Winning the Cancer Journey: Dr. Tiffany Troso-Sandoval, Women's Cancer Medical Oncologist

In episode forty of Everything Cancer, host Jill Squire welcomes Dr. Tiffany Troso-Sandoval, a highly experienced medical oncologist and founder of Winning the Cancer Journey and Second Look. Dr. Troso-Sandoval shares invaluable insights from her 25 years at Memorial Sloan Kettering Cancer Center, where she became a trusted voice in women’s cancers. Our conversation with Dr. Troso-Sandoval is a perfect way to close October, Breast Cancer Awareness Month.

Known for her candid, compassionate approach, Dr. Troso-Sandoval dives into the importance of whole-person care, discussing sensitive topics such as sexual health and survivorship—areas that often go unaddressed yet impact quality of life profoundly.

Listeners will appreciate Dr. Troso-Sandoval’s perspective on navigating complex cancer care systems, the benefits of second opinions, and strategies to build transparent, effective communication with oncologists and advanced practice providers. She underscores the power of patient education in reducing stress and fostering trust, making a compelling case for self-advocacy and resilience. She emphasizes the importance of informed, collaborative care.

Whether you’re a survivor, caregiver, or healthcare provider, Dr. Troso-Sandoval’s reflections on balancing expert guidance with personal resilience offer a fresh perspective on thriving through the cancer journey. Tune in for a deeply empowering conversation.

Dr. Troso-Sandoval’s LinkedIn linkedin.com/in/tiffany-troso-sandoval-md-b897a017

Dr. Troso-Sandoval’s  email:  drtroso@winningthecancerjourney.com

Dr. Troso-Sandoval’s Winning the Cancer Journey website: https://www.winningthecancerjourney.com/

Memorial Sloan Kettering Cancer Center About Herbs, Botanicals, and Other Products https://www.mskcc.org/cancer-care/diagnosis-treatment/symptom-management/integrative-medicine/herbs

Transcript

Everything Cancer (01:03)
Hello everybody and welcome to the Everything Cancer podcast. We have an amazing guest with us in Dr. Tiffany Trosso Sandoval. She is an expert medical oncologist and a cancer concierge, speaker and author. The name of her company is Winning the Cancer Journey and you're going to discover from her today that is a very appropriate name. And she also has another service called Second Look.

oncology which we'll go into today. She is a very passionate advocate for the survivor, for the patient. And I'm so pleased to have Dr. Troso Sandoval here. She has 25 years of experience with Memorial Sloan Kettering Cancer Center which is one of the lead cancer centers, an NCI National Cancer Institute designated cancer center in the US. She really knows what she's talking about.

but she's also very approachable, warm, and easy to speak with. I'm so pleased to have you here, Tiffany. Thank you.

Dr Tiffany Troso-Sandoval (02:05)
I'm honored. Thank you so much, Jill. That was wonderful. Can you please introduce me again somewhere else? That was great. Thank you so much for having me really and sharing your audience with me.

Everything Cancer (02:12)
well thank you.

Absolutely. Well, I appreciate you taking the time and being here. Really, I think you have so much to share and I would love to have you back. We can touch upon specific topics. So I understand that you specialized in women's cancers, breast cancer and gynecologic oncology cancers, correct?

What drew you to that population?

Dr Tiffany Troso-Sandoval (02:35)
So when I was originally going into medicine, I'm just going to go back up a tiny bit. When I was originally going into medicine, I was at Cornell Medical School in New York Hospital, which actually, by the way, was right across the street from Sloan Kettering. So I lived in this three block radius for like 10 years. I found internal medicine to be really interesting, but I was always frustrated by a lot of the patients that didn't seem like they really were invested in their care.

Everything Cancer (02:49)
Mm -hmm.

Dr Tiffany Troso-Sandoval (03:00)
So, know, Mrs. Jones would come in, she'd have high blood pressure and she was smoking and she'd come back two weeks later and I said, you how's the medicine working for you? I didn't pick it up. Okay. So as I was learning more and growing in my medical fields, I really was drawn to oncology and in particular to women's cancers because of, guess, who I am and who I've always been. I'm pretty social and gregarious type of a person and I have...

always had lots of girlfriends and I like women. I love relating to women and I love helping women. I love meeting them where they are and I always feel that I can help them on a level that a man can't and that because I understand and I'm not afraid to ask the harder questions like, you have vaginal dryness or are you having difficulty having sex or what have you and then.

I really think that my patients appreciate that I am a woman and that I am open to discussing those types of things. And so I've built some very, you know, close relationships with my patients based on, you know, the fact that we can really get down deep into what's going on and where the symptoms are and how can I help you.

