Emma Lande and Dr. Molly Taylor | Conquer Cancer, the ASCO Foundation

Dr. Molly Taylor:
This podcast is brought to you by Conquer Cancer, the ASCO Foundation. Our mission is to accelerate breakthroughs in life saving research and empower people everywhere to conquer cancer. Welcome to Your Stories, a podcast where we hear candid stories from people conquering cancer. I'm Dr. Molly Taylor, a Conquer Cancer grant recipient and your host for this month's episode.

If you've ever watched a teenage coming of age movie or listened to a Taylor Swift song, you know the character. She's pretty, she's popular, probably a high school cheerleader, possibly dating the captain of the football team. And in this case, she's Emma Lande, one of my former patients who's conquered cancer not once but twice in her life, all before the age of 22. But first, let me back up a bit. To truly understand what makes Emma's story such a success and so inspiring, you first need to know something important about pediatric patients with cancer. You see, every day I work with adolescents and young adults who are conquering cancer, and every day I see the deep impact and emotional toll that cancer takes on their lives. It's a reality that bears out in statistics. In fact, according to a 2023 study published in JAMA, an estimated 40% of childhood cancer survivors go on to experience depression. Another study, this one in the Journal of Pediatric Psychology, found that 75% of children diagnosed with cancer will cope with PTSD during or after treatment. So it makes it all the more rewarding whenever I see one of my patients go on to build a life that's filled with meaning and joy and a determination to help others. Which brings me back to Emma, whose story offers everyone's favorite plotline: the triumphant comeback.

Emma, as your oncologist, or I guess former oncologist, I cannot tell you how much it means to me to be with you here today.

Emma Lande:
Well, I am so excited to be here with you as well. This is such, like a full circle moment and I cannot tell you how honored I am to be sitting across from you, but also having this conversation today because I feel like both of our sides tell the full story. So I'm excited to be able to share that.

Dr. Molly Taylor:
Yeah, yeah, me too. So before we dive in, let's hear where you're joining us from today.

Emma Lande:
Yeah, so I am going to grad school in Phoenix, Arizona right, now. So that is where I am joining from. And how about you, Dr. Taylor?

Dr. Molly Taylor:
The slightly cloudier Seattle. I am in my office in downtown Seattle where I do most of my work.

Okay. So let's start from the beginning. So you yourself have previously said that before your diagnosis, you were, “living the life of a cheesy high school rom-com.” So tell us more about where you were in life when you first got your diagnosis and what your initial feelings and thoughts were when you heard those words, “You have cancer.”

Emma Lande:
Yeah, absolutely. So I was 17 when I started experiencing some symptoms. And at the time, it really was just me having kind of a continuous itching sensation. Didn't really think much of it. I was going to a dermatologist at the time. Everyone was kind of just suspecting it to be maybe some eczema, things like that. And I had a pretty great childhood. That's the best way to put it. I was growing up in the town of Snohomish, Washington, with my amazing family and all my extended family live within, like five minutes of us. So it was just really a great environment to grow up. I was doing cheerleading. I was a college commit for softball. I was doing musical theater with my brother. And so really, at 17, there were no complaints besides that pesky itching that would not go away. And I remember after multiple trips to the dermatologist and trying to figure out how to treat this “eczema,” I was going as far as to taking bleach baths to get this itching sensation to go away. And the dermatologist finally said to me, he was like, “Emily, we have basically exhausted any option that I know of to treat eczema,, so why don't we take chest X ray and do some blood work and see maybe if there's some issues with your kidney function,” things like that.

And I remember that my brother and I were at musical theater rehearsal. It was a long one, it was like a 10-hour rehearsal. And I came home and my house was spotless. Now, my parents keep a clean house normally, but this was like different level spotless. And then I really started to get suspicious when I went into my room, and my room was also spotless because my mom always kept care of the house, but my brother and my rooms were our responsibility. So the fact that that had been cleaned kind of put like a, “Something's not right here.” And then I went into the kitchen and my dad had cooked my favorite meal. And I was like, “Okay, there is definitely something going on here.” And so we had dinner and dinner was great.

