[Susanna Quinn] Welcome to The Cancer SIGNAL, a podcast presented by GRAIL, where we share the stories behind multi-cancer early detection testing. I’m your host, Susanna Quinn.

Today we welcome Kevin McFarland, a lieutenant with his local fire department, and Dr. Robert Merritt, a thoracic surgeon who helped diagnose and treat Kevin. Kevin had the opportunity to take a multi-cancer early detection test, which led to a surprising cancer diagnosis. Kevin and Dr. Merritt shared their experiences with the Galleri test earlier this year, which you can watch on the GRAIL YouTube channel. But we are so thrilled to have the opportunity to sit down with both of you to have an in-depth conversation. Welcome to The Cancer SIGNAL, Kevin and Dr. Merritt.

[Kevin McFarland and Dr. Robert Merritt speaking simultaneously] Thank you.

[Susanna Quinn] Kevin, can you please tell us a little bit about yourself, including where you’re from and what you do now?

[Kevin McFarland] I’m from Columbus, Ohio. I’ve lived here pretty much my entire life in the central Ohio area. I’m 49 years old, just finished up 26 years in the fire service full-time and 30 total. Just love what I do, love being outside, doing different things outside when I’m off duty, very active, go to the gym a lot, go play golf, shoot, just, just like being outside.

[Susanna Quinn] Thank you so much for sharing, Kevin. And Dr. Merritt, can you please tell us about your work in oncology, where you practice, and what your specialty areas are?

[Dr. Robert Merritt] Sure, so I’m a general thoracic surgeon. I practice at a comprehensive cancer center, The James at Ohio State University, Wexner Medical Center. My practice focuses on esophageal cancer and other cancers of the thorax or chest. So I see patients with different stages of esophageal cancer. And I work with a multiple disciplinary team, which includes medical oncologists, radiation oncologists, to treat all stages of esophageal cancer.

[Susanna Quinn] That’s a tough cancer. Requires … a lot of grit to get through it.

[Dr. Robert Merritt] Absolutely, absolutely. It’s a rare cancer. It’s a very challenging cancer to treat, particularly at later stages. Most patients unfortunately present at stage 3 or stage 4, which is more challenging for us to treat and to cure. So we don’t have active screening for esophageal cancer like we do for colon cancer and breast cancer.

[Susanna Quinn] I think it’s a very, very hard area of practice to be in when you’re having patients come to you at a later stage and trying to inspire hope in them. What inspires your work in oncology? What keeps you going when it’s really hard, hard to face some of these difficult cases?

[Dr. Robert Merritt] No, I agree. Cancer in general is difficult for providers, but, you know, also for patients and their families, particularly when we can’t really offer a reliable cure. You know, this is, you know, devastating, you know, to patients and their families. A lot of them have, you know, children, they have jobs, they have responsibilities, and cancer really disrupts, you know, a patient’s life. Really disrupts their, you know, connections, you know, with their community, with their families, and really our hope is that we can offer a cure, you know, not only just give them, you know, a little bit more time, but to cure them so that they can continue, you know, with these meaningful, you know, relationships with their families, their communities, you know, being able to, you know, provide that for patients is really what drives myself as a cancer surgeon. Because really we’re trying to, you know, provide cure in most cases.

[Susanna Quinn] I really admire you. It’s a very difficult profession to be in. And, you know, as we don’t really have a cure, early detection is our biggest tool at this point. So, Kevin, we’re here to talk about your experience with cancer. Before we dig into what happened, can you tell me how you felt about cancer before you were diagnosed? Was it something that was on your mind or had you ever considered cancer affecting you?

[Kevin McFarland] It had been on my mind. It’s talked about in the fire service, has been for a long time, what we absorb through our skin, what we used to inhale when we didn’t wear our masks all the time. And that has, that’s changed with the newer generations wearing their masks longer, but it’s in the forefront now. It’s talked about a lot, with everything I did, both working and I traveled and taught a lot and did a lot of live fire exercises. So it was always in the back of your head. But you, it’s just a profession where you don’t think about it, you can’t sit and dwell on it and, and anything like that, and I just went out and, and did my job and, you know, knew there were chances, but, you know, it was one of those where I never thought it would be me.

[Susanna Quinn] Has anyone close to you had, been impacted by cancer?

