Kicking Cancer's Ass

Why does the second cancer hit harder than the first? Even when it’s smaller? Even when you’re a psychotherapist?

Dr. Erin Gray, two-time cancer survivor (BRCA2 breast cancer in her early 40s, then thyroid cancer eight years later), had her own answer when it happened to her. The thing that separates the diagnoses you survive well from the ones that wreck you isn’t preparation. It isn’t knowing what comes next. It’s a guide.

In this conversation, Erin walks through both of her diagnoses, what changed between cancer #1 and cancer #2, the question that comes before every other one when you’re newly diagnosed (or carrying a known mutation, or facing a recurrence), and what patient navigation (a clinical intervention with thirty-five years of outcomes data) does, plus why most patients never get to experience it.

Also in this episode: the breast MRI moment where the radiologist pulled Erin aside before she could even get dressed; why her oncologist told her not to Google “triple negative” and what proved him right in the chemo room; the 28% lower recurrence risk from 150 minutes of cardio a week; and what no one tells you about the second time around.

Dr. Erin Gray is a psychotherapist specializing in patients with chronic illness, co-host of Wicked Psychotherapists, and author of Crushing the Cancer Curveball.

Erin’s counseling website: www.bewellwithincounseling.comErin’s podcast website: www.wickedpsychotherapists.com

Kicking Cancer's Ass. We never chose the pitch, but we always choose the swing.

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Everyone said Joelle was done with cancer. She wasn't.

Three years past her pathologically complete response, she has a urologist, a cardiologist, and an annual abdominal CT scan she'll get for the rest of her life. The word done was on the chart. It was not on the calendar. And she's one of the easier cases.

The most common cancer post on Reddit is some version of three words. Done. Now what? One thread pulled 143 upvotes and 115 comments under the title "In a weird in-between. What do I say to people now?" Not a single physician answered. The thread is just survivors trading the answers their care teams never wrote down.

In this solo episode: what the research actually says about post-treatment depression and anxiety five years out, why fewer than half of patients receive the survivorship care plan the Institute of Medicine recommended in 2005, the cardiovascular risk nobody warned her about, and the three moves she made to live inside the in-between instead of bracing through it. Plus the Fuck Cancer World Tour, the recast of the annual CT scan, and the grandmother who danced with her grandfather at their 50th anniversary three weeks before she died.

You're not done. That's not a failure. The calendar is yours.

Full subscriber deep dive at cancercurveballslugger.substack.com.

Twenty-five years of friendship trained Jessica Rosenbaum for the call she didn't want. When Joelle was diagnosed with triple-negative breast cancer the day before her preventative mastectomy, Jessica didn't ask what Joelle needed. She'd already designed the role only she could fill.

Jessica Rosenbaum, PhD, is a licensed clinical psychologist and Joelle's best friend of 25 years. When the BRCA-related diagnosis came, Jessica became the coordinator of an entire support architecture. She set up the meal train and the chemo driver schedule, but didn't take those roles for herself. She kept the workout slot. Three mornings a week in Joelle's home gym, lifting heavy weights together. Her reason: she'd been Joelle's training partner for almost two decades and was the only person who could read what was actually happening to her under a heavy bar.

The conversation covers the day Jessica had to cancel a party without saying why, the original Bye-Bye Boobies sendoff that got pushed four months, the moment they realized chemo wasn't taking Joelle's strength, the surgeon (Dr. Merisa Piper at UCSF) who approached DIEP flap reconstruction like an artist with a canvas, the kintsugi reframe that let Joelle see her scars as beautiful, and the research on why exercise during chemo measurably improves treatment outcomes and reduces recurrence.

In this episode: how to design a support role instead of asking what's needed, why "how are they doing?" is a kindness that costs the patient something, what 25 years of paid attention earns you when the call comes, and Jessica's own answer to the question Joelle asks every guest.

Jessica Rosenbaum, PhD, is a licensed clinical psychologist who works with parents and children on how children learn.

