Interview with Michael Buoncristiani, November 7, 2019

THOMPSON: Hello, my name is Hannah Thompson. I'm a biology major with minors in Writing, Rhetoric, and Digital studies and Cognitive Science. I'm pursuing medicine as my career and I'm very interested in the intersection between medicine and literature. Particularly interesting to me is the stories of those affected by cancer in Kentucky. In the United States, Kentucky has the largest number of deaths and new cases of cancer each year. Specifically, the 54 counties that make up the Appalachian region of Kentucky have the highest rates of both cancer incidence and mortality in the state. With the support of the Lewis Honors College, the department of Writing, Rhetoric and Digital studies and the Louis B. Nunn Center for Oral History at the University of Kentucky, I am conducting interviews that investigate the high rates of cancer that Kentucky faces and the impact of cancer in our state. Today is November 7th, 2019 and it is my great honor and pleasure to interview Michael Buoncristiani, a biology 00:01:00pre-medical student at the University of Kentucky who has participated in the Appalachian Career Training in Oncology program known as ACTION. Thank you, Michael, for joining us today. To begin the interview, I'm going to ask you a few questions about yourself and background in medicine. Tell me about yourself, what you're studying and what you hope to do in the future.

BUONCRISTIANI: Um, like you said, I'm a premed student studying biology at the University of Kentucky and, um, my future goals would be to continue to medical school and hopefully become a doctor in the future.

THOMPSON: That's great. Tell me a little bit about your family background and where you were raised.

BUONCRISTIANI: So, my parents, um, they met in the Virginia Beach area. My mother moved a few times. She was originally born in Kentucky, but her father was a, uh, or is still a preacher, so they moved around a lot. And, um, my father was raised in Virginia. They met there, they moved to Monticello, Kentucky, which is about two hours south of Lexington. And, um, they followed my 00:02:00grandfather who moved there to preach from Virginia. They got married in Monticello and raised my brother and I there. There. Yeah.

THOMPSON: That's great. What was it like being raised in Appalachia? How is the culture there different from that of Lexington?

BUONCRISTIANI: I believe that being raised in that area was great. Um, all the people were really close. Uh, all of them pretty much loved each other. I mean, we knew each other very well. Um, everyone at my high school, we knew each other, had close relationships with the teachers. Um, the culture there is, is much different than Lexington. Here it seems like you rarely see the same people twice. And if you talk to someone, you may not ever catch their name or see them again. So it's been kind of my experience and uh, everything here is much faster pace. It's really slow in Monticello. It's kind of laid back and I'm not sure about the grade school situation, but I imagine that you don't know everybody in your graduating class when they walk across the stage and when you see your 00:03:00teachers in Walmart, you probably don't have conversations with them normally.

THOMPSON: Yeah, that's what I see that like here compared to like where I went to elementary school, like we knew everyone. Everyone knew everyone's parents and siblings and you knew where they lived. You knew who their grandparents were. It's just not like that in bigger towns.

BUONCRISTIANI: No, it doesn't seem the same.

THOMPSON: Exactly. Like you were saying, like you never see the same person twice. That's really true. Unless you know them.

BUONCRISTIANI: I, lots of people I've talked to and never caught their name. Like in the mathskeller.

THOMPSON: Oh yeah, all around campus. It's a new face every day. When did you first become interested in medicine and why?

BUONCRISTIANI: I've always been interested in science and medicine like slowly came along with that. Um, I was never like really interested in anything other than science. I, I like history, but not like as a career path. Um, so throughout school I became more passionate about medicine. Um, my grandfather being diagnosed with leiomyosarcoma, uh, really made me like dive deeper into 00:04:00researching medicine. Um, I was young when it happened, but whenever I kinda came along to understanding, I, I started to research it more. And then, um, as I learned more about human science, I just fell in love with that and I was lucky enough to take some college level biology in high school and uh, these made me really enjoy it and I got to go with my brother to talk to his professors and sit through some classes with him. Um, so that really brought me to where I am today, majoring in biology. So.

THOMPSON: that's awesome. Is your brother in medicine?

BUONCRISTIANI: He is a kinesiology major.

THOMPSON: Oh, that's awesome.

BUONCRISTIANI: He likes it more than, than like medicine. S

THOMPSON: So does he want to do like physical therapy, that kind of thing?

BUONCRISTIANI: Um, I think he wants to be more of like a teacher. I think he wants to go to graduate school.

THOMPSON: That's awesome. My sister went and like, did like the dental assistant and like all the dental kind of stuff.

BUONCRISTIANI: Oh really?

THOMPSON: Like, it's not like the type of medicine like we're interested in, but like I still got to learn from her that. So it's interesting.

BUONCRISTIANI: Older siblings pave the way.

THOMPSON: Oh, that's for sure. Please describe what medicine was like in your hometown.

BUONCRISTIANI: Um, medicine, my hometown is not anything like it is in Lexington. My grandfather, um, a few weeks ago he told me it was like in, in Monticello we don't really say, we don't know oncologists, we just say, oh, they're a cancer doctor or an orthopedic surgeon. The bone guy, I mean, no, pretty, I mean that sums it up. We'd not much, not much knowledge about that. And there's, neither of those specialties are practicing in Monticello, so we just kind of have general and we, we've got a um, internal medicine, pediatrics doctor that moved there. Mark came in not long ago. He's from Monticello but came to UK for awhile. So the knowledge of medicine understanding is not where it needs be. I don't think in any way.

THOMPSON: Yeah, I've seen that a lot too with like the type of specialties, like 00:06:00you were saying, it's mostly just family medicine or you know general medicine, internal medicine rather than having specialists and then if you need a specialist you have to travel to Lexington or Louisville, whichever is closer.

BUONCRISTIANI: Lexington, I mean would really be one of the closer places. I think Rockcastle is a Markey Cancer Center affiliate, but I mean if you're going to go that far from where I'm from, you might as well. I think it's extra 20, 30 minutes yeah.

THOMPSON: Might as well come to the big Lexington hospital instead. Yeah, it's completely different than in Lexington or Louisville. Whereas here you can just go and see a dermatologist or go see an orthopedic if your arm's hurting you. Whereas rather than getting like a referral and having to travel. Growing up in Appalachia were you're aware of the health disparities in this region?

BUONCRISTIANI: As a child, I don't think I was really aware. I think my parents being from a bigger city, they understand that you kind of had to get out of Monticello if you really wanted like and like to actual an actual answer to I guess what was wrong. And we never really had like many health issues like me 00:07:00and my brother were pretty healthy growing up. Um, but as I grew older, like now I know there's a tremendous gap, especially being in Lexington, like actually living here and seeing how it was there. It's just, it's crazy seeing the gap between like where I'm from and just two hours up the road. So that's been a, that's been a good, I guess probably a good insight.