[Kevin McFarland] Yeah, my mom had a soft tissue sarcoma. She was treated at Ohio State, and everything, and with some surgery and she was cancer-free after her, you know, surgery and everything and some treatments. And then my paternal grandmother also had cancer years ago. So I’ve had some close family members have it, tons of friends in the fire service that have had it. And our department has had multiple bladder cancers and some other cancers. For us being a small 80-member department, our cancer rates are actually kind of high.

[Susanna Quinn] That doesn’t surprise me. It’s, it’s not surprising, but it’s shocking. Can you explain how the opportunity to take the Galleri test came up for you?

[Kevin McFarland] Our fire chief was at a conference, and I believe was just, it was either a class that he went to or just saw the booth, got the information and everything, and brought it to our department. And we have a very progressive-thinking department, very supportive of health and wellness with what they’ve done for us throughout the years and they budgeted it and, and put it through to where it was paid for and we were just, we were sent an email that we’re going to provide this test for you to screen for cancer.

[Susanna Quinn] That’s terrific. Before you took the test, did you have any thoughts or expectations about it?

[Kevin McFarland] As a typical firefighter, it’s like, “Okay, I’ll take the test,” but I didn’t think anything about it. I was like, and the great part was it was on duty. I didn’t have to be fasting. Went in, had a quick blood draw, I, nothing to it. I mean, I didn’t put any, any thought into it. I was just figuring that, hey, I’m going to get this, it’s going to come back negative and it’s, you know, a box I can check that, just moving on.

[Susanna Quinn] So you weren’t having conversations with people about it? You didn’t have any fear about it?

[Kevin McFarland] I did not. There were some in our department that were worried about taking it and this and that, and I did, it didn’t even cross my mind. I figured I’m, I’m pretty healthy. I’ll just, I’ll go in, I’ll do this and, and be done.

[Susanna Quinn] So, you weren’t having any symptoms?

[Kevin McFarland] No symptoms whatsoever. I didn’t have heartburn. I didn’t have any reflux or anything. No trouble swallowing. I had no symptoms whatsoever.

[Susanna Quinn] Extraordinary. So how long did it take for you to get the results?

[Kevin McFarland] I believe it was maybe 2 to 3 weeks. And some of the guys at work were talking that they had been contacted and it was if you get an email, you’re negative, you get the phone call, you have some kind of result that they want you to look at. And I got the phone call. That was, you know, it came quick and it was to where I, I really wasn’t thinking too much about it, like I said, but, you know, when you get that call and they say there’s a chance, once again, I was in the mindset of, okay, it’s a false positive.

[Susanna Quinn] Yeah.

[Kevin McFarland] Like I feel fine, there’s nothing going on, you know, I don’t feel sick. So I was still in the, I guess you could call it denial, but it was just, hey, we’ll go get looked at and, and go from there, but I don’t feel this is going to turn into anything.

[Susanna Quinn] Well, I think that is also reflective. You have a very positive personality and outlook. Not a lot of people would react like that. So after you received that call, what were your next steps in getting a diagnosis?

[Kevin McFarland] I went to my primary care doctor who was the first one to kind of have to be told what the test was and how the results came about and what I was looking to do. So I finally got in to visit with her and was able to explain what was going on and I just needed a referral to move on to the next step to get some scopes done. And once I had those done, they were able to, with the second scope, I believe they found the tumor. And then I was sent on to a third scope. And once I had that one done, the surgeon that did that used to work at, or interned at Ohio State and sent me to Dr. Merritt, said this is 100% surgical, where it’s at, what we’re seeing, and this is who you want to go see. And he referred to him as “the legend.” And I was so happy to hear that because if you’re going to see somebody for a surgery, that’s what you want them to be called. You want to go see the best.

[Susanna Quinn] That’s great. It’s so unbelievably stressful to have a tumor, to find out you have a tumor. And to have a doctor nicknamed “the legend.” So, Dr. Merritt, what does follow-up look like after somebody receives a cancer signal-detected result? What were the next steps? What images, tests, or procedures were required to confirm Kevin’s diagnosis?

[Dr. Robert Merritt] Yeah, no, so that’s a great question. So just to kind of summarize as Kevin stated earlier, you know, once you get the abnormal signal and it localizes to a region of the body, whether it’s the, you know, upper digestive tract, the esophagus, or any other organ, you want to get, you know, diagnostic test. In this case, an upper endoscopy or scope was the appropriate test to look for a tumor, which was detected and then it was biopsied to confirm a diagnosis of esophageal cancer. And then the endoscopic ultrasound is for staging to determine, you know, if this is stage 1 or if it’s stage 2 or 3. And then also we will get what’s called a PET/CT scan, and that’s a test that scans the entire body to look for metastatic or, or spread of the cancer from the primary site.

