Survivorship
It All Begins Here
By: Dr. Pranav Oza, MD, PhDFrom the Desk of Dr. Oza: This article was originally published on my personal Substack, where I write about the intersection of rigorous medical science, public health advocacy, and long-term primary care. To get updates on clinical insights and systemic health strategies delivered directly to your inbox, you can read and subscribe to the full publication here.
I have been reflecting on the two patients I saw this week. Lets call them Mike and Tom. Mike as been my patient for over 8 years, having been treated for head and neck cancer before he ever saw me and Tom had new lung cancer that I diagnosed through a screening CT scan. Unfortunately both of them had recurrences after initial treatment, necessitating re-diagnosis and re-treatment. However, their stories are very different from what I saw in residency – a mere decade prior – before the advent of immunotherapy. The newly dropped data for agents like daraxonrsib at ASCO 2026 show that we aren’t just extending life by months anymore. We are minting a new generation of chronic disease survivors.
And as they navigate the fragile path back to health, they are landing right back on the doorsteps of the primary care physicians who knew them before the word “cancer” ever entered their charts.’'
Knowing the Person Before the Patient
For Tom, before the dawn of checkpoint inhibitors, a Stage IV lung cancer diagnosis carried a brutal five-year survival rate of just 5%. We caught it early, but after what we thought was successful surgical treatment – it recurred (or was it a new occurrence? – real cancer care is often messy). I remember the frustration of Tom as we went through the recurrence and helping him connect with a new oncologist and surgeon due to local shifts in care caused by the COVID pandemic. Locally advanced head and neck cancers weren’t much better, frequently hovering below 50%. Mike’s recurrence of cancer was identified by his ENT surgeon, and treated expeditiously by a very dedicated doctor.
My patients always struggle - with the diagnosis and its implications. I struggle with them. When the diagnosis hits, a patient is instantly thrust into a whirlwind of oncology specialists, surgeons, and aggressive treatment schedules. In that chaotic space, the primary care clinic becomes something vital: an emotional and clinical anchor. I encourage them to focus on the long term - often at the cost of their short term mental and physical health. We put statins and colonoscopies on hold, we create new goals in collaboration with the Oncology team.
They didn’t come to me for medication adjustments; they came because they needed to sit with a trusted physician who still saw the person underneath the cancer patient. I was the one who remembered them before they lost thirty pounds, before the treatments stole their voices or their stamina. My job during those brutal months of chemotherapy, radiation, and immunotherapy wasn’t to design the battle plan, but to hold the space for their humanity.
The Toxicities of the Miracle
The oncologists deployed brilliant weapons, and the immunotherapy worked beautifully. But landmark clinical trials don’t capture the messy, daily reality of keeping these patients whole while the drugs do their work.
While Mike’s tumor shrank, his immune system began attacking his thyroid, plunging him into profound autoimmune thyroiditis. While Tom fought through local tissue destruction, his blood pressure fluctuated wildly, threatening his kidneys, all while his baseline diabetes demanded constant, delicate re-balancing.
The oncologist monitors the scans for recurrence, but someone has to manage the fallout of the cure. Someone has to differentiate between a routine sore throat and the terrifying psychological weight of “scanxiety”. That required someone who knew their baseline. It required a longitudinal relationship.
Reclamation: Working Back to Health
The NCCN Survivorship Guidelines emphasize a shared, coordinated care model between oncology and primary care. As the US cancer survivor population surges toward an estimated 26 million by 2040, the true frontier of medicine is what happens after the cancer is gone.
Surviving is not the same thing as being whole. The end of active treatment kicks off a long, arduous process of reclamation. These patients don’t just automatically snap back into their old lives; they have to work their way back to health, rebuilding their bodies and reforming their identities.
In both cases, my highest clinical contribution was helping them peel back the label of “cancer patient” so they could become themselves again. I got to watch them reclaim their unique personalities, their humor, and their independent lives.
What Doesn’t Fit in a Chart
I did not cure these men. Their surgeons, their oncologists, and the incredible, rapid evolution of molecules like pembrolizumab and daraxonrsib did that. But I was there to bear witness to their suffering and triumph. I followed their care – often with anxiety and sometimes getting close to hopelessness. They both needed feeding tubes and I was nearly despondent. I stalked their charts and talked to their spouses (joys of primary care – often I have the whole family that I treat!)
Medicine has transformed completely since I was a resident. A Stage IV lung cancer patient crossing a five-year milestone was once labeled a medical anomaly. Today, they are a regular Tuesday afternoon appointment—a living, breathing person working hard to regain their fitness, balance their life, and live fully.
The tools of oncology will keep evolving, but the core requirement of healing remains unchanged: someone has to know the patient, walk with them through the fire, and hand them their life back on the other side. That walk is the essence of longitudinal primary care. And it has been the absolute privilege of my career.