THOMPSON: Oh yeah, for sure. Kind of like a new perspective because like if you don't go out and see other regions or travel, you don't necessarily know that it's any different anywhere else. And like when I grew up in Vine Grove, Kentucky, which is further South from like Louisville, it's a pretty small town. Like you didn't realize that not everyone lived the way that you lived, you know, in the state. So, it was always interesting to see like compared to Lexington or Louisville, how much more bigger and overwhelming it is.

BUONCRISTIANI: Yeah.

THOMPSON: When did you first hear about the Appalachian Career Training in Oncology program and why did you apply?

BUONCRISTIANI: So, um, if this does you, how close to school was I. I wasn't 00:08:00Chris Prichard, one of the directors, he came and spoke to my school about the program and um, I wasn't even in the, in the class that he was speaking in, but one of my friends sent me a text and I was like, hey, you would probably be interested in this program from University of Kentucky, you should come in here. So I went in and sat down and listened to like half of the speech, talk to Chris afterwards, got some of the, like the papers that he had brought, researched it a little bit and I was really nervous about applying, but I was really interested in the program and oncology. So I took the shot and just waited scared for weeks running how my application looked or would turn out. So that's kinda how that went.

THOMPSON: That's awesome. It's just like felt natural since you were interested in it.

BUONCRISTIANI: Yeah. And I mean it, it all worked out good too. Cause out. Like I said, I wasn't even in there. Somebody texted me and then they had, they have a really good website too, so I've got to figure out what I missed from that 00:09:00meeting. So.

THOMPSON: That's awesome. Where are you going to come to UK anyways?

BUONCRISTIANI: Yeah, I was, I was going to come to UK. I kind of thought about Western cause that's where my brother is, but I feel like UK was the best fit. So this was where, where I was more than likely headed.

THOMPSON: That's awesome. Close to home too. Only a couple hours.

BUONCRISTIANI: Yeah. It's a little bit shorter than traveling to Bowling Green.

THOMPSON: Yeah. Tell me about your experience at the ACTION program and how it impacted you.

BUONCRISTIANI: So I've only been in ACTION since the beginning of the fall semester, um, but since I've been here it's been, it's been really impactful and it's opened up a lot of great opportunity for me to just be a freshman. Um, I really enjoyed being a part of the program. Chris Prichard and Dr. Vanderford have really helped me in other ways. I've went in to talk to Dr. Vanderford and Chris about like major cause like it's one of like the, I guess is hopefully it's the normal freshman thing. I didn't really, I was really worried about what was going on and I was in a major that I really didn't mean to be in. Um, when I 00:10:00first got here, I, think I accidentally filled out the wrong thing on my application. So I had to switch to biology from a medical lab science. But I like, I couldn't pick apart like the classes as well as they could. So they really helped me figure out where I needed to go. So just, just being in the program even more than just having the opportunity to shadow and do research and outreach. I'll have, I've had support in many other areas too, so, and um, I can, I can tell that, uh, Dr. Vanderford and Chris Prichard, they're really passionate about cancer and Appalachia, which impacts me in many ways because I'm from Appalachia and there's a ton of cancer there and it's a big problem. So that's been good.

THOMPSON: That's awesome. It seems like you've had a good experience so far and we'll continue to throughout all of undergrad for sure. Have you been able to learn anything from your peers in ACTION? Perhaps they've had similar experiences as you have?

BUONCRISTIANI: I've, I've had somewhat limited interaction with them. We've met 00:11:00a few times though and, and from what I understand, all of us have been affected tremendously by cancer and um, all of us are from the Appalachia region and we're all interested in medicine and all of them are very caring. So I've, I've been very grateful to be a part of the program and amongst some people that feel the same way about me as with medicine.

THOMPSON: Exactly. It's always nice to have like peers around you that have the same interests as you and background and want to do the same thing. That's always great to have that system. Now that we've discussed your background, we will now discuss cancer and its prevalence in Kentucky. Please tell me about the first time you remember learning about cancer.

BUONCRISTIANI: Um, I was about six when my grandfather was diagnosed with cancer. Um, he had, he was diagnosed with leiomyosarcoma in his thigh. I didn't really understand what it was, but this was probably my first real interaction 00:12:00with cancer.

THOMPSON: Is that like a type, I'm not familiar with that one. Is that a type of bone cancer or a soft muscle?

BUONCRISTIANI: It's a soft tissue cancer and it, a lot of times it metastasizes. So, in his case he went from his thigh to his lung, so we knew that it was going to metastasize after he got it removed from his leg. But, but that was, that's what that is.

THOMPSON: Yeah. I feel like a lot of people like for at least like, well at least at our age, like our first experiences with cancer, were really with like family members. Like mine was the same way with my grandmother and I was like five. So it's like you just learn that from a young age.

BUONCRISTIANI: Yeah. And it's just never seems like seems normal I guess. I don't know about, Oh, I mean like to know about it.

THOMPSON: Yeah, exactly. Yeah. It's just like, I remember like when I first learned about it, I didn't understand it completely. I just thought like it was like you get sick, like you get sick with a cold and like I thought like everyone just got better. You went to the doctor, got medicine and it's just like when you're so young you don't really realize what's, what everything is 00:13:00going on. Was cancer prevalent in your community growing up?

BUONCRISTIANI: Um, cancer was very prevalent and like being in Lexington and I hear a lot of people say like if you don't have a relative with cancer, you probably know someone who does. And it makes me think, cause like where I'm from. I like I don't know anyone in my community that isn't related to at least one person is had cancer. So.

THOMPSON: Exactly. I feel like that's like all across the state too because like even here, like most of my friends, like their grandparents or they have like an aunt or uncle or cousin or you know, has had someone affected by cancer. As you're aware, Kentucky has some of the highest rates of cancer in our country and specifically the 54 counties that make up the Appalachian region of Kentucky have the highest rates of both cancer incidence and mortality in the state. Why do you think that is?

BUONCRISTIANI: I am aware of this. Um, and more recently as I haven't been exposed to statistics on the topic, I believe that many factors are involved in 00:14:00this. I believe that knowledge is a great, great place to start because it can, it covers most reasons why a lot of the rates are so high. Not only knowledge of cancer, not only knowledge of what cancer is, but why it happens and what prevents it, the knowledge on what causes cancer would be very low in my community. Also, the prevention of cancer, this was boiled down to just how to, just how generally to take care of yourself. This definitely does not apply to everyone, but there are many people that have just not been exposed to cancer and prevention, like knowledge in any way. And in most cases, it's not their fault. Um, where I'm from, there are many people that don't have phones, internet, computers or high school education if they have middle school education. Also many people don't know what to do when they have cancer. Um, like most people from where I'm from, if you get cancer, I mean that's kinda the end of the line and cause there's nowhere to really go. There's, we've got a got 00:15:00a really small hospital that I don't think they do much cancer treatment in my hometown and then 30 minutes up the road they do a little bit. But closest place is in Lexington and a lot of people don't know about Markey and don't understand that there's a big difference in the quality of care that you get here than there. So.