Everything Cancer (04:08)
Wow. And you know, those questions that you just brought up, I mean, it's a small part of it, but vaginal dryness. Are you having problems having sex? That's a huge part of quality of life. And it segues into a person's relationship and how they feel about themselves. And that is a hard thing for a person to bring up. So what happens when you bring that up?

Dr Tiffany Troso-Sandoval (04:29)
They usually they'll answer me. And you know, because it wouldn't be the first thing I'm going to ask them about obviously, right? So this would be I mean, most of the time when I'm talking to women about, know, their symptoms from menopause or what have you, it's usually a little bit further down in the treatment because now they're in menopause from one of the chemotherapies or from one of the injections I'm giving them or they had their ovaries removed because of surgeries, what have you.

Everything Cancer (04:30)
Hahaha

Right, right.

Right.

Dr Tiffany Troso-Sandoval (04:51)
So it's not usually, by the time that we're discussing that, we have more of a relationship. And I don't think that I've ever shocked a patient by asking them because I'll ask them about everything. How are you sleeping at night? How's your relationships going? Are you eating okay? And to me, that's a bodily function. And as you said, it's an essential part of survivorship. And I think it's very important to address all of that.

Everything Cancer (04:52)
Right.

Right.

Right? Right?

Yes. Yes, I would imagine you see relief come across someone's face when you ask that and I can actually start talking about it or share it and then get some direction and help in things to try initially, which is amazing. And it's so it's so helpful because it is hard for them to bring that up. But you're right, it is the whole person that you're looking at. to our audience, I mean, we're speaking to the survivor crowd here and

Dr Tiffany Troso-Sandoval (05:20)
Mm -hmm. Mm -hmm.

Mm

Everything Cancer (05:39)
many of our audience are survivors and they're very aware that those conversations happen later, but they're so key. you know, when I'm with a support group and we bring up things like that, they nod their heads emphatically that this is such an important topic. What would you like people to know, what do you feel is really important for them to discuss with their oncologist at the beginning?

Dr Tiffany Troso-Sandoval (05:45)
Mm

You know, besides what kind of cancer I have and what are my treatment options? Okay, besides all that. I think it's very important to lay the ground rules in terms of communication because I feel that a lot of times it's hard to get the doctor and it's hard and a lot of my patients I remember used to be upset because you know, they wouldn't when they call they wouldn't get me on the phone specifically. And so, you know, I always try to make it very clear to everyone that

Everything Cancer (06:08)
Yes. Yes.

Mm

Dr Tiffany Troso-Sandoval (06:30)
If there's something medically that I need to answer, I will absolutely get on the phone, but it's probably gonna be after hours because during the day is when I'm seeing all the patients and just like I'm having one -on -one time with that patient, I don't make phone calls in the middle of the day. On the other hand, there's a lot of information that given to the patients that is relayed from me, so to speak. So if there's something, for example, that can't wait for me to call at the end of the day, which is usually some medical issue, then we have

systems involved and how to get to that. And so I always make sure that they understand, you you call for this problem, make sure that, you know, with the symptoms, any acute symptoms you need to call and if they don't call you back, you call again. You know, I like to always make sure that my patients know that I don't review scans over the phone. I don't think it's good for them. I don't think it's good for me. And I try very hard, for example, to set up my scans, you know, within 48 hours of an appointment with me so that we can review it in real time.

Everything Cancer (07:13)
Mm

Dr Tiffany Troso-Sandoval (07:24)
And the problem with that is it might be obvious, but if you get the call from me when it's normal, and then one time when it's not normal and you get the call that you have to come into the office to review it, now I've almost given you a heart attack at home. in general, all scans are reviewed in person. And it helps me as a physician to be able to assess the patient's understanding, their reaction to it, gives them a chance to mull it over and ask questions, to physically look at it with me.

Everything Cancer (07:37)
Right.

Dr Tiffany Troso-Sandoval (07:51)
And I think it's best on all fronts. again, communication I think is important and sort of laying the ground rules of like or understanding of when you're going to get doctor on the phone, when you're going to speak to the nurse, when you need to speak to triage, the cadence of the appointments, how often are you going to see your doctor, right? So you have chemotherapy every two weeks, are you going to see the doctor every two weeks?

know, every practice is different. And in my practice, I used to alternate visits usually with a nurse practitioner so that the patient would see me at least once a cycle or something and the nurse practitioner in between, but, or a PA or what have you, depends on how the practice works. so that they're not disappointed, you know, when they come in for that visit and they're not seeing the doctor and they, they didn't understand that, you know, this is the cadence of how the clinic works. So I think that's important as well.