[Susanna Quinn] So what stage was Kevin and what was the treatment plan that you put in place for him?

[Dr. Robert Merritt] So Kevin is a unique case. He presented as stage 1, which is the earliest possible stage for esophageal cancer. It’s very rare that we see patients with stage 1. There’s no current screening program for esophageal cancer. So most patients present when they have symptoms, and often they present with what’s called dysphagia or difficulty swallowing because once the tumor reaches a certain size, it blocks the passageway within the esophagus, which prevents food and water from getting through the point of the tumor into the stomach. So they often present with this terrible symptom, and then they get the workup and it’s determined that they have advanced-stage esophageal cancer. But in Kevin’s case, it was unique because he presented with stage 1, which, you know, is a stage where we can actually offer primary surgery as the main treatment as opposed to chemo, radiation, and then surgery, or in some cases in stage 4 we can’t cure it, so we don’t even offer surgery. We offer chemotherapy alone. So in his case it was very unique. It presented at the earliest possible stage, and we can offer primary surgery as the treatment.

[Susanna Quinn] So at that point, Kevin, you were probably feeling some fear and anxiety, but at the same time, a bit of gratitude that you’d been able to take the Galleri test and discover it at an earlier stage.

[Kevin McFarland] Yeah, there was a lot of fear of what was to come, the unknown, just not knowing anything about esophageal cancer. I made a promise to myself and I kept it. I wasn’t going to get on WebMD or Google or anything or research how bad this could be. I just trusted the process and what was going to happen. I love my job, what I do. I was worried about my career. I was worried about, you know, just life after and everything, what would happen. But I also was still naive enough that I’m like, okay, I’ll be down with the surgery and then I’m going to be right back up being the exact same person I once was.”

[Susanna Quinn] That’s incredible. So, just really admirable. I, somebody said to me during my cancer treatment, worry is misuse of the imagination. No matter whether you worry or not, the outcome is going to be the same. So you might as well, have, you know, meditate, be positive. Dr. Merritt, what role did early detection play in that prognosis?

[Dr. Merritt] I think in Kevin’s case, early detection played a critical role in diagnosing his esophageal cancer at the earliest possible stage, which is stage 1. As you mentioned earlier, he was completely asymptomatic, didn’t have any symptoms or any inkling that, you know, this cancer was present, and thankfully the Galleri test provided some clues that, you know, there could be something there in the esophagus, which led to the workup, the endoscopy, the biopsy, and then the subsequent surgery. So I think, you know, detecting any cancer at stage 1 provides the best chance for cure and long-term survival. So early detection is definitely critical in improving the prognosis for really any cancer.

[Susanna Quinn] Absolutely. Kevin, how did you feel when you were first given the cancer diagnosis?

[Kevin McFarland] I had my moment, you know, you’re going to break down. I have a good support system. My wife and kids were in the house at the time when I got the phone call, so we were all able to talk. So, and, and my kids are older. They’re actually, they’re 21 years old today. I have twins that are a boy and a girl. They were able to sit with me and, and we laid it out. It was like, okay, it’s here and, and we’re a family that’s never kept things away from each other or something like that. So we laid it out, hey, this is what it is, you know, we have no idea at this time, you know, when I first got the call that I had, I had no idea what treatments were, anything like that. It’s just, “Hey, you have cancer.” And so that was tough, got through it, had my breakdown moment and then said, all right, let’s get to work and figure out what we got to do with this.

[Susanna Quinn] So, tell me a little bit about your treatment. How difficult it was, how did it impact you physically and emotionally?

[Kevin McFarland] It was very tough physically. Went through, and with it being, you know, of the esophagus and everything for the first, I believe, 6 days I was in the hospital, you have no intake, food or water so that you can heal, and then had to pass a swallow test and you go on the liquids. And you’re working your way back through eating food. And then just learning to eat again, not eating too much, your, your portion is what you can eat. It has changed it, it’s changed it for the better, I think, because it’s probably the way I should have been eating in the first place with eating a little healthier and, and doing some things with that in the long run.

