnosis, because many patients         that death is imminent. Research data
        here they are having to think about dying         have active symptoms from diagnosis and           actually shows that the longer a patient
        – as opposed to older patients, who may           we want them to enjoy the best possible           is in hospice care, the better is his or her
        still want more time, but who can also look       quality of life. Sometimes, interventions         quality of life. So I think there are many
        back over long lives.                             are simple and don’t require specialized          benefits to starting hospice sooner than
                                                          palliative care. But we also see patients who     we tend to in the U.S. When I talk with
        One challenge we confront everyday is             present with complicated pain and other           patients about hospice, I emphasize what
        finding ways to effectively help people           symptoms from the onset of their illness –        it provides: expert pain and symptom
        from different cultural backgrounds deal          and this way, we are able to help maintain        control, emotional support, and practical
        with a diagnosis of pancreatic cancer.            quality-of-life from the beginning.               resources to help deal with needs in the


PANCREATIC C ANCER RESEARCH                                                                          | 1111 Stewart Avenue • Bethpage, NY 11714 | 516-803-2304   3
    ask
    an Expert:                         coping with pancreatic cancer

                                                  “
                                                  It is important to help someone
    home (including help with personal care,
    access to nurses, hospital supplies, oxygen
    and other medical needs). Hospice can
    also provide treatment as necessary and       facing a life-threatening illness to
    bereavement support for more than a
    year after a person dies.                     continue feeling ‘whole’ throughout
    VC: You mentioned that chemotherapy
    is increasingly being used later during
    the course of the cancer experience, and
    also talked about patients picking up cues
                                                  the course of his or her illness.
                                                  The choice to stop treatment is influenced
                                                                                                                                      ”
                                                                                                  a support group and see how it feels, and
    in their own bodies. How active a role do     both by the patient and oncologist. There       to decide for themselves whether it’s a fit.
    most patients play in the decision to         are certainly many patients who wonder          Support groups can be a useful adjunct to
    continue treatment, versus “letting go”       about chemotherapy and whether it’s time        help patients and loved ones cope with
    of hope for a cure?                           to stop, or whether it’s still working. It is   serious illness.
                                                  important that patients bring these concerns
                                                  to their oncologists. My observation has        VC: Complimentary and Alternative
    SB: I think that for most patients,
                                                  been that many patients are comfortable         Medicine (CAM) tends to be a ‘sticky subject’
    chemotherapy means the chance to live.
                                                  talking about those issues with me, but         in the context of traditional western medicine.
    So it is completely understandable that
                                                  they’re reluctant to bring them up with         When and how can CAM help pancreatic
    people want every shot they can get at
                                                  their oncologists – partly because they’re      cancer patients cope? Are there dangers to
    life, and that they’re going to continue
                                                  afraid the oncologist will have hurt            CAM, and/or have certain CAM approaches
    chemotherapy as long as there’s any
                                                  feelings if they don’t want to continue         been found particularly beneficial with
    hope for a benefit.
                                                  treatment, and also they worry that they’ll     pancreatic cancer?
                                                  be abandoned if they decide to stop.
            ADDITIONAL RESOURCES                                                                  SB: There is a growing evidence base for
                                                  It’s a tall order for patients to bring up
                                                                                                  CAM, but it’s still pretty small. Acupunc-
                                                  the issue of discontinuing treatment with
                                                                                                  ture can be helpful for managing symptoms,
           The Anatomy of Hope:                   their oncologists. Oncologists need to
                                                                                                  including pain and nausea and vomiting.
              How People Prevail                  “check-in” regularly with patients and
                                                                                                  Relaxation, meditation, and mind-body
                                                  simply ask, “Is this still making sense to
             in the Face of Illness               you?” This is an important question for
                                                                                                  approaches can also be helpful interventions,
        by Jerome Groopman, M.D.                                                                  which can help manage anxiety and
                                                  patients, because there is some research
                                                                                                  enhance coping. Both of these approaches
                                                  data suggesting that chemotherapy is over-
                                                  used (or used without benefit), and it          are beneficial and have an evidence base
         The Human Side of Cancer                                                                 behind them.
                                                  does sap energy and time that sometimes
        by Jimmie C. Holland, M.D.                could be used for other purposes. So, it’s
                                                  a delicate, complicated issue, and one          VC: Let’s turn to end-of-life issues. I would
        CancerCare Support Groups                 that is important for patients and their        imagine that patients have their own sense
                                                  oncologists to communicate openly about.        of when they’re approaching end-of-life.
           for Pancreatic Cancer
                                                                                                  What about caregivers? How do you work
           Patients & Caregivers                                                                  with caregivers to help get them “on the
                                                  VC: What other kinds of services should
            www.cancercare.org                    patients and their families know about?         same page” with patients?
              1-800-813-HOPE                      Are support groups helpful to pancreatic
                                                  cancer patients? Also, would these benefits     SB: My own belief with a disease like
                                                  extend to caregivers?                           pancreatic cancer is that from the very
        The Wellness Community                                                                    beginning we need to adopt an attitude
       www.wellnesscommunity.org                  SB: There is research data suggesting that      that we’re going to do everything we can
            1-888-793-WELL                        support groups improve quality of life for      to treat this disease and create as much
                                                  patients with breast cancer. Generally          time as possible. At the same time, the
                                                  speaking, support groups are helpful for the    oncologist, patient and caregiver all need
          Randy Pausch’s Web site                                                                 to think about end-of-life concerns in case
                                                  people they’re helpful for. That sounds
           www.randypausch.com                    trite, but some patients and caregivers         things don’t progress as hoped. So it’s a
                                                  find groups beneficial, while others do not.    kind of “hope for the best, prepare for the
                                                  I encourage patients and caregivers to try      worst” strategy. And I think caregivers