Everything Cancer (08:27)
Mm

Dr Tiffany Troso-Sandoval (08:38)
I also think it's important for the patient to tell the doctor how much they want to know, right? And how they want to receive that information. So there are many patients that don't want to know. They want me to talk to their son or to their daughter or just tell me the basics. And that's not my style, but I respect that if that's their wishes. And so I need to know that, for example.

Everything Cancer (08:44)
Yeah.

Mm

Dr Tiffany Troso-Sandoval (09:03)
I've also had the opposite where a patient comes in and then as soon as the daughter walks out she goes, don't call her. So I think it's important to make sure that you understand who to discuss with and such. And it's also important to make sure you have your healthcare proxy set up and clear. So that's just one aspect.

Everything Cancer (09:22)
Well, I think it's really interesting for our survivor audience to hear that from your perspective because oftentimes I think it's interpreted differently from where they're sitting. so while they're trying to get a hold of the doctor during the day, the oncologist, because they're very worried about something, they're probably not thinking that that oncologist is in individual appointments like they were with you the week prior.

You know, so I think having that sense, but also there are many other people in the practice who are very capable of answering the question. And it is just as much it's just as well rounded an expert of an answer at that moment for to help that person move forward until they can have a more in -depth conversation with you. And then.

Dr Tiffany Troso-Sandoval (10:12)
Absolutely.

Everything Cancer (10:13)
I think the advanced practice provider, which is the CRNP, the Certified Registered Nurse Practitioner and the PA, Physician's Assistant, I think that's a really important conversation to have because I hear from a lot of people, they feel slighted by their oncologist when they see the advanced practice providers when in fact, these are very invested and passionate caregivers who become experts.

Dr Tiffany Troso-Sandoval (10:29)
Mm -hmm.

Everything Cancer (10:39)
in the area that they're working in and have very close relationships with their oncologist. And can you describe how that interaction works when they meet with a patient, then they come and see you after the advanced practitioner discusses the case with you and goes over everything so that our survivor audience understands that you are involved in every step.

Dr Tiffany Troso-Sandoval (11:01)
Absolutely. So first off, let me back up. My, my NP, when I was at Sloan, only saw good patients. I didn't give her the problem patients, the ones that had a lot of medical issues, the one who's called four times and has 15 things that they want to discuss with me. My, so to be honest with you, if you're seeing the NP, you've already been screened in as being somebody who's probably doing really well.

Everything Cancer (11:27)
Yeah.

Dr Tiffany Troso-Sandoval (11:27)
So if that that gives you any like reassurance whatsoever, hopefully but besides that yes my my NP used to come in and I mean my my system was different so When I saw patients my in the office my nurse would go in first and screen with you know certain questions and help just streamline my visit so that I made sure that I hit on the most important things with them and we would do the same thing with the NP so

I would used to have, you know, weekly patient meetings. And so we would go over the whole schedule for the week. And we would review my patients, the nurse practitioner's patients, and discuss what's going on with each of them. So that the whole team, which includes my secretary, my clinic manager, my nurse, my nurse practitioner, and myself, we were all on the same page together. So.

Everything Cancer (11:54)
Mm -hmm.

Dr Tiffany Troso-Sandoval (12:09)
So she's already been prepped before that, usually after that, especially if there's any treatment changes or something slightly out of the ordinary other than, you're feeling okay, your nausea is controlled well, you tolerated last cycle of chemotherapy, we're gonna go ahead with today, your blood counts look good. That one, she doesn't necessarily need to come and speak to me about, but anything out of the straight line, normal, expected appointment, she would absolutely find me and come to my...

to my little office, we worked in the same area and review the case with me, absolutely. And I weighed in on almost every patient that the NP saw.

Everything Cancer (12:45)
Wow. Okay. And I think that's really helpful. And it's helpful, I think, for people to understand that your entire team was always on the same page. And when you say prepped, you mean all of the information prior to that visit for that patient is reviewed so that all of you know what the lab work shows, what the diagnostic imaging is showing, any notes that are coming in from other specialists are reviewed and

Dr Tiffany Troso-Sandoval (12:58)
up. Correct.

Everything Cancer (13:10)
And someone so you are ready for that visit whenever that person walks in to see you.

Dr Tiffany Troso-Sandoval (13:15)
I mean, to the best of our ability, obviously. That's certainly not a perfect system by any stretch. of course, would always have a running list. My secretary would actually pull all of my scans so that we could review them together. Yeah.

Everything Cancer (13:16)
Right, right, right, right.

Mm -hmm.

What are some ways you think people can best advocate for themselves initially upon diagnosis and then moving through being treated?