There were, there were some dark times, you know, in the, in the healing and, and things at home. It was wintertime, and I could just sit inside and focus on my recovery. But it was, it took a lot out of you physically. And, and some days mentally in that too.

The side effects and stuff for me was the soreness. And it wasn’t so much where the surgery was. It was just being static for that long, you know, you’re sitting around, you’re, you just get sore from not doing your normal daily movements. Once I was able to walk and start exercising, things started to change. But the one thing throughout the process that I noticed and when I had a bad day mentally, and I was feeling sorry for myself for the situation, I had a bad day physically. It is truly tied together. You’re, you know, and if I was positive and like I can get through this, even if I was having trouble physically, it wasn’t as bad, and that was one thing that that just when I had a bad day mentally, it just, it was a bad day all the way around.

But from the care in the hospital, the, the staff at the hospital was phenomenal. All the nurses, all the techs, the respiratory, everybody was just phenomenal. I laugh about when I’m doing my laps in the hospital with the, the chest tubes and everything you had. I had, you know, two IV poles trailing me. I’ve got all this stuff on a cart in front of me and you’re pushing it around, but you’re up walking. And they, they got you up moving pretty quick. But I, I think being healthy and catching it as early as we did really helped with the recovery. If it would have been different or I, I would have had to do chemo or something like that before, I think it would have been a, a total, different recovery process.

[Susanna Quinn] Well, it’s a harder recovery process for sure, but what I tell people is it is so important to move. It makes such a difference. Your job as a firefighter is quite physically demanding. How did you feel about a cancer diagnosis and its potential impact on your job?

[Kevin McFarland] I was scared. It’s been my livelihood. It’s what I love, what I do. And I was afraid I’d never go back. And against, probably a lot of recommendations and odds and things like that, I fought and just 3 months after surgery, I was back on the truck as a firefighter. And, and my “back” was full duty. I have recently, as of July 10, come off the truck and am in the process of retiring. The job is very physically demanding. I was beating myself up to try to get 4 more years at work just so I could say I did 30. And that’s, that’s about where I was. I’ve met the retirement age. I’ve met the retirement years of service. And, you know, it’s time now for me to take this second chance at life and go do something else.

[Susanna Quinn] That’s amazing. Congratulations. It, it really is interesting how there are silver linings in these experiences. So how is your health today?

[Kevin McFarland] I’m doing really well. I get up in the morning, go to the gym. I’m able to do light workouts. I don’t lift like I once did, but then again, at 49 years old, I’m probably not supposed to, do some of the things I was trying to do. But I’m healthy, I can walk, I can go out, I can exercise, do different things. I feel good. I still at times, eating sometimes can be a roll of the dice. It’s just a side effect of how your stomach’s going to react that day to certain things or if I overeat, there is a, you know, a reaction to that. Still have some reflux, but overall, the, the small side effects that come from this procedure and everything that was, that was done are minor compared to what it could be, you know, if we wouldn’t have caught it this early.

So I’m very lucky. I, I’m happy. It’s better now that I am in the retirement process. I’m home sleeping in my own bed every night where I can adjust it and be propped up where I’m supposed to be. The 24-hour shifts was really taking it out of me. With trying to stay hydrated and, and enough calories and then not getting sick while I’m at work and things like that. It was, so now being on more of a, a regular-person schedule as I always like to say, because we’re on those 24/48s where we would work, has really changed it and I feel a, a ton better since I’ve been, been home and, and able to rest and kind of get on a certain daily schedule.

[Susanna Quinn] Well, thank you for your 26 years of service. I think you deserve to be on a normal schedule and resting. How do you feel when you reflect on this experience in, in terms of, you know, the impact on your family, how they, were they supportive of you, you know, moving forward, is it really changed your outlook on things?

[Kevin McFarland] Yeah, it has. I mean, outlook-wise, I just enjoy every day. There were times where I would not do something because I wanted to go teach, I wanted to do something more in the fire service. And, and now I’m like, no, I’m going to go spend time with the kids or I’m going golfing, or I’m going to do this or that. I’m really enjoying each day. To be 100% honest, looking back at all of it, I wish it never happened. I mean, that’s, nobody wishes they got cancer or they go through any of this process, but that’s nothing to reflect on and being, you know, beat yourself up over.

