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Health Chatter

Minnesota State Cancer Plan

Fri, 17 Nov 2023

Description

Stan and Clarence chat with Dr. Sumedha Penheiter about Minnesota's State Cancer Plan.Dr. Penheiter - an experienced cancer expert - holds a doctoral degree in biochemistry and genetics from the University of Nebraska-Lincoln. She then completed postdoc work at Mayo Clinic focusing on cancer biology and signaling pathways in carcinogenesis. Currently, Dr. Penheiter serves as manager and consultant within the Mayo Clinic strategy department advising on system optimization and enhancement.Listen along as Dr. Penheiter shares her wealth of knowledge on the Minnesota State Cancer Plan.Join the conversation at healthchatterpodcast.comBrought to you in support of Hue-MAN, who is Creating Healthy Communities through Innovative Partnerships.More about their work can be found at http://huemanpartnership.org/

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Transcription

16.522 - 38.776 Stan

Hello everybody, welcome to Health Chatter and today's show is on the state of Minnesota cancer plan, but I'm only guessing that all the different objectives that we're going to be talking about for this particular state plan is appropriate for many of the other states in the country as well.

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38.796 - 64.925 Stan

We'll also link some of our discussion with Healthy People 2030 to see how we here connect with the plans and objectives for the nation as a whole. So stay tuned. In one second, we'll introduce our illustrious guests. We've got a great crew that really does super-duper work in the background for us.

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64.965 - 94.666 Stan

We have our researchers that include Manny Levine-Wolfe, Aaron Collins, Deandra Howard, and Sheridan Nygaard. Sheridan also does some marketing work for us. And then our math, our Our production person is Matthew Campbell, who gets our shows out almost on a weekly basis now. So it's been great. This is our, I believe it's close to our 70th show. So it's been a good, good run.

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95.427 - 116.762 Stan

Clarence Jones is my co-host with me on this show. And it's been a wonderful venture. He provides some incredible insights from a community perspective and greatly, greatly appreciated. So Clarence, thanks for being with us. And then also Human Partnership.

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150.892 - 174.703 Stan

What did I say? 2025, cancer plan. And today we have Dr. Sumeda Penheider from the Mayo Clinic with us. And she's got an illustrious background here. She's done her postdoctoral work at Mayo Clinic and has her doctoral degree in biochemistry and genetics.

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176.292 - 205.219 Stan

She currently works as a manager and consultant with the Mayo Clinic in their strategy department, where she advises on strategies for systems and procedures for clinical practice optimization and enhancement. It's interesting, my daughter in Boston works in that area, in cancer, actually.

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206.921 - 231.905 Stan

Also, she's involved a lot with health equity, which also overlaps with a lot of the different objectives in the state plan. So thank you. Thank you so much for being with us. By the way, she also serves as the vice chair of the Minnesota Cancer Alliance, which frankly was involved in developing this. this plan that we're going to be talking about today. So thank you very, very much.

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232.526 - 267.598 Stan

So let's get this show going here. Let's talk about the answer in general. You know, from your perspective, Sumita, cancer obviously is one of the major chronic diseases that we're facing in the country. Ironically, and maybe sadly, in the state of Minnesota, cancer is the number one cause of death in Minnesota.

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269.438 - 280.041 Stan

In most other states in the country, it's second behind cardiovascular disease, heart disease, and stroke. So you want to comment on that a little bit?

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282.722 - 315.902 Dr. Sumedha Penheiter

I think that The reason being is that we have great health inequities in our states. And a lot of those numbers are skewed a little primarily because we have high rates of incidents and mortality, not in total number, but rates in tribal areas. And we also have a lot of underserved populations that are so disproportionately impacted by this that the numbers overall are skewed.

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316.682 - 339.784 Dr. Sumedha Penheiter

And therefore I think cancer is the number one cause of death in Minnesota. However, I also think that our state has spent a lot of energy and time in controlling cardiovascular diseases and also investing in efforts to prevent cardiovascular diseases. bringing awareness to those.

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340.364 - 367.183 Dr. Sumedha Penheiter

But that level of engagement is still lacking in the cancer space, especially in the preventive and early detection areas. A lot of work is done post-diagnosis in treatment and then survivorship. And sometimes that is too late. And so I think those are a couple of factors that I can think of right away that are contributing to

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367.674 - 371.676 Dr. Sumedha Penheiter

cancer being the number one cause in Minnesota versus the rest of the state.

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372.516 - 388.283 Stan

So let me ask you as a follow-up to that, do you think that's unique for Minnesota? Or do you think that the similar problems as far as cancer reporting exist in other states as well?

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390.324 - 412.617 Dr. Sumedha Penheiter

Well, I think that there's great inequities in cancer incidence and mortality rates. inequities, and they are around race, ethnicity, and other underserved populations and along ability, disability. I think it's a two-edged sword. I think Minnesota is a very health-conscious state.

