Independent Insights, a Health Mart Podcast
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Independent Insights, a Health Mart Podcast
Optimizing Care with Integrative Oncology - Part ONE
Integrative oncology blends conventional cancer treatments with supportive therapies like nutrition, acupuncture, and mind-body practices to improve patient outcomes and quality of life. This episode outlines what pharmacists need to know about the principles of integrative medicine, how to evaluate evidence-based resources, and counseling tips for guiding patients through safe, effective complementary options. Tune in to strengthen your ability to support cancer patients with credible, compassionate, and comprehensive care.
HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact
GUEST
Ginger Blackmon, PharmD
Associate Director of Clinical Initiatives
NCODA
Joshua Davis Kinsey and Ginger Blackmon have no relevant financial relationships to disclose.
Pharmacists, REDEEM YOUR CPE HERE!
CPE is available to Health Mart franchise members only
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CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Define integrative oncology and identify its role in supporting patients undergoing conventional cancer treatment.
2. Describe how pharmacists can evaluate and counsel on evidence-based complementary therapies used in integrative oncology.
0.05 CEU/0.5 Hr
UAN: 0107-0000-25-256-H01-P
Initial release date: 7/7/2025
Expiration date: 7/7/2028
Additional CPE details can be found here.
Hi, Health Mart Pharmacists From your education partner, CEimpact. This is Game Changers and each week we have a conversation on a hot clinical topic that will keep you current in practice and position you as a resource for prescribers and patients. Thanks for listening in.
Speaker 2:Welcome to the Game Changers Clinical Conversations Podcast. I'm your host, Josh Kinsey, and as always, I'm excited about our conversation today. Cancer care is no longer just about treating the disease. It's about supporting the whole person. In this episode, we'll discuss the growing field of integrative oncology and how pharmacists can help patients safely navigate complementary therapies alongside conventional treatment.
Speaker 2:It's so great to have Ginger Blackmon as our guest for this episode, and for many reasons not just because she's brilliant in this space and not because she's just dedicated her whole career to cancer care, but because Ginger and I have been friends for 25 years, which that seems like a lot when I say it out loud, but Ginger and I went to pharmacy school together and we studied abroad in Europe together. We have great stories and memories from that and oddly enough now my husband works with her at NCODA, so lots of connections. Ginger and her family are very special people to us. So, Ginger welcome. Thank you so much for being here. Thank you, Josh.
Speaker 2:I'm so excited to be here and I was thinking it's 20 years this year.
Speaker 2:Yeah, I know, we celebrated our 20th graduation, so we have been pharmacists for 20 years. Yeah, wild.
Speaker 3:It's crazy, but I also like you. I know we're the planner, so I don't know where our 20-year reunion is, but it didn't happen.
Speaker 2:Yeah, you know it was on me as president of the class. I was supposed to be planning that 20th year. You know what? We'll just do a 25th, We'll do a silver and just make it really big that sounds great and just make it really big.
Speaker 3:So that's the plan.
Speaker 2:That's the plan, all right? Well, ginger, again, thank you so much. As I always like to do before we get started, I want our learners to know a little bit more about you. So if you'll just take a couple of minutes to tell us a little bit about your practice site and you know the company and just I know that I know that you have a reason why you're passionate about this topic, so tell us a little bit about that too.
Speaker 3:Yes, certainly so. As you said, besides getting to travel to Europe and all those good things with you many years ago, I do have a passion and background in oncology. So soon after we graduated from pharmacy school, like within a week, I was diagnosed with non-Hodgkin's lymphoma, had it a couple of times. Week I was diagnosed with non-Hodgkin's lymphoma, had it a couple of times and in that kind of shifted my path to oncology from community pharmacy. So I ended up a few several years later in a community oncology practice.
Speaker 3:Here I'm in Jacksonville, florida. I was pharmacy manager there at a medically integrated pharmacy and an NCODA member at the time for about eight years, and then I've been on staff with NCODA and the associate director of clinical initiatives. So I've been with NCODA for five. During the time in the clinic I did become certified in aromatherapy. I used a lot of integrative medicine during my own treatment and after during survivorship, helped heal a lot of things, so really became a believer in absolutely. We have amazing, amazing oncology treatments right now. That landscape is changing every day, changes so fast, which is one reason why what we do at NCODA is so fun and unique because we get to be part of that, but also the need to combine that treatment with things that are more integrative and complimentary, sometimes a little bit more like Eastern medicine in care.
