Sandy Alderson's Playbook for Cancer and Why Teamwork is Key

Dr. Diane Reidy-Lagunes:

Caring for someone with cancer is like a team sport. It takes different players each with their own expertise to create a winning strategy for the patient. No one knows the importance of a team better than our guest today. Sandy Alderson is a baseball legend and a longtime executive of multiple baseball organizations, most recently as former president of the New York Mets. When he came to MSK as a patient close to eight years ago, he didn't just have one doctor. Like many MSK patients, he had several kinds of experts, what we call a multidisciplinary team, treating his cancer. Today, Sandy will publicly share his personal cancer journey. Let's talk about it.

Hello, I'm Dr. Diane Reidy-Lagunes from Memorial Sloan Kettering Cancer Center and welcome to Cancer Straight Talk. We're bringing together national experts and patients fighting these diseases to have evidence-based conversations. Our mission is to educate and empower you and your family members to make the right decisions and live happier and healthier lives. For more information on the topics discussed here, or to send us your questions, please visit us at mskcc.org/podcast.

Sandy Alderson came into the world of baseball as both a former marine and a lawyer, and in fact, knew very little about the game. It was Sandy, the outsider, who helped introduce his protege, Billy Bean, to the world of analytics, using a statistical method that would transform the game of baseball, as described in the book-turned-movie “Moneyball.” Throughout his forty-plus year career in baseball, Sandy has worked with a number of teams, including the Oakland A's, the San Diego Padres, and the New York Mets.

It was during his time as general manager with the Mets that he learned he had cancer. There's never a good time to be diagnosed with cancer, and in Sandy's case, the timing was particularly challenging. It was fall of 2015 and the Mets had just entered the postseason for the first time in almost a decade. Sandy waited until after the season was over to share the news with the team, but he kept his specific diagnosis private from the public eye. Today he's ready to share his story.

As his oncologist, I've had the honor and pleasure of getting to know Sandy over the past eight years. Joining us today is the rest of his medical care team at MSK: his colorectal surgeon, Dr. Marty Weiser; the chief of our hepatobiliary service, Dr. Bill Jarnagin; and infectious disease specialist, Dr. Monika Shah. Thank you all for joining us.

Sandy, Bill, Marty and I met you back in 2015 when you were first diagnosed. It's the first time you're going public. So can you share your story with us?

Sandy Alderson:

Sure. We had just clenched the National League East Championship in Cincinnati and we had moved on to Philadelphia where I was scheduled to get hernia surgery. The doctor did an MRI in preparation for that surgery and discovered something entirely different. A day later I was referred to you and your team and that's where the journey began.

Dr. Diane Reidy-Lagunes:

Bill, Marty, when Sandy came here, clearly this was not just a hernia operation or a benign problem. Do you want to share a little bit about that?

Dr. William Jarnagin:

It was clear this was an intestinal cancer of some sort with spread of the disease. As a liver surgeon, I’m not the first person to talk to about treatment. The need was for other expertise, Dr. Weiser or Dr. Reidy, to get involved in managing this as an initial step. My involvement would come later.

Dr. Martin Weiser:

At that point, we secured the diagnosis of metastatic appendix cancer. The treatment for that generally is surgery to remove as much disease as possible called a cytoreductive surgery. And so we planned the surgery. Dr. Jarnagin and I actually operated on the same day. We collaborate frequently.

I started the operation, and it wasn't this well-differentiated appendix cancer that can be easily debulked. So we made a game-time decision to stop the surgery, to abort that first operation so as not to affect future surgeries that would later be successful after a round of chemotherapy. So in the operating room, I called you Diane, I talked to Bill, and we decided we would give chemotherapy first and then come back another day to fight another battle.

Dr. Diane Reidy-Lagunes:

Sandy, how'd that make you feel? Because here you are expecting you're going to wake up and be like, “Okay done,” moving on to the next play, and it wasn't exactly what we were hoping or expecting.

Sandy Alderson:

So I can remember sitting in the recovery room and looking at the clock. I had been told that this surgery was going to last nine or ten hours, but it wasn't two. So I thought to myself, “Wait a minute. This has only lasted two hours. I'm not sure what's going on here.” And then as I woke up, there was sort of a phalanx of doctors in front of me all saying, “Plan B.” It was a little bit of a surprise. I wouldn't say it was depressing, but it was certainly a recalibration over the next four or five days sitting in the hospital waiting to get out and thinking about the fact that there'd be another one.