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412.857 - 433.57 Dr. Sumedha Penheiter

So I think compared to other states, we have a lot of efforts on health fitness in general, which has lowered our cardiac death rates compared to other states. So it's that we're doing really well in that space or we continue to do well in the space of cardiac health.

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434.591 - 455.965 Dr. Sumedha Penheiter

So we are ahead of other states, but then we don't have that level of matching efforts yet, or even understanding because cancer is a very complex disease and it spans all the way from etiology to prevention, detection, treatment. So I think one is there's just not enough understanding

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457.122 - 486.248 Dr. Sumedha Penheiter

of the disease amongst common people and to the methods that are in place vigorously for cardiac disease, you know, such as getting your parameters checked cholesterol and your BMI, and also making sure that exercise is part of your early lifestyle. The same level of awareness and intention is not there in the cancer space to the same degree.

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486.874 - 513.408 Stan

Yeah, yeah. And then a quick one, and then Clarence, you can chime in here. Do we link our efforts that you know of, you know, even our statewide efforts that we'll get into in a second here, with other with other groups around the country? Like for instance, I'd mentioned like my daughter, she works at Dana Fiber Cancer Institute in Boston.

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513.688 - 525.471 Stan

So do we cross over with any of their initiatives at all or look at data together? Or is it really more state by state from what you know?

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526.971 - 551.363 Dr. Sumedha Penheiter

Well, we definitely get ideas on how to design and implement the cancer plan. across, based on other states. However, the emphasis here is to really focus on local Minnesota problems because of the fact that there is quite a bit of differences between states in terms of local burden.

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552.003 - 570.458 Dr. Sumedha Penheiter

And even within the state of Minnesota, we're trying to be very mindful of identifying regional burdens of cancer, for instance, like I said, on tribal land versus urban communities versus rural communities and understanding that the cancer burden is different.

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570.498 - 597.281 Dr. Sumedha Penheiter

So although we definitely get implementation and design ideas from other states, CDC does a really good job of, Center for Disease Control does a really good job of making sure that there's data available openly for all of us to examine what the cancer burdens are per state. And we are aware of that. So we do contact other states for tactics.

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597.441 - 610.994 Dr. Sumedha Penheiter

There are meetings that MDH attends with other state cancer plan committees. The goal is really to get ideas from them, but to focus on the local burden.

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611.374 - 612.295 Stan

Yeah, gotcha.

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613.28 - 640.888 Clarence

Clarence, go ahead. Dr. Samia, you spoke in your previous conversation a lot of times about the lack of awareness among groups of people. Could you talk about this plan and how does it plan to address that? I mean, are people not aware or is there a strategy for that or communicating more effectively with people to make them more aware of the risk of cancer?

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642.509 - 670.867 Dr. Sumedha Penheiter

So, This plan is actually, the genesis of this plan is a lot of listening sessions, data review of cancer burden, and then concerns of the community. And Minnesota Cancer Alliance has a very robust partnership of members across the state that act as amplifiers of our information as well as information in and information out.

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671.889 - 700.412 Dr. Sumedha Penheiter

So the way this is done is trying to reach communities at the grassroots levels to the most extent possible and ensuring that not only are we looking at the data, but looking at logistics and practical tactics that either prevent early detection and screening or eventual cure and the process of cure. So we even help with legal insurance

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701.112 - 729.638 Dr. Sumedha Penheiter

we help with legal tactics with making sure that some of the screens as well as treatments are covered by insurance and are legislatively impacting the insurance companies so that they're enforced almost to cover some of the costs occurring with diagnostics as well as treatment. So I think the way that we are addressing this is

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730.191 - 745.838 Dr. Sumedha Penheiter

Again, going to grassroots level, looking at burdens, and then forming our strategies. So it's never an isolation or vacuum. It's always done in concert with the community members and the members that are part of the alliance.

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747.439 - 775.206 Stan

So, you know, a few shows back, we had Matt Flory on the show, and he was talking about cancer screenings. And I noticed as I reviewed the plan, some of the objectives really focus in on screening, whether it be for breast, cervical, colorectal cancer, lung cancer screening, et cetera.

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775.667 - 793.678 Stan

So talk to me about screening from an objective standpoint, and then perhaps we can apply this to many of the objectives here. You're eight years into this plan already, okay? So how are we doing? So let's talk about screening first of all. Go ahead.

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795.68 - 818.419 Dr. Sumedha Penheiter

So as you mentioned, we do focus on breast, cervical, and colorectal cancer screening. I want to point out that things that are in the objectives can only go so far unless they are adopted into policy. They really don't continue long-term and they are not sustainable.

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818.679 - 847.808 Dr. Sumedha Penheiter

And so to that, well, we have a very robust policy committee within the Alliance that has gone and lobbied at the state level with the senators and tried to tie almost every initiative with a policy so that it can actually be long-term sustainable and come to fruition. So we have done significant work in that space.

