Courtney Collen (Host): Hello, welcome to our podcast series ‘Beyond the Diagnosis’, focusing on embracing life after cancer, through Sanford Health survivorship programs. I’m your host, Courtney Collen with Sanford Health News. We’re so glad you’re here. Once a patient hears those words, “you have cancer,” that patient becomes a survivor. Through my conversations with health providers on topics related to survivorship, we’re learning more about how Sanford continues its commitment to help people live their best life beyond the diagnosis.
Our topic today is all about lifestyle as medicine. I’m so pleased to have two guests to talk about this. First Dr. Shelby Terstriep, a medical oncologist at the Sanford Roger Maris Cancer Center in Fargo, specializing in breast cancer and survivorship care. We also have Alexis Allen who is a senior wellness program specialists with Sanford Health Plan in Fargo.
Thank you both for joining me and for being a part of this conversation.
Alexis Allen: Thanks for having us.
Dr. Shelby Terstriep: Thanks so much for having us here.
Host: Alexis, I’ll begin with you to learn more about your role in Fargo.
Alexis Allen: Sure. So my role in Fargo here is I’m a registered dietician. I work with patients with the Sanford health plan. That’s primarily who we serve over here. I also got a extensive background in overall wellness. That is kind of my role here in Fargo and our primary patient population is those with hypertension, hyperlipidemia metabolic syndrome, pre-diabetes type two diabetes, depression and/or anxiety as well as obesity of 30 or greater. So, that is kind of the patient population that we reach out to here. But we’ve also got lifestyle medicine specialists and registered dieticians in Bismarck, Sioux Falls, as well as the rural communities.
Host: And then talk about where the Center for Lifestyle Medicine comes in.
Alexis Allen: What I’ll do is I will visit with a patient for the first time for about an hour and we will touch on the six dimensions of wellness. So, we’ll kind of take an inventory of, you know, where they’re at with their overall wellness. So what we’ve got the six dimensions of course, is physical – the one that you would expect, but we also touch other topics such as financial wellness, social wellness, community, career, and emotional wellness, just because when you kind of get into it, it all ties together with overall wellness. And then from there we will create a plan and we’ll put a time on that, which is always subject to change based off of the patient’s needs. And that plan is really just to indicate what the patient’s long-term goals are as far as their overall wellness goals. So it’s very patient-led and the specialist is there to provide guidance and education for that patient. And on average, I would say we visit with these patients every week or every other week, depending on their needs for about four to five months or until they feel like they have reached their goals.
Host: Dr. Terstriep, why is this concept of lifestyle as medicine and the Center for Lifestyle Medicine at so important for patients?
Dr. Shelby Terstriep: Well, I’m so excited that we have this here now because the data for cancer patients and prevention and survivorship is really crazy actually how important it is in the long-term outcomes for our people. When we look at prevention, we know that healthy lifestyle can prevent up to 40% of cancers. So, if we don’t address this, we’re really missing the mark. In addition, when we look at people who’ve already had cancer – if people are obese, they have an increased death rate with their cancer and if they are sedentary, they have a 22% increased death rate. So, if we don’t focus on this, we really are missing a major part of effective treatment for their cancer.
You know, the other aspect of it is that we know from all the research that’s coming in is these are some of the most important aspects of improving people’s quality of life. So, it helps with anxiety, depression, and improves mood. It improves cancer related fatigue and also improves their physical functioning. So it’s a very effective treatment.
Host: Tell me about some of the outcomes that you see through this program and what makes it so successful.
Alexis Allen: Yeah, I’m actually really glad you brought up quality of life because that is something that we really like to kind of touch on through the lifestyle medicine program. And we do measure some quality of life metrics and outcomes, you know, such as energy levels, quality of sleep, and overall, emotional wellness. We’ve had it up and running for just over a year now. So we’ve been really fortunate to get some solid metrics, statistics and outcomes through the program. So just to list a couple of those off that we are really proud of is: the patients that graduate our lifestyle medicine program with an obesity diagnosis, we’re able to reduce their BMI by on average 4% which is really great. We also have found that lifestyle medicine, patient graduates with a type two diabetes diagnosis have reduced their glucose by about 59 points on average. So for a 32% reduction, and that moves them from the type two diabetes glucose range down to the pre diabetes glucose range. We’re really excited about that. Our last goal with the lifestyle medicine program is not just to give them the education and send them on their way, it’s to kind of create those long lasting habit changes that are going to, you know, less than four years to come. And our last metric really, it demonstrates that by showing that our lifestyle medicine graduates were able to increase their physical activity by 106%. Those are some solid outcomes that we have been able to show the success of the program over the last year and a half.
Host: Wow. That is amazing. Alexis. Dr. Terstriep, what is it like to see these numbers?