I will say the most important thing over the ensuing two or three days was the confidence that the doctors expressed; just the tone of voice, the confidence that they had, that this was just a minor setback, something that would just require a different approach. I can remember virtually everything that was said to me during that first day in the hospital. Dr. Weiser came in and said, “Don't worry about it.” Diane came in and said, “Don't worry about it,” and Dr. Jarnagin said the same. So I didn't worry about it. And I think what I've found over the last eight years is, following the doctors and not worrying about it is a good approach on behalf of any patient.

Dr. Diane Reidy-Lagunes:

It is, and yet sometimes it's so hard for patients. Understandingly, it can be quite disappointing and devastating when you're expecting a surgery and you have to go to plan B. You got some chemotherapy and thank heavens you had a beautiful response, and then went back to the operating room in 2016. How'd that go?

Sandy Alderson:

That went great. The only problem with that surgery was that I missed Bartolo Colón's only lifetime home run in San Diego. Other than that, it went really well.

Dr. Diane Reidy-Lagunes:

And Bill and Marty, you're both surgical oncologists. You do this all day long. You could probably take out anything anywhere. And yet both of you were in that operating room to help. Can you speak a little bit about the expertise, even in the operating room? Because in some places, you may have one general surgeon that's doing the treatment and the surgery, which can be quite overwhelming depending on the surgery you're undergoing.

Dr. Martin Weiser:

To keep up the baseball analogy, the bench is quite deep here, and there are a lot of people that we can call on. We’re always better as a team than as an individual, and we don't hesitate to call someone in. It's not a sign of weakness. It's really a sign of strength. That's what we did here, and it was very successful. The chemotherapy worked beautifully, and we were able to remove all visible disease and we were all quite happy. And his recovery was pretty straightforward considering the massive operation he had.

Dr. Diane Reidy-Lagunes:

Thankfully, it was a success. A couple years later, the cancer did come back. When we say, “come back,” what we mean is that there were microscopic cells that were still there that eventually started to grow. So you’ve been off and on therapy since then.

Sandy, I want to go back to the fact that not only were you in the postseason when you got your original diagnosis, during this hurricane of things all going on at once, but you were clearly in a really high-profile role at the time, and you decided to keep it on the down low. What is that like for you, when you are dealing with a lot of stuff? You certainly had your friends and family for support, yet there is a certain responsibility in those high-profile jobs: Do you say something? Do you not say something?

Sandy Alderson:

It's a very good question and one that I've wrestled with over time. Initially, given the fact the Mets were in the postseason and ultimately got to the World Series, it just wasn't the right time to disclose any sort of information that would've been a distraction for the players or the staff. So I pretty much kept it to myself for a month or so.

I wouldn't say that was difficult, but it was unusual thinking about it and sort of having to internalize it without talking about it much beyond my family. One of the reasons I didn't disclose the exact nature of the cancer for so long is that I didn't want to be identified by it. I felt that if I disclosed the type of cancer it was, there would be doctors or people opining frequently over you, probabilities of this or that or what have you. And that's something I didn't want, in fact, something I've pretty much ignored over the last eight years.

I spend a lot of time dealing with analytics and probabilities in baseball, but ultimately you got to play the game. And sometimes we overload players with too much information. So rightly or wrongly, the approach I've taken is, look, I have total confidence in the medical team. They've demonstrated their entitlement to that confidence more than once. I don't spend a lot of time second guessing.

Dr. Diane Reidy-Lagunes:

I think for many of our listeners that resonates because we don't want the cancer to define who we are. It's a part of the reality of what you have to deal with, but it doesn't have to define you and who you are. And patients will tell me, “People look at me a different way or talk to me in a different way,” and that can be a lot.

Sandy Alderson:

Yeah, there's no question about that, and they often evaluate you through that lens as well. For example, if I'm being patient and making a measured decision, that’s just my style as opposed to a function of the disease. That’s a way that things can be characterized.

Dr. Diane Reidy-Lagunes:

You also sort of leaned into the role you were playing as a leader in your profession because it was therapeutic, I think. Can you talk a little bit about that? Because it could go both ways; at some point you could be like, “Maybe I don't need to run this marathon in the middle of getting really strong chemo every two weeks.”