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848.288 - 874.071 Dr. Sumedha Penheiter

For instance, we have made sure that the cost sharing part of insurance, that insurance charges for breast cancer diagnostic testing is removed. We have also recently worked hard to have biomarker testing, which would be biomarkers that could lead to understanding of early cancer. that is not symptomatic yet or very early symptoms.

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875.172 - 894.668 Dr. Sumedha Penheiter

We have made sure that those are covered by state regulated insurers. So we have done some efforts in that space through policy. In addition, we have also gone through things like mobile mammography units and a lot of awareness in that space into rural areas

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896.598 - 908.041 Dr. Sumedha Penheiter

We actually use funding mechanisms through the Alliance where we fund our partners and community members to amplify the work around these objectives.

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908.061 - 932.247 Dr. Sumedha Penheiter

So we have done significant amounts in each space in terms of we've created a community health worker program where we talk about insurance, again, covering community health worker charges so that they can be navigators within the system to talk about screening and detection and awareness at an early stage with the communities. So it's a multi-pronged approach.

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933.187 - 962.597 Dr. Sumedha Penheiter

And while I do talk about early detection, I want to say that we follow the whole spectrum from detection, but then a lot of people are in the treatment phase and the survivorship phase. So we also support them in that space. But early detection, this is an ever-evolving, innovative space. You have people that can be family or genetically predisposed to cancer that are human for early screening.

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962.637 - 968.825 Dr. Sumedha Penheiter

But then there's a lot that do not have familial history and yet could develop some of these cancers. Yeah.

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969.522 - 997.295 Dr. Sumedha Penheiter

The idea is to do early screening based on a variety of techniques, one of which is genetic testing or genetic screening and several others like diagnostics, like breast exams, and just going into communities and removing the hesitation and cultural nuances that are around testing and encouraging them to take care of their health.

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1000.498 - 1022.272 Clarence

Yeah, so Dr. Simeo, you talked a little bit about challenges. There's always the rural versus urban strategy. Could you talk a little bit more about that? Because were the challenges the same or was there a special strategy that had to be developed for each group, for the rural versus the urban?

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1024.533 - 1058.882 Dr. Sumedha Penheiter

Well, I think from what I understand is that There are some common denominators across the board, but there's also unique factors. Starting with urban, I think I can point out that there's a lot more access in the areas of urban clinics. However, I feel that there's still, depending on what city you live in, transportation can still be a barrier.

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1060.324 - 1085.679 Dr. Sumedha Penheiter

And in urban areas, people are working, you know, some cases around the clock. So making time for health appointments and coming in to get their screening done. And a lot of efforts are in clinical trial space to address and understand cancer and provide state-of-the-art therapeutics to make sure that cancers are cured if they are indeed

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1086.403 - 1116.427 Dr. Sumedha Penheiter

occurring and there's just that social determinants of health are much more complex in urban areas, although they exist in rural areas as well, but they're different. And so the complexity of the social determinants of health with an additional factors that contribute to risk of cancer, such as environment and pollution, definitely add to that burden.

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1117.227 - 1146.989 Dr. Sumedha Penheiter

So I think the strategy has to be different, again, based on the cancer burden, which is different, but also the social determinants of health, which vary between rural and urban areas. And in rural areas, access is a concern. A lot of rural communities have to drive for miles before they can come to a place where they can see a physician or get treatment.

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1147.689 - 1175.239 Dr. Sumedha Penheiter

And in that, we've worked hard to establish pilot hubs in the rural areas through the Minnesota Clinical Cancer Trial Network. to have some of these clinical trials available in some of the smaller communities within greater Minnesota. So there's different factors and different social determinants of health, although they exist in both.

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1175.439 - 1193.958 Dr. Sumedha Penheiter

They just, the strategy to address them are different based on what they are. There's more food insecurity in urban areas. There's more, you know, inability to walk and get exercise because obesity does help just lead to cancer occurrence.

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1194.718 - 1217.286 Dr. Sumedha Penheiter

There's just not as much available even though there is a lot of money in terms of the underserved community being able to access clean trails, to be able to walk to school, to be able to, I mean, just the difficult gap between neighborhoods is immense.

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1220.445 - 1266.781 Stan

so let me let me connect a little bit here so we just got done a couple weeks ago doing a similar show in the cardiovascular arena and they just finished the development of their new plan 2023 to 20 or 2035, I think. Okay. So this particular plan was developed in 2015. And I'm just curious with the cardiovascular side of the equation, this, their plan really focuses on community engagement.

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1267.582 - 1294.537 Stan

Okay. So was that part of the, perhaps you can recall, was that part of the psyche putting together the, the plan for cancer or it has, community engagement as far as the objectives for this plan become more of a thing that's happening today than it did back in 2015. Do you recall at all?