THOMPSON: Definitely. I see that like to like where I'm from. Like some people like when they get cancer, like they just think let's like the way it is and it's not like worth all the trouble going through treatment and like all the physical stress of it or emotional stress. It's just like kind of what happens.

BUONCRISTIANI: Especially like if they don't know anybody that's survived, like they don't know why they would put themselves through that. Like I know some people that, yeah. So they don't understand why I'd like to go through all the treatment if it's not gonna work.

THOMPSON: I've seen that too. Like I had a family member of my family and like she was a little hesitant. Well not a little, she was very hesitant about getting treatment at first because she didn't want to lose her hair and she didn't want everyone to know that she was going through treatment or had cancer 00:16:00and it's just, it was so advanced. She thought there's no purpose in going through this. Why would I live my last like my last year of my life in pain all the time when I can just do what I'm doing now, I'm okay and just let it happen. Yeah. So that's interesting. I've always find that like perspective interesting. Cause like you think like if I were to get sick I would, I would get treatment obviously. But like when you're older, like it's some people have to balance like is it worth it or not worth it?

BUONCRISTIANI: Yeah. And a lot of people just want to keep doing what they're doing and yeah. So that's, I understand that completely.

THOMPSON: Exactly. How do you think the incidence of cancer has impacted our state?

BUONCRISTIANI: I believe that cancer has impacted us greatly. Um, obviously I know that death is a very negative impact along along with the pain and of many treatments like the, like we say, a lot of people don't want to put themselves through that. And even though it has been very negative, I do believe that that we can make it a positive for future generations if we promote knowledge and 00:17:00prevention and just overall health and how to take care of yourself. I think that this like this really bad thing can be, can become negative in a way of promotion of health.

THOMPSON: Exactly. Um, do you think the culture of Appalachia has played a role in any of these statistics? I know like we briefly mentioned, like some people think like it's just my time. It's God's will, like the fatalistic mindset or anything like that.

BUONCRISTIANI: Yeah, for sure. Especially like what you said, it's like God's will and um, that's a, that's a big role. Like a lot of people don't want to take advantage of, uh, of like the things they have around them because that's, that's the way they've grown up is like it just happens, it happens. Um, you can't do anything about it, but there are resources available to help you, help you survive. And um, like the overall culture, I mean it's kinda in many places, not like taking care of yourself is not like a big deal. You just kind of do, do 00:18:00whatever. Um, eat whatever you want, drink whatever you want. And it will be fine whenever you, whenever it's your time, it's your time. So yeah, I think the culture of Appalachia does play a big role in the statistics.

THOMPSON: I think so too. And I think it's not just like limited Appalachia, but like in like all underserved regions in our state. I feel like, like even Western Kentucky or even like in the city, there's probably people who have those mindsets who probably come from like underserved areas where like, where we're from and they have those perspectives where it's just like, huh. That's whatever. You know?

BUONCRISTIANI: Yeah. And I, I think you could find that like anywhere, especially not even in just in Kentucky, but like in other states, I'm sure that there are people that are just all, whatever it is, whatever, I'm going to keep doing what I can do until I can't do it anymore.

THOMPSON: That's very true. And like, although I like unhealthy eating habits, like everyone knows like McDonald's is unhealthy, but we still all eat it.

BUONCRISTIANI: Yeah.

THOMPSON: It's little things like that that add up that you don't really think about at first.

BUONCRISTIANI: Yeah. Taking care of yourself is a, is a really big deal. Um, 00:19:00I've had to stop myself from going to the Papa John's. It's right across the street. I'm not, not used to having one of those, so,

THOMPSON: Oh yeah. It wasn't the taco next door. I've ate at the taco bell quite a few times. I'm not gonna lie. I'm not perfect. We're all like that. From the essays of other participants in the ACTION program. Like I was just mentioning, I recently learned that several people who are diagnosed with cancer have a fatalistic mindset and believe if they are diagnosed with cancer, it is simply their time. I know we just discussed this, but do you think this mindset is very common in your community and other parts of Kentucky?

BUONCRISTIANI: Um, I believe this is very common. Uh, like I said before, this all so many people know. Um, the good thing is that a lot of people from my community have started to seek quality care and um, most of them have came to Markey and are having very positive results or have been cured of their cancer. And this is changing the mindsets slowly and kind of getting out there more and more to the people, even though you still have people with the mindset that I 00:20:00don't need to do anything. Um, if like it's, it's impacting a few people and they're seeing that there's, there's positive results going with cancer. So that's really affecting my community.

THOMPSON: That's great. And like, just like having those people who have gone through treatment and then do get better or like get cured. Like you're saying. I like you've mentioned, I feel like that would like make more people inclined to come and get care rather than just saying well it is what it is. That it's like more worth it to them cause they see someone who's done well.

BUONCRISTIANI: It takes like one person in the family to just kind of talk them into like, cause there may be one person that gets cancer, has a really negative outlook. Well if their whole family is pressuring them and family means a lot in Appalachia. So if you have everybody in your family telling you, Hey there's a good cancer center, Markey in Lexington, you need to go like this, there's a good chance that just, just a small, just a small word can travel a long way

THOMPSON: For sure. And I'm like this isn't necessarily the end. You know, just like showing that it's not always, you don't always pass away. Like it's never 00:21:00always the end of it as I think is important.

BUONCRISTIANI: Especially if people around you that have done the same thing in your community. So for sure. Yeah.

THOMPSON: As we know, low health literacy leads to negative health outcomes. What do you think we can do better to help? What can you, what do you think we can do to better the health literacy of patients?

BUONCRISTIANI: I believe the best way to better health literacy is to do outreach and continue to have positive results from people seeking quality treatment and just spreading that word because word of mouth, I know it's not as big of thing in a bigger city, but word of mouth in a small community, especially in the Appalachia region is a really big thing. It's much bigger than a Facebook post. If you can talk to somebody, that means a lot, even though Facebook's become more prevalent, but I think I think the best way is to outreach or do outreach and have positive results from quality treatment at places like Markey.

THOMPSON: Mhm. I think so too. And just like, like you said, like talking. A word does go a long way and then if you talk to one person, they're probably 00:22:00going to take it and talk to their, their spouse or their kids, you know,

BUONCRISTIANI: Just, yeah, just like old business, I guess. Word of mouth was the way to increase your business.

THOMPSON: Oh yeah, for sure. It just like reaches more and more people as time goes on. Yeah. Another barrier to healthcare is a lack of transportation insurance in the prevalence of language barriers. Have you known anyone effected by these barriers and what do you believe is the impact of these barriers on cancer patients and their treatment?