Sandy Alderson:

I've always been able to compartmentalize, which I think is valuable. I don't worry about the next scan three or four months in advance. I've also found that the busier I am, the better I do. That was also in the back of my mind. I think if you stay busy, you have less time to think about certain things. And that doesn't mean you forget about them entirely, but I think it's great to have a distraction, and I certainly felt that was true in my case.

Dr. Diane Reidy-Lagunes:

So throughout the years, as we said, you've been on and off chemotherapy treatments. Then last July, we had a curve ball thrown to us that I think no one expected, when you developed Lyme disease and babesiosis, two tick-borne illnesses. That's when you met Dr. Monika Shah, quite sick and in the hospital. Monika, could you share a little bit about bit why Sandy may have gotten a little sicker than others and the sort of events that took place then?

Dr. Monika Shah:

You were in the hospital when we met. To speak a little bit about these illnesses, I'm going to put Lyme disease aside because that's not really what made you truly sick in this situation. It was the Babesiosis, and Babesia is a tick-borne parasite that infects red blood cells. I like to say it's the malaria of the United States, certainly the malaria of the Northeastern United States and parts of the upper Midwest. And what can happen sometimes with Babesiosis, vast majority of people who get it may not even know that they're infected. They become asymptomatic, and some people can get really ill, seriously ill, and it can be life-threatening.

In some patients who've had certain types of therapies or certain parts of their body removed – which was, in your case, your spleen removed as a part of your cancer cytoreductive surgery – the Babesia infection has a chance to proliferate. Our spleen is an important filtration system for our blood cells. So when you don't have a spleen, your body's not able to clear those infected red blood cells as well.

So what happened here is that when you came in, it was pretty clear you had an infection and you got sicker quite quickly, and you went to the ICU. Your parasite load, or the percentage of your red blood cells that were infected, was really quite high so we needed to give you some specialized treatments. They worked beautifully, but it definitely took a few days to work, and you really made a remarkable recovery.

Sandy Alderson:

I was really fortunate because when I went in, I had tested positive for Covid, and so maybe this was a heavy case of covid. When I got in, various tests were done and this Babesiosis was uncovered pretty quickly. Had I not been at MSK it could have been a very different outcome. I'm lucky that you have that infectious disease department that provides a specialized approach for cancer patients. Once again, I fell into the right hands.

Dr. Monika Shah:

I will say again, cancer is a team sport, and it requires not only our cancer-focused clinicians, surgeons, and oncologists, but the specialists who see cancer patients through the lens of their discipline.

Dr. Diane Reidy-Lagunes:

That was a pretty tumultuous time, but here's the clincher. Here's the silver lining, miraculous part of all of this: You are discharged from the hospital and a couple weeks later, after many, many weeks off all chemotherapy and being so sick, we get a follow-up scan and the disease that we used to see on imaging is no longer there. It’s actually shrunk. So Babesiosis is our new chemotherapy. Incredible.

Bill, Marty, Monika, anyone want to talk about, like, have we seen this before? Can we make any sense of this scientifically? How could that potentially happen?

Dr. Monika Shah:

This is going back hundreds of years to what we would call toxin-based immunotherapy or bacterial immunotherapy or Coley’s Toxin, which are basically bacterial products that are formed in the setting of bacterial infections and were used in medicine to cause a regression of tumors.

Of course, cancer-directed immunotherapy is now an established field and different mechanism of action, but this probably represents the earliest form of immunotherapy. I don't think any of us can prove that it was the Babesiosis that caused the regression, but it is compelling. I wouldn't recommend it as an approach because there are quite a lot of harms associated.

Dr. Diane Reidy-Lagunes:

Don't do this at home!

Dr. Monika Shah:

Yeah, please folks, don't get infected intentionally. Obviously, that's the harm of the Coley’s Toxin approach, which is why it is not used in modern practice these days. There are safer ways to unleash our immune system without using bacterial byproducts to do so. Although we could never prove causation, it is certainly a real silver lining in your story, Mr. Alderson.

Sandy Alderson:

It was a shock, but like I said at the outset, you got to play the game, right? You don't know what's going to happen. And this was an incredible turn of events.