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1296.599 - 1313.952 Dr. Sumedha Penheiter

Like I shared, you know, we're kind of using the same playbook with some modifications for the new cancer plan that we're formulating And it was very much based on listening sessions. We call them listening sessions that were at the grassroots level to understand the burden.

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1314.592 - 1345.817 Dr. Sumedha Penheiter

But in addition, we fund a lot of grants through the strategy action group is what we call them, where we target any time we have an initiative, we need to make sure that there's community engagement and community involvement. and always, always a community partner as a co-partner if possible. So that's kind of our strategy that we adopt to make sure there's community engagement.

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1347.077 - 1370.359 Dr. Sumedha Penheiter

Like I shared, you know, we worked on legislation to get a grant funded for community health workers. We worked with the community health workers organizations in Minnesota very closely to ensure that their work could be covered and paid for. So community is definitely the center of our work.

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1370.799 - 1391.227 Clarence

Yeah. And I can vouch for that. I want to just say, I can vouch for that. I was involved with the alliance and there was definitely a community engagement aspect of it. So it was great. Yeah. Which is why we're glad that Dr. Samea is here to talk about that.

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1391.656 - 1432.366 Stan

Yeah, great. So, you know, a lot, there's like 19 objectives in the plan that I see. And a bunch of them. focus on prevention. So, and, you know, maybe we can kind of encapsulate them all, because I'm sure they all have some kind of a risk factor aspect to it. But, you know, like tobacco, obesity, vaccinations, radon, sunburn, and inboard tanning, salons, etc. So can you kind of

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1433.604 - 1447.614 Stan

encapsulate, I guess is the best way of saying this, the prevention-oriented objectives and how it is that the plan hopes to engage the public more in prevention?

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1450.596 - 1483.752 Dr. Sumedha Penheiter

I think I would like to say that when the cancer plan is formed, there is definitely the burden and the local burden, but also to understand that we rely heavily on our partners. So the feasibility is definitely an aspect of what we end up doing in the sense that we are relying heavily on our extended partners, and somewhat on MDH to help us with the initiatives that we formed.

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1483.892 - 1510.075 Dr. Sumedha Penheiter

So a lot of times it seems that whatever the interest of our steering committee members as well as our partners on earth is what we solicit to advance certain initiatives. So I feel that it's very, this is a multifactorial issue when you say prevention it's hard to know what prevention should look like if you don't have data.

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1510.475 - 1536.43 Dr. Sumedha Penheiter

And so we have focused highly on getting accurate data, current data, and making sure that a recent win in the legislative efforts was to make sure that the data that Minnesota collects is now linked to other Kansas plans as well as to the CDC. And that was something that we requested through the legislature, and it was a win for us. So, you know, accurate data is one.

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1537.31 - 1566.749 Dr. Sumedha Penheiter

And we've funded a lot of grants, strategy action grants around breast, cervical, and colorectal cancer screening. We always have had patient survivors, advocacy groups, and coaches. coalition leaders as part of our members who have gone and brought our message forward, as well as helped bring in the needs of the state and overall the cancer in concern.

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1568.27 - 1596.987 Dr. Sumedha Penheiter

We have also worked with the lung cancer screening task force that was established. And so in addition to screening, you know, the tactical aspect of the technical aspect of screening, There's a lot of information or support that needs to be provided before and after. So we worked in a lot of those support services as well, where we hosted support center events for patients and their families.

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1597.647 - 1612.877 Dr. Sumedha Penheiter

And we created these pink shawls for the American Indians, women that were diagnosed with cancer. And so it's very multifactorial and doesn't just target the actual screening part as such.

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1613.337 - 1646.339 Stan

Yeah. You know, it's interesting. I can't help but think that for most people, it's a major shock when you are diagnosed with cancer. I mean, it's just like, you know, if all of a sudden somebody, you know, a health care provider says, unfortunately, you have cancer, whatever cancer it may be.

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1647.26 - 1687.931 Stan

And I was struck by the objectives that focused on help or assistance, like support services or patient navigation or financial and legal burdens, those types of things. So can you touch on that a little bit to help people who are All of a sudden, they're recently diagnosed with it or they're in the midst of it. I'm impressed, frankly, by the objectives that focus on assistance.

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1689.952 - 1698.277 Dr. Sumedha Penheiter

Well, I think it's interesting. There's a lot of efforts in place to get the screening part done.

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1700.118 - 1732.302 Dr. Sumedha Penheiter

And a lot of federally qualified health centers offer screening now. But the thing is, what next if you do end up positive? There has to be this medical neighborhood that exists or the support system that follows through with a patient that doesn't have resources or awareness once they are diagnosed with cancer. And that's where the mortality and morbidity rates become a concern. And so-

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1733.683 - 1759.328 Dr. Sumedha Penheiter

we realized that while the medical centers are still on top of screening somewhat because of the HEDIS or their reporting requirements, because that impacts their overall status as health centers, the space that was lacking was really the support. And a lot of people, for instance, in some cultures, in the Indian country, the word cancer is taboo.