Speaker 2:Yeah, no, that's great. And Ginger mentioned another word which I'm gonna pull out and mention to our audience that I'm hoping to have an episode on this soon. But she mentioned survivorship and that was a new thing for me to hear about and understand in the space of oncology practice. So hopefully I'll whet your appetite a little bit as a listener and you'll tune back in when we release an episode at some point on survivorship. But, yes, thanks again, ginger. Such a great story and I mean your passion is so incredible and it's because, like you said, you've been through it and you really wanted to help others and to make that change and it's just so great. So let's talk about what we're here to talk about today. We could reminisce, we could go down the path of reminiscing for a long time.
Speaker 3:We could have a three-hour podcast.
Speaker 2:Absolutely. If everyone wants to sit back, we could pull out old pictures and we studied abroad before smartphones were a thing. So when I say we have pictures, we have actual printed out pictures. So I was thinking about that the other day. I wanted to grab something and I realized that I would have to take a picture of a picture in order to like post it somewhere.
Speaker 3:Yeah, and then I even like did that bad thing and was scrapbooking, so, like some of mine, I'm like, oh man, like I cut this, like everything is cut up. I wanted to make it look so nice.
Speaker 2:So nice. Yeah, it's different times, yeah, we're definitely getting old, but anyway, what we're here to talk about today is integrative oncology, and what I want you to do first, ginger, is to really define that for us, like what does that mean? What do you mean? When you say integrative oncology, you've kind of hinted to it a little bit like aromatherapy and complimentary products and things like that. So if you'll tell us exactly what integrative oncology means, so that we're just kind of on that same foundation as we talk through things today, Absolutely and I'm going to actually give you.
Speaker 3:There's a society for integrative oncology. So I will plug them and say check out their website. They have a lot of the guidelines and different things which we'll talk about shortly for integrative care and oncology, but I'm going to give you their actual definition. So they define it as a patient-centered, evidence-informed which evidence we love field of cancer care that uses mind and body practices, natural products and or lifestyle modifications from different traditions. Alongside conventional cancer treatments, integrative oncology aims to optimize health, quality of life and clinical outcomes across the cancer care continuum and to empower people to prevent cancer and become active participants before, during and beyond cancer treatment. So I do.
Speaker 3:I would love to highlight in that, again, like the evidence there, while we don't have enough and we'll talk about that as well, there is a lot of evidence towards the integrative medicine and different kind of components of that, and also patient centered, because again, we're giving a little, giving patients a little bit of power back into their hands through this but, also alongside conventional treatment.
Speaker 3:So we're not asking anyone to forego conventional treatment, to not listen to what their oncologist says but, these are things that can help really improve a patient's quality of life and even some treatment outcomes, alongside what their oncologist prescribes for them.
Speaker 2:Yeah, and those are the exact things I would have pulled out as well and I wanted to highlight. So thank you for doing that. But yeah, just to reiterate, we're not saying like, instead of the traditional treatment that would actually potentially cure you or help you through or whatever, we're going to tell you to go take some vitamin C, like that's not what we're talking about today. You know, we're talking about, again, those complementary things, those things that have shown evidence to help support, as Ginger said, the quality of life of the patient and just to kind of make that process better. So this is not in place of, this is in addition to and I think that's what's really important to note as well, and I think that's what's really important to note as well. Okay, so why is this relevant? Like why is this? I feel like it's something. It's probably not brand new, but I feel like it's gaining traction, I would say, in the last few years, and so you know what has kind of built that scope and relevance around integrative oncology.
Speaker 3:So I will say say as pharmacists, sometimes we hear it and we're a little bit afraid because it's not our traditional medicine, traditional drugs.
Speaker 2:Well, it sounds like, oh, you know, like, oh, this is this like witchcraft, or are they telling me to, like, you know, go out and scrape tree bark and you know all that kind of stuff, like that's what we think when we hear, like non-traditional or complimentary. So, yeah, I completely agree, there's hesitancy sometimes.