Full subscriber deep dive, with research on social support and cancer outcomes, on www.kcapodcast.com.

The technology exists. The blood draw is simple. So why won't most oncologists order it?

Amy Delson has been treated for cancer four times. She's currently in active treatment. She's also a longtime breast cancer patient advocate — she reviews research grants for the Department of Defense, sits on lab teams asking researchers to do fewer biopsies on patients, and edits the informed-consent forms patients sign before clinical trials.

She can't have mammograms anymore. So she fought to get a circulating tumor DNA test — ctDNA — through a researcher she works with, because her own community oncologist wouldn't order one. She talks about that fight in this episode, and about the bigger argument behind it: most oncologists are deciding for patients whether patients can handle the test results. Amy thinks that decision belongs to the patient.

The science is moving fast. In 2025, the SERENA-6 trial — published in the New England Journal of Medicine — showed that switching therapy based on a ctDNA signal, before any scan showed progression, nearly doubled progression-free survival in HR-positive HER2-negative metastatic breast cancer. The "we don't have clinical utility yet" objection just got harder to hold.

The test isn't perfect. It can detect DNA from cancer your immune system has already cleared. Amy is direct about that. The argument isn't that ctDNA is a crystal ball. The argument is that patients deserve to know what's available, what it can show, what it can't, and to decide for themselves.

About Amy Delson Four-time cancer survivor. Breast cancer patient advocate. Reviews research grants for the Department of Defense. Works with I-SPY, the Translational Breast Cancer Research Consortium, and Komen.

Recorded at RiseUp 2026.

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Learn more about scalp cooling from episode sponsor - www.coldcap.com

Learn more about UCSF RiseUp at https://riseup.ucsf.edu/ 

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"You're the only person who truly cares about you."

Jeffrey Eisenberg faced three cancer diagnoses during the pandemic: stage 1 colon cancer that turned into a four-month ileostomy after his intestines burst during surgery, large B-cell lymphoma, and then a 2cm lymphoma tumor behind his brain where his MD Anderson oncologists couldn't promise the chemo would cross the blood-brain barrier. He came out cancer-free after an autologous stem cell transplant at Houston Methodist on December 28, 2023 — and in this conversation he tells Joelle why most "survivor talk" is too shallow to help anyone, and what actually got him through.

They dive deep into:

• Why the question is never "what are my odds?" — population studies lump 97-year-old grandmothers and 20-year-old athletes together. The phrasing that actually gets an oncologist to answer: "Do I have a fighting chance?"

• The sequencing logic for picking autologous stem cell transplant over CAR-T first — and what three months living within five minutes of Houston Methodist, with zero ports and a non-functional immune system, actually requires.

• Mia's three-poster-board strategy for humanizing a patient in a transplant unit — and how it shifted the care Jeffrey received on a floor where staff are trained to disengage.

• Why Jeffrey and Mia got legally married mid-treatment despite decades together in Texas, a common-law state — and exactly what their estate attorney flagged about insurance, power of attorney, and the paperwork limbo unmarried partners hit.

• EMDR as a treatment for cancer-specific trauma — the non-talk modality Jeffrey and Mia both used, and why it's often harder to find a practitioner in New York or California than in Texas.

• The one-line question Jeffrey used to replace a pharmaceutical cardiac stress test with a treadmill: "If I can't make it on the treadmill, you still have the option of doing the shot, right?"

• What actually breaks through professional detachment on a transplant floor — the Patch Adams book inscribed to a covering doctor, and the nurses who quietly started bringing him coffee from their own break room.

• The 26:40-per-mile walk with his aging labradoodle that Jeffrey now ranks alongside Rome, Zurich, Jerusalem, Istanbul, and the New York Times bestseller list — plus what his father, who outlived a six-month mantle cell lymphoma prognosis by six and a half years, taught him about regret.

Kicking Cancer's Ass. We never chose the pitch, but we always choose the swing.