BUONCRISTIANI: I personally do not know of anyone that has had a barrier with, um, language or transportation or insurance. But, um, you were at the Patient Advisory Group meeting that that's, that's a big insecurity. So if somebody was having trouble with transfer transportation or insurance payments and stuff, that would, that would definitely affect them, but they may not share it with someone that they weren't closely related to. Um, and another way I could really see a language barrier coming in contact though would not just be like speaking 00:23:00a different language, but like somebody from Appalachia understanding what a physician in Lexington is saying. So, um, cause like as most people are not most people, but a lot of people don't have an education like into high school, not just college. So they may not understand what's going on directly. So

THOMPSON: Mhm. I mean even I get confused, like I'm sure you can relate with medical jargon. Like sometimes if you don't, if you've never been exposed to it or haven't learned it, then how are you supposed to understand it? You know?

BUONCRISTIANI: There's like I, I get confused all the time.

THOMPSON: Oh, me too.

BUONCRISTIANI: And it, it makes complete sense to the physician. It's not their fault. Cause sometimes, I mean there's physicians at Markey I'm sure that aren't even from anywhere close to Kentucky. So they're like, if they weren't from a bigger city and always around people, they understood what they were talking about. And especially if they're an older physician, they've been around physicians for a long time. So they wouldn't, they may have trouble talking to 00:24:00somebody that doesn't have a high school education whenever they have a MD. So.

THOMPSON: Exactly. Cause like their medical knowledge become second nature to them. And I feel like sometimes maybe they like forget that not everyone else knows it exactly the way that they do or like even like just simplifying it to terms that are easier for people to understand.

BUONCRISTIANI: Yeah. And that's a, that's a really big thing because especially, I mean getting diagnosed with cancer it, I mean if you, you wouldn't really know what was going on in that moment anyway. So there's some big words being thrown around. Even if you kinda understood that you wouldn't really pick up on it. So.

THOMPSON: Exactly. Cause it's just so overwhelming in that moment to begin with. And then you go home and you're like, well I got cancer but I don't know what else they said cause it was just too much at once. Which like I feel like anyone would be like that in that situation.

BUONCRISTIANI: Oh yeah. For sure.

THOMPSON: We both recently attended a Patient Advisory Group meeting, like you mentioned where cancer patients and their medical providers joined together in conversation. We learned that in a recent survey of a limited sample size, 00:25:00approximately 40% of cancer patients had faced some form of food insecurity during their cancer diagnosis. I was shocked by this data. How do you feel about this data and what do you believe can be done to decrease a startling number?

BUONCRISTIANI: The number to me, it was also surprisingly high, but I can see it, especially in my community that if people traveled to Lexington to receive care, um, paid for everything they had to here, um, that that number would be very close if not much higher of people from Monticello. Um, I believe the first thing that could be done is to like get out the resources that are available now to patients and their families. Cause I, I know that at the PAG meeting some of the patients were saying that like, you get a big pamphlet but nobody really reads pamphlets. I, I, and I completely understand that cause I, I probably wouldn't either. So, um, that be a big deal. Like making it, making that simpler 00:26:00too and um, more groups that provide food and support would be a great help also, I'm sure.

THOMPSON: Exactly. I feel like just like food insecurity, like when you think of cancer patients, like that's not something that comes to your mind naturally when you think about like problems they face. You think of the physical problems, like the mental problems, the emotional problems. I mean not being able to work but you don't think of like food insecurity. And seeing that number was just so startling to me and I was like, wow, I never expected that. So that's definitely something.

BUONCRISTIANI: Yeah 40% was, was much higher than I would've expected.

THOMPSON: Yeah, that's definitely something that like they need to work on to make sure that people are getting the food they need because you need food. Even if you're healthy, if you have cancer, you need really healthy food to help with nutrients and vitamins and everything.

BUONCRISTIANI: For sure, yes.

THOMPSON: We will now shift our discussion to focus on the prevalence of lung cancer in Kentucky. Kentucky is ranked second in the country for the most smokers in the US. According to the CDC, Kentucky also has the highest rates of 00:27:00cancer deaths caused by tobacco use. What do you believe can be done to diminish the prevalence of smoking in our state?

BUONCRISTIANI: I believe that the easiest thing that we could do is, um, like promote smoke, smoking knowledge, uh, to schools at like a younger age. Cause I think that affects people like in a bigger way. If you show like the, the raw facts to younger kids, then they're going to pick up on that much quicker than like they're, they're going to listen to that more than an adult would I believe. Um, because it's, it's really hard to get somebody that's been smoking for 40 years to stop smoking. I mean, even, even if they understand that, I know this is not good for me. Um, it's, it's just, it's a lot easier to prevent that in the younger generation than it is to stop it in the older generation. Um, but out like for the older generation adults that have been smoking, um, outreach and telling them like the facts and the statistics that we've seen. Uh, and just make sure and that's that's promoted. I mean it could change change a couple, 00:28:00couple of their outlooks maybe and people that don't really understand the statistics as well so that those were the, those are the ways that I believe we can lower the prevalence of smoking.

THOMPSON: I think those would definitely help. And like you were saying, I do think we have to approach the issue differently depending on like what age group they are trying to target. Cause like with our generation and younger like it's a little easier to help like people like our age to stop smoking than someone who's 80 or 70 years old. Like you said, well that's they've been smoking since they were like 10. So, it's a lot different and needs different strategies I feel like.

BUONCRISTIANI: Yeah.

THOMPSON: Approximately 80 to 90% of lung cancer cases are due to tobacco smoke. Do you believe the citizens of Kentucky are aware of the statistic? If not, what do you believe our state can do to educate people of the harms of smoking?

BUONCRISTIANI: I believe that people generally now they know that smoking is not good. I know that probably whenever a lot of them started it was just a cool thing to do. I guess like the e-cigarette thing is for us. But um, I think, I 00:29:00think that some people don't really realize how high the correlation between smoking and health risk and cancer, um, are like, I mean a lot of people don't realize that like if you smoke, something's more than likely going to happen and if it doesn't happen you would be considered lucky. I would, I would think. And um, to educate people like promote the statistics and do outreach, like we said, and to all corners of the state are necessary and for all ages, they all need to see the statistics and we needed to reach out to all of them.

THOMPSON: Definitely. I like, like you were saying, people, everyone in America knows that smoking is not healthy for you. Like, we all know that there's been enough like public service announcements and that kind of thing but like these statistics, like 80, 90% of lung cancers because of smoking or like the high rates of cancer and how many people get lung cancer in Kentucky every year. I feel like we need to promote those statistics more so people realize like, oh my 00:30:00gosh are thousands and thousands of people every year. What if I'm one of them?

BUONCRISTIANI: Yeah. Yeah.

THOMPSON: Do you think the popularity of e-cigarettes will have an effect on rates of cancer in the future and how do you believe we should address this before it becomes too late?