I’m very grateful for the test, that it caught it, because if not, by the time I would have seen Dr. Merritt, I may have been stage 3 or stage 4 because then I would have had symptoms. I’d have had problems. Luckily, we went in there and, and found it this early. So looking back on all that, I think it gave me a new lease on life. My family was phenomenal from day 1. They were very supportive. They’d go walk with me. They’d help drive me to the gym if it was too nasty out to walk outside to where I could go walk on a treadmill.

My wife was with me the entire way, supportive. I think had 9 alarms set on her phone for all the medications and stuff on the timings and when we were supposed to take something and has just been, been behind me the whole way. The, my entire family, has been …in, in the fire, the, the family at the firehouse, you live with them, work with them every day for 26 years. They are your family. They had bracelets to support my cancer. It was out there. And just looking back at that, you know, it’s really impacted the Central Ohio Fire Service in general because they’re, now I know of at least 6 departments in central Ohio that have taken the test to get their guys tested just because of my story.

[Susanna Quinn] That’s incredible. Kevin, thank you so much for sharing this, and I’m sorry that you had to go through that experience, but there’s got to be some comfort in the fact that it’s going to change things for other people as this test becomes more readily available to them. So, thank you, thank you so much. Dr. Merritt, how can the Galleri test help you screen your patients for cancer at an early stage?

[Dr. Robert Merritt] I think for cancers like esophageal cancer that don’t have active screening programs, I think the Galleri test would be a very viable option for these patients. And you know, before I saw Kevin, I had very little knowledge about, you know, this test or that it even existed, and that’s probably true of most, you know, providers now, but I know, I think with Kevin’s story, seeing the impact of you know, early detection for him, I really, you know, opens my eyes to this new possibility of, you know, adding this test to our early detection regimen. In addition to screening tests, we can also, you know, provide this blood test which may give us some clues, you know, that someone may have an early-stage cancer that they didn’t know about or was asymptomatic.

[Susanna Quinn] Absolutely. Thank you. Thank you both so much for joining us today and sharing your stories. It was lovely meeting you, Kevin and Dr. Merritt.

[Dr. Robert Merritt] Thank you.

[Kevin McFarland] Thank you.

[Susanna Quinn] Listeners, be sure to visit GRAIL’s YouTube channel to watch this episode there. We will link to it in the show notes for this episode. This is The Cancer SIGNAL presented by GRAIL. Please subscribe so you don’t miss an episode, and thank you for listening.

[Voice Over] Based on a clinical study of people ages 50 to 79 around 1% are expected to receive a cancer signal detected result, which includes predicted cancer signal origins. After diagnostic evaluation, around 40% of people are expected to have a confirmed cancer diagnosis. The Galleri test is prescription only. The Galleri test is recommended for use in adults with an elevated risk for cancer, such as those age 50 or older. It is not recommended for individuals who are pregnant, 21 years or younger, or undergoing active cancer treatment. Galleri should be used in addition to routine cancer screening. Galleri does not detect a signal for all cancers. False positive and false negative results do occur. For more information, including important safety information, please visit galleri.com.

Important Safety Information
The Galleri test is recommended for use in adults with an elevated risk for cancer, such as those age 50 or older. The test does not detect all cancers and should be used in addition to routine cancer screening tests recommended by a healthcare provider. The Galleri test is intended to detect cancer signals and predict where in the body the cancer signal is located. Use of the test is not recommended in individuals who are pregnant, 21 years old or younger, or undergoing active cancer treatment.

Results should be interpreted by a healthcare provider in the context of medical history, clinical signs, and symptoms. A test result of No Cancer Signal Detected does not rule out cancer. A test result of Cancer Signal Detected requires confirmatory diagnostic evaluation by medically established procedures (e.g., imaging) to confirm cancer.

If cancer is not confirmed with further testing, it could mean that cancer is not present or testing was insufficient to detect cancer, including due to the cancer being located in a different part of the body. False positive (a cancer signal detected when cancer is not present) and false negative (a cancer signal not detected when cancer is present) test results do occur. Rx only.

Laboratory/Test Information
The GRAIL clinical laboratory is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) and accredited by the College of American Pathologists. The Galleri test was developed — and its performance characteristics were determined — by GRAIL. The Galleri test has not been cleared or approved by the Food and Drug Administration. The GRAIL clinical laboratory is regulated under CLIA to perform high-complexity testing. The Galleri test is intended for clinical purposes.