"30 times more women die from breast cancer than need a liver transplant because of UPA. And yet the drug is paused."

What if the drug that could prevent your breast cancer is already on pharmacy shelves — and regulators won't let your doctor prescribe it for that purpose?

Dr. Sasha Howell, a medical oncologist from Manchester who runs one of the UK's leading breast cancer prevention programs, joined Kicking Cancer's Ass at the 2026 Rise Up Conference. His team's research, published in Nature in December, shows that three months of Ulipristal acetate reduced pre-cancerous cell proliferation and produced measurable changes in breast tissue on MRI.

European regulators suspended the drug after five women in nearly a million developed liver failure. Statins and hormonal contraceptives carry higher risks and remain widely prescribed.

This episode covers why two-thirds of women who develop breast cancer have no family history, what a polygenic risk score actually measures, and how clinical trial participation often means better monitoring than standard care.

If you're worried about breast cancer risk, start with thewisdomstudy.org 

The Wisdom Study is open to anyone 30+ in the US who hasn't had breast cancer: thewisdomstudy.org. Polygenic risk scoring is available in the UK for roughly £500 (about $650 USD), though accessing someone who can interpret results and prescribe risk-reducing medication remains a gap almost everywhere outside specialized centers like Manchester.

Kicking Cancer's Ass. We never chose the pitch, but we always choose the swing.

A drug that reduces pre-cancerous breast cells has been sitting in U.S. pharmacies for twenty years. OB/GYNs prescribe it every day. Most oncologists have never heard of it.

Dr. Abigail Liberty, an OB/GYN at OHSU, attended a cancer prevention conference in Manchester where British researcher Dr. Sasha Howell (next week’s guest) presented findings on anti-progestins — drugs that block the progesterone receptor — showing significant reductions in pre-cancerous breast cells and changes in tissue stiffness that make it harder for dangerous cells to survive undetected.

When the room asked why we weren't doing this everywhere, someone noted: this drug doesn't exist in America. Dr. Liberty stood up and said: actually, it does. It's called Ella. It's emergency contraception. And the reason it hasn't crossed into breast cancer prevention is politics, not science.

In this episode: the biology of why progesterone may matter more than estrogen in breast cancer risk, the regulatory and social barriers keeping this drug from women who need it, and what to ask your doctor for today.

The drug: Ella (ulipristal acetate, 30mg). Ask for advanced provision — a prescription before you need it.

Kicking Cancer's Ass. We never chose the pitch, but we always choose the swing.

Learn more about scalp cooling from episode sponsor - www.coldcap.com

Learn more about UCSF RiseUp at https://riseup.ucsf.edu/ 

Learn more about ELLA: https://www.ellarx.com/

"If someone would have told me there was a vacuum erection device — I wouldn't have even had to have it in my hand yet. But if I had just known that was there, it might have kept me from having those thoughts."

Three men — a stage four prostate cancer survivor dating in his 60s, a gay man navigating anal cancer and an ostomy, and a married man who overheard nurses discussing his own "male castration" before anyone explained his treatment options — break open the conversation that oncologists almost never start. This is what cancer does to male sexual identity, desire, and relationships, and more importantly, what actually helps.

They dive deep into:

• How Mike fired his first physician after overhearing nurses discuss "male castration" for his case and built a full sexual function advocacy strategy with his surgical team

• Mike's post-prostatectomy toolkit: vacuum erection device, penile injections, a performance ring, and Viagra, including why morning use worked when evening use produced nothing

• Why three weeks of post-surgery incontinence pushed Mike to suicidal ideation and how learning the vacuum device existed could have changed that

• How Tim's hormone therapy ended his marriage and what the first woman he dated post-divorce taught him about decentering penetration completely

• Daniel losing the sexual role that defined his identity as a gay man and what rebuilding intimacy actually looked like with a partner who had been his caregiver

• The caregiver-to-partner trap: why Christian's protective instincts made sexual reconnection harder, and why that tension still surfaces a decade later

• What pelvic floor PT with biometric ultrasound feedback looks like and why Mike was doing every exercise wrong without the visual

• Why all three men say doctors are optimizing to save your life, not your intimate life, and what they each wish they had been told before treatment started

"8% of female patients said they would forgo chemotherapy due to fear of hair loss. We actually had one of those patients that we worked with that became not a statistic anymore."