And then when dinner was over, my dad asked if my brother and I would come into the living room because we need to have a family meeting. And my initial thought process was, “Oh, goodness, there's been a death in the family. Someone has passed away,” because that was kind of the atmosphere that was hovering over everyone. And when we sat down, my dad told us that the doctor had called and they had found tumors in my chest X ray. And it was to be believed that I had cancer. And I kind of feel like Hollywood actually gets this moment pretty dang right where the world around you slows. You kind of get tunnel vision, a little dizzy. The only thing you can really hear is your breathing and your heart rate. And I remember that I ended up kind of falling over and my brother caught me and everyone else was crying and they were having all of these moments of panic, but I just had multiple hours of kind of feeling nothing. It was later to look back that it was the start of a panic attack, which I think is a valid reaction in a moment like that. But my initial kind of moments were a lot of just nothing, just a lot of heartbeat, a lot of breathing until I was able to kind of come out of that initial shock.

Dr. Molly Taylor:
Oh, gosh. Thanks for sharing. You know it's so interesting that we don't really get to hear that side of things. And our version of that was being a busy first year fellow working 100 hours a week and seeing a piece of paper from a dermatologist come across our desk and saying, “There's a 17-year-old girl with a mediastinal mass and some other symptoms concerning for lymphoma,and blah, blah, blah.” And it all- sort of get you all scheduled to meet you. And it's just like the parallels of what's happening in your world from noticing your room was clean to your favorite meal and just the way your family rallied around you in that moment like they did throughout your entire treatment. It's really an interesting parallel.

Emma Lande:
Yeah, absolutely.

Dr. Molly Taylor:
So, I mean, you have this huge, busy and full life and then your world turns totally upside down. And I think again for me, on the oncologist side of things, there are some common things that happen when people hear this news of a new diagnosis. The shock, like you mentioned, the worry, which sometimes for teenagers is disproportionately held by their parents.

Emma Lande:
That's so true.

Dr. Molly Taylor:
They're very common. But there is a lot of variability also in how people respond in the days and weeks that follow. So could you tell us, you know, once that initial numbness and shock wore off, what came next for you?

Emma Lande:
Yeah. I feel like I had a really up and down journey that consisted of a lot of different parts and feelings. And so after that initial shock kind of wore off as much as you and the rest of my oncology team really tried to prepare me for what was to come, you really don't know what you don't know. You can think that you know what chemo is going to look like. You can think that you know what those side effects are going to feel like, but until you're actually living it, you don't understand the gravity of it, I guess. And so at the beginning, I had such an amazing support system, such an amazing family and friends, and so I was feeling quite positive. I was like, we’ve got this. I got all these people behind me. I'm not going to let cancer change my life. Like, it was a lot of positivity and feeling like this is my fight, this is a fight I'm going to win. And that was a great way to go into it. Unfortunately, I feel like that positivity didn't last very long. And I think, again, it's because the gravity of what actually going through treatment looks like kind of hit me like a ton of bricks.

I think once I started treatment and I was kind of struggling a little bit physically, the next thing that I remember is, because of those physical implications, it kind of led to the fizzle out of some of those occupations or hobbies that I liked to do. And so no longer was I doing the cheerleading, no longer was I the college commit for softball or playing in my spring season. All of that kind of went away. And I think that's when the mental health implications really started to hit. Because at 17, you don't really have a great sense of identity of yourself, you know? And so if someone would have asked me at 17, all those things that I just mentioned, all those hobbies, those were my identifiers. That's what was me. And so not only was my life feeling a little bit unfulfilled because those hobbies were gone, it also kind of felt like I was missing a part of me. And that was a really difficult feeling for me to have to grasp. And it sent me kind of in a tailspin for a while, a dark tailspin where I felt like it was really hard to kind of climb out of. And it's a journey that I think to this day, I'm still on.