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1761.215 - 1787.039 Dr. Sumedha Penheiter

And there's so many cultural nuances in the Hispanic community where it's very fatalistic and left to God. And you always discuss things as a family versus alone. So there's a lot of cultural nuances that are not as straightforward as you would think in addressing cancer post-diagnosis. So a navigator is someone who helps this whole

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1787.509 - 1813.011 Dr. Sumedha Penheiter

a patient who really may not be part of the mainstream care on a regular basis to then understand what the next steps would be and to make sure that they get the kind of support that they need in terms of childcare if needed or transportation, like again, the social determinants of health, but also a familiar person that they can trust because trust in the medical system is, is low overall.

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1813.031 - 1833.463 Dr. Sumedha Penheiter

And with that, this is someone that's familiar, that speaks their language at their level, can spend a lot of time with them. So navigators in that space and community health workers are just instrumental in making sure that this patient doesn't feel lost. There's genetic, there's also always counseling.

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1833.603 - 1852.293 Dr. Sumedha Penheiter

I know at the Mayo Clinic, once you're diagnosed with cancer, there's regular counseling for the family to be prepared for what lies ahead. So diagnosis, um, Treatment is one aspect, but the social-emotional aspect of cancer, like you shared, is so shocking.

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1852.313 - 1867.345 Dr. Sumedha Penheiter

It can be so overwhelming that we feel that we're letting our cancer patients down if we're not also focusing on the support and the legal aspect of it.

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1867.819 - 1891.86 Clarence

Yeah. Yeah. Clarence. Yes. So, Dr. Simeo, um, so, you know, this is health chatter. So I'm going to ask you a very, very chattery, chattery question. What's been the biggest challenge with this plan? I mean, you know, you've been, I mean, you've got some, you got, you've got all these, you got 90 strategies, you know, 90 strategies. You got, you've got, uh, a lot of focuses.

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1892.22 - 1895.563 Clarence

What's been the biggest challenge with this plan? Uh,

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1897.373 - 1927.283 Dr. Sumedha Penheiter

So from what I understand, the challenges has been we've tried to have so many objectives and tactics so that we can indicate the state's interest in this area. And I think a lot of times some agencies and nonprofit agencies or some health agencies can use this plan as a platform for justification for applying for subsequent grants in saying that they align with the state plan.

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1927.323 - 1951.326 Dr. Sumedha Penheiter

So we've tried to be very broad and inclusive to allow for those small groups that want to focus on a certain aspect of this plan. The challenge has been, as you said, it's very broad and And again, COVID didn't help. We lost about five years in this mix with COVID where we were really slowed down.

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1951.346 - 1973.118 Dr. Sumedha Penheiter

So I think the understanding is that we are going to continue to kind of streamline our efforts based on, as we're developing the plan, reaching out to our partners, ensure that there's commitment at the level that is required to carry out a plan in action. and also resources in place.

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1973.758 - 2006.243 Dr. Sumedha Penheiter

So the biggest challenge really has been in that space where we just have not had enough resources in terms of human resources to amplify some of the work. So I think that is really the crux of it is the feasibility of it. But I would say there have been successes as well. We've worked aggressively in like the HPV cancer space and really addressed inequities.

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2006.563 - 2032.069 Dr. Sumedha Penheiter

We have a health equity network group, a cancer health equity network group that works very closely with us and has a lot of health equity focused objectives. And so, you know, instead of focusing on one aspect per se, we've really gone through and all, use the inequity as an underlying theme to address a lot of cancers.

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2032.75 - 2062.209 Dr. Sumedha Penheiter

And so I think that the challenge has been, you know, going from just individual organ focused, really understanding a common health equity theme, which we have overcome successfully now, but it was difficult during the times of COVID. So just, you know, and also the support from, Agencies and lobbying agencies, our policy network has done a lot of work to lobby for some of those things.

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2063.389 - 2081.254 Dr. Sumedha Penheiter

So once they are in policy, it's been a lot easier. So without policy work, some things have not advanced as much as you would think. So those are the general challenges that I can, did I address your question correctly?

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2082.603 - 2112.627 Stan

You know, one thing that I've noticed, because I've been involved in creating plans, you know, these big, all-encompassing plans, and you don't want to forget something. That's one thing, you know, no matter how complicated the, in this case, the chronic disease might be, you don't want to forget some aspect of it. And so you're always assessing and reassessing in the developments. of the plan.

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2114.028 - 2134.326 Stan

One thing that we had Dr. Nico Prang from Health Partners on who was the co-chair in the development of the Healthy People 2030 objectives for the nation that were developed basically in 2020, okay?