BUONCRISTIANI: Um, so I had kind of kind of looked at the e-cigarettes and I know they, they contained less carcinogens than a normal cigarette, but like it would, it would take a long time to see what the effects would be cause that would be longterm. Just like smoking. I mean it, it took until, I mean, not recently, but like whenever everybody started smoking, they didn't realize what was going on. So whenever everybody started doing e-cigarettes, we still don't know what's going to happen. We've seen, we've seen some pretty bad, um, health issues recently.

THOMPSON: Oh yeah.

BUONCRISTIANI: I know it's been a big factor in the news, but, um, um, I think controlling this, it's, if it's not too light to completely stop it yet, I think 00:31:00that just attacking on the kids that have started and, and preventing younger kids from doing it and promoting the, the health risks, uh, would be the best way to lower the popularity. Um, uh, the only bad thing about that would be that if it was a positive thing that the people that switched from cigarettes to e-cigarettes, if e-cigarettes were completely banned, those people would go back to smoking.

THOMPSON: Exactly.

BUONCRISTIANI: So, um, I think that, that, that's going to be a tricky situation and not much, not much research has been done. It's definitely not a positive thing and if you have to worry about it, a lot of the times it's better to just not do it.

THOMPSON: Exactly.

BUONCRISTIANI: If you have to worry about like, uh, there's, um, less cancer-causing chemicals, but there's still stuff in there that you don't need.

THOMPSON: Yeah, there's still some carcinogens.

BUONCRISTIANI: Yeah. Yeah. Just, just don't do it. So.

THOMPSON: Exactly. I think it's interesting how like statistically most like our generation, like statistically we would probably never smoke like a cigarette just based on statistics. But then like people, our generation are smoking e-cigarettes when e-cigarettes were originally for people trying to get off of e-cigarette or trying to get off of cigarettes. So I just find it interesting how like the market of e-cigarettes has shifted like within the past like five years to people our age.

BUONCRISTIANI: Yeah. Yes, for sure. It has definitely. Uh, I would say that more more people under 30 probably use e-cigarettes and people that have been smoking 20 years I would say.

THOMPSON: Oh, I think so too. And I think like older people will just from like the perspective of like my grandpa when he talks, he thinks that it's like the young cool like hipster crowd of people who are all using the e-cigarettes. And I mean, from what I've seen, I've never seen like an older person using an e-cigarette from at least what I've seen. So I do think it really is affecting 00:33:00like our age group and generation.

BUONCRISTIANI: Like a long time ago. I know, um, mom, my mother smokes, but like when she started that was like the, that was a cool hipster thing to do. I mean that was like uh, everybody's smoking, I should do it too. And seemed like my senior year it kind of my junior year of high school and it was like, oh these kids have a vape. That's cool. I'll get one too. And that just kinda took off probably the same way I would assume the same way that tobacco smoking took off

THOMPSON: For sure. Definitely like with pop culture and I think social media hasn't helped it necessarily cause like you see people on Instagram or YouTube, Facebook, whatever, like with all the different e-cigarettes and flavors and all that stuff. I mean I even see it pop up on mine sometimes and I'm like, what in the world.

BUONCRISTIANI: Yeah, I was listening to the news the other day and they, they tried to somewhat ban the flavors like the like raspberry and stuff. Cause the people that were trying to get off cigarettes weren't probably weren't smoking 00:34:00raspberry, they were kind of just trying to get their fee; of nicotine. So I think, I think that it was um, they realized that younger kids were doing it. So I think that it kind of, they kind of moved their advertisement to where they were selling it at. But they can't really say that. So.

THOMPSON: No. But I do think like the candy flavors like appealed to like the 13-14 year olds, cause I know even that young people are already using e-cigarettes. So it's just crazy.

BUONCRISTIANI: I would, I would probably be surprised about how how heavy the e-cigarette uses in middle schools. I know that it's being used, but like even that low of an age, I mean it's, it's gotten to that point where if you, if you walked into the middle school bathroom you probably wouldn't be able to see where you're going because there's so much e-cigarettes smoke.

THOMPSON: Probably smelled like cotton candy. Yeah. No, it's funny cause like I am one of my classes the other day, my professor has a son and he's in middle school and his son was telling him about like how on Instagram he knows these 00:35:00kids in his class, like sell the, like the pods or whatever, like the juice pods on their Instagram stories and they'll post them and say, Oh we have the raspberry or the blueberry whatever for like 30 bucks a pod. And they make like, I mean they're little, they're essentially like drug dealers in a way since it's not, you know, legal for them. But it's, it's crazy. I think. I think it will impact in the future.

BUONCRISTIANI: And that that might be how it got spread in younger age. Just cause these kids could get it and sell it and make money. And I mean middle school you got 40 bucks.

THOMPSON: Yeah that's a lot.

BUONCRISTIANI: Yeah. Yeah. You were, you were the millionaire of the school. So I could say see how that was making, there'll be pop and make that popular.

THOMPSON: I know, and I was sitting there, I was thinking, well, when I was in middle school, if I spent 40 bucks on something, my mom would know where it went. But I don't know, I guess it's different. The census of 2012 found that Kentucky has the highest number of tobacco farms in the country. Many people in 00:36:00our state take pride in tobacco farming. However, tobacco is clearly unhealthy. Do you think it is difficult for people who work in this industry to realize its health dangers?

BUONCRISTIANI: Um, I think that anything that people in Appalachia do for years and it has been in their family, they like that's the way that's the way it is. They think. And if you tell them that's not right, it probably wouldn't end up in a positive conversation. Um, so I mean, in many cases they just don't believe what they're doing is, is wrong. And if they do, they're making money in an Appalachia lot of regions, that's hard to come by. So if, uh, if you can make money, tobacco farming, that's, that's what they do. Or working in the farm. I mean they don't really question what they're, where that's going or if it's harming anyone that you just, it's a job.

THOMPSON: Mhm. it's just the way they make their livelihood. I don't think like people, I mean they know it's, I don't think it's like their fault obviously cause they're, they're farming it.

BUONCRISTIANI: Yeah.

THOMPSON: So, it's just like how they make their money and how they put food on the table. And I don't think being in--

BUONCRISTIANI: Especially being in the family for years, cause so many tobacco farms get passed down from generation to generation.

THOMPSON: Yeah. Like I've even seen that. So I do think like they take pride in, in it, pride in it. And even though they know like essentially this is probably going to go towards cigarettes or whatever else it goes towards. But I don't think it really affects them that much. Which if I was a tobacco farmer, I wouldn't let it affect me either. I would just think I farmed it. It's not my business where it goes from here.

BUONCRISTIANI: Yeah. I mean, I, if I were to put myself in their shoes, I mean there's good money in tobacco farming. So if you were, if you were making money, it's been in the family, everybody else you knew did it. I mean, what, what else were you supposed to like that's what, that's what you do. That's what's been in the family. That's, that's just how you make your living.