But I think that I am one of the lucky ones that I have such an amazing family, that I have such an amazing support system. And I like to say that they walked the dark path with me back to the light, because they did. They held my hand through this whole process, and they helped me find that joy in loving life again and find that motivation, that drive to want to go back to school, to want to be an active participant in my own life. And for a while, that felt like a very daunting feeling. And so, again, I can just never thank them enough for going on that journey with me.

Dr. Molly Taylor:
I think that's so important, what you said about, you know, it's one thing to sort of like, theoretically try to conceptualize what it might be like to go through cancer treatment, but no matter how many pamphlets or words or meeting with your oncology team, it's just got to be so different when it's actually happening to you.

Emma Lande:
Exactly. Yeah. You don't know what you don't know. And so it's definitely a trial by fire, learning as you go.

So speaking of kind of hearing those perspectives from patients, so you do hear a lot about what those moments are after diagnosis from patients, but you don't often hear people talk about what it's like for doctors giving them those diagnoses. How do you kind of get used to that or how do you handle having to do that every day?

Dr. Molly Taylor:
Yeah, I don't think that you ever actually get used to it. I hope actually that I never get used to it and that my colleagues never get used to it, because it is such a vulnerable and intense moment that you're having with people that you're often meeting for the first time time and being with them on what is probably the worst day of their lives. And so, you know, that is sort of always painful. But, you know, I think that, I mean, it sounds super cliche, but it is incredibly meaningful to me and to, I know, people in my field, my colleagues, to be able to be there with those patients and families in that moment, because we can help in one way, shape or form. And so it does feel like it's such an immense privilege that comes with a lot of responsibility, but a huge privilege to be able to be there to walk with people also sometimes along that path of darkness from the very beginning. But it does take a toll, for sure.

Emma Lande:
Absolutely. I can imagine, I will say, having you and my team, that was one of the things that I think I loved most about being treated by my team, was that you guys truly made it feel like you were on that journey with me. And I remember that day, which was the worst day of my life and the scariest day of my life, you and the rest of the members of the team just made me feel so comfortable and so supported in that moment. And I can't imagine how it would have felt if that moment would have gone a different direction. And so I hope you never get used to it, because what you're doing right now and the way that you handle it means the world to your patients. So I just thought you should know that.

Dr. Molly Taylor:
Thank you. You make me cry too early in this.  

Emma Lande:
We have shared enough tears together.

Dr. Molly Taylor:
Yeah. It will feel very familiar.

You know, you had not one, but two of the worst days of your life, so you had to deal with that news that you have cancer twice. So tell us a little bit about that and whether you noticed a difference in your response the first time compared to when you were told that your cancer had come back.

Emma Lande:
Yes, that was the second worst day of my life. And I still think back to that day, that I should have known what was coming for me when I walked in and all three of my oncologists were sitting in the room. I should have known. That should have been my moment. But I will never forget you sitting in the chair and you looking at my family and going, “Today is going to be a hard appointment. Emma's cancer is back.” And I remember I was sitting and I kind of fell back against the wall. And again, it's kind of one of those moments where just the shock sets in and everything else kind of dissipates.

But the thing that I think is the key difference between the two is the first time you have fear of the unknown. You don't know what's coming for you. So, again, you don't know what you don't know. And so you can think that you know what's coming for you, but to understand the gravity of it, you have to go through it. Well, this time I now have. So I do know what's coming for me. I do know what I'm going to be facing. And I would argue that that is almost worse. I know the pain that's coming. I know the mental health implications, the physical implications, the emotional implications. And having to deal with all of that, again, was terrifying. If you're going to relapse, there's only one positive, and the positive is that you know how to do it better this time. I knew some of those tips and tricks. I knew for me, that peppermint was super helpful for nausea. I knew that lemon drops were super nice to suck on while I'm getting my port flushed, or when I'm having chemo because it cuts through kind of that metallic taste. I knew that I needed hobbies that I was able to do from bed to, like, keep me entertained and keep my mind stimulated. I knew that I needed some more kind of social supports, and so I was making more of an active attempt to have friends come and visit me or me try and connect with friends. The only other benefit to getting cancer twice is it does convince your parents to get you a puppy that is also super, super helpful in that department. But she was also great for having that social support and having someone to hang out with on those low days. So I guess the difference is you now know and it does help you prepare for that fight a little bit better.

