Episode 5: Taking ACTION in Appalachia

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Episode Guests

Nathan Vanderford, PhD, MBA

Dr. Vanderford is an Associate Professor at the University of Kentucky College of Medicine within the Department of Toxicology and Cancer Biology. His research focuses on cancer disparities, health promotion, and cancer education and training. He holds several administrative positions including being the Assistant Director for Education and Research for the Markey Cancer Center, Director of Administration for the Center for Cancer and Metabolism, and Director of the Appalachian Career Training in Oncology Program. In these administrative positions, he works to facilitate cancer research and education initiatives across the university.

 

Susanna Goggans

Susanna Goggans is a second year medical student at the University of Kentucky. She graduated from the University of Kentucky with a Bachelor of Science in Human Nutrition in 2021. Susanna was a participant in the Appalachian Career Training in Oncology (ACTION) Program from 2018-2020. She is from Johnson County, Kentucky. 

 

 

Michael Buoncristiani

Michael Buoncristiani is a senior at the University of Kentucky majoring in Biology, Neuroscience, and Agricultural and Medical Biotechnology. He will be a first year medical student at the University of Kentucky in the Fall of 2023. Michael was a participant in the Appalachian Career Training in Oncology (ACTION) Program from 2019-2021. He is from Wayne County, Kentucky.  

 

 

Show Notes

Nathan Vanderford, Ph.D., MBA 
Appalachian Career Training in Oncology (ACTION) Program
Youth Enjoy Science (YES) Research Education Program (R25)
Book Recommendation: ReSearch: A Career Guide for Scientists 

Your Turn: Guests Recommendations 

The Guest List by Lucy Foley
The Cancer Crisis in Appalachia: Kentucky Students Take ACTION (1st edition)
The Cancer Crisis in Appalachia: Kentucky Students Take ACTION (2nd edition)
Cancer in Appalachia Instagram Page

Episode Transcript

[UPBEAT MUSIC]

OLIVER BOGLER: Hello and welcome to Inside Cancer Careers, a podcast from the National Cancer Institute. I'm your host Oliver Bogler. I work at the NCI, in the Center for Cancer Training.

On Inside Cancer Careers we explore all the different ways that people join the fight against disease and hear their stories.

Today we are talking to Dr. Nathan Vanderford from the University of Kentucky who runs a program for high school and undergraduate students that are tackling the cancer crisis in Appalachia and two alums from that program.

OLIVER: It's a pleasure to welcome Dr. Nathan Vanderford to the show. He's an associate professor in the Department of Toxicology and Cancer Biology at the University of Kentucky College of Medicine and the Director of the Appalachian Career Training and Oncology or ACTION Program. Welcome, Dr. Vanderford.

NATHAN VANDERFORD: Thank you very much, it's great to be here.

OLIVER: Before we jump in to learn more about the ACTION Program, I wanted to ask you about your own journey to the position that you hold today, what was it that you got you interested in science and cancer?

NATHAN: Yeah, you know, from a very early age, I mean, from, you know, from five years old or maybe a little younger I had aspirations of being a medical doctor. Didn't quite make it there, but, you know, in science nonetheless. But I think I was inspired by, you know, being sick as a kid, it turns out, long story short, grew up in a house where we burned wood to heat our house and I was allergic to the wood smoke and it would make me very sick as a kid in the wintertime. And, so, I was inspired, I wanted to, you know, help others that were sick like me. And then, you know, over time I just got even more interested in science, basic biology, I wanted to really understand how we worked, like, you know, biomedicine, biomedical research really interested me. And, so, when I went to college all I wanted to do was just take biology and chemistry classes and learn as much as I could about how we as humans functioned.

OLIVER: Fascinating. You have an MBA, a Masters in Business Administration, that's not a common qualification among scientists, can you tell us what prompted you to get an MBA?

NATHAN: Yeah, so, when I finished training, so I did a post-doc in Vanderbilt and then I came back to the University of Kentucky and started out a quote real job, real world job, and, you know, some of the things that I was doing I could see where even though, you know, I just said I loved being an undergraduate and grad student, learning everything I could about science, but I missed out on opportunities to learn other things and, you know, business administration concepts I think many of use in a variety of different job settings. You know, as scientists, you know, if you run your own research program, you have grant funding, whatever the case might be, you know, having some business acumens, some business, understanding of business principles, even working in an organization and trying to understand how the organization functions and how projects work and all that kind of thing, I think is really useful. And, so, I was inspired by that and the lack of knowledge in these areas and, you know, just being sort of a sucker for wanting to learn more and, you know, loving education, I thought I'd go back and get an MBA and it's been really useful I think. You know, I learned a ton of things that I wouldn't have otherwise known, met a lot of great people that some of which I'm still connected with through that program, so it was a great opportunity for me.

