Mo A 0:48
I'm very excited to welcome onto today's show. Our first guest of many an expert in many fields of psychological research among them.
Neurocognitive mechanisms underlying anxiety and depressive vulnerability and neurocognitive interventions for vulnerable populations. Nazanin Dashan is currently professor of experimental psychopathology at the University of Reading.
Following her own personal experience of breast cancer, Doctor Derakhshan founded the BRIC Centre, or the Centre for Building Resilience in breast cancer in 2015, which I'm excited to hear more about. Over the course of this episode.
Thank you very much for joining me today, Doctor Derakhshan.
Nazanin Derakhshan 1:43
Thank you for having me. Yeah. I'm looking forward to the podcast.
Mo A 1:49
So let's just go straight in. Could we first talk about something that you often mention in your own research as being ignored? Specifically the mental health of cancer patients?
Nazanin Derakhshan 1:52
Sure.
Mo A 2:02
Especially those dealing with breast cancer. In what ways is the mental health of breast cancer patients being ignored as a society, and also by national policy? And why is this the case in the first place?
Nazanin Derakhshan 2:15
Yeah, really good questions. My mantra has always been that there's no help without mental health the, the medical system is increasingly recognising this, that the mental health.
Of patients with any kind of disease and we're going to be talking about cancer and breast cancer today need to be taken into account alongside their physical treatment.
So cancer is a significant risk for psychological morbidity. So even if you don't experience anxiety or depression, pride, you're diagnosed with cancer, the cancer diagnosis and it's associated.
Treatment will put you at risk for a lot of psychological morbidities, including PTSD, which sounds for post traumatic stress disorder, anxiety, depression.
What is currently expected as a cancer related cognitive decline or perhaps related cognitive impairment, which is the classic chemo brain or a chemo fog that we refer to?
Unfortunately, that over 70% of patients in the psychological intervention do not receive treatment. Yeah, so those types of patients.
Significant majority who are in need of psychological therapy don't get it. I was reading a review recently that painted less than 25.
Thank you.
I think it was a year or a month. I'm not quite sure if spent on mental health research and considering how much money goes to the military and other purposes, it's staggering to hear such low, minuscule levels of government funding.
Doing a an all my whole house.
Now breast cancer is of particular interest to us and me, especially because it's the most prevalent cancer worldwide. It's predominantly of females that men get breast cancer too.
It's very much affecting a woman's womanhood and putting women high risk of longer term anxiety and depression.
The treatment side effects linger for many years post active treatment, and they're challenging to deal with, and many women don't have the coping resources and the, you know, self management strategy.
Is to deal with these challenges.
Research shows that women are active.
It require high risk of developing anxiety and depression as a clinical level in breast cancer, which significantly increases risk of mortality in this population and factors such as being lonely not being followed up.
Past the treatment and age, so the younger you are, the greater the anxiety and depression. While you know having a lived experience of breast cancer.
Umm.
When psychological outcomes impact clinical outcomes, we really cannot ignore them. You know these statistics are prevalent. The study that I referred to looked at a population of just under 300.
1000 patients across studies included in a big meta analysis that anxiety and depression increased risk of mortality by up to 30% independently. This is after controlling for lots and lots of factors.
Mo A 6:46
Oh wow.
Nazanin Derakhshan 6:57
Yeah.
Why is this the case that you know these statistics? These complaints are ignored for a long time, they were dismissed by medical practitioners and.
And.
There's also some kind of sigmatisation associated with poor mental health after a cancer diagnosis, one of the main reasons is that after you finish active treatment, your dearest, your friends, your employers, etcetera, expect you to be.
Fine. It'd be OK. The Council's gone. So you're all cheerful and ready to run the marathons and climb the Himalayas and new public talks and whatnot. However, whilst the Council's post so you you've gone through gruelling.
Treatment, which then starts to hit back at you in terms of its side effects and when you get out there in the real world, you're on your own. You're trying to find yourself this new normal whilst everyone else is expecting you to be OK and good and healthy.
The greater this discrepancy where you feel like you've been fallen off a Cliff and you have to do it on your own now whilst before your medical team was helping you get through the chemo or radiotherapy or surgery, etcetera.
And others have this high expectations, so the greater the discrepancy, the greater the risk of depression. OK, the where you are and others expectations. And because you've hit bottom, you've hit.