Dr. Martin Weiser:

Diane, it's an interesting approach that Sandy has. He has mentioned it before, that you have to play the game. And Bill and I just had clinic today seeing newly diagnosed cancer patients, and they really want the playbook, as Monika said. They want to know how it's going to go in every possibility, and we just don't know. We have to make game time decisions all the time and then follow those through. So it's something to learn from, but it's hard to do, and Sandy was particularly good at going with the flow.

Sandy Alderson:

You know, I'm also extraordinarily lucky. There are others who've been diagnosed with cancers that proved to be far more deadly. I've used the poker analogy: you get dealt a hand and sometimes it's not a good one, but you play it the best you can. I have a tremendous amount of respect for those who fight the good fight spiritually but have been dealt a really terrible hand. Fortunately, mine has not been as bad as many, many others.

Dr. Diane Reidy-Lagunes:

I think that's absolutely right. That's one of the first things that all of us try to share with a patient: that there's something about the biology of that cancer that we can't change. I may give exactly the same regimens as Bill and Marty, and may do the exact same surgery, and Monika may treat patients that have infections, and it just doesn't go the way we want. So I do think that's a really important message to convey.

Sandy, does your love of sports get you through the day? Is there anything you can share with us that gives you that faith and calmness that many patients aren't able to achieve?

Sandy Alderson:

This has not been the case over the entire eight years, but I have gotten to the point where I don't worry about it because as time has gone on, my expectation has evolved. It's not my expectation that it'll never come back but is my expectation that if it does come back, I and we will deal with it. So from that standpoint, I worry less about it. I've been through it enough that the next “whatever” won’t surprise me one way or the other.

The thing about baseball is that I've been in the game forty years, and I've been to the World Series four times. That's not a great batting average, but it's typical or better. That probably tempers one’s expectations. So, you deal with the disappointment, but at the same time recognize that there's always tomorrow. There's always next season. There's always something to look forward to.

Dr. William Jarnagin:

You raise an important point that a lot of patients have trouble with, and that is to try and in between scans, in between treatments, try and live as normal a life as possible, which many people can't do. It's tough. They're always focusing on the next scan, and I think unfortunately a lot of people miss out on a lot of life because of that.

Sandy Alderson:

I would say that was probably true for me initially, and it took a while to get out of that little spiral. Again, it's a function of one's own outlook, family, friends, work, or some sort of diversion that just limits the number of hours a day you can think about it. That's the first step.

Dr. Monika Shah:

One thing that you said earlier really resonated with me, which is your approach of compartmentalization and having distractions. That can be really critical and healthy in this circumstance. If you can put the cancer in a box and you go to that box when you need to go to that box, but that box is not the only box. That is really, really hard for a lot of our patients.

Dr. Diane Reidy-Lagunes:

Sandy, any parting advice for our listeners?

Sandy Alderson:

Look, I'm one person. I've got one set of data. But what I guess I would recommend is that people offload a lot of their anxiety as much as they possibly can to their medical team. Develop a reliance on that team and less reliance on third-party advice or suggestions or information.

I don't want my mind filled with a bunch of statistics and stuff and try to figure where I or someone sits on the continuum of survival. I don't worry about that. I can't say that I did the first month or so, but since that time, as I've developed a better understanding of my particular situation and the team that I have at MSK and my family and friends and so forth, I've worried less and less about it.

Dr. Diane Reidy-Lagunes:

Bill, Marty, Monika, any closing advice?

Dr. Monika Shah:

Listen to the patient. I'm listening to Mr. Alderson. Can't say it better than he did.

Dr. William Jarnagin:

That's right.

Dr. Weiser:

Agree. Absolutely.

Dr. Diane Reidy-Lagunes:

Sandy, thank you so much for coming on and joining us today.

Sandy Alderson:

Thanks for giving me the opportunity. I appreciate it.

Dr. Diane Reidy-Lagunes:

Thank you for listening to Cancer Straight Talk from Memorial Sloan Kettering Cancer Center. For more information or to send us your questions, please visit us at mskcc.org/podcast. Help others find this helpful resource by rating and reviewing it on Apple Podcasts or wherever you listen. Any products mentioned on this show are not official endorsements by MSK. These episodes are for you but are not intended to be a medical substitute. Please remember to consult your doctor with any questions you have regarding medical conditions. I'm Dr. Diane Reidy-Lagunes. Onward and upward.