OLIVER: You focused on mentoring and teaching, as you just mentioned, and giving career guidance to the people you are mentoring, you've even co-authored book, “Research, a Career Guide for Scientists” and you've written about graduate education, so where are we, in your opinion, in 2023 regarding the biomedical scientist training path?

NATHAN: Yeah, that's a great question, and I think, you know, it's a question that is being asked out there a lot, you know, and in the media, you know, what I tell people is getting a graduate degree or professional degree is a phenomenal opportunity. I think, you know, we are blessed to have these opportunities to get, you know, a high level of education. If we talk specifically about, you know, PhD level education, we're getting paid to get educated and to learn and to, you know, to do science, discover things that nobody else has discovered for, so it's a fantastic opportunity. That said though, as many of us know, there's issue in the PhD training world and I think, you know, while it's a phenomenal opportunity, I think we have a lot to do in terms of making the training experiences better, more positive for trainees. And I think that we have some opportunities to improve how we train trainees and to better align that training with the jobs that our trainees are actually getting to get, rather than focusing specifically on preparing the next generation of faculty members when, you know, as many of know, a small sliver percentage of our PhD trainees are actually going to pursue and obtain that kind of career path. So there's a lot of other training that we need to be providing our grads.

OLIVER: I'd like to pivot to talk a little bit about the ACTION Program now. Can you tell us what it is and how the idea came about?

NATHAN: Yeah, so ACTION -- the Appalachian Group Career Training Oncology Program, it's an experiential cancer education training program, it's funded by the National Cancer Institute, which I'm very, very, very appreciative of. I think we'll get into this more in a little bit, but it's a Youth Enjoy Science R25 program. We're very fortunate to be funded through that mechanism, it's a fantastic mechanism. It's through this R25 mechanism, there are three components of the training, there's research, education and outreach aspects of the program. And, so, we recruit students and prepare and motivate them for cancer biomedical careers. And I think we're going to get more into the specifics of who we're reaching and what our specific goals are and, you know, we're very excited about those goals, because our program is really situated in an area that has great need for this kind of work.

OLIVER: Yeah, you mentioned the R25 YES, that's a program through the Center to Reduce Cancer Health Disparities at NCI and it is a program designed to help people to experience science and think about careers in science. So, I think your program is definitely excellent component of that bigger program. So you mentioned just briefly, you alluded to the cancer situation in Kentucky and the books that you've published with your participants, we'll get to in a moment, but they talk about a cancer crisis in Kentucky, can you tell us a little bit about that?

NATHAN: That's right and I think I forgot to answer part of your other questions, so I'll circle back too .

OLIVER: Sure.

NATHAN: So, sort of how it came about, so it came about because of this cancer crisis in part. So, for those who don't know, Kentucky has a massive cancer problem. We rank first in the nation in overall cancer incidence and mortality levels. So, no other state in the US has a worse cancer problem than does Kentucky. And that's bad, I mean, we're talking, you know, over 30,000 new cases each year, over 10,000 deaths in the state, so significant cancer problem. That's bad, but what's worse is that the cancer problem is significantly worse in the eastern part of the state, the part that's in the Appalachian region. There's 54 counties, out of the 120 counties in Kentucky. These 54 counties have really significantly higher cancer rates than does the rest of Kentucky, which again is already number one in the country. So that was part of the motivation for this program. I mean, I think that describes the cancer crisis, you know, and it's not to be sensational in saying that, I think from my opinion, we really do have a crisis, I mean, in terms of the high rates of the disease. The other inspiration for the program was, and this is some of the reason why the cancer rates are so bad in Kentucky, there's also, again, Kentucky doesn't rank so well in education levels across the state, but again, that's worse in east Kentucky, so education attainment levels are low, so you sort of marry the cancer crisis with the education crisis and so coming up with the ACTION Program sort of, you know, was a no brainer in terms of trying to think of a long-term strategy to help solve the cancer problem, while also addressing the education attainment, really focusing on, you know, providing opportunities, resources for students to help them prepare academically and succeed academically, while also providing this cancer training was, I thought, a phenomenal opportunity.