THOMPSON: Mhm and they're still, I mean, even if like one farm stopped growing tobacco, the next one's going to start growing it. It's not like it's going to stop. So.

BUONCRISTIANI: Yeah. I mean if you got something that makes money, people are going to do it, especially if it's legal.

THOMPSON: Oh yeah, definitely. As you know, Kentucky has the highest rate of lung cancer incidence and mortality nationwide. Why do you think this is?

BUONCRISTIANI: So. I believe that a lot of it is the mixture of lack, lack of knowledge about cancer as a whole. And tobacco. Um, I do understand that there are more cases, there are some cases that do not involve the use of tobacco. Like my grandfather's was not correlated with tobacco. Uh, um, um, but most of it, like you said, 80 to 90% is related to, to tobacco. So, um, it is, it's relatable and there's, there's excess tobacco in Kentucky. So, uh, I, I mean tobacco would definitely be a big reason to why lung cancer rates would be high and mortality would relate to the knowledge. Like they don't know what to do whenever you get it.

THOMPSON: Exactly. I feel like it's just like a cycle kind of like is probably 00:39:00not going to end anytime soon because it's just going to keep going on and on. But yeah, I think smoking does play such a huge role. But like you said, like not everyone's cancer is related to smoking. Like your grandfather wasn't, like I've known people who were never smokers and have gotten lung cancer just from like environmental reasons or genetic reasons.

BUONCRISTIANI: Yeah, for sure. They could definitely like second hand smoke. I mean there's, I guess, I don't know how long ago was, but there's some studies that said that was somewhat worse if you were, if you were exposed to that. So, yeah.

THOMPSON: Especially like at a young age, like when you're like a child, I think I've read articles too where like with parents, like smoking around kids when they're like six or seven, like that has a large impact on their health later in life.

BUONCRISTIANI: Oh yeah. Yeah, for sure. And I mean it's very common to see parents smoking with young kids in the car where I'm from with the windows rolled up I've seen many times. So that's, that's definitely a scary truth 00:40:00about, about that.

THOMPSON: For sure. And they're just sitting there breathing it in. It's different if you're outside where there's air everywhere rather than you're in car, you're just in that one car.

BUONCRISTIANI: Yeah. And especially being that young like, I mean we would mean you would probably be sticking our head out the window being that young. I mean I could just sit in there breathing. You don't really think about that at all. So.

THOMPSON: You don't think it's like your parents, like you don't think they're going to do anything to hurt you or anything.

BUONCRISTIANI: So, in some cases they don't know. So, I mean that's just, that's just scary. That's, that's something that definitely needs to be definitely needs to be looked at for sure.

THOMPSON: I think so too. According to the national or the National Cancer Institute, one of the primary risk factors for lung cancer includes environmental exposure. Do you believe the coal industry is responsible for part of the reason why lung cancer is very prevalent in Kentucky? Appalachia, I know 00:41:00like some research has said like tobacco is one of the main causes of lung cancer, but there's like all the environmental reasons such as breathing in the coal and getting that into your lungs.

BUONCRISTIANI: I believe that's definitely, especially here a topic of could use much more research. Um, I know there are studies in other parts of the world where coal miners didn't have really an increase rate of lung cancer, but, um, there was increased rates in other types of cancer in the people that they took the studies in. But um, with, with coal miners too, especially in Appalachia, you would see an increase smoking rate with them. So it would be a really, really hard study to find the correlation. But I think that it's for sure something that needs to be looked at in depth, really good debt.

THOMPSON: Definitely. I do think it'd be difficult, like you were saying, to divide it among like what exactly caused it or if it was like a combination of smoking or unhealthy eating or like breathing in the coal from the mines.

BUONCRISTIANI: Which I would say that you would find a significant amount of people there that would be doing all those things.

THOMPSON: Oh yeah, exactly. Cause that just kinda goes along with it.

BUONCRISTIANI: Yeah with the culture. I mean, yeah.

THOMPSON: Like I said like black lung, I do think plays like another role in it. Obviously like through medical studies like that has had a huge impact on cancer rates and lung cancer. So I do think like more research is necessary for that since it affects like such a large group of people in our state. I'm surprised that there's not more active research for them, you know?

BUONCRISTIANI: Yeah, yeah. That's, that's true. Uh, I really think that that's a, that's a topic, especially like Appalachia is such a high rate of cancer. I mean this is a hot zone for studies. So if you have something like that that's this obviously showing like there's a bunch of people in this area and this is some of the things that goes on. I mean you've got, you definitely have to take tackle that for research.

THOMPSON: Exactly. With the high rates of cancer in our state, I believe almost 00:43:00every person has known someone who has been diagnosed or affected by cancer like you were saying earlier. I for one have had several family members and I know you have to, can you please describe what it was like when your grandfather was first diagnosed with lung cancer?

BUONCRISTIANI: Um, so I was really young whenever he was diagnosed, but it you can just kinda tell like they, I think they tried to keep it from keep it from the younger, the younger kids, like what's really going on cause it's not not a good thing at all. And I'm sure you can relate to like they, they don't really want you to know what's going on cause you would first, I wouldn't have been able to understand it. And, um, it's just probably some that you don't want your, want the kids in the family to be really upset cause, if like, especially in our area, if there's kids that hear cancer and all that, they know is death, then that's just going to continue to produce that idea.

THOMPSON: Exactly.

BUONCRISTIANI: Um, so whenever the tumor in his leg was removed, it was, it was 00:44:00pretty much understood that it was going to metastasize somewhere to his body. And I think the, the lungs were a hot zone for leiomyosarcoma. Um, so when he was diagnosed with lung cancer, it was, um, it was very sad, but I think we were somewhat more prepared for that. And I mean, for me, I can't, like I'd got to the point where I understood what happened before I understood that it was going to happen again. So um I'm more, I guess more prepared if you can prepare for that. Uh, but it was, it was definitely, it was definitely a big deal. And, and not a, not a great time.

THOMPSON: Exactly. Like I can relate to that too. And like, like you were saying like when I was so young, you didn't, my parents, I'm like, you know, they try to protect you and shield you from it even though like, you know, your grandparent is sick but you don't necessarily, like I was saying, you don't necessarily realize like how sick, like you think it's just like a cold or 00:45:00whatever, how like you get sick, but you just don't really realize that it's the same until you get older and you're able to reflect upon, like reflect back on that.

BUONCRISTIANI: Yeah.

THOMPSON: I know that cancer not only affects the patient but their family and support system. What has it been like for you and your family during this difficult time?