Dr Tiffany Troso-Sandoval (13:30)
Cough

Hmm. Well, that's a key question for my new company. So in my opinion, education is key. And the more you understand about the process, your disease, the treatment options you have, the different types of radiology, how are you going to be worked up, what the side effects are of the treatment, what else needs to be done, all of that. And there's a lot. It's a whole, I have a whole course. I have a 12 week course on that. And so I

Everything Cancer (13:47)
huh.

Yes, there is a lot.

Dr Tiffany Troso-Sandoval (14:05)
I am a huge advocate of education. I think that the more you understand, the better that you can participate and the less stress and anxiety that you have. Because if you actually understand why the doctor is ordering you an MRI instead of a PET scan, right? I have to tell you, so many patients that I've saw, I was at a tertiary center, obviously, so I saw lots of second opinions and what have you, and I'd had so many patients come in and be,

Everything Cancer (14:14)
Mm

Right.

Dr Tiffany Troso-Sandoval (14:32)
so frustrated and angry with their doctor because they didn't order a PET scan and they think that that would have made the difference at some point. And so I have a whole education that I give on the different types of radiology, when to use it and why. And especially in patients, gynecological patients, for example, somebody that just had a major ovary cancer surgery, we don't do a PET scan.

especially right after surgery, four to six weeks, because everything's inflamed. PET scans are going to show up, inflammation everywhere, right? So an MRI, if there's some question, an MRI of the pelvis is actually a much more accurate way to look at that area. But people don't understand that, and they don't know the difference. And unfortunately, there are a lot of friends and family who are well -meaning, but are not necessarily educated on the difference. And they say, well, I had a PET scan. How come you didn't have a PET scan?

Everything Cancer (14:58)
Right? Right.

Dr Tiffany Troso-Sandoval (15:23)
so the PSUBF study can affect you. And I just think that's a shame. And I think it's a missed opportunity as an oncologist to help your patient, to empower them, to have decision -making together. Because if you understand, it cuts down that whole level of stress, anxiety, disappointment, frustration with your doctor, and it was all a misunderstanding because you didn't know the difference. know, fairness to the patient, patient doesn't know what she doesn't know, right?

Everything Cancer (15:23)
Right.

Mm

Dr Tiffany Troso-Sandoval (15:52)
So that's why I'm such a big advocate of educating patients. And I also think that by educating them, again, they'll be able to, like I said, participate in their care and empowers them, but it also allows them to trust their doctor better. And that's key because you can't go through this journey always looking at your doctor like, don't trust you. That's not good. And I don't think that helps the patient at all.

Everything Cancer (16:07)
Yeah.

Mm -hmm. That's a phenomenal answer. And I have like a whole bunch of thoughts going through my head with that answer. First of all, I sat in on several tumor boards and it's amazing to have the radiologist pull up the different types of imaging for one person and compare.

Dr Tiffany Troso-Sandoval (16:18)
I don't even know where to start with that.

Mm

Mm

Everything Cancer (16:37)
so for our listeners, the tumor board is multiple disciplines, such as a medical oncologist like yourself, a surgical oncologist, a radiation oncologist, the pathologists, the radiologists who read all of the advanced imaging. Oftentimes we have physical therapy, there are rehabilitation therapy, social workers and navigators and geneticists all together.

Dr Tiffany Troso-Sandoval (16:39)
Okay.

Everything Cancer (17:01)
And so they review a case to come up with a recommendation based on everybody's expertise and standards of care. And it's fascinating to see the radiologists pull up the various types of imaging when decision discussions are happening as to whether or not to proceed with surgery. And

how things can be viewed in MRI versus CT scan. And actually the PET scans have a tendency to be very fuzzy They're intended to look for distant metastasis or you can explain it better or even local metastasis,

Dr Tiffany Troso-Sandoval (17:35)
Yes.

Everything Cancer (17:36)
And I really wish, maybe something we can collaborate on sometimes is to put together with some other people, kind of like a mock tumor board where people could understand how that conversation occurs and they gain an understanding for how each discipline interacts with each other and how pathology really helps in that conversation and so on.

Dr Tiffany Troso-Sandoval (17:37)
Mm

Everything Cancer (17:58)
So I hope that helps our listeners understand a little better. the other thing that came to mind for me, is that educational aspect is so important for people to be able to really understand their treatment options. Second opinions. They can really build a person's confidence in their treatment plan. But what's your thought?

I just saw you kind of like, yeah.