OLIVER: So you draw your participants in the program from those 54 counties on the east side of the state, the Appalachian region, is that correct?

NATHAN: Absolutely, yes. So, and our program we engage high school and undergraduate students as participants. Through our outreach we reach elementary through, you know, community members of all ages, but participants specifically in the program are high school students to undergraduates and specifically from those 54 counties in eastern Kentucky.

OLIVER: Yeah, we're going to get to talk to two of your alums in this the next segment, but I read the books that you published with your participants, these are personal essays written by the high school students and undergraduate students. I tell you, very impressive, very moving, very thoughtful essays. How did you come up with the idea of actually bringing out these books?

NATHAN: Yeah, that's a great question. You know, these essays are -- I'm biased and you said it too, but I, you know, they're phenomenal, you know, I originally I wanted a way that we could sort of innovatively uniquely engage the students in a learning exercise, have them explore their personal connections with cancer and get them to think about cancer in their families and their communities. And, so, that sort of was the inspiration of this idea to have them write essays. You know, originally it wasn't a project where I thought we would publish these essays, it was just, you know, really an activity to get the students to think and, you know, start talking with their families, learn about cancer in their communities, but they were just so phenomenal and I thought, man, you know, other people need to read these. And, so, that's when, you know, I started talking, we have our a university press, our university -- the first book was published by our university press and they also thought it was something that needed to get out there in the community. So, you know, the students learned a lot about cancer, I think many of them, particularly the high school students, it was a great exercise in writing and being critiqued and learning how to be, you know, go through edits. As a high school student -- when I was a high school student, you know, I would write something, turn it in, I might get a C on the paper, but I didn't have an opportunity to revise it, you know. And in the scientific world it's all about writing and rewriting and editing and revisions, so I think that was a big learning step too for the students. So we went through all that process and then getting it out there has been a great opportunity to engage the community here in Kentucky, but even more broadly. You know, you said you've read the books and, so, they've been distributed beyond the borders of Kentucky, which I think is phenomenal.

OLIVER: Yeah, absolutely, I recommend them. On your website, the program website at the University of Kentucky, you have information about all the different folks, can you give us just a feel for the numbers how many participants have you had over the years?

NATHAN: Yeah, so, alumni and current students we're at a 116 now and that breaks down to about -- there's 60 high school students, 56 undergraduates. And for those who aren't maybe as familiar with the YES Program as others, it's a two year program, so students are in the program two years and we engage our students continuously across those two years, not just in the summer. So, you know, that, you know, 116 may not sound as high as what some other programs are able to accumulate over the years, but I think this long-term engagement, you know, is significant, it has a significant impact on our students.

OLIVER: And one of the goals, I guess, is to interest students in a career and in biomedicine, perhaps even in cancer research, have you got some outcomes information, has that happened?

NATHAN: Yeah, I think, you know, the students are who make the magic happen, they're the phenomenal ones of this whole thing. And we've been very fortunate, so our undergraduates we have 40 alum who, you know, have finished the program. Out of those 40, so the undergraduates, we have 33 that have gone on to either professional or graduate programs. And out of those 33, we have 25 that have gone to medical school. And you're going to hear from one that's in medical school now in just a little bit and another that's going in the fall and that's phenomenal, I think. And what's really exciting is that these students are continuing to also be interested in research, not only medicine, but they're continuing with research too, which I think that, you know, I hope, and we'll see what the students say, but I think that we helped spark that interest, you know. Or maybe they might have done some research without this program, but I think they might not have done it as deeply or in such a sustained way without. Our high school students are also being, you know, very successful, out of 20 that have graduated high school now, 18 of those have gone on to college, which is way above what's expected in Appalachian, Kentucky, you know, we've already talked about the educational issues, it far exceeds the percentage of those that go to college. And, I mean, I think all of them, the last time I checked, are in a science related field and are continuing the, you know, the steps to pursue the next thing of graduate school or, you know, professional school and focusing on research or medicine.

OLIVER: Anything else, Dr. Vanderford, that you'd like to share about the ACTION Program?