4   www.lustgarten.org |                                                                                               THE LUSTGARTEN FOUNDATION FOR
        need to be included in the conversation
        all along. Our tendency is to not talk
        about these issues in any depth until the
        very end. The problem with this approach
        is that these are extraordinarily difficult
        and painful human issues, which take
        time to process.

        Too often, we see patients come to the
        hospital on the verge of needing critical
        care, and nobody has approached a single
        conversation about end-of-life issues.
        The expectation is that the caregiver
        would make a decision to curtail aggressive
        treatment for the patient with metastatic
        cancer. But unless they’ve had a chance
        to process this kind of decision over time,
        it’s very difficult to do under pressure. We
        need to do a better job preparing patients
        and family members for end-of-life issues,
        before times of crisis.

        For example, we could ask, “If you were to
        become very sick and we didn’t think we
        had treatments to help your cancer, what
        kind of care would you want? Where
        would you want to be?” Patients can
        answer those kinds of questions, and I
        think it’s often helpful to have those
        conversations with caregivers present
        so everyone is on the same page. Early
        conversations give people time to process
                                                        Request your
        their own feelings and to prepare for                          free copy of “U
                                                        at 1-866-789-1                nderstanding
        death, which helps both the patient and                       000.                         Pancreatic Ca
                                                                                                                ncer”
        his or her loved ones to be at peace.

        VC: What would you like to see happen in
        the future for pancreatic cancer patients?

        SB: As clinicians, we need to advocate
        for the best possible psychosocial care
        for patients and their families. We need
        research to help us understand the ways in
        which patients cope with serious illness, and
        specifically, how we can help them better
        cope with a diagnosis of pancreatic cancer.
        The good news is that today more than ever
        there is growing interest in this disease,
        and with support from organizations like
        The Lustgarten Foundation, the research
        community is working harder than ever to
        find effective treatments and a cure.

PANCREATIC C ANCER RESEARCH                                                         | 1111 Stewart Avenue • Bethpage, NY 11714 | 516-803-2304   5
    ask
    an Expert:             coping with pancreatic cancer

        Dr. Randy Pausch:
        Playing Your Hand
        After Being Dealt
        Pancreatic Cancer
        Contributed by Dr. Randy Pausch




    I have pancreatic cancer.
    I fought like hell and actually thought
    I’d be one of those five-year survivors:
                                                                       L         ike all people in this (or any)
                                                                                 circumstance, I can’t control
                                                                                 the cards I’m dealt, just how
                                                                       I play the hand. While not in denial,
                                                                       I see no reason to be depressed; that
    I had a successful Whipple surgery at UPMC, an aggressive          won’t help anybody. I spend my time
    (Virginia Mason-developed) chemoradiation protocol at M.D.         helping my wife and three young
    Anderson, and then a vaccine from Johns Hopkins. Unfortunately,    children; helping them today, while
    I’ve now got a dozen metastases in my liver, and while I’m still   I’m still healthy, to be prepared for
    fighting like hell, I pretty much know how this movie will end.    when I’m gone.