Rock bottom you can feel like a failure. You know, I should be grateful. I should be happy. I've been given a second chance. Why do I feel this? I feel shameful. I feel guilty for not being OK.
And you want to seek help for your support, but psychological support, to be frank and you know, open it doesn't feature in the cancer care pathway. If you can afford it, you know 200 lbs a session or £250 a session.
But private psychological help.
How long can you, you know, continue. But many of us need help. We need help to get back on our feet, and sometimes more than a.
Mo A 9:33
Sure, sure.
Nazanin Derakhshan 9:46
Other times we need to be able to be resilient enough to accept and embrace the vulnerabilities that we may go through and.
Rebuild ourselves so that we can not just simply survive, but to leave fruitfully. Have the treatment.
Mo A 10:14
Sure. Sure. That's really interesting stuff there. One thing I picked up on there was especially was the feelings of guiltiness of shame and in just being general, generally with conversation with friends, colleagues who.
Women who've dealt with long lasting issues that certainly seems to be a common issue, and I was just wondering in terms of.
I just want to say how.
How in obviously you said breast cancer isn't necessarily just something that affects women, but in general it does. So how does the experience of somebody dealing with breast cancer differ? I suppose from people dealing with other types of cancer, what makes it a unique, unique experience and.
What big what is the shared? What's the thing that shares people share going through the same experience of breast cancer? And I suppose it could be this question could lead on to what made you start the BRIC, the BRIC centre, and what kind of experiences.
Did you share in talking to people when you started the centre?
Nazanin Derakhshan 11:31
Yeah, I was quite knocked back when I was diagnosed with breast cancer. There was no cancer in the family breast cancer, for that matter. I have a large family on my father and my mum's side, and no one has had breast cancer. So I was the first case.
I thought that breast cancer is an old woman's disease and I was in my 30s and I had a young child. She was just under the age of 3.
And so it was a shock, and it's too much for the brain. When you're diagnosed that the brain kind of shuts down and you go through some kind of depersonalization.
And you become numb emotionally and then dealing throughout the whole treatment is difficult because, you know, it has its physical and psychological toll.
Especially with chemotherapy, the causes of breast cancer and also well known, there isn't one particular factor that causes breast cancer. So we mean, like myself, are often looking for answers, you know.
What did I do? You know, I mean, if the genetics explains less than 4% of the variance and more younger women are being diagnosed with breast cancer as we speak.
So you kind of think, did I bring this on myself? Should I have had more greens like more broccoli? Should I have exercise more? Should I have done slept more? Should I have done this? And so because there are no answers out there, you kind of left with a lot of questions.
Mo A 13:15
Yeah, sure.
Nazanin Derakhshan 13:24
And people's perception of force and effect is quite poor in general, people's perceptions of probabilities, not, you know, they're not very rich. In fact, you know, even scientists and, you know, academics, etcetera. We also have a.
Or perception of probability.
Mo A 13:46
Of course, very much a human thing. Sure, sure.
Nazanin Derakhshan 13:47
So when we say risk and when we say calls and then we say correlation, these you know can be sexually different. So many women, especially younger women, feel guilty or I've brought this on.
And my child. And because breast cancer, the younger women are also of a more aggressive type, the prognosis usually isn't that great and you think, well, it's something I've done or.
I could have done or should have done, and then you tend to kind of worry about whether it's going to come back and it's going to take your life and what should you be doing now to, you know, prevent recurrence etcetera.
The corporate breast cancer is the most common cause of malignancy in women worldwide. It kind of it is AI don't want to say it's special case gynaecological cancers, you know, come second, you know that they're quite important to address as well.
You know, in women and of course, all councillors are important. You know, we're not in a position to compare, but the myth that breast cancer is the easiest to treat and it's the easiest to cure is completely false in it's a myth.
You know, it's not the easiest to treat. It's not the easiest to cure. Every day 31 women die of breast cancer in the UK.
And while breast Cancer Month is very pink and fluffy, you know with lots of kind of feathers and you know, pink things here and there. The reality of it for a lot of us isn't pink and fluffy. The reality is that we lose.
31 women a day to breast cancer. So, and you know.
Families and partners are affected as well, so you can feel guilty for bringing this on your partner or your family. And of course, when you have younger children, the experiences are greater and because breast has the effect.
You know your womanhood, for example, sexual dysfunction is very, very common phenomenon and it can affect a majority of women. And it's the treatment that.