NATHAN: Well I, you know, I'm -- I'm just so grateful for the opportunity. We have, you know, we have a renewal grant in review right now, it's going to be actually reviewed later this month, so we'll see what happens in review, but I really look forward to, you know, either now or in the near future getting this program refunded and continuing. The other exciting thing that has just very recently happened, I think that as another layer of impact is that I've worked with our philanthropy groups here on campus in a variety of different ways, but we just had some donations to start a scholarship program for our students and current students and alumni, which is huge, because, you know, many students from this area need significant financial support to be able to attend college and so I think this is going to be a great opportunity to continue supporting our students beyond being in this program and helping them, you know, be successful doing whatever it is they want to do.

OLIVER: Well, thank you very much, Dr. Vanderford. We're going to take a quick break and when we come back we'll talk to two of the alums of the ACTION Program.

[NanCI ad]

Welcome back. I'd like to welcome Susanna Goggans, who is a second year medical student at the University of Kentucky. Susanna participated in the ACTION Program from 2018 to 2020 and is from Johnson County, Kentucky. Welcome, Susanna.

SUSANNA GOGGANS: Hello, thank you for having me.

OLIVER: Also with us is Michael Buoncristiani, a senior at the University of Kentucky, majoring in biology, neuroscience and agriculture and medical biotechnology. He's starting med school there in the fall of 2023. Michael was a participant in the ACTION Program from 2019 to 2021 and he's from Wayne County, Kentucky. Welcome, Michael.

MICHAEL BUONCRISTIANI: Hello, thanks for having me.

OLIVER: I'd like to start with you, Susanna. In your essay, Malignancy in the Mountains, which is in the first book, you described the events of the summer of your freshman year, what happened?

SUSANNA: So, the summer of my freshman year -- well, first of all, in like April my mom called me and she said that I went to go get my yearly free scan from UK, she had been going once a year through UK's ovarian cancer prevention program and getting a transvaginal ultrasound, which was part of a study that they were doing, so her and my grandma would go once a year and get this ultrasound done and it was to detect any signs of ovarian cancer. And she told me, she said, "They saw something a little suspicious, they're not too worried, I'm going to the doctor." And then I was like, "Okay, well, you say not to be worried." And so then in that May I took my first finals of my freshman year at UK, I came home, my mom went to the doctor, she said, "Well, they said I need a hysterectomy, but like still nothing to be worried about," and I said, "Okay," you know, I still like, hysterectomy, like, you know, but okay. And so then the hysterectomy came around and I had already -- I was interested in medicine, so I had already watched the YouTube videos and how, you know, what a hysterectomy is, I knew how long it was supposed to take and it was supposed to take around two-ish hours. And I was at home, my dad was in Lexington where she got the surgery with my mom and I was at home because I was in charge of watching my little sister who has cerebral palsy, so she needs 24 hour care, so I was in charge of babysitting her for like these couple of days that my mom was going to be in Lexington. And I kept on waiting and I noticed that she wasn't coming out of surgery and I kept on texting my dad, I was like, "Did you forget to text me, is she out?" And he's like, "No, no." And then eventually I got the phone call that she -- that they found cancer, that the cyst on her ovary was ovarian cancer. And I guess I should have been a little bit more expected, because I knew there was -- or a little bit less surprised because I knew there was a chance, but it really took me aback or it took me back by surprise for some reason. And, yeah, the good news is because she was part of this screening program, they found it extremely early. Ovarian cancer is notorious, if you Google just ovarian cancer you'll see that the mortality rate is like 50%, it's really high. But usually they don't find it until around stage 3, they found hers in stage 1 at the very, very, very beginning. So that -- we were very, very lucky for that. And then she went through her six rounds of chemo and ever since then she's been good. So, it was an interesting summer, it was kind of a rough summer and fall, but we're all so thankful for that program that found her cancer so early that she just needed the chemo and now it's been over five years and she's still good.

OLIVER: Yeah, you described the wait during the surgery when you don't get the text and you don't get the text, it's definitely -- I wonder what was going through your mind at the time?

SUSANNA: A lot of thoughts. I was having a busy day anyways, because I was taking care of my sister and I wasn't, like, too used to taking care of her without my mom, because my mom is a stay at home mom, so she's generally at home, like I help her with her a lot. And so I was already a little bit overwhelmed with that and I was also trying to get, like, this shadowing program set up at home so I could be shadowing in the local hospital that summer, it was the very beginning of my summer break. And so I just kept on wondering, I don't think cancer really crossed my mind, but maybe that's what happened, I just kept on thinking that she had just gotten out and my dad was just so over -- you know, like, someone gets out of surgery, he was just busy and had forgotten to text me. So, that's really all that was going through my mind and eventually when it hit around hour 3 or 4 I was thinking, well, maybe something's wrong. Maybe, but, you know, it really didn't cross my mind that much until he called me.