6   www.lustgarten.org |                                                               THE LUSTGARTEN FOUNDATION FOR
            “
          Pancreatic cancer has
      taught me that brick walls
       are there for a reason —
     not to keep us out, but to give
      us a chance to show how
      badly we want something.
        I also try to help other people. I’m a
        professor at Carnegie-Mellon University
        and I recently gave a “Last Lecture” to
                                                                                ”
                                                  performance. But one of my most
                                                  valuable lessons from the field – which
                                                  has stuck with me all my life – is this:
                                                                                               chance to show how badly we want
                                                                                               something. Find your something.
                                                                                               And fight like hell. My oncologist
        my students. I became an accidental       “Your toughest critics are the ones          said something that stuck with me:
        celebrity when a video of it was          telling you they still love you and          “Not everybody who stays positive
        uploaded to the internet and viewed       care.” Looking back, I realized that         survives. But everybody who survives
        by millions of people.You can view it,    parents don’t really send their kids         is positive.”
        and related information, from             to football to learn the game; we
        www.randypausch.com. Over six             send them to learn more intangible,          When I told the President of Carnegie-
        thousand people have                                    important things: team-        Mellon I was giving a “Last Lecture,”
        sent me emails. Some                                    work; sportsmanship;           he said, “Please tell people about
        have told me they are                                   perseverance. Keep your        having fun – because that’s what I
        now going to stop feeling     “Your toughest            eye out for this kind of       will most remember you for.” And I
                                                                                               explained, “I can do that, but it’s a bit
        sorry for themselves: if                                ‘indirect’ learning because
        I can stay positive as a       critics are the          it’s everywhere in life. In    like asking a fish to underscore the
                                                                                               importance of water, because I don’t
        terminal cancer patient,
        they can stop obsessing
                                     ones telling you           particular, my experience
                                                                with football gave me          know how not to have fun.” I’m dying
        about whatever is wrong     they still love you         the physical and mental        and I’m still having fun. And I’m going
        in their life. I am thrilled                            toughness that allows          to keep having fun every day that I
        that this “Last Lecture”
                                         and care.”             me to face cancer the          have left, because there’s no other
        has helped so many.                                     way I do.                      way to play it.

        In the Lecture, I talk about the impor-   I never dreamed I’d be given a second        Specific advice I gave in the lecture
                                                                                               included:
        tance of having dreams, and of working    chance to fulfill (a slightly modified
        hard to achieve them. Many of my          version of) my childhood NFL dream –         • Always tell the truth
        dreams I was fortunate enough to          which has led to another important           • Apologize when you make
        accomplish; others I was not. But by      lesson:“Never give up on your dreams,          a mistake
        striving for them, I learned a great      because you never know when they             • Be patient, and people will
        deal, whether or not I achieved them.     might come true.” A few weeks after            show their ‘good’ side
                                                  delivering my “Last Lecture” at              • Show gratitude
        I had a childhood dream to play in the    Carnegie-Mellon, I was invited to            • Don’t complain, just work harder
        NFL. At the tender age of nine, my        practice with the Pittsburgh Steelers!
        parents signed me up for little league                                                 One last thing. Millions of people have
        football.While I obviously did not earn   One of my favorite expressions is,           seen the lecture, but the truth is that
        an NFL career, I learned more from        “Experience is what you get when             the only reason it was videotaped
        not accomplishing this dream than         you didn’t get what you wanted.”             was because I was really making it for
        from any of the ones I did accomplish.    Pancreatic cancer has taught me that         my children, so they could watch it
        Let’s just say I was not the team MVP,    brick walls are there for a reason –         later and see what was important to
        and sometimes my coach reamed my          not to keep us out, but to give us a         their old man.