BUONCRISTIANI: Um, so me being where I'm at, I don't like to have a negative negative like output on the situation. So I try to stay pretty positive because I know that all my grandparents is very tough. Um, so I try to, I try to stay pretty positive with them and I always like to be there to help. Uh, I've seen so many struggles. He's the, my grandfather's went through with treatment, so I try to make myself available anytime that he needs anything. Um, I mean mentally, obviously it's, it's, it affects me a lot, but I just try to, I try to be as positive as I can and just be helpful in that situation. But I know that, especially, especially for my mom and uncles and my grandma, that that's 00:46:00definitely not a, um, the, it's, it would be very hard to be a positive in that situation.

THOMPSON: Yeah, definitely. I mean, I feel like it's probably, it's hard on you too.

BUONCRISTIANI: Yeah.

THOMPSON: But I feel like just like us being younger, like we try to be more positive to like, maybe help our mom or like help her dad or like try to be the one that's not always so sad all the time. Like I can relate to that too.

BUONCRISTIANI: I, and I mean, that's a, it's tough to do that, but you kind of, I mean, you have to cause, um, you gotta be there to just be there to help, not just my grandfather, but like you said, like your parents or your, um, their spouse too. So yeah, that it has been, it's difficult. But just having a positive outlook I think makes, makes a big, is a big deal.

THOMPSON: For sure. And it's definitely probably helped like your mom and your uncles, like you said in your grandma, how you having the positive outlook and not being like sad or crying like they, you know what I mean?

BUONCRISTIANI: Yeah.

THOMPSON: Just like having the positive outlook probably has to help them a lot too. Based on your personal experience, what have you learned about lung cancer?

BUONCRISTIANI: So, um, when not started to understand like what was going on, this, it, I started to research cancer more cause I mean you got a computer in your hand so I mean you can type in anything and, and research anything that you want. So, uh, I think that that's really me research more on the topic and especially now it's like whenever my grandfather's diagnosed with lung cancer, I understood it more than I did when I was six. So I mean, you can tap in stuff about lung cancer and leiomyosarcoma. And I mean it's just really opened up the like me researching into cancer more and more. So that's really, um, made me much more interested in that. So.

THOMPSON: Definitely I feel like when you are exposed to things and you don't necessarily know about them when you're like our age, like I Google stuff all 00:48:00the time. Like I want to know all about what's going on and like what to expect.

BUONCRISTIANI: Yeah. Yeah. And it's, it's easy to find. So.

THOMPSON: Definitely a lot easier than it used to be. Like before iPhones were a thing, you know. Yeah. I understand from previous conversations that your grandfather's being treated here at the Markey Cancer Center at the University of Kentucky, how far has he been traveling for his treatments and do you think the traveling has been difficult on him?

BUONCRISTIANI: Um, so my grandfather travels from Wayne County to Lexington, so that takes around an hour and a half to can be a little bit over two hours. It depends on traffic. It's usually pretty slow until you get around Lexington. Um, I think the, the traveling is really been more difficult on my grandmother cause she has to worry about how he's driving though. But um, I know that a lot. I know it's very tiring for him to travel up here. I mean, um, being an older couple, I know on him and my grandmother that, I mean that's not an easy trip to drive drive so long. But um, he's recently been staying at the Hope Lodge, the 00:49:00night before his, uh, appointment. So he always schedules really early. So he was, I mean he was leaving like waking up at four or five AM and traveling up here. So being able to stay there, it's really, really helped him a lot.

THOMPSON: That's nice. Are you able to see them when they come up here sometimes?

BUONCRISTIANI: So he, he always schedules it on Monday and I have class from Monday, from morning until, until like three.

THOMPSON: That's a bummer.

BUONCRISTIANI: Yeah, his appointment is like same time as my first class, so I haven't got to get to see him cause he just recently started back up with his amino therapy. So, um, they've been up here I think three times since school started. So, but I haven't got to see him. My mom comes with them a lot, so it would really, really be nice to see him, but I haven't gotten, I haven't had the opportunity to yet.

THOMPSON: Yeah, maybe next semester your schedule will help you, allow you to just see them more based on statistics provided to me at a patient advisory group meeting. I believe you were, I think you were at this meeting to 00:50:00approximately 48% of cancer patients and a limited sample size study said they were not aware that there may be resources for them. Has your grandfather used any resources and if so, how do you think they have helped him?

BUONCRISTIANI: Um, so this was a great, great topic for, for like my grandfather. Um, he's, he's been a patient at Markey for about 13 years and it was just recently this summer of about the same time that I like learned about it. They found, found out about the Hope Lodge. So he didn't know, he didn't know anything about the hope lodge, which is a really big resource. I mean that has food and everything there. So, um, that's that. But being able to say there's been tremendous for him, I mean, being able to sleep a little bit later, I know that would make me happy.

THOMPSON: Me too.

BUONCRISTIANI: But he, but he really loves it. He loves the hope lodge and uh, it makes his appointment so much easier for him to get to. So that's been, 00:51:00that's been great.

THOMPSON: Definitely. I feel like that's such a great resource for people who are traveling. I couldn't imagine like having to drive here two or three hours after getting chemo when you're not feeling that great anyways. And then you're worried about driving safe and worried about getting home. So I do think that's a great resource, but I do, I also think that more people should become aware of the resource. Like share it more with patients because I've talked to multiple people and they like your grandfather, they didn't even know it was a thing.

BUONCRISTIANI: Yeah. I mean like, I'm not for sure how long the Hope Lodge has been opened, but he's been going here for 13 years and just found out about it a few months ago. So, um, um, I mean, promotion of those resources would definitely, and I know that like they want, they want people to know about them, so it would, that's definitely a big thing that needs to be looked at a little bit, a little bit more.

THOMPSON: Definitely. I feel like maybe like physicians should maybe ask their or like nurses ask like how far they're traveling if the traveling far and oh, by the way, you know, we have these resources where you can stay here.

BUONCRISTIANI: Yeah. Yeah, for sure.

THOMPSON: That would help a lot.

BUONCRISTIANI: I think so.

THOMPSON: How has your experience with cancer changed your attitudes toward medicine and health care?

BUONCRISTIANI: Um, yes, it's, it's, uh, my experience with cancer has dramatically increased my interest in medicine. Like I said, I mean, just research and everything and one thing leads to another and then you find yourself researching one topic for, for a few hours. So, I mean, you just get interested in, in what you're, what you're engulfing yourself in. So, and it's, it's made me really understand how important healthcare is, especially to our region and, and um, cancer, like healthcare is, is so important and a lot of people don't know about it. So that's, it's my, my interest in medicine and my attitude towards medicine has dramatically changed. Um, as I see how, how important it is a lot more than I used to.

THOMPSON: Mhm. I think like that's like I had a similar experience to you and just like seeing how important it is and how medicine really does affect 00:53:00people's lives to a great point. Like I don't think we always realize that until like we go through something or someone in our family goes through something and that's like part of the reason why I want to go into medicine to, to like help people in situations similar to family members, you know, I'm sure you can relate to that.