Speaker 3:Yeah, I also like we don't wanna tell completely because of that, tell patients like no, don't do anything. Um, it is. There are already around 50 of cancer patients worldwide that are using integrative medicine or some type, something that we'll talk about here today. So, and that I was surprised even to find out like low middle income and developing countries are included in that. So so, just everywhere the goals are really of integrative medicine are to improve again quality of life, clinical outcomes, and I think the biggest and one reason it's gained such traction is it does empower patient participation.
Speaker 3:So, when you're diagnosed and you're getting all of this information and you're having to basically do. You know you're getting all of this information and you're having to basically do. I mean you should do what your team tells you. You do feel out of control. Um, you know you have this cancer. Usually you don't expect it and I feel like having the um. Integrative medicine are things that patients can control themselves so it hands back a little bit of a sense of that control to them themselves.
Speaker 3:So it hands back a little bit of a sense of that control to them, so really important and it addresses the whole person. So I think again a lot of times with our standard drugs we're addressing physical symptoms, but it can address emotional, social, spiritual health. All of these play a role and I think more and more evidence is showing that all of the total package really plays a role in wellness and healing for a patient.
Speaker 2:Yeah, absolutely yeah. I love the idea of you know we always talk about. You know, patients need to advocate for themselves. Patients need to be a part of the process. You know, when we make decisions, it needs to be clinical decisions, with the patient, you know, informed, to help with that. And so I think it's really important that we, that we, we call out that this, that this therapy does empower the patient and it does, it does allow them to feel like they do have a say in some of the things. Because I can, I can only imagine, like you said, once you get the diagnosis and then all of these things okay, you have to do this, you have to do that, and we're going to start on this, we're going to do this, we're going to do that, and then, all of a sudden, you're not even. You're just yes, okay, yes, yes, yes, you're not even in control of anything anymore. So, yeah, so I love the fact that it brings into that that the patient and makes makes it more about them, which is great.
Speaker 3:Can I also add one more thing as far as, like, I think it's really important for us to know what we're about to talk about, like things that do have guideline support, because, if you think about it, if 50% of people are at least are going to do it anyway, like you want to make sure you're having that conversation and asking them that you can guide them towards things that are at least evidence based and not going to. That will hopefully help and that will not cause harm. So you know.
Speaker 3:I really would also encourage people to have have an open mind as we talk about these things, because if they're going to do it, at least as the pharmacist you can, you know, guide them towards the things that do have better evidence and that may actually help with their outcomes.
Speaker 2:Absolutely yeah, as opposed to just they heard it on the TV talk show. You know whatever morning show and they they're like I'm just going to do it. And you know if, if they ask us about it as a pharmacist and we downplay it or we say that that's bad or whatever, it doesn't always mean that they're going to shy away from it.
Speaker 2:Like yeah, they're probably, it's probably actually going to push them. You know in the other direction. Yeah, they're probably, it's probably actually going to push them, you know in the other direction. And then they're not ever going to ask you a question again because they don't want to want you to think that they're always doing stuff off book or whatever.
Speaker 3:So they're not going to tell you too.
Speaker 2:Exactly. They're just not going to tell you, and then you're not going to have a whole picture of what's going on and what your patient is taking. So, yeah, that's such a great point to you know, even if you I mean using the things that are evidence-based, even if you are, you know, still not I don't know what the word is like sold on the idea. I don't want to say that in a bad way, but you still should be the one that's providing the information. We're the experts, we're the medication experts. That goes across. You know supplements and other things like that as well, so we should be the expert in that space. So, yes, anytime they're asking about something, if you don't know, don't just say I don't know, don't do that, that's not proven. Find out before you say that, because we want to be sure that we're keeping our patients close to us and that they're telling us things. So all right.
Speaker 2:So with that, let's jump into what are some of the opportunities and challenges that we see with integrative oncology. So, again, from the lens of a pharmacist, because that's obviously who our audience base is and that's who we're speaking to today. So let's talk about some of the things that they need to know, in this space of integrative oncology, to be aware of what are all the space of integrative oncology, to be aware of what, what are all the components of integrative oncology? So I'll let you start. You've got listed up here. The first one is mental health support, so let's talk about that yes, yes.
Speaker 3:So I'm going to start the first three that we'll talk about. I do want to say come from the asco, which is the american society for clinical oncology. I know, kelly, kelly, your Kelly just had the chance to attend that meeting, but it's the largest oncology meeting worldwide, so it is huge.