Dr. Molly Taylor:
Yeah, I mean, I remember that day like it was yesterday because I actually, I wasn't at the hospital that day. We're all over the place as fellows, and so I was across town and I think you were supposed to see Tina, your nurse practitioner, that day, and she called me, like, as soon as she saw your results, and I just, like, hoofed it and rushed to the hospital as fast as I could. So, you know, we had your, like, the bat signal went up and your team assembled. But what's also something that I haven't really thought about much is similar to your last question, having to give the news of a relapse. It's also really different because we've known you for two years. We know your dad and your mom and your brother, and we love you all. And so it is just sort of like a different flavor of hard and pain to be able to- It's hard to give a hard news to a stranger. It's also really hard to give hard news to people who you've come to know and gotten really close with over a couple years. But my recollection is also, you know, we had a moment. Everybody in that tiny, teeny, tiny little clinic room, very claustrophobic moment. And then it took, like, two blinks of an eye. And then you just, like that, you had that laser focus in your eye again. You're like, “Okay, where do we go? Like, what's our next step?” And that in some, like, strange way, I know it's not supposed to be this way, but your determination and spirit and drive also helps us, helps your team that are like, “Okay, Emma's ready to go, so we're ready to go. Like, here we go. We’ve got this. And so it is so different. But, you know, since that day and all the days that follow, you have come so far, graduated from college, and now you are working in your doctorate in occupational therapy, right?

Emma Lande:
Yes, that is correct. I'm in my third year and I graduate in June.

Dr. Molly Taylor:
So can you talk a little bit about how your experience- I'm sure it influenced your decision to become an OT - how your experience influenced that?

Emma Lande:
Yeah, absolutely. So I got introduced to the world of OT during and post cancer treatment. And the thing that I like to say about occupational therapy is that it gives you a piece of your life back. And for me, I was really struggling with chemo-induced peripheral neuropathy, and it was presenting as some difficulties with sensation in my fingers, some difficulty with some coordination, dexterity, motor planning in my fingers. And that was heavily impacting my ability to go to school. And as someone who was a senior in high school at that point in time, I knew that I was going to need some support going into college. And having someone give me that piece of my life back, have them help me do the things that I wanted and needed to do, had such an impact on my life. It's the reason why I went to college. It's the reason why I'm sitting here today having this conversation with you. It's the reason I was able to log on to my laptop. And that for me, obviously, physically was very important, but mentally having this newfound independence that felt like I had lost, giving me back an occupation that was so important to me, it just really kind of set me on a new path for life.

And I have found in my journey with kind of healing from cancer, that wanting to give back is such a strong desire for me. And so it felt like this was a profession and an opportunity that I would be able to do that. And so I started my journey to become a doctor of occupational therapy. And so again, kind of tying in with really that like, mental component and helping people kind of with like their own resiliency and their ability to thrive, I know that a lot of the research that you have done has focused on resiliency as well, nd I would love to hear more about what resilience and patience looks like to you as an oncologist and what tells you when a patient might have resilience to navigate cancer and coming out thriving.

Dr. Molly Taylor:
Such a big question. It really does look different for everyone. There's sort of the scientific lens about what resilience is. And so there's a lot of debate in our field about whether it's sort of the outcome, whether you're sort of working to this end goal, which is to be a resilient person, or whether it's a process, whether it is the mode by which you get through difficult circumstances. And I think I fall more in the latter camp that it is a dynamic process that really does look so different for everyone.

There are, I think, people like you who are so externally positive and articulate, and you are just like this shining light of every room that you walk into. And I think that that is probably like a textbook of what some people might think of as resilience. But what it doesn't mean is that you don't have hard days. You know that I think what resilience isn't is a sort of, like, total suppression of the very real stress and trauma and difficulty that comes with dealing with something as crazy hard and complicated as cancer, especially when you're just about to launch into your own life as an adolescent. We know that that's really different from when you get diagnosed as a younger or older person.