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2136.952 - 2162.179 Stan

And so this particular plan, this state plan in cancer was already five years into it, even though there was kind of a, shall we say, a holding pattern on many of the objectives given COVID and what COVID did for a lot of the public health oriented things. So let me ask you, when you developed the 2015 plan,

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2164.281 - 2180.986 Stan

Was there a connection made with Healthy People 2020 to see if there was overlap between the objectives that you're developing and the objectives for the nation? So there's some sinking going on.

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2183.687 - 2191.25 Dr. Sumedha Penheiter

I think we looked at a variety of resources. And although I was not in the leadership team at the time, I am

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2192.702 - 2220.802 Dr. Sumedha Penheiter

almost certain that we did you know we we did follow a lot of guidelines and healthy people 2020 must have been one of them as well yeah i can imagine that i can't imagine that not being a resource that we so we we solicit help from a lot of resources and information and then ultimately we you know vetted with the communities and those that are going to actually do the work

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2221.584 - 2243.672 Dr. Sumedha Penheiter

to see what's most feasible and what speaks to them. Because if it is not addressing the local burden and if it has not got the engagement of our partners, it's not going to go anywhere. So long story, you know, the crux of it is yes, I'm sure we looked at healthy people. We've looked at many other parameters. There's the Minnesota Community Measurement Resource.

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2243.752 - 2267.133 Dr. Sumedha Penheiter

There's a variety of resources that establish many things around cancer burden cure treatment, availability, access, community resources. it's a, it's a composite picture. I know mine doesn't seem straightforward, but what I'm saying is it probably was one of the reasons.

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2267.293 - 2294.625 Stan

Yeah. Yeah. And I'm sure it will be going, going forward in the, in the, in the development of, uh, of a new plan. So, um, talk to us a little bit about the, um, the Minnesota Cancer Alliance overall, you know, who, who are, who's part of that, um, What's their particular goal, et cetera, as it relates to the plan itself?

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2296.507 - 2336.035 Dr. Sumedha Penheiter

So the Minnesota Cancer Alliance is actually an organization that's formed in partnership with the Minnesota Department of Health. And it's a result of the new CDC requirement that all states receiving cancer funding must have a state plan and should be done independent of the guidance of MDA, direct guidance, and really be an outcome of public awareness, public concerns, and public needs.

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2338.659 - 2367.177 Dr. Sumedha Penheiter

The main purpose of the Minnesota Cancer Alliance is really to form this cancer plan independently in collaboration with the community and focus on the spectrum from etiology to detection to cure and then palliative care or survivorship. So I feel the Alliance is an organic evolution

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2367.748 - 2385.342 Dr. Sumedha Penheiter

It was initiated around the cancer plan, but it is a lot of advocates as well as institutions, health institutions, advocacy institutions, all gathered together to help reduce the burden of cancer across the state of Minnesota.

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2386.362 - 2405.579 Stan

So it's interesting that you say how CDC requires it as far as a grant. to develop, to have, first of all, have an alliance. And then second of all, to develop a plan. It's interesting in the cardiovascular, you know, they did that, they required that as well for years.

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2405.779 - 2439.237 Stan

And then most recently they did not require it, but it was interesting because we had a cardiovascular alliance and we asked the very question, well, should we continue doing a plan, making a plan? And the answer from the partners was absolutely yes. And I'm sure the same thing is true in the cancer arena as well, because they felt that a plan provides a framework.

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2439.998 - 2453.583 Stan

It helps us frame what we want to do. And we're all talking within that framework. going forward as opposed to all over the place. Do you think that there's that same sense in the cancer arena as well?

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2455.425 - 2474.1 Dr. Sumedha Penheiter

Definitely. I think you spoke very elegantly. It is the framework that is written and documented and a guideline that helps us go back and see where our efforts are productive, where they need more energy, and also...

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2475.285 - 2500.192 Dr. Sumedha Penheiter

For us to point out what the burdens are and bring it to the attention of the general public as well as state level, there can be a lot of individual efforts that are not concerted and then although they are very valuable, sometimes collective efforts lead to collective actions which are more impactful. So this helps identify

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2500.779 - 2525.824 Dr. Sumedha Penheiter

what the framework is, but then also for individuals, like I shared, you know, they're able to use these as guidelines in their own community partnerships, action groups to further their work and reduce the burden of cancer. So it's a nice guideline, as I would say, for people to go to. So I agree. I think the framework is very necessary.

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2527.141 - 2551.96 Dr. Sumedha Penheiter

And it also helps, you know, everybody's so focused in their specific space. Clinicians are very focused on diagnosis and treatment. And then there's this financial legal companies that are focused very much on the financial legal part of it. Insurance clinical trials group focuses very much on making sure that, you know, state-of-the-art clinical therapeutics are available to the patients.