BUONCRISTIANI: Yeah. And like that will, that will definitely help you. Like whenever you get to where you're going, like you'll know what you didn't have. And just if you keep that in mind, you'll be able to help other people. Cause a lot of people go through the same thing. Um, so that, that will, they'll definitely be good.

THOMPSON: That would I think so too, similar to you. I think it will help you a lot too. Like when you get into like, I think you want to go into oncology, right? Most likely or, well you have plenty of time

BUONCRISTIANI: I am interested, but there's a lot of time between.

THOMPSON: Definitely. But whatever specialty you go into, I think like experience like this would help you in the long run.

BUONCRISTIANI: Yeah.

THOMPSON: Has anyone else in your family had been diagnosed with cancer? And if so, where? What are their similarities and differences between their experience and your grandfather's?

BUONCRISTIANI: So my dad's father was diagnosed with cancer, but I was really 00:54:00young whenever this happened and he lives in Australia.

THOMPSON: Oh wow.

BUONCRISTIANI: So, um, not only was out of the young kid that wasn't told about it, I wasn't even there. So I, I really had no idea what was going on. He, um, he completely recovered. He's fine now. This was a long time ago and um, I see him about once a year, so, so he's doing good now. But whenever that happened, um, honestly I did not know much about it at all. I mean, he's a significant distance away and whenever all that happened I was, I was really young so I'm not, I don't know much about that.

THOMPSON: I understand that like my dad's family, they kind of live far that like my mom's family is here, but most of my dad's family's kind of all over the country. And like when my dad's dad, my grandfather, he got diagnosed with leukemia and I was in middle school, high school, that kind of age. So I knew 00:55:00about it, but like we weren't next door to them or we weren't down the street. So it's like a different experience. And when you're like next door to someone or just a phone call, you know, a phone call away.

BUONCRISTIANI: Oh yeah for sure.

THOMPSON: Well, thank you for sharing your personal experience with cancer and I appreciate your openness with it as I know it's a very difficult topic to discuss. To conclude the interview, we will focus on the future of cancer treatment in the future efforts to minimize the incidence of cancer in Kentucky. Throughout this interview, we have discussed many efforts that we both think will diminish the prevalent rates of cancer in our state. Out of those which you believe is the most important and why?

BUONCRISTIANI: I believe that increasing knowledge and overall awareness about cancer in our state is very important. Um, I also believe that people need to know the quality of care that they can receive at a cancer cancer center like Markey because a lot of people don't, um, this would prevent cancer, uh, cure patients and provide much better outcomes and lifestyles of people affected not just the patient but the families too. So I think that this is a big deal and I 00:56:00think that is very important

THOMPSON: For sure. I think awareness is the main key to any of these problems. You know?

BUONCRISTIANI: Yeah, yeah.

THOMPSON: Just sharing the knowledge with as many people as possible and saying like, they're not alone. There's many people who have gone through similar situations as you and have turned out well. So I think that's definitely important.

BUONCRISTIANI: That's, that's definitely put on our shoulders cause we've been made aware of it. So, we just have to share it.

THOMPSON: Exactly. And share it with other people that may not have had like the opportunities you and I have had to learn about it, you know?

BUONCRISTIANI: Yeah.

THOMPSON: Do you think there are different strategies to diminish the commonality of cancer in rural or underserved areas in Kentucky such as Appalachian versus the urban areas such as Lexington and Louisville?

BUONCRISTIANI: I believe that in a bigger city like Lexington or Louisville, um spreading the word to others about cancer and prevention of cancer is, is sort of easier. Um, because like, I mean, even just a billboard, like we don't really have billboards where in my community. Um, so like where I'm from, you can't, 00:57:00you can't just advertise, you can't advertise it well or really can't use the internet because a big problem is some of those people that you're, that you're reaching out to, they don't have electricity so they definitely wouldn't have a cell phone or or internet. So, um, and in that, in a bigger city there, there are still people in the same conditions. I just, I believe that the groundwork in a community like where I'm from would be, would be really heavy.

THOMPSON: Definitely. I think like more like medical professionals in communities such as like in Eastern Kentucky is definitely a big part of that too. Like having more physicians and specialists like we were saying earlier so that people know.

BUONCRISTIANI: Yeah so that they know there's help out there.

THOMPSON: Exactly. Whereas in like Lexington and Louisville, there's all the hospitals and all the clinics and specialties you could ever want. But in other communities it's not like that at all.

BUONCRISTIANI: Yeah.

THOMPSON: So I recently watched a Ted talk by Dr. Rita Charon who explained the 00:58:00importance of the narratives patients give to their physicians. What do you believe physicians can do to provide better care to cancer patients? And do you believe physicians should consider each patient's cultural background and their difficulties when deciding how to treat them?

BUONCRISTIANI: Um, I do believe that the physicians, uh, need to consider all of those things, um, because, and in many cases, some people like just need to understand what's going on better. And, uh, like the way some physicians talk, especially like some of the people that come from Monticello would definitely not understand what was going on. I wouldn't understand what was going on.

THOMPSON: Mhm.

BUONCRISTIANI: So, um, I know that that's a big factor and, um, uh, there's a lot of people with a fatalistic attitude. So if all they know is like, well, I'm going to have to go through all this rough treatment and, um, this doctor's telling me that I'm gonna have to do this, my, I'm going to lose my hair, it's going to be hard on me that they just say, ah, I might as well not do it. So 00:59:00kinda like if, if you're a physician and you understand that that's their outlook, there may be different ways to approach it and to tell them about how it's going to happen. Then just saying you've got to do this and this might be the outcome. This might not be that way.

THOMPSON: Exactly. I think that's important. What do you believe students our age can do to minimize the incidence of cancer in Kentucky?

BUONCRISTIANI: Um, I believe that providing knowledge to others, outreach to our peers cause we have a bigger impact on them than we would.

THOMPSON: For sure.

BUONCRISTIANI: Cause I mean, I guess we could've said use e-cigarettes instead of cigarettes, but that's not really getting information. So probably just say using either, um, uh, reaching out to our old schools and making sure that younger kids understand it is very important. And I think that that would help 01:00:00help a lot in future generations.

THOMPSON: I think so too. And like, I've never really thought about like re like you just said, reaching out to schools like the schools that we grew up with because I had people come to my school and talk about like don't do drugs, like the DARE program, that kind of stuff. But having someone who's gone to that school and been in those same shoes, I think that would be very powerful for those kids from the younger generations. Is there anything else you would like to share that I have not asked you about yet?

BUONCRISTIANI: No, I think that covered pretty much all the bases.

THOMPSON: That's what I'm thinking too. I think your answers were very thorough. Well, thank you so much, Michael, for spending time with me today and allowing me to conduct this interview. I have learned so much from your personal experiences and I'm grateful for the opportunity to learn more about the attitudes towards and experiences of lung cancer in Kentucky. Thank you.

BUONCRISTIANI: Thank you.