PANCREATIC C ANCER RESEARCH                                                             | 1111 Stewart Avenue • Bethpage, NY 11714 | 516-803-2304   7
      ask
     an Expert:                                contributors
SUSAN D. BLOCK, M.D.                                She has been a leader in the development        leadership in education and research.
Chief, Division of Psychosocial Oncology            of the field of Palliative Medicine             Her research interests are in the areas
and Palliative Care                                 nationally and has been responsible             of physician factors that influence
Dana-Farber Cancer Institute and                    for the development of innovative               clinical outcomes, mental health
Brigham and Women’s Hospital                        educational programs for medical                aspects of cancer, and in medical
Co-Director, HMS Center for Palliative Care         students, residents, fellows, and faculty.      education reform. She has numerous
Professor of Psychiatry                             She has trained more than 800 faculty           publications and grants to evaluate and
Harvard Medical School                              nationally and internationally in               improve education in palliative care.
Susan D. Block, M.D. is the Chief of                palliative medicine. From 1994-2004,
                                                    she was the National Program Director           VIRGINIA CRAVOTTA
the Division of Psychosocial Oncology
                                                    for the Project on Death in America             Award-winning journalist Virginia
and Palliative Care at Dana-Farber and
                                                    (PDIA) Faculty Scholars Program and             Cravotta has been Senior Affairs
Brigham and Women’s Hospital and
                                                    a member of the Board of the PDIA,              Correspondent for News 12 Long Island
Co-Director of the Harvard Medical
                                                    which created much of the infrastructure        since 1995. A noted expert in the
School Center for Palliative Care, a
                                                    for the field of palliative medicine.           field of long-term care, she reports on
national center of excellence in palliative
                                                    Dr. Block is a member of the ACGME              medical and social issues that impact
care education. Dr. Block received her              Advisory Committee for Hospice and              the aging process.
AB from Stanford University, her MD                 Palliative Care and serves as a Trustee
from Case Western Reserve University                                                                KERRI KAPLAN
                                                    of the American Academy of Hospice
School of Medicine, and completed                   and Palliative Medicine. She has been           Kerri Kaplan serves as Executive Director
residencies in both internal medicine               recognized by many organizations for            of The Lustgarten Foundation For
and psychiatry at Beth Israel Hospital              her achievements in medical education           Pancreatic Cancer Research. Ms. Kaplan
in Boston. She is board-certified in                and palliative care; these include the          helps lead the Foundation in its mission
both fields. Throughout her career,                 Association for Academic Psychiatry,            to advance the diagnosis, treatment,
Dr. Block has had a strong interest in              the Association of American Medical             cure and prevention of pancreatic cancer.
enhancing humanistic competencies                   Colleges, the Veterans Administration,          She brings to the Foundation extensive
of physicians and improving care of                 and the American Academy of Hospice             background and expertise in non-profit
patients with life-threatening illness.             and Palliative Medicine for national            finance and cancer-related issues.


About The      Lustgarten Foundation
The Lustgarten Foundation For Pancreatic Cancer Research is a               cancer public awareness campaign. Former President Jimmy Carter,
not-for-profit organization dedicated to advancing the diagnosis,           Honorary Chairman of the Foundation’s Corporate Advisory Board,
treatment, cure and prevention of pancreatic cancer.The Foundation          and veteran actor Matthew Modine, lead the Foundation’s public
was named for Marc Lustgarten,Vice-Chairman of Cablevision                  awareness campaign with public service announcements (PSA) that
Systems Corporation, who was diagnosed with pancreatic cancer.              appear on major television and cable networks nationwide, and
                                                                            print versions of the PSA that appear in major print vehicles.
The Lustgarten Foundation concentrates on stimulating the scientific
community to conduct the research necessary to find a cure for              The Lustgarten Foundation also distributes a comprehensive
pancreatic cancer.The Foundation has sponsored international                handbook for pancreatic cancer patients and their families.
research conferences, launched a national public awareness                  “Understanding Pancreatic Cancer” offers up-to-date information
campaign, and committed nearly $18 million in support of promising          on the disease. Copies are available free-of-charge by request to
pancreatic cancer research.Today,The Lustgarten Foundation is the           The Lustgarten Foundation.
nation’s largest private supporter of pancreatic cancer research.
                                                                                         Supported by an educational grant from
To help support these activities, the Foundation has established a
Scientific Advisory Board of renowned researchers and clinicians to help
direct its research funding activities, and a Corporate Advisory Board of
leading cable and media executives to support a national pancreatic



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