OLIVER: Yeah.

SUSANNA: Once he called me, I kind of knew, since I saw it was a phone call, but.

OLIVER: Yeah.

SUSANNA: Yeah.

OLIVER: Came out of the blue, like a shock, yeah. So, Michael, in your essay, A Continuous War, Cancer in Kentucky, it's in the second book, you described that your first contact with cancer through your grandfathers. You were pretty young at the time, if I remember, and I wonder how it felt to see this in your family and what was the impact?

MICHAEL: So I think that was an interesting part of my, like, journey with recognizing cancer. So when my grandfather was diagnosed, like you said, I was very young, so you don't really know, don't really know what cancer is, you don't really know what's going on, but you can just feel how people are interacting, you can tell that something's wrong, but you don't really understand it. And I think that that really, really impacted me as, like, I got to -- got to see it first hand from, like, the -- how big of an effect cancer has on not just the patient with it, but the family. And I also got to see, as I got older, how big of a role that the provider played in the cancer journey of each patient and  -- so I really respected my grandfather as most grandkids do and I got to see how much he liked his cancer care providers, his oncologists and nurses and everybody, they that were at the Markey Cancer Center. And, so as I was growing up I got to -- I kind of transitioned more into, like, the understanding of how it affected everyone and then I was like, okay, so this is what's going on and then I got to see, even when I was still early on in college when he was still receiving treatment here at Markey, got to see the power of the advanced medicine that goes on at big cancer care centers, because we're from -- I'm from about 2 1/2 hours from here, from Lexington, so to get cancer treatment this is the closest place you can go to get that kind of care. So I remember my grandfather would drive up to Lexington and there's a Hope Lodge here in Lexington, he got to stay there a few times. But I got to see how much -- how much of a toll that took on him and so it was kind of a unique transition into, like, understanding the emotions around it and how it affected everyone. And then I got to kind of see more of the science side when I was middle/high school and then transitioning into college I got to see how much of a role that can play if people are able to get that quality cancer care. So I think that was a great part of that journey being able to see it through different stages as I got older. And thankfully to cancer care at places like Markey, in the book I think I even wrote that he lived 15 years after his initial diagnosis, so I just -- I do think that played a big role in how I decided to do what I'm doing now and kind of get involved with the ACTION Program, which was amazing for me. So, yeah, I think that was really interesting and I think that progression made a big difference.

OLIVER: In your essays you both described the high rate of cancer that Dr. Vanderford already talked about and you identified some reasons, I wonder what your research showed? Michael, do you want to start?

MICHAEL: Yeah, so I got the amazing opportunity with Dr. Vanderford's direction to work in a research lab. It was here, they moved here recently to another university, but I got to work in a research lab for 2 to 3 years and worked mainly on a project. So they knew I was coming from the ACTION Program and the PI that I was working for knew Dr. Vanderford, so they let me work with one of the post-docs on an Appalachian lung cancer project, which was amazing. So my grandfather's tumor metastasized to his lung, so he lived with lung cancer for many years, so I got to work with that project and we were -- some of this stuff has been published, but we were using mass spectrometry to investigate the tumor microenvironment on -- of lung cancer patients from Appalachia versus non-Appalachia patients. So that's the cool thing about the Markey Cancer Center here is they get these patient samples and they put whether these patients were from Appalachia County, so those 54 counties that the ACTION Program has and then patients that weren't from there with different types of lung tumors and we compared these lung tumors and trying to investigate whether diet plays a role in that. So, the Appalachian region is well-known for poor dietary habits and it's not because people have a choice, it's because a lot of places don't have fresh food around, the nearest Wal-Mart could be 45 minutes, an hour away, so you've got to go to McDonald's, you have to go to Wendy's, you don't really have a choice if you're running late at night, you've worked a 12 hour shift. So, a lot of these individuals have to -- have to pretty much eat unhealthy and we wanted to investigate the impacts of these unhealthy diets on this and eventually transferred that into other studies and things. That's an ongoing process, it's a big project, but I was really glad to be able to do that. And one thing that I wanted to say was, it was really interesting, so I got to go out of state to present some of this, some of the data that we had and people that were from states that were not around Kentucky, they had no idea that this was such a big issue and they were really surprised. And that was another really interesting thing to me and I was glad that I talked about some of the statistics in the book, because I don't think even in the Appalachia region I don't think a lot of people realized the rates that we have and how much difference some of those, like, food insecurity and stuff is between there and places like Lexington, places like these bigger cities. And I also know that that plays a role to areas in the bigger cities that are really far away from fresh food, so I think that investigating that Appalachian lung cancer may unlock a lot of answers to what's going on in a lot of these regions that have these insecurities and a lot of the issues that we have in the region.

