Richard C. Frank, MD, realized that many of the patients he saw in his community oncology practice were asking the same questions and desperate for the same information. His patient-focused book, Fighting Cancer with Knowledge and Hope: A Guide for Patients, Families and Health Care Providers, covers the scientific principles of cancer diagnosis, treatment, and survivorship at a level appropriate for a lay audience. Between explanations of crucial oncology topics such as how cancer is staged and how treatment strategies are determined, the text is peppered with Dr. Frank’s experiences with extraordinary patients, many of whom continue to live healthy, fulfilling lives beyond their original prognosis.

“I made the transition from a big academic cancer hospital to a community hospital ten years ago,” Dr. Frank said. “I live and work among my patients, so this book is from the heart. Oncology challenges us to be our very best for our patients. I wanted to convey the challenges faced by both patients as well as their oncologists, to provide insight into the difficult world of the doctors striving to help them.”

He writes a "Fighting Cancer" blog as a companion to the book. CURE magazine recently published an essay in which Dr. Frank reflects on the experience of losing a patient.

The Director of Cancer Research at Whittingham Cancer Center and Medical Director at Mid-Fairfield Hospice, in Connecticut, Dr. Frank discussed the philosophy behind his book with ASCO Connection.

AC: What was your writing process like?
Dr. Frank: I didn’t write every day. When I was sitting with a patient and they would say something to me, such as, “I wonder why I have a lung tumor but not lung cancer—I don’t understand that,” then I would immediately have to go write, because I knew that was something all patients were asking. So when someone would say something to me in the process of my interview—coming to grips with an incurable cancer or trying to understand the disease and how we treat it—a light bulb would come on and I would run to the computer and write.

AC: How did you come to realize that there was an audience for this kind of book—comprehensive science written for a lay audience?
Dr. Frank: First, every patient with cancer wants to know these things and many are afraid to ask, or they feel it’s too complicated to ask about certain things. Most conversations about science just don’t go on in the doctor’s office. It’s impossible in the course of a short office visit to talk about something like clonal evolution, for example. It sounds like a complicated term, but when you break it down, it’s the basis of tumor resistance, and that’s what people want to know—why did the cancer respond for six months and now it’s going off in another direction? If a patient could nuzzle up to a non-threatening way to understand that, it would really be of great benefit, and it certainly has been from the feedback that I’ve gotten.

The second thing is that the Internet is just a minefield. People gravitate toward the Internet because it’s easily accessible and free, but I don’t know one person who hasn’t been misled or scared by something they read online. If they have medical backgrounds—if they or their children or their friends are doctors or scientists—then they can sift through the information. But if they’re on their own like the vast majority, they’re just scared and overwhelmed. They come in saying, “My doctor told me it could be MDS. I read online that I need a bone marrow transplant but I’m 75, I can’t get that. I’m going to die.” But odds are that people are leaving my office a lot happier than they came in because the Internet doesn’t speak to the individual. The doctor does. Pancreatic cancer: three to six months is the prognosis on the Internet, but how many people do we know who are living a lot longer?

AC: How do you hope patients will use your book as they go through their cancer journey?
Dr. Frank: A lot of my patients have said that they read some of the book at the beginning of their diagnosis, then they would read parts again after they were finished with treatment, and a lot continued to carry it around and refer to it. There are certainly some concepts that require rereading. I think it demystifies and desensitizes them to the scariness of the disease. It also gives them hope because I have a lot of real-life stories of people living way beyond the odds—I’ve seen extraordinary responses to standard therapy. We all have. I want patients to take away comfort, definitely more knowledge, and a sense of realism and hope.

AC: One of the messages in your book is that patients often feel helpless, but knowledge can give them a sense of control.
Dr. Frank: Absolutely. Before you come into an oncologist’s office, you don’t know if you’re dying, if your surgery worked—you just don’t know. Your oncologist can only take you so far in terms of that knowledge, and today people want a lot more knowledge. Good knowledge is empowering, good knowledge is comforting. A lack of knowledge is scary—it’s the fear of the unknown. What I hope the book does is explain the known and take the fear out of it.

AC: One of the things you suggest is mindfulness and focused thinking on the part of the patient during cancer treatment. Can you explain what you mean by that?
Dr. Frank: I wanted people to understand that we all are in agreement that good cancer care consists of much more than surgery and chemotherapy—it involves being cared for. Good cancer care includes, first of all, dealing with the psychological impact of the diagnosis. Whether the cancer is curable or not, the patient is facing a new threat to their life and they need to psychologically explore how they’re doing with that. They and their loved ones need help navigating emotionally through the diagnosis and treatment. Especially in an incurable situation, people really need to be meeting with oncology therapists or social workers at least a few times. If those services are not available at that hospital, they can call CancerCare and set up a phone appointment. (Editor’s note: 10% of the book proceeds are donated to CancerCare.)

The second thing is to alleviate the anxiety of the diagnosis and treatment. A lot of people do like to partake in certain mind/body approaches, whether that’s Reiki or massage or something to just relax them. I try to explain to them that “it’s all good,” as long as they’re not doing themselves any harm. I play music and it’s therapy for me.

AC: How would an oncology professional use your book?
Dr. Frank: I wrote it hoping that doctors and nurses would use the book to help their patients. It has met with rave published reviews from physicians in the U.S. and in other countries. Our hospital will give it out to every new patient, for free. The Leukemia and Lymphoma Society is starting to sponsor it. I’m not saying this selfishly—there’s little money in it for me—but if you’re an oncologist and you care about what your patients are reading, and you want to improve the dialogue between you and your patients, then tell them about the book or make it available to them. I wrote the book because I felt that I had the clinical and scientific background, the writing ability, and the humanistic approach to put together a unique resource for patients. I’d love it if doctors made the book available to patients.

AC: The foreword is written not by a doctor, but by a professor of literature. What’s the story there?
Dr. Frank: Dr. Edmundo Bendezu was one of my patients who is now doing well. I gave advanced copies and some early chapters of the book to some of my patients, including Dr. Bendezu—I had my patients guide me in terms of whether it was good or not. He was blown away by it and said all these wonderful things, so I asked him to write it down and that became the foreword. This book has been endorsed by real patients and this is that kind of endorsement. That’s why I asked him to do it—no one could have said it better.