Dr Tiffany Troso-Sandoval (18:20)
No, I, well, I mean, it's true. I agree. know. So I'm a huge proponent of second opinions, but because I think everyone should have more than one opinion, especially if they're not at an academic medical center. Because I do think that although there are thousands of fabulous oncologists across the country, some of them are generalists and are maybe not

Everything Cancer (18:27)
Yes.

Yes.

Mm -hmm.

Dr Tiffany Troso-Sandoval (18:47)
as up to date and specific subtypes or treatments of certain cancers, And so particularly if you have a slightly unusual treatment of cancer, I would absolutely look for a second opinion at an academic medical center. Doesn't mean that that other doctor can't treat you, but I would just confirm that, you know, this is the things change so quickly. The only problem with the second opinion is that what if they don't agree with the first opinion, right? So then you're stuck, the patient is stuck sort of deciding

Everything Cancer (19:12)
Right.

Dr Tiffany Troso-Sandoval (19:16)
Which one is right? Who's right? Who do I trust more? And that's really tough. And then you go for a third opinion. And now, now you've delayed your care, right? Whereas if you had just started treatment, you would be farther into the process already. I, I'd always, particularly in a patient that has, you know, advanced cancer, when they're shopping for multiple treatments and, know, they come in to see me and they're like, been sitting on treatment for six weeks because they wanted to see, you know, the specialist at the Mecca.

I felt terrible. You know, you need you need to start anything at this point, you know Because you don't want to wait till somebody's cancer gets out of control because then it gets you know It's even harder to get it under control So, yes, I think of second opinions I'm a proponent for them But I also do you know You have to realize that you might not get the same opinion and then you have to you're left with the bag of deciding what to do Which is honestly, I think

Everything Cancer (19:51)
Mm -hmm.

Right.

Dr Tiffany Troso-Sandoval (20:08)
going forward, my concierge consultations I think will be very important for that. I help patients basically go through those two discussions. you know, I can help them make a decision. I don't want to make it for them, but I'll help educate them. I'll help review them with them so they understand each side and why. And so help to bring clarity to help make them decisions. So hopefully, you know, that's, I'll be able to help a lot of people like that.

Everything Cancer (20:36)
That clarity can make a tremendous difference and there are times when a different treatment plan is suggested. Usually what I have found is oftentimes the two oncologists will confer and discuss and possibly come to an agreement. But let's say a different treatment plan is discussed and ultimately agreed on, it doesn't mean you have to go to that academic center.

for that treatment. Right, that plan can be shared with your local oncologist. Right, yeah, it happens a lot, so.

Dr Tiffany Troso-Sandoval (21:02)
No! Nope.

100 % all the time, all the time, all the time. But I also, in that note, I agree with you, absolutely. And I would very frequently call other doctors and discuss, know, this is what I think and this is why, why did you come to that conclusion? And we'd, you know, banter back and forth and come up with a plan for the patient together. But that's because I knew that they were there for a second opinion and the other doctor knew that they were going for a second opinion.

Everything Cancer (21:18)
Mm

Dr Tiffany Troso-Sandoval (21:31)
So that's always the tricky part, because a lot of patients don't want to tell their doctor that they're going for another opinion. And then the communication between the two doctors can't occur. And that's tough. So it's really important to be honest with your doctor that you're going to be doing that, because it'll help you. Yeah.

Everything Cancer (21:35)
Right.

Right. So.

It is for our audience. Most oncologists would not be upset if you were going for a second opinion and they would actually probably try to help you get that opinion done quickly so that you don't have a delay in care. Most of them would welcome it because if it agrees with their plan, they know that you're going to have more confidence in the plan and you'll proceed with.

feeling really good about things, which is important. If there's a suggestion made that can, from a nuanced standpoint, that can help augment that plan all the better. But if you have an oncologist, so I agree with you, absolutely, Tiffany, as a survivor, as a patient, and when I say survivor, I'm talking about from the day of diagnosis, NCCS, National Coalition for Cancer Survivorship says from day diagnosis, you're a survivor.

You need to be honest with your oncologists to avoid a delay in care, but also they can get a navigator in their office or a nurse in their office to get that second opinion scheduled for you pronto and make sure your records get there quickly. That's their job is to advocate for you. Yeah.

Dr Tiffany Troso-Sandoval (22:54)
Yep, I agree with that. In fact, I have often said to patients when they question me, you think I should get a second opinion? said, that would make you more comfortable? Absolutely. In fact, I'll help you get them. And I can actually probably text doctors in the area that I know that do the specialty and get them an appointment sooner rather than later personally. And I would always say, this is not about me. It's about you, about you and your comfort and your path.

Everything Cancer (23:06)
Mm

Mm

Yeah.