OLIVER: Yeah, lots of social determinants of health play a role. Susanna, in your essay you also talk about opportunities to maybe turn the tide a little bit in Kentucky and make advances on these issues, I wonder if you could tell us your thoughts on that?

SUSANNA: Yeah, like Michael was talking about, where there's so many factors that go into these high cancer rates in eastern Kentucky, I think it's difficult to target all those factors at once, but I think just having the overarching goal to try to improve, oh no, like make -- help eastern Kentucky have a healthier lifestyle. As Michael was kind of talking with the obesity rates, I think that might be a hot high -- there might be a high correlation between that and cancer to just try to encourage healthy eating habits, which is difficult because of, you know, the distance to -- you have to drive sometimes to go to a grocery store when you live in a very rural area and just the availability of fast-food over other types of food. But I think just trying to target some of these factors might be a good way to start the process of helping to decrease these cancer rates. Along with also just preventative screenings. I'm into preventative screenings since that's what caught my mom's cancer. But it's hard to go to -- get to the doctor sometimes when you live very far away to do a screen that might not even detect anything. You can see how it would be hard to motivate yourself or find the time or resources to be able to do that. We don't even know for sure it will help, but just making all of these things more accessible I think could be a good start.

OLIVER: Thanks. So I'm curious, what was it like to be in the ACTION Program, Susanna, and has it -- I think you indicated you were already interested in medicine when your mom was diagnosed, so maybe those are longstanding interests, but I wonder if it's influenced perhaps even the direction of the medicine that you intend to practice?

SUSANNA: It definitely has influenced the direction of medicine I intend to practice. When I first started undergrad I was interested in medicine because of growing up with my sister with cerebral palsy, as I previously mentioned. So I was looking into PM & R, physical medicine and rehabilitation and I was just kind of looking into specialties like that, because I wanted to be a doctor like the doctors that have worked with my sister and I had never really -- I definitely never even thought of oncology, I just thought what everyone else thinks, oh, that would be so sad. And then my mom got diagnosed and I saw what impact her doctor had on my family and on her cancer journey and how amazing her doctor was. When my dad did that first phone call he said, "I wish you were here just so you could see her doctor, she's amazing, you need to be a doctor like her." And then through the ACTION Program I got the opportunity to shadow my mom's doctor specifically and other oncologists a lot throughout -- all throughout my undergrad experience and something that I saw over and over again is that these doctors had such a high impact on their patient's lives. And when you have a cancer diagnosis it is likely going to be one of the worst times of your life and it just kind of resonated with me that I could be someone to help people through that time of their life and be there for them and help make this worse time in their life hopefully not as bad and help them get through it.

OLIVER: Yeah, yeah, I think that's fantastic and I wish you all the best in that journey. Michael, you had already indicated a little bit that the ACTION Program influenced your choice to go to medical school later this year, are you thinking of oncology as a specialty?