Bethany Hornthal, co-founder and executive director of Hair to Stay — the only national nonprofit exclusively funding scalp cooling access for low-income chemo patients — built the infrastructure behind scalp cooling's FDA clearance and then stayed to solve the access problem nobody else was addressing. In this conversation, she breaks down the science, the insurance battle strategy, and the personal history that drove her to turn a napkin idea into an organization that has awarded over 8,000 subsidies and $5 million to patients across the country.

They dive deep into:

• The clinical trial that forced FDA clearance: how a 2010–2015 study proved 69% of breast cancer patients could maintain at least 50% of their hair — and why there was no control group needed, because without scalp cooling, all patients would have been bald

• The two-mechanism science behind why scalp cooling works: vasoconstriction limits how much chemo reaches the follicle, while cellular chilling slows metabolism so fast-replicating cells become less vulnerable to chemo's targeting

• Why filing your insurance claim anyway — even expecting a denial — is the actual lever moving the industry: every appeal and state-level escalation is what's building the case for coverage, with 14 states now carrying pending legislation

• How Hair to Stay's targeted donor funds work in practice: segments by age, geography, and profession mean patients who don't qualify under standard income criteria may still have a path to a subsidy — with eligibility decisions returned within 24 hours

• The honest answer on AC/doxorubicin protocols: harder, not disqualifying — and why younger patients with unprocessed hair have shown better outcomes even on the most toxic regimens

• The privacy and control case that goes beyond vanity: a therapist in the episode describes how visibly losing hair changed how her patients treated her in session — affecting the quality of care she could deliver

• Save It Forward, the peer fundraising model where past patients run golf tournaments, gym classes, and cold plunges to fund the next person — every $1,000 raised covers one additional subsidy

• What to do if your care team never mentions scalp cooling: ask directly whether the facility bills insurance on your behalf, because facility-based billing is increasingly common and materially improves reimbursement odds compared to filing solo

  
  

Learn more about scalp cooling from episode sponsor - www.coldcap.com
Learn more about UCSF RiseUp at https://riseup.ucsf.edu/

"The leading cause of non-cancer death in cancer survivors is heart disease. The treatments for cancer may be increasing your probability of getting heart disease.."

Dr. Anju Nohria runs the Cardio-Oncology Program at Dana-Farber and Brigham and Women's Hospital. She's one of the few doctors whose entire job is protecting cancer patients' hearts while they fight for their lives. 

In this episode, she tells Joelle exactly what questions to ask your oncologist, what to watch for, and what you can actually do to protect your heart during and after treatment.

They dive deep into:

• Why heart damage from chemo is almost always silent, no symptoms, no warning, and why by the time you feel something, you've already missed the best window to act

• How to know whether your specific treatment is even risky for your heart, and what monitoring to ask for if it is, because one test does not fit all drugs

• A major study showed that colon cancer survivors who did structured exercise after finishing treatment, not gym workouts, just regular walking, had lower rates of cancer coming back and lived longer at eight years of follow-up

• What happens to your heart when cancer treatment forces you into early menopause overnight, and why your regular OB or endocrinologist may not be the right person to manage it

• Why stopping your blood pressure or cholesterol medication during chemo is one of the most common and most harmful things patients do without realizing it

• The one number Dr. Nohria says every cancer patient should track at home, and exactly what to do if it's too high

• How newer immunotherapy treatments may be creating a long-term heart risk that nobody fully understands yet, and what researchers are trying to figure out right now

You fought hard to get through treatment. This episode is about making sure your heart is there for everything that comes next.

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