Speaker 3:But so ASCO and then the Society for Integrative Oncology, which I mentioned earlier, have guidelines. They are published Typically anything that's an ASCO NCODA. has an NCODA ASCO guideline on oral dispensing. But you can trust those. They're well-researched. They're not going to publish anything. That's not so. The first three areas we'll talk about come from the ASCO SIO guidelines and, like you said, mental health support. So, not surprisingly, I think, up to 21% of patients, which I think may even be kind of low have been shown to have depression during cancer treatment, with anxiety as high as 17.9% is the most recent number I found.
Speaker 3:Again, I would think that that's underreported 100% percent, but even higher when first diagnosed, which makes sense right yep sure so there are evidence-based methodologies for integrative medicine here, and the top, the top ones recommended by the guidelines are mind, body interventions, yoga. There is some evidence for hypnosis. I will not claim to be an expert on hypnosis, so we probably won't talk about that much. Actually, acupuncture for anxiety, music therapy and aromatherapy comes in here, which I love. So there is some evidence as well for lavender inhalation.
Speaker 3:So, not ingesting. We never want to tell patients to ingest essential oils not ingesting, we never want to tell patients to ingest essential oils but inhalation. That could be through a diffuser or they'll be like personal diffusers. They can make that looks just like a little. You probably can't hear it if it's just audio, but it looks like a little pen or a little lipstick almost.
Speaker 3:You can cap off and you can just kind of like sniff it and that also is good for like if they were sitting in a treatment center, um, and you can use your own personal inhaler instead of, you know, diffusing it throughout the entire center right, yeah, someone may be allergic or something yeah, it almost kind of looks like a like a roll-on perfume or something kind of, yeah, and you just kind of take it off and yeah, yeah, I know what you're talking about.
Speaker 2:I, I love the. You know, the idea of music therapy, I mean something as simple as, as you know, like that is, and I think that we know that like what puts you in a happy place in general, you know, and I feel like music is that for a lot of people. So, yeah, I, I, these are great, so Ginger. When you mentioned MBIs, the mind-body interventions what's an example for the listeners on that? What do you mean by that?
Speaker 3:So there are going to be things, as it sounds, that connect your mind and body, physical and mental, but things like guided meditation have been shown to do wonders in this space and I know I'll say our team has even tried this on recent meetings and it's been pretty amazing. But he's like guided meditation.
Speaker 2:Okay, okay, great, all right. So next on the list is you kind of captured these first three, as you mentioned, so the next one in this kind of little group is pain management, so let's talk about that for a little bit.
Speaker 3:Yes, so pain management a lot of patients have pain, whether it is from their disease treatment or their aromatase inhibitor can also. Aromatase inhibitors used in breast cancer can also cause pain for patients. So acupuncture has actually been shown to help with AI or aromatase inhibitor pain, pain and also just general musculoskeletal pain. And then also massage, and I do know of several even community oncology practices, in addition to your bigger academic centers, that do have incorporated massage therapy for various patients. That can be for chronic pain and also in like a hospice if you're in palliative care, can help there as well.
Speaker 2:Wow, that's great. And then another one in that space is cancer-related fatigue, so let's talk about that one for a little bit, yes.
Speaker 3:So cancer-related fatigue, I will say, is probably one of the most common side effects Also can be very distressing during treatment. It's different. It's different and I I can speak to this. It's very different from you're like oh, I've had a, I'm tired, a, I'm exhausted, I just want to go to bed. It's persistent, it can be overwhelming for people physical, mental, even emotional exhaustion and it differs again from the fatigue that's just caused by your everyday like exertion.
Speaker 3:You can't just rest, rest it or sleep it away like it's around it has sometimes debilitating effects on your quality of life, you know, if you can't do the things that you love, or even that you need to do for your family and sometimes your occupation, so you know you may not be able to get up and work, even though you really may love to work or be may need to work to continue to have a source of income during your treatment.
Speaker 3:But it really like it. It. I think part of the problem is there's no like one cause of it. It's multifaceted, so they don't really there's not an easy treatment solution target yeah yeah, and it could be multiple causes. So you know, it could be treatment and the disease itself from all different things, but here again mind body interventions um, which is like meditation, and things um exercise has been shown, which I I believe this fully, but has been shown to help with fatigue.