And so I think that, again, we're probably learning a whole lot more about resilience and how to teach it and how to train it and how to help people sort of bolster their own resilience by understanding that it doesn't mean that you don't allow yourself to have down days and hard days, and that just because you're having a tough time doesn't mean that you're not that resilient person. And so I think a lot about what are the tools that we can give people that might be new, new strategies or techniques to use sort of at the beginning, middle, and later on during their cancer journey, but then what are also just some of the already existing sort of resources that people have that we can just kind of remind them to draw from, you know, like you said, like, second time around. I knew I needed my people. I knew I needed my hobbies. I knew I needed my peppermint.

Emma Lande:
That's a trifecta right there.

Dr. Molly Taylor:
Your recipe. But those are all, like, part of your resilience toolbox that is going to look really different from the person next to you. And so I think just sort of like opening that conversation with people and their caregivers and the people who love them about what are ways that we, as the medical team and sort of the larger provider group, what can we do to help just sort of bring a lot of those resilience resources to the surface. There's a lot of people. I mean, they're all there. It's just really easy to sort of lose track of them when you're dealing with such a stressful thing.

Emma Lande:
Yeah, absolutely. For sure. It's definitely easy to lose those strategies or find it difficult to access them. Your point in regards to those difficult days, I remember I was sitting during chemo one time, and I was reading a book, and I was having a particularly bad day. And I read a chapter of this book, and the line was, “Don't let the hard days win.” And that, like, has stuck with me ever since. You can have good days, you can have bad days, but it's not letting those hard days win.

Dr. Molly Taylor:
Yeah. Well, this actually, I think, brings us to the end of this conversation. And so our last question, which is one that Conquer Cancer likes to ask everyone who comes on this podcast or share their story in any way, Emma, what does conquering cancer look like to you?

Emma Lande:
When asked this question, I think I look at it through the lens of a cancer patient or a cancer survivor, and for me, conquering cancer means living. And I don't mean just being alive, because during my cancer treatment, it felt like I was just alive and I was not living. And it took a long time to fall back in love with the concept of living, to fall back in love with my life and all of the wonderful things that were around me. And so even though, yes, we had the markers of time that were like, “Oh, she's six months in remission. She's eight months in remission. She's a year in remission,” I don't feel like I actually conquered cancer until I started living again.

And I think that now that I have gotten to that, I view every day as a gift and that there's just so much that, like, I want to accomplish in this world, I want to do and be a part of. And I think back to that girl who was in the dark and was on that dark path and didn't think that she would ever be excited about those things again and the fact that I am, that's conquering cancer for me.

All right. Now it's your turn, Dr. Taylor, what does a world where cancer is conquered look like to you? Dr. Molly Taylor:
That's hard to follow, Emma. From where I sit, as an oncologist and a researcher- Because I see it, that there are so many people around the world who are working furiously to cure cancer, I am so inspired by how focused and driven our field is in developing cures for cancer. I think, again, from my vantage point in the world, what conquering cancer really looks like is when we're able to decrease the cost of those cures. Not just financial, but also emotional, social, occupational, educational. Now, when we're able to really reduce the toll that our patients and their families face, because I think that, again, we are fortunate, especially in the pediatric and young adult world that most people will survive their cancer, but all of them will leave with some kind of scar. And so whether that scar is visible, physical scar, or invisible, like an emotional scar, I think what conquering cancer looks like to me is when we're able to heal those scars in a way that matters to people, but maybe they're a little less deep or they show a little less. And I think that that's when we'll know that we've gotten there.

Emma Lande:
I love that. I second that. Can I say “ditto”?

Dr. Molly Taylor:
Okay. With that, I'm going to wrap us up. Thank you for listening to this podcast brought to you by Conquer Cancer, the ASCO Foundation. Conquer Cancer is creating a world where cancer is prevented or cured and every survivor is healthy. You can make a gift at conquer.org/podcast.

The participants of this podcast report no conflicts of interest relevant to this podcast. Full disclosures can be found on the episode page on conquer.org. 

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.

Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.