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2552.02 - 2578.381 Dr. Sumedha Penheiter

So everybody can end up being kind of in their own very focused, silo is not the right word, but field. And I think this plan then kind of also connects the dots between all aspects of cancer from, you know, prevention, detection to all the way to survivorship. And it's a composite picture so that not just one aspect of the disease gets more of the attention or effort.

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2580.121 - 2598.387 Clarence

Clarence. Yes, Dr. Samia, once again, I know I asked you about the biggest challenges. Now I'm going to ask you in this plan, and I know it doesn't end till 2025, but what are some of your greatest successes? What really stands out for you as a success with this plan?

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2599.928 - 2630.503 Dr. Sumedha Penheiter

No, like I said, a lot of it is the success. We gauge our success as reality. enforcing or emboldening something to policy. I think the biggest successes from what I see based on the evaluation database is we have really addressed the HPV vaccination issue. The Minnesota Commission on Cancer has presented to a lot of medical professionals on increasing HPV vaccinations.

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2631.328 - 2666.769 Dr. Sumedha Penheiter

We've funded some stakeholder advisory groups and trained young leaders on the information of HPV and really tried to bring awareness of this very preventable cancer to a lot of areas. And I think we've seen a lot of effort and success database in adoption of the vaccine. in young preteen adolescents, despite of a lot of hesitation in both males and females.

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2667.269 - 2701.445 Dr. Sumedha Penheiter

So I think HPV cancer vaccination and awareness of the HPV cancers has been a very successful aspect of it. I also think tobacco use in general, we've presented several times and advocated for statewide legislation for raising the age of tobacco to 21. And that was passed into a law in 2020. We also advocated for 2019 legislative session to ban e-cigarette use indoors.

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2702.526 - 2730.924 Dr. Sumedha Penheiter

And so I think tobacco has always been kind of like a favorite spot of the policy committee and also ours in general. But like I would say, the success has been weaving in health inequities as a premise in every single objective. We have come away from not only focusing on the greatest, but for the greatest number of all, but also for those that are not in the greatest number.

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2731.385 - 2759.458 Dr. Sumedha Penheiter

And I think that just the understanding of health inequities and the availability of clinical care, as well as survivorship, and how differently it impacts some community versus the other and making sure that that's kept in mind. I think that's been the biggest success. It's just increasing awareness and focus on health inequities in addition to overall cancer care.

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2760.418 - 2787.671 Stan

Thank you. Let me ask you, is there an entity that's responsible for reporting out how things are going with the plan? Or was it just kind of a a total partnership type of thing. You know, like there's some plans where the Department of Health, for instance, is responsible for getting the measurement. Where are we with our screening levels?

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2787.751 - 2801.877 Stan

Or where are we with our, you know, policy development or whatever? And then consequently then reporting out. Is there, is like the Cancer Alliance responsible for that? Or is it like a shared ownership on everything?

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2803.393 - 2832.577 Dr. Sumedha Penheiter

I think when it comes down to it, it's the Minnesota Department of Health that is the center point of receiving funding and reallocating funding for the work we do is the one that sends these reports. But we definitely have input on that and we definitely review that. And we have an evaluation committee within our alliance as well where we have evaluation scientists that

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2833.103 - 2856.885 Dr. Sumedha Penheiter

continuously review and evaluate on how we're doing in terms of, you know, indicators, the success, the effort put in, and the barriers addressed. And so the answer is it's MDH, Minnesota Department of Health, that sends the progress reports on a regular basis. But definitely it's not something that we do just for reporting purposes.

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2857.205 - 2864.089 Dr. Sumedha Penheiter

We constantly review our strategies and tactics and the efforts that have gone in and how much we've done.

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2864.109 - 2899.1 Stan

Yeah. So, you know, going forward, okay, because you are going forward in the development of a plan. These plans take a while to develop for sure. If you're seated at the table, for the development of the next plan. And you were kind of heading up the initiative. Where would you start? Okay, would you start on the existing plan that we have and where we've been?

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2900.728 - 2920.79 Stan

Or, you know, tabula rasa, clean the slate and let's get a new plant going with some different exciting things in it. Tell me maybe where your head is at with regards to that. And then maybe your assessment on where the Minnesota Cancer Alliance is on the development of a new plant.

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2922.85 - 2950.983 Dr. Sumedha Penheiter

So the plan, the leadership team for the plan is already in place and they've done a lot of great work already. Heather Keene is leading the actual plan team, formed an advisory team. And what we have done is we've really used, we've gone within our alliance and used the equity portion to inform us on the cancer health, through the Cancer Health Equity Network, which is again, one of the

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2953.446 - 2979.556 Dr. Sumedha Penheiter

within the alliance that focuses on health equity. We have brought the policy committee in, the evaluation committee in, and then we have the community listening sessions that we have started with our partners. We had a summit not too long ago where we did some listening sessions to understand the burden. We are looking at the Minnesota cancer reporting systems to see what our current burden is.