Speaker 3:So it may seem counterintuitive and yeah, like go out and run a marathon, but like walking and you know, light, maybe weight, but exercise can help with that. Tai Chi, and I can never say this right, so I'm going to key gong.
Speaker 2:You're right. Yeah, I think that's it.
Speaker 3:Like cognitive behavioral therapy. And then actually here's where one of our natural products comes in. There is some evidence for American ginseng you could recommend, I would say, and we'll introduce the About Herbs app. Definitely I'm not going to give a dose on here, but that would be something you would need to evaluate the patient, the medications they're on. It's not necessarily for long-term but in short-term.
Speaker 2:Okay, yeah, Interesting. So that's a great segue because you kind of set it up as one of the interventions of cancer-related fatigue is exercise, and so the next thing on our list is to talk about how exercise in and of itself can help with integrative. It can be a component of integrative oncology. So what does that look like for if we're not using it in the fatigue related component? Like what, what should exercise look for for? Look like for a patient with cancer?
Speaker 3:So I think that this is one of the most some some studies that are coming out make this like very exciting times for exercise, cause I think things that we know now are actually coming to fruition with the evidence, studies and trials that have gone on. And I'll just give a personal aside here. I'll say during, like during all of my treatment, I made sure I walked whenever possible. Like I had a stem cell transplant and my dad my dad will tell you he was there at 6am like walking the halls with me when there was not a crowd around and I believe like that got me out quickly. Like I do believe that that helped me keep up stamina and really like respond to treatment and be able to complete treatment a lot more easily than if I hadn't done that.
Speaker 3:But there is some evidence as well here. So there's evidence that structured programs post chemotherapy significantly reduce recurrence and mortality. And we just had a colon cancer study come out it's kind of during ASCO times this year that resulted in a 37% reduction in risk of death. So I'm going to go through some of those numbers just to really show what an impact it can have.
Speaker 3:This three-year structured exercise program. It's initiated soon after adjuvant chemotherapy, which adjuvant is after for colon cancer, resulted in a significantly longer disease-free survival and findings consistent with longer overall survival. So in oncology too, our endpoint, like they were always looking for, is overall survival and so this actually showed some of that.
Speaker 3:But, colon cancer again is the third leading cancer and the second cause of cancer-related death. It's despite the treatment the recurrent disease develops in 20 to 40% of patients, and surgery and adjuvant chemo for colon cancer can cause side effects that undermine quality of life and reduce physical functioning. So the population is already at risk for, you know, decreased physical functioning. But this study showed that exercise significantly reduced the relative risk of disease recurrence, new primary cancer or death by 28%.
Speaker 3:The disease-free survival curves began to separate at about a year and then continued to separate which I found really interesting over the 10-year follow-up. So I mean that's pretty amazing, just showing you keep keeping.
Speaker 3:You can continue to do well into survivorship. Exercise reduced the relative risk of death by 37%. The overall survival curves began to separate at about four years and continued to separate over the 10 year followup. So the magnitude of benefit from exercise delivered after surgery and adjuvant chemo was similar to that of many currently approved standard drug treatments. The study concluded which.
Speaker 3:I mean that's amazing. So the increase is the equivalent of because you'll ask what does that mean? About 45 to 60 minutes of brisk walking three to four times per week, or 25 to 30 minutes of jogging three to four times a week. So I mean that's not, when you think about it, that's not huge to get that kind of a benefit To get that result.
Speaker 2:Yeah, yeah, that's great.
Speaker 3:So I know they also. One thing mentioned in the study that I also found interesting is the patients in the exercise group receive more social contacts with the physical activity consultants. So I think that was one of the things they couldn't completely rule out, that part of it even could have been related to that social interaction.
Speaker 2:Wow.
Speaker 3:And then they also concluded that you do need behavioral support programs to go along with it. So it's not just like telling patients to exercise goodbye, it's really supporting them through that. You know, having check-ins, giving them guided instruction, things that they can do, but really having, like that, actual program set up for it and almost accountability and follow up care.
Speaker 2:Yeah, exactly, wow, that's such a great impactful study. So, yeah, thank you for sharing that.
Speaker 1:I was going to mention what others would like to know, I mean exercise.