MICHAEL: Yeah, the ACTION Program really -- definitely influenced my decision to do that. So I already had that previous experience with cancer, but coming from a small town in the Appalachian region you don't -- you don't have anybody to ask what to do, so you kind of just -- you come here on campus with a bag and you got to figure it out from there. And I noticed that some of the individuals that have these interactions with the colleges while they're in high school and stuff, they kind of knew what was going on, they already found a research lab right after they graduated high school. So I was influenced there, but I didn't know how to go about it. I knew I was here, I Googled everything that I could, but the ACTION Program was really pivotal in helping me direct my career trajectory to what I wanted to do and what I was really interested in. So working with Dr. Vanderford and Chris -- my first semester I was just trying to make it through college, so the ACTION Program was like a backbone of support of, like, what should I do here, what do I need to do and they helped me find shadowing opportunities while we were still able to shadow my -- during my freshman and sophomore year. And I got to shadow oncology, I got to shadow a great oncologist and he actually worked with my grandfather, like Susanna said her oncologist that she shadowed worked with her mother. So I got to shadow an oncologist and see how much of a role he played with his patients and it was amazing to see the interaction. So I got to go to a few of my -- with my grandfather to a few of his oncologist appointments, so getting to see that -- because whenever you're going with a family member it's a little bit different, because you have, like, you -- it's hard to listen after you're -- whenever you're hearing the word cancer and it's somebody so close to you, but if you get to sit on the outside and watch a provider interact with a patient and their family, it's just really amazing to watch maybe a really good physician. So the ACTION Program brought that opportunity. And then further, the opportunity to work in a research lab and see what goes on behind all of that. So, and see what's really driving the needle as far as cancer research and cancer therapeutics and care goes. So I got to do all of these things and immerse myself in these opportunities I would never -- I wouldn't have even known how to type an email -- I didn't know you could type an email and ask if you could work in their lab and it was thanks to Dr. Vanderford helping me navigate all that, because it's -- you kind of get in, you get slammed with all these opportunities and you just got to throw your hands up and grab as many as you can like you're in a money -- wind money tunnel and you just got to grab the $1 bills. So the ACTION Program helped me navigate that and really decide, like, hey, I'm very interested in oncology, I know that I still have a lot to learn and things can change, but I will always have that -- I know for sure that I will always have that piece of cancer care, cancer education, cancer outreach, even if I decide to do primary care in a rural area or oncology, I will still know that -- how important cancer education is and especially to the Appalachian region of Kentucky. So the ACTION Program was very pivotal in me navigating those pathways and figuring out what opportunities I should take advantage of.

OLIVER: Thank you for sharing that. I, likewise, wish you all the best in your journey. Michael, to end with, I wonder, what would you say to someone, perhaps, coming up behind you, someone younger, if they were thinking about cancer as a career, what would you say to them?

MICHAEL: I -- first things first, with everybody that that even mentions that to me, if they're from the county that I'm from or any of the other 53 counties involved in ACTION, I say, "Apply to ACTION." We've got a little program here at school and I tell everybody, like, you need to apply to the ACTION Program, it's amazing. We had Dr. Vanderford come talk. So -- and based off that I know that there are some students that can or whatever happens and what I would say is, find a mentor and I think that's important and I think that's a great thing that the ACTION Program provides, because you can't navigate all that stuff alone. So, especially being a young student freshman year, because you guys, UK is a great research institution here in the state of Kentucky and coming from a high school, it doesn't really matter the size, you're going to be in a bigger place than you've ever been before and the classes are going to be bigger than any class you've been in. And as a young student coming in at 18 years old, you can't navigate that alone. So I would say one of the many things is find a mentor, find mentors to help guide you on the path that you want to go and that's the amazing thing that I've seen with the ACTION Program and a lot of the other faculty here is they're really willing to help undergraduate students, which is also been very great for me, because I hope one day that I'm able to provide some type of help to somebody. I don't know if anybody would want my advice, but I can at least tell them what not to do sometimes maybe.

OLIVER: I'm sure they would, I'm sure they would.

MICHAEL: But I think mentor, mentorship and just immersing yourself in the opportunities available are probably the two biggest pieces of advice that I would give.

OLIVER: Susanna, what about you?

SUSANNA: I would tell that student to not be afraid, to get involved in research, get involved in shadowing, because when I first started undergrad that was my main issue is that I was just too scared to reach out to anyone, to scared to -- research, the thought of that just intimidated so much and I really needed ACTION, I was so grateful for it, because I needed someone to basically hold my hand while I wrote an email to the PIs and, like, tell me that it was okay, look over it and tell me that I deserved to be there and I deserved to do research too, because I felt a lot of times that I came from a high school that was really, really small, we didn't have a super strong science program just because of the size of it. And then in my classes I was surrounded by a bunch of people that went to these fancy high schools and they did AP this and that, that I just didn't have. So I needed some guidance and someone to tell me that I can do the research and do the shadowing and all of that, all the things that are important to do if you want to go to medical school and to confirm your interest in medical school and then oncology.

OLIVER: Thank you. Dr. Vanderford, the last word to you, I'm sure you have that conversation with a lot of students as well, what advice do you give them?