Dr Tiffany Troso-Sandoval (23:21)
right? And so whatever I'm here to help you, no oncologist went into medical oncology to become a billionaire. Trust me, we're there because we want to help you. And it's our passion. It's my life goal to do this. you know, and just to share a little bit about myself that I, you know, I had my own medical issues and I had to step back and I'm not in, I'm not at Sloan anymore. I just retired a couple of weeks ago.

Everything Cancer (23:22)
Right.

Mm

Dr Tiffany Troso-Sandoval (23:46)
But I am continuing my path in my own way to continue to help patients because like I said, it's part of my being. It's part of my essence at this point. Like I couldn't imagine doing anything else. And I just have to do it in a way that I can take care of myself as well. Seeing 100 patients a week in a major medical cancer center wasn't in the cards for me, but 25 years I did it. And yeah, it's wonderful.

Everything Cancer (23:56)
Right.

Right.

You've seen a lot in those 25 years. Yes, you have. And you've seen a lot of changes. And the way you're going about things now may give you an opportunity to help more people. Yeah. Then you were able to reach more people, which I think is amazing. And I think it's a wonderful way to proceed. I really do. You're welcome. You're welcome. So why is it really important for people to use when they're coming to you with,

Dr Tiffany Troso-Sandoval (24:15)
Being a lot and a lot.

I think so too. I think so too. Yeah. Yeah.

Thank you. Thank you.

Everything Cancer (24:42)
things that they want to discuss, ideas they're hearing. Why is it really important for people to use credible sources of information to educate themselves? I love the smile you're getting on your face when I ask you that question.

Dr Tiffany Troso-Sandoval (24:54)
So I want to start with an analogy. So one of the things I've been doing is to sort of get myself, my name out there, my brand, and to help people because I'm not established yet. so I'm in a lot of Facebook groups, for example. I'm in 15 different cancer groups, ovary, uterine, five different breast groups, And I read, and I read what people say. And it amazes me. There are tons of people out there that know a lot. There really are.

I feel like it's a little concerning because people are looking for their medical care and medical opinions in these Facebook groups that are not, sometimes they're very helpful, but, you know, we have to gauge where the information is coming from, right? And so, you know, I was just reading a text message or a Facebook message. Somebody was talking about, have a pleural effusion. What does that mean? Is it in my lungs? And somebody said, somebody answered, well, sometimes

you can use Lasix or something else to get rid of it. And I thought, no, no, no, no, don't do that. And I just thought, why is this person recommending a diuretic to get rid of a cancer derived fluid? And that's certainly not the most efficient or safe way to get rid of it, right? So you have to be really wary of where you're getting information from for sure. There are plenty of national guidelines and information sources that are on the internet as well.

that your doctor can give you printouts of. On my website, I have listed a bunch of the sites where I think if you wanted information where you should go, if I wasn't covering it or if you wanted another source sort of thing. So yeah, because you need credible medical information. You don't want to you know, it's...

Everything Cancer (26:24)
Mm -hmm.

Dr Tiffany Troso-Sandoval (26:39)
It's concerning to me also. The other thing I find in these Facebook groups is that there are tons of people trolling in there talking about herbal medications and Dr. Gawander, you know, special diet and buy this book and, you know, I take these herbs and they fix my cancer. I think, God, because I've, I've seen that too in real life. I've seen that play out.

Everything Cancer (26:59)
Yeah, yeah, right. am, you know, and everybody is welcome to their own decision. Absolutely. When it comes to, think integrative oncology is an excellent thing because that's exactly what integrative oncology is. The care is integrated with your current oncology care to help with symptom management. And they...

depending on who the discipline is, where the discipline is coming from, they can collaborate with your oncologist or with someone in the office. Another person to really rely on in that situation is your clinical oncology pharmacist who understands the interaction with supplements, herbal supplements and so on, and your treatment regimen and when to safely combine those. But again, that...

Dr Tiffany Troso-Sandoval (27:33)
100%.

Mm

Everything Cancer (27:52)
that takes honesty and accountability from the patient, from the survivor to be honest about what they're, what they're doing. so I completely agree. And I have seen people go with alternate treatments, but I think it needs to be a well informed decision when you do that. So I cringe when I see someone say with metastatic melanoma, which is very aggressive.

going for alternative treatment because I feel they are very, very likely probably going to die from that decision, from the delay of care. And when there are, when there is very good standards of care available for that with the immune checkpoint inhibitors. And so yeah, that's, that is a frustrating thing. It is.