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References:
Stage IV lung cancer before immunotherapy: 5-year survival was approximately 5–6% in the pre-immunotherapy era (2008–2014). Since the introduction of pembrolizumab and other checkpoint inhibitors, 5-year survival has nearly doubled at the population level to 10–12%, and in clinical trials with high PD-L1 expressors (≥50%), 5-year survival reaches 27–32%.[1][2][3][4]
Head and neck cancer: Locally advanced disease historically carried 5-year survival below 50%. Immunotherapy has now entered the perioperative space — the KEYNOTE-689 trial showed neoadjuvant/adjuvant pembrolizumab improved 36-month event-free survival from 45.9% to 59.8%. For recurrent/metastatic disease, pembrolizumab-based regimens have become first-line standard of care.[5][6]
Feeding tubes in head and neck cancer: Approximately 30–50% of patients are malnourished at diagnosis, and over 60% lose ≥5% body weight during treatment. Nutritional support via feeding tubes is a critical bridge that enables treatment completion and reduces dehydration-related complications.[7][8]
Primary care in survivorship: Nearly 20 million cancer survivors live in the US, and primary care plays an increasingly central role in managing long-term and late effects. The NCCN Survivorship Guidelines emphasize shared coordinated care between oncology and primary care, with defined roles for each.[9][10][11]
Why Care Should Be Longitudinal
It All Begins Here
The damage that stays: why quitting alcohol does not always erase the past
By: Dr. Pranav Oza, MD, PhDFrom the Desk of Dr. Oza: This article was originally published on my personal Substack, where I write about the intersection of rigorous medical science, public health advocacy, and long-term primary care. To get updates on clinical insights and systemic health strategies delivered directly to your inbox, you can read and subscribe to the full publication here.
A patient I saw recently has been on my mind. I will call him Mike.
Mike quit drinking more than ten years ago. He stopped after a terrible gout attack that left him barely able to walk. It was his third flare in two years, and by then his body was making the message hard to ignore.
To his credit, he changed his life. He joined a support group. He started exercising. He replaced his nightly beer with sparkling water and lime. He stayed sober.
So, when we sat down to review his labs at his annual physical, I could see the disappointment on his face.
“But doc, I quit. I have been good for eleven years.”
And he had been.
But his body was still carrying some of the effects of those earlier years. His blood pressure was high. His cholesterol had crept up. His uric acid was still elevated. An ultrasound showed fatty liver disease.
That is the part many people do not realize.
Stopping alcohol is worth it. It lowers risk. It allows healing. It can change the course of someone’s life.
But it does not always mean the body goes back to a clean slate.
Years of heavy drinking can leave a biological footprint. It can affect the liver, blood pressure, metabolism, uric acid, the heart, and even the brain. Some damage improves and some risk decreases over time. But some changes need to be watched and managed long after the drinking has stopped.
Mike’s gout, in hindsight, was not just gout.
It was a warning signal.
Alcohol, especially beer, can drive up uric acid and trigger gout attacks. But elevated uric acid is not just about painful joints. It is also linked with kidney disease, cardiovascular risk, and metabolic problems.
For Mike, the gout was the loud symptom. The blood pressure, fatty liver, and cholesterol were the quieter ones.
When I explained this to him, he was quiet for a while.
Then he asked the question I hear often:
“Was quitting even worth it?”
YES! Absolutely.
Quitting was one of the best decisions he could have made. It likely prevented things from getting much worse. It gave his body a chance to recover. It improved his quality of life.
But quitting does not mean he no longer needs follow-up.
That is where the partnership with his doctor matters.
My role is not to make him feel punished for his past. My role is to help him understand what his body is telling us now, and to make a plan with him. We can treat the blood pressure. We can manage the cholesterol. We can monitor the liver. We can follow the uric acid. We can help keep him healthy and reduce the chance that old damage turns into bigger problems later.
He still needs his doctors to know his alcohol history, even though it is years behind him. Not because it defines him, but because it helps us take better care of him.
That is really the point of this post.
If you are drinking heavily now, do not wait for your body to force the decision. The sooner you stop, the less damage there is to carry forward.
If you have already stopped, do not skip your checkups. Be honest with your doctor about your past drinking, even if it feels irrelevant now. It is not. Your doctor can help you build a plan to stay well.
And if you are young and thinking, “I will deal with it later,” please know that later comes faster than most people expect.
Mike is doing well now. He is still sober. He is taking care of his health. And we are watching the things that need to be watched. That ongoing partnership is part of what will keep him going strong.
He wanted his story shared because he knows it may help someone else take action sooner.
The body can heal a great deal. But it also remembers.
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References:
1. Udo, Vásquez Shaw (2015) N = 25,840 U.S. adults ≥30 years old; compared individuals in full AUD remission >5 years vs. those with no AUD history.
After adjusting for current drinking, smoking, BMI, psychiatric comorbidities, and sociodemographics, a lifetime history of AUD remained independently associated with increased risk for:
Hypertension (OR 1.12)
Diabetes (OR 1.23)
Myocardial infarction (OR 1.35)
Liver disease (OR 1.24)
Arthritis (OR 1.06)
Elderly individuals (≥65 years) were most affected — AUD history was associated with significantly more total chronic conditions (1.93 vs. 1.73, p .01), even after full adjustment
Women with past AUD had independently elevated risk for myocardial infarction (OR 1.45) and liver disease (OR 1.71)
Longer AUD exposure (>5 years) doubled the risk of myocardial infarction (OR 2.05) and nearly doubled arteriosclerosis risk (OR 1.79)
2. Kendler et al., 2016 Swedish cohort, N = 2.8 million, (1973–2010):
AUD was associated with an overall mortality HR of 5.83
Even after accounting for familial/genetic confounding, AUD independently increased mortality risk
3. Jung et al. (2022) 372 AUD cases vs. 243 healthy controls; replicated in Generation Scotland (N = 4,219).
AUD causes measurable, dose-dependent acceleration of biological aging through epigenetic mechanisms. These changes (telomere shortening, immune dysregulation, and hippocampal volume loss) may persist after cessation and contribute to the residual morbidity observed in remitted AUD patients.
4. Kamsvaag et al. (2026) Norwegian registry study, N = 2,736 adults ≥60 years assessed for cognitive impairment (NorCog registry, 2014–2018).
This study examined whether AUD diagnoses (ICD-10 codes F10, G31.2, G62.1, K70, T51.0) were associated with healthcare costs among older adults being evaluated for cognitive symptoms.