Dina Randazzo, DO, was 13 when she was told that her father had less than three months to live. This event inspired her to become a neuro-oncologist, both to help people with brain tumors and to provide compassion and honesty to patients and their loved ones. In this interview, Randazzo talks to us about how her grief helps her interact with patients and their families, integrating complementary therapies into her patient care, and her own efforts to prevent and cope with burnout at work.
What are your responsibilities within the Department? What does a typical day for you look like?
Most of my day is centered around patient care such as seeing patients, following up with them or their families with questions they may have, reading outside MRIs, writing notes, and conversing with the local physicians. The rest of the time is dedicated to research and administrative meetings, writing abstracts, manuscripts, presentations/lectures and grants and hopefully catching up with a colleague at the water fountain.
How did you first get interested in neuro-oncology? What do you enjoy most about your work?
My most vivid memory at the age of 13 were these following words about my father: "I'm sorry. The tumor is malignant and is everywhere (in his brain). He already had radiation and chemotherapy does not work. He will die within 3 months. There is nothing to be done." There is nothing to be done. I hate those words. Since that time, I vowed that I would do everything possible to never say those words.
The reason why I became a neuro-oncologist was to bring hope into the lives of brain tumor patients and their families. I know their strife and their heartache and I am specially equipped to deal with this, but I want to share in their happiness also. This is thing I enjoy most; interacting with them, helping them, caring for them. Even if I give them only a few more months to spend with their loved ones, in order to experience a little more joy, love and laughter, I have succeeded. In fact, with all the new research with targeted therapies and immune treatments on the horizon, those months could be years and I would never have to say those words.
In addition to your background in this field, you also have expertise in complementary and alternative therapies such acupressure, osteopathic manipulative treatment, and Reiki. How does this knowledge complement your clinical background (and vice versa)?
While working as a massage therapist I have incorporated modalities such as different types of massage, aromatherapy, healing/energy work and acupressure into my practice. In learning to use these techniques, including osteopathic manipulation, I have had to experience them myself; so I know first hand that these treatments can help. In fact, I routinely get massages to help with my migraines and back pain and use aromatherapy. My colleagues often know when I am in my office because of the aromas wafting through the air. I also periodically go on seminars or vacations where I can meditate or experience Reiki healings or other types of energy work for stress relief. I feel that with this knowledge I can offer my patients more options.
My experience in both receiving and performing these complementary therapies gives me a more holistic approach to patient care because I also incorporate these modalities into my life. It also makes me a little more open minded and tolerant of some of the “treatments” that are found over the internet. It is good to know that I can recommend adjuncts to my patients' treatment plan, that does not include a medication. By doing these extra things such as exercise, meditation, massage etc, this can give patients’ a sense of empowerment, and will hopefully improve their quality of life. From my observation of those individuals who have included complementary therapies in their lives for stress relief, alleviation of symptoms or just improvement of overall well being; they seem to have a more positive outlook and better quality of life.
How have efforts to improve quality of life for patients with these conditions improved over the past decade? What changes do you see coming in the next 10 years?
Primary brain tumor patients are still battling cognitive dysfunction, fatigue, personality changes, insomnia, speech and motor problems, anxiety, depression, seizures, and the stigma of having a brain tumor. Our patients are living longer today compared to a decade ago but they face different challenges as a survivor. While there have been evidence-based treatments to help with some of these problems, we have not seen great strides for improving QOL of the brain tumor patient, therefore, we need more research. Because of the increasing incidence of CNS tumors over the years, there is more awareness of this disease and the problems these patients and caregivers experience.
Since there is greater awareness and brain tumor patients are living longer and more are re-entering the workforce, there may be a greater incentive to perform better controlled and larger powered studies to help improve QOL. I am hopeful with all the new targeted and immunotherapy research, that we will start to move toward a more natural approach with stimulating the immune system and building up the body instead of knocking it down. Instead of combating the fatigue, nausea, and cytopenias, etc. that some treatments may cause, I am hopeful that we will see more patients living their lives with less sequelae from treatment.
Do you have any current or forthcoming journal articles, lectures, presentations, awards or other news worth sharing with the Department?
I recently published an article in CNS Oncology titled “An overview of psychosocial distress and its effects on the health related quality of life of primary brain tumor patients” and have submitted my original research on a cross-sectional analysis of psychosocial distress in our patient population. I am currently working on manuscripts on spirituality, complementary and alternative medicine, caregiver distress and thrombocytopenia due to chemoradiation.
In the interim, I am trying to get funding for trials involving the use of melatonin to protect against neurocognitive deterioration during radiation and another describing caregiver distress in our patient population. Some of my research interests include studying the effects of CBD and THC and other natural supplements in brain cancer patients along with the CAM treatments mentioned previously. I recently also have been invited to present at Grand Rounds to the Neurology Department at UF Jacksonville, where I did my residency.
Have you recently read any books, articles, or websites that would be of interest to others in the Department?
Most of the books I read have nothing to do with medicine or neurology unless there is an alien, shapeshifter or vampire as the protagonist. One of the most helpful articles and websites I have read is from Food and Wine: 150 best wines for $15 or less. As for one of the most interesting, it was in the online issue of Neurology last month titled “Burnout, career satisfaction, and well-being among US neurologists in 2016” by Busis MD et al. The gist is as long as we find meaning in our work, we will have better career satisfaction which in turn can decrease the chance of burnout. Therefore, as a whole, we need to have better work-life balance. I think we are all aware of this but we need to do something about it.
What passions or hobbies do you have outside of the Department?
My hobbies include arts and crafts, snorkeling, reading paranormal/sci-fi/fantasy and horror novels along with watching movies of the same genre, cooking and visiting different wineries. I try to meditate and do yoga but it is not as often as I would like. Even though it is not the usual action films I enjoy, I highly recommend Hidden Figures. It was amazing what Katherine Johnson, Dorothy Vaughan and Mary Jackson, had to overcome and their perseverance in spite of prejudice was truly inspirational.
This article originally appeared on the web site of the Department of Neurology, Duke University School of Medicine, and is re-published here with permission.