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2980.626 - 3003.811 Dr. Sumedha Penheiter

And then also the commission on cancer network for the practice aspect of it. So we are looking at the playbook from other cancer plans that we feel have similar burdens and dynamics as the state of Minnesota. We are looking at the last plan as really some of the things that were very successful in establishing that plan, the lessons from that playbook.

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3005.391 - 3033.435 Dr. Sumedha Penheiter

But like I said, we are using a multi-pronged approach with equity policy evaluation community data and practice to make sure that we form this plan. So although it will be a similar framework, I think it will be very current and informed based on the recent concerns and burdens of cancer and making sure that every objective has health equity embedded, like I said, to eliminate health equity.

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3035.381 - 3046.046 Dr. Sumedha Penheiter

And the main goals will be still around etiology, prevention, detection, treatment, survivorship. That's the general spectrum that we followed over the years.

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3046.126 - 3069.885 Dr. Sumedha Penheiter

And that's what most cancer plans as well as the National Cancer Institute follows to make sure that, you know, one of the, you know, it's very, sometimes celebrities bring a lot of attention to one aspect of prevention and detection and they become the, the highlight of the whole work, um, but we want to make sure that all the entire spectrum is addressed.

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3070.006 - 3082.756 Dr. Sumedha Penheiter

So, so yes, using the playbook from the last cancer plan, but then also using current data burden and input from the communities to understand what we should do next.

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3083.056 - 3122.771 Stan

Yeah. Yeah. So let's go full circle here. Um, we started out by, by saying that, um, Cancer is the leading cause of death in Minnesota. And every year, close to 30,000 Minnesotans are diagnosed with cancer, okay? Just for our listening audience, in Minnesota, do you have a handle on what's the most prevalent cancer? that we're dealing with?

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3125.473 - 3130.558 Dr. Sumedha Penheiter

I think, again, you know, I would hate to say that prevalence is so dependent on health disparities.

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3130.618 - 3132.76 Stan

You know, what my... Yeah, that's true.

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3132.96 - 3166.873 Dr. Sumedha Penheiter

I would alienate some if I said that, for instance, gallbladder cancer is a real concern in Native communities, but doesn't even come in the top five overall in the numbers. But I would say the... The most preventable and the most addressed are colorectal cancer, the breast cancer, the prostate. Those are the ones. Then there's also pancreatic cancer that has very high mortality rates. Correct.

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3167.193 - 3191.976 Dr. Sumedha Penheiter

There's the incidence rate, the mortality rate. There's a whole balance of that. Really, it's through the lens that you're looking at. I don't want to pick or bring attention to a favorite cancer, but in general, I would say that there's the incidences and then there's the treatments and then there's the mortality. And the most commonly discussed ones are colorectal, breast, front stage.

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3194.338 - 3203.584 Dr. Sumedha Penheiter

And some of these are early detection, have early detection. And the earlier you're diagnosed, the better the prognosis is. Yeah, yeah.

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3204.965 - 3206.346 Stan

Final comments, Clarence?

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3207.449 - 3235.539 Clarence

Well, I just want to say, Dr. Samir, I thank you for the conversation. I mean, there is so much that we need to learn more about. I mean, and I think that one of the important things for us is having people like you who can come on and to help us understand more clearly and also for us to better understand the communities of but also to talk about also how the community can be more engaged.

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3235.979 - 3245.365 Clarence

And so we need to make sure that the community is engaged in this conversation as well. And so I just want to thank you once again, and I'll turn it back to you, Stan.

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3245.385 - 3281.375 Stan

And I thank you as well for your leadership on this. I think it's important for the community to know that that we have good, trusted professional leaders that are trying to really, really make a difference in this arena. So many thanks to you and your insights into this plan and the future plan. For our listening audience, we will have a lot of information available on our website.

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3282.41 - 3291.397 Stan

And Dr. Sumeda, if there's other information that you wanna share with regards to that, we can also get that on our website. Might there be?

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3292.477 - 3319.957 Dr. Sumedha Penheiter

Sure, we have the plan listed on our website. I can share that. And we are also now constantly updating how our new plan is evolving on our main page. So minnesotacancerline.org. I'm happy to send the website to you. I also want to say I'm really honored and thankful to be part of this discussion. The Alliance means a lot to me. I've been part of the Alliance for over a decade.

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3320.177 - 3325.741 Dr. Sumedha Penheiter

And the fact that we were able to bring some attention to it this morning means a lot to me.

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3326.226 - 3354.545 Stan

Yeah, well, thank you. You're a great spokesman for it. So thank you. Thank you. So going forward, our next show for Health Chatter, we are going to be addressing the issue of grief. So Clarence and I are going to look at that topic. And there's a lot of things that we're grieving about individually as a nation and as a world that certainly affects our health.

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3355.123 - 3360.08 Stan

So with that, everybody keep health chatting away.

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