Dr Tiffany Troso-Sandoval (28:25)
Mm

Yeah. I want to comment on what you said about the herbs and the clinical oncology pharmacist. I have a whole chapter on this in my book that's coming out, but a great resource, if you want to put it in the notes for the show, is MSK has an app. It's not available on the computer. It's just on your phone or your tablet. It's called About Herbs. And it is one of the most comprehensive

Everything Cancer (28:46)
Yes.

Dr Tiffany Troso-Sandoval (29:06)
scientifically backed herbal reviews I have ever seen. And they have a site that's for physicians and a site that are for patients as well. it goes, you you can pretty, you just look up an herb and you can read what it's used for purportedly and you can look at what its potential interactions are and recommendations. I mean, it's still, you still should discuss it with your doctor, obviously, but I think it's a great resource for patients and survivors.

Everything Cancer (29:10)
Mm

absolutely. For our audience, MSK is Memorial Sloan Kettering, which is an amazing cancer center that really leads the way in so many things. I think that I'm going to add that as a resource. That's really amazing. In your observation, Tiffany, what traits and habits drive success for people to get through tough treatments?

Dr Tiffany Troso-Sandoval (29:49)
Mm -hmm. Yep. Very, very, very poignant question. So mindset is very important, and it's also very difficult to affect. I feel that having sort of a fighter mentality, an educated mentality, really helps patients to do well, to thrive.

as best they can during this difficult time in their life. And I really feel that patients that almost embrace the diagnosis and the treatment as this is what I'm going to do and I'm going to do it the best that I can, as opposed to I have some patients that have more of a victim mentality where they feel like it's happening to them or people are doing this to them. And you can imagine if you put yourself in that kind of a mindset,

Everything Cancer (30:12)
Mm -hmm.

Dr Tiffany Troso-Sandoval (30:38)
everything sets you off, right? So if you feel like you're the victim and that's where your brain is taking you, you're that much more upset when you have to wait too long. You're that much more upset when the nurse couldn't get the IV in the second time. You're that much more, you're just on, you're on edge and everything sets you off. And I feel like people that can just take a step back and be like, and accept the fact that this stinks.

This is absolutely not where I wanted to be in life right now. And I wish I wasn't here, but here I am. This is the facts and I'm going to embrace this and I'm going to win my cancer journey, which is one of the things that I try to support my patients to learn. And it's tough. mean, how do you tell? It's like somebody telling you like, cheer up or calm down. Why don't you calm down? Can you imagine somebody telling me to calm down? I get twice as now.

Everything Cancer (31:27)
Yeah.

Dr Tiffany Troso-Sandoval (31:32)
So it's something that you can't be told, but you have to sort of bring yourself into. And maybe working with a care manager or a social worker will help you to get into that mind space where you're taking charge of your life and you're taking charge of leading this pathway through your cancer treatment.

Everything Cancer (31:50)
That's a really interesting thing to bring up and that's actually a trait of people that do very well in resilience through cancer treatment. They accept what is happening. Doesn't mean they like it, but they accept it and they learn how to roll with everything and then how to control what they can, which includes living a healthy lifestyle, getting to their appointments on time. And when you're talking about that reactionary response,

Dr Tiffany Troso-Sandoval (32:02)
Yep. Yep. Exactly what I'm

Everything Cancer (32:17)
That's raising a person's cortisol level, which is no good in terms of in the cancer fight because it's the inflammatory response, which is no good when you are in the midst of this at all for your health. It decreases your immune system. It has all kinds of negative effects on you. And also it takes you out of that good mental space that you really need when you have. So I really try to coach myself out of that and mindfulness, which

Dr Tiffany Troso-Sandoval (32:29)
100%.

Yep.

Everything Cancer (32:46)
The mind -body connection, which the National Cancer Institute talks about quite a bit now, is so key, I think, to that acceptance piece, as taking personal accountability for your health, such as exercising, taking walks, taking a break, and so on. But I love that. I think you're right. I think that is key, is being the fighter in this through...

Dr Tiffany Troso-Sandoval (33:01)
Yep. Yeah.

Everything Cancer (33:10)
not letting things get to you, but saying this stinks and I'm just going to make it work and I'm going to get through this one day at a time, one step at a time.

Dr Tiffany Troso-Sandoval (33:16)
Yeah. Yeah. I have a whole keynote speech that I've given to a couple associations on grit and resilience in oncology patients. Yep.

Everything Cancer (33:24)
Yes, and resilience is important, but for our survivors listening, an article I just read said that oncology patients, cancer survivors are some of the most resilient people around. And it shows, and also they have higher self -esteem after they've been treated because of their resilience. So there you go. I will, I will. And we were just talking about this. How important is,

Dr Tiffany Troso-Sandoval (33:43)
You should share that link to that article. That's a great article.