Dr. Terstriep: This was the first time I saw the numbers, today. I was like, ‘oh my gosh, this is fantastic!’ because coaching is such an important piece of changing your lifestyle because everybody’s different and the factors that affect them and make them make it difficult for them to change unhealthy behaviors. You have to go on a one-on-one basis. I think the fact that these coaches can really design a plan that’s specific to hat person’s needs and then also help to work with them, to uncover barriers and work through those barriers and then when you see these outcomes you know this is working. I mean, these are really, really amazing metrics. If all of our cancer survivors go through this, they’re really going to be reducing their risk of recurrence and their risk of a secondary cancer, because we know in cancer survivors, they have a very high risk of a second cancer. So we need to try to prevent that as well.
Host: Alexis, walk me through the process of getting patients involved in this program.
Alexis Allen: Yep. So there are a few different ways for patients to get involved. On the provider side, they are able to place a referral through Epic, by typing in “lifestyle medicine”, and they can select one of the diagnoses listed on Epic.
Lifestyle Medicine is available to patients with Sanford Health Plan insurance with one or more of the following diagnosis:
- Metabolic syndrome
- Type 2 diabetes
- Obesity (BMI > 30)
If patients are interested in this program, they are able to ask for the referral. The patients that we primarily serve our Sanford Health Plan, insured patients. So with those patients, they are able to receive this through their wellness benefits at no charge. However, for non-Sanford Health Plan patients, we do have programs such as the diabetes prevention program, which has a lot of research behind that as well as exercises medicine, which is a 12-week exercise program that we host in-person and virtually right now. So those are available for our non-Sanford Health Plan patients. For any patient that is interested in this talking to their provider and having them place that Epic referral is the best way for them to get involved.
Host: And on the medical oncology side, Dr. Terstriep where, and when do lifestyle and wellness fit into a patient’s treatment plan?
Dr. Terstriep: When I think about developing a treatment plan for my patients with their cancer. Their lifestyle is always incorporated into that treatment. So we think about the chemotherapy, the radiation and the surgery, but then it’s, ‘Okay what type of connections do you have?’ How do we talk about financial health because that’s very important. And then looking at exercise and nutrition. So that is, you know, a conversation I have at the very beginning. The problem is we previously didn’t have a resource to be able to have that type of coaching, which we know is the most effective form of habit change. So I think addressing it at the beginning and then also addressing it at the end of treatment is what we typically do. We have a survivorship, our survivorship clinic, we’ll be referring patients as well to this program and then really thinking about it every step of the way. I think, you know, people’s lives and habits change over time. And so if people are kind of going off track, really thinking about it each time we’re seeing someone so that we are, you know, getting them into an effective change management program.
Medicine should be looking at what’s the underlying problem here and how can we prevent issues from happening? And I think this is one step of that process.
Host: How can somebody find support through the center for lifestyle medicine or any additional resources in their community?
Alexis Allen: I think the first thing is just having that conversation with their provider … is really opening the door to this program. I think one of the greatest things about this program is on our back end, we’re focusing on the metrics and making sure that we are reducing that second occurrence, or we are kind of being preventative, but on the patient side, they are increasing their quality of life and maybe able to do activities of daily living more comfortably, or keep up with their grandkids. Having that initial conversation is, I think, the first step in finding that support that’s needed and then throughout the program, you know, we really like to provide that support to the patient on an ongoing basis.
Dr. Shelby Terstriep: The other thing I think they can access, you know, for free right away is the Sanford Health Cancer Survivorship Facebook Page, which is really a page that is used to help promote these types of services include and including other services for cancer survivors. For example, education efforts and retreats that really focus on connection and connecting people with these types of resources. So that would be an easy thing to just, you know, like us on that, on that platform as well.
Host: Yeah. What else do you want our listeners to know on this topic of lifestyle as medicine?
Dr. Shelby Terstriep: One of my mentors when I was in training used to always say our job as an oncologist is really to help people live as, as well as possible, as long as possible and well is first. I think we really need to focus on living well. And what does that mean for each person and how, how can we be supportive in doing that? And I think this program is a great resource for doing that.
Alexis Allen: I think one thing also that is really fantastic to focus on is creating that long lasting habit change and flipping the perspective of ‘wellness is not something that we have to do. It’s something that we get to do’. It’s something we enjoy and kind of making it a positive experience and not so much a chore for those patients and kind of making it, yeah, I want to be, well, I want to do these things. I want to you know, incorporate exercise and fuel myself with good nutrition.
Host: Wonderful Alexis Allen, Dr. Shelby Terstriep, what a fantastic program and great conversation. The more we can talk wellness that better. Thanks so much for your insight and for all that you do.
Guests: Thank you so much for having us. Thank you.
Host: This was another episode of our cancer survivorship series Beyond the Diagnosis. I’m your host, Courtney Collen. Stay well and we’ll see you soon.