NATHAN: Well, I think, as I said earlier, these -- these are just such phenomenal opportunities, you know, to be here at this university, others like it, where you have an opportunity to do research, shadowing. We're fortunate that we are on a campus where, you know, the undergraduate campus is on the same -- it's at the same location as the medical school. So I tell students all the time, you know, you can go from your chemistry classroom, walk 5 minutes down Rose Street and you can be in a world class research lab or you can be in an OR observing a cancer surgery. And take advantage of those opportunities. You know, I think as the students have said, these are phenomenal opportunities that are going to be transformational for you as an undergraduate student, but also for your futures in whatever it is you want to do. So take advantage, you know, even manage your time well and do well in class, but all these other activities, you know, they're at your fingertips and they are great things to part of.

OLIVER: Well, thank you all very much, very much appreciate you sharing your journeys and your insights, thank you.

NATHAN: Thank you for having us.

MICHAEL: Yeah, appreciate you having us.

[UPBEAT MUSIC]:

OLIVER: Now it's time for segment we call Your Turn, because it's a chance for our listeners to send in a recommendation that they would like to share. If you're listening, then you're invited to take your turn. Send us a tip of a book or a video, a podcast or a talk that you found inspirational or amusing or interesting. You can send those to us at nciicc@nih.gov. Record a voice memo and send it along, we may just play it an upcoming episode. Now I'd like to invite our guests to take their turn, let's start with you, Dr. Vanderford.

NATHAN: Yeah, I've given this a lot of thought and I think I want to recommend the books we've already talked about, you know, the books are titled, The Cancer Crisis in Appalachia, Kentucky Students Take Action. And I think if you want to, you know, if listeners want a better understanding of the cancer problem in Kentucky and particularly the problem through the lens of our students and what they think the problems are and how to deal with those problems, then these books are phenomenal -- a phenomenal lens to sort of get perspective on that.

OLIVER: Thank you. Susanna, it's your turn.

SUSANNA: So, this is now necessarily cancer related. But just a random book recommendation, it's one -- I just got back into kind of not really reading, but listening to audio books and such as I, like, drive or walk, which is a great way to relieve some stress and just take my mind off medical school, sometimes you need to do that. But the most recent one that I listened to is The Guest List, by Lucy Foley, I think that's how you pronounce her last name. And that book, let me tell you, it just -- it starts out kind of here on suspense and it just gradually builds. So if you need a way to de-stress by getting stressed about something else, I think that's a great book to listen or read to.

OLIVER: Thank you, Susanna. Michael, please take a turn.

MICHAEL: I wanted to mention, I thought maybe Dr. Vanderford might steal it, but the ACTION Program has the cancer and Appalachian page where they post these pictures that students take from around the state of Kentucky and they just represent cancer in the area and I always thought that was really interesting, because a lot of them are high school students too and just see, like, behind the mind of -- before you kind of get immersed in, like, being stressed out about medical school or being stressed out about science classes and what you think about the cancer and what reminds you of cancer. And I think that the images and things that the students upload are really cool and better pictures than I would ever take, so I just like to scroll on there and see what could be if I had a steady hand that could take a good photo, so I think that's really interesting.

OLIVER: Thank you for sharing that. I was going to recommend the books that Dr. Vanderford already recommended, the books from this program, so I will just endorse his recommendation and remind our listeners that links to all of these recommendations can be found on our show notes and on our webpage. And with that, I'll thank our guests one more time and thank you.

NATHAN: So much for having us, appreciate it.

SUSANNA: Thank you for having us.

[UPBEAT MUSIC]

OLIVER: That’s all we have time for on today’s episode of Inside Cancer Careers! Thank you for joining us and thank you to our guests.

We want to hear from you – your stories, your ideas and your feedback are always welcome. And you are invited to take your turn to make a recommendation we can share with our listeners. You can reach us at NCIICC@nih.gov.

Inside Cancer Careers is a collaboration between NCI’s Office of Communications and Public Liaison and the Center for Cancer Training.

It is produced by Angela Jones and Astrid Masfar and Edited by Janette Goeser.

A special thanks to Lakshmi Grama and Sabrina Islam-Rahman.

Join us every first and third Thursday of the month when new episodes can be found wherever you listen – subscribe so you won’t miss an episode. I'm your host Oliver Bogler from the National Cancer Institute and I look forward to sharing your stories here on Inside Cancer Careers.

If you have questions about cancer or comments about this podcast, email us at NCIinfo@nih.gov or call us at 800-422-6237. And please be sure to mention Inside Cancer Careers in your query.

We are a production of the U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute. Thanks for listening.