Everything Cancer (33:49)
Dr. Trosta Sandoval, how important is self -care through treatment?

Dr Tiffany Troso-Sandoval (33:54)
It's paramount. It's paramount. I usually tell my patients to become selfish. I treat almost all women who are often the caregivers to others. And that at some point you're going to need to change the percentage or the paradigm of who's taking care of whom at this point.

Everything Cancer (33:57)
Mm -hmm.

Dr Tiffany Troso-Sandoval (34:13)
I'm not saying give up your whole family or anything, but on the other hand, you have to make sure that you're rested properly and that you're getting enough fluid and that you're not getting overly stressed because of the cortisol level, I agree with you, and that you really need to put yourself first. Now it's an important, while you're in treatment especially, you have to really take care of yourself. Making sure you're getting enough sleep, enough fluids, you're eating healthy, balanced, that you're moving your bowels every day.

Everything Cancer (34:25)
Mm

Dr Tiffany Troso-Sandoval (34:40)
I usually tell my patients that I want you to go back to basics. I want you to remember the basic things. And if you take care of the basic things, a lot of the other things will fall into place. Basics, sleep, drink enough water, eat a balanced diet, make sure you go to the bathroom every day. I mean, it's just the basic. Walk, I want you to walk every day. I'm not telling you to go pick up a new weight lifting routine, but go out and walk for 20 minutes every day. It'll do your mind and your body.

Everything Cancer (35:09)
And that's important after treatment too through survivorship. Absolutely. That makes such a big difference. So we'll have links in the podcast as to how people on the notes as to how people can get hold of you. I would love to have you back. And what would you like to share that we haven't covered yet that's really important to you? Besides everything. Yeah.

Dr Tiffany Troso-Sandoval (35:12)
Absolutely. Yep.

Sure, I would love to come.

Besides everything, just to, you know, I just want to encourage women to advocate for themselves and to keep a very close eye on how you're feeling, how you're doing. And bringing that thing that I was saying to you about the basics, especially for somebody that's in treatment, for example, I always recommend you keep a diary and or, but not just for your mindset, but for your medical treatment as well.

I usually recommend that women buy a nice planner that has the weekly and the monthly in it. And in those weekly sections, you can use, you can apply this to anything, but in the weekly sections, usually you'll have two pages of each day. We'll have a nice big box like that and discuss with your doctor what you should be tracking. I used to have my patients track, were you nauseous? What time, what day was that following chemotherapy? But you could do the same thing with

hydration and moving your bowels and mindset and were you constipated? Did you take something and then you went to the bathroom and it worked and okay, good. all that is like kind of there. Cause you know, you can bring that book to your doctor and the doctor can really help micromanage and help you feel better. But this works, you know, in the, maintenance phase or even in the survivorship phase, right? It just, it's just, you'd be tracking slightly different things, right? But it's, it's always good to have.

Everything Cancer (36:38)
Mm -hmm.

Dr Tiffany Troso-Sandoval (36:46)
data and even if you don't, I'm an old school. I like it in a binder on paper. But you could do it on your phone too. So mindfulness, being aware of yourself and the symptoms and how you're feeling I think is really important. Advocate for yourself and educate yourself. Get educated.

Everything Cancer (37:01)
I think when you'll get my journal, you'll be really surprised, pleasantly surprised because it's outlined to do just that. yeah, yes, they do. They do. And that tracking is so important and having that data in front of you when you're talking with your doctor really helps that conversation go so much better. Yeah, because you're not trying to remember. Yes. Yes. It's huge.

Dr Tiffany Troso-Sandoval (37:08)
Good. Great minds think alike, right?

Mm -hmm.

So true. It's so much easier to help you if I know exactly what's going on. Yeah, exactly.

Everything Cancer (37:28)
I so appreciate your time with us today and I can't wait to have you back again and hear how things are going for you and hear about your course. You're welcome. Thank you for taking time to be here.

Dr Tiffany Troso-Sandoval (37:36)
thank you.

Thank My pleasure. Thank you so much for having me, really. Have a wonderful day, everyone. Bye.

Everything Cancer (37:43)
Absolutely, you too.

Dr. Troso-Sandoval’s LinkedIn linkedin.com/in/tiffany-troso-sandoval-md-b897a017

Dr. Troso-Sandoval’s  email:  ttrososandoval@gmail.com

Dr. Troso-Sandoval’s Winning the Cancer Journey website: https://www.winningthecancerjourney.com/

Memorial Sloan Kettering Cancer Center About Herbs, Botanicals, and Other Products https://www.mskcc.org/cancer-care/diagnosis-treatment/symptom-management/integrative-medicine/herbs