Speaker 2:this is huge because this is a cornerstone in care for so many disease states. Exercise in general, you know, for diabetes, for hypertension, for like so many of those. And so to hear it now being extrapolated and showing that it helps with cancer, survivorship, like that's it's, it's just important, yeah, so please go ahead.
Speaker 3:There's just no reason not to exercise. Yeah exactly as we're sitting in our desk chairs. So there's also a study with an exercise show the exercise enhanced immune infiltration during neoadjuvant so kind of before surgery, chemotherapy and prehabilitation. Exercise was associated with an altered even tumor microenvironment and enhanced immune infiltration. So I just found that really interesting some of the preliminary studies that it may I mean it was affecting immune systems.
Speaker 2:Yeah, which, if you think about it, it makes sense. You know, like you're revving up your system, you're keeping it active and it's going to be stronger and better to fight off things. Like I especially thought about that when you were talking about it with your stem cell transplant. Like you think about what's involved with that, like it's all about infection and you know white blood cell count and like all that kind of stuff. Like you think about like you were boosting your system and I, I agree, I think that that is what gave you, you know, a quicker turnaround than others is because you were, you were keeping your system active.
Speaker 3:So, yeah, and I think we'll see with like immunotherapy and some of the like till, because the one thing that it did is raise the tumor, infiltrating lymphocytes, which is another type of immunotherapy that's coming out. I think hopefully there'll be some studies in the future that look at that and really helping those therapies.
Speaker 2:Yeah, that's great.
Speaker 3:Utilize your immune system.
Speaker 2:Yeah, that's really good. All right, so let's move into some of the. Getting into more of the I don't know what would you say. Actual things, you take, I guess. Yeah, the actual medications or whatnot. So yeah, let's start with vitamin D. It's next on your list.
Speaker 3:Yes, so there have been multiple studies that have shown support for survival across different types of cancer breast, colon, lung lymphoma and there was one recent study, which is also exciting, I think, that women with breast cancer who were undergoing neoadjuvant chemotherapy and receiving vitamin D supplementation so 2000 IU had a higher pathological complete response rate than women in a placebo group. So some of it the study will talk about their levels and different things, but if they had a value of greater than 20, we're more likely to achieve that complete response. So again, I think further studies are needed to validate, but really exciting. I mean, how hard is it to supplement vitamin D?
Speaker 2:Yeah.
Speaker 3:Something really easy that a patient could do.
Speaker 2:Absolutely, absolutely. So, keeping in that kind of supplement space and whatnot, let's get into some of the herbal and traditional medicines that have shown some evidence and talk about those.
Speaker 3:So there are several I'm not going to really get into like any specific ones right here.
Speaker 3:But I just want to point there is evidence from traditional Chinese medicine improving outcomes in advanced breast cancer, again being used in addition to treatment, not by itself, and there are several reliable sources now, but probably the best that we use in practice we used at the clinic. We've had one of the pharmacists who runs this website come and speak at one of our meetings with NCODA, but it's Memorial Sloan Kettering, so they're a huge oncology center out of New York but, they have an About Herbs app and you can really find answers.
Speaker 3:They have everything is evidence-based research there, so that's a great place to start. If you sign up for their newsletter, I know they'll send you, like a spotlight, herb of the month or week. I'm not sure what it is, but something like that as well.
Speaker 2:And to clarify on MSK's about herbs, ginger, is that, is it strictly? I know slum catering is big in the cancer space Is it strictly about cancer care or is it just in general about?
Speaker 3:So it's in general, but it's really going to like focus on how things can be used in oncology.
Speaker 2:Got it Okay.
Speaker 3:So it has that spin, but also it's going to tell but I mean it will tell, it will give you a good amount of information on the herb that you could potentially extrapolate into some other.
Speaker 2:And to set into use in some other space.
Speaker 3:Yeah, Again, primarily it's oncology focused.
Speaker 2:Sure, sure, okay, and that's all the time we have for today's episode, but don't worry, we're just getting started. There's so much more to explore in the world of integrative oncology and we'll pick up this conversation right where we left off in part two. Be sure to join us for the next episode, as we continue unpacking practical strategies and insights for pharmacists supporting patients through cancer care. Ginger and I look forward to seeing you back here again next week.
Speaker 1:And that's it for this week. Be sure to log in to Health Mart University to claim your CE credit for this episode. As always, have a great week and keep learning. We'll talk to you next week.