Lead to this phenomenon and some of the treatment that you have to take after your active treatment. So if you're on endocrine therapy with over 80% of women with a breast cancer diagnosis will end up being on for 10 years.
After active treatment, they need to take the pill to kind of help with the cancer not coming back. This affects your, you know, your joint, your cognitive function, your workability, your depression may become suicidal on the.
There's a function of taking these drugs, which the eastern Rob East region of your board.
And so, you know, considering that a large majority of the working population being female and going through breast cancer diagnosis and treatment.
Surely we need better systems in place so that we can get these women back up and running. This will come with economic cost. If I can't go back to work or if I downgrade my work if I think I'm not good enough, I've lost myself confidence and self esteem because I can't follow conversation.
After 10 minutes due to cognitive relate, you know Council related cognitive decline.
The workforce is going to be affected. My children are going to be affected. The family, you know, many systems in society are going to be affected.
Mo A 18:24
Yeah, of course. Of course. Yeah, indeed. There's lots of talks whenever in many articles about how the social care system in the UK is almost entirely propped up by voluntary work by women, women who spend their time taking care of children, taking care of their family.
For no pay. So of course it's going to have a humongous effect when billions of pounds worth of the time is being spent unpaid by women just taking care of people. And that another thing I wanted to just.
Nazanin Derakhshan 18:57
Yeah, yeah.
Mo A 19:00
Touch upon is you mentioned as well about how breast cancers got this myth around it of being a very easy cancer to treat a very simple cancer and to just sort of connect it with another one of my questions.
Nazanin Derakhshan 19:10
Yes.
Mo A 19:20
Why do you think that is? And do you think it might be in a way because we live in the UK and in the UK, Healthcare is free at the point of use there is seen as a human right. Everybody is seen to be equal in the eyes of the law when it comes to healthcare. But what do you think?
The reason is why breast cancer is being treated differently. Do you believe it is an issue of fundamentally an issue of gender inequality or women being believed less as?
Actors with agency in in society, what are your thoughts on that?
Nazanin Derakhshan 20:00
I really don't know, to be honest. I'm not sure why there is such a perception and maybe because medical advances have enabled long the survival in survivorship. Yeah, that that has been.
But maybe because it's the most frequent cancer, you know it and it's there, you can see a lot people talk about it and therefore they think it's more treated.
Treatable than you know other types of brain cancer, etcetera. I'm not quite sure, to be honest. Why this is the case. Every year, 57,000 new cases of breast cancer are diagnosed in women in the UK.
And about 300 men. It's much less prevalent in men, not that they need should be forgotten. No, it's very important to look at that as well, but.
I don't know why breast, in particular, breast cancer, has been, yeah.
Mo A 21:14
Sure, sure. But I suppose I suppose what I would follow up with that then instead is based on your own research and hearing from people at the BRICS Centre and your many conversations that you've had, I'm sure.
What would you suggest is are the best solutions for our healthcare system? How can we better tune the NHS to become better equipped for ensuring cancer survivors? In your own words, not only survive not only live, but.
Nazanin Derakhshan 21:40
Yeah.
Mo A 21:49
Sorry, no, I'm getting confused over my words, but not only simply survive, but actually can live, yes.
Nazanin Derakhshan 21:51
And you survive, but you.
Yeah, this is a really good question. I mean, this was one of the main reasons I set up brick. Brick is a unique centre for research and practise of resilience in breast cancer.
I set up break a few years after my own diagnosis. I was diagnosed in 2013, and in fact my mum was especially.
You know, encouraging me to set up brick, and I noticed the gap, you know, the supportive care gap, the women like myself.
You know, we're feeling that there wasn't support out there that there wasn't anyone to kind of listen to the emotional roller coaster that we were going through trying to come to terms with the treatment and live fruitfully.
And so forth. So when I set up brick, it was actually first the research that I wanted to pursue. So being a College of neuroscientists working on anxiety and depression for many years prior to my own diagnosis, I started looking up the literature.
To see what the status, what the psychological state of women like myself, who've been diagnosed with breast cancer, and I soon came across quite a lot of literature, you know, noting these morbid disease, these vulnerabilities.
So I decided to take this work further and identify key vulnerability factors which could then be targeted to boost resilience using the interventions that I have.
Been developing and disseminating the interventions that target attention control so brick you know, needed a translational arm and the translational arm is the support network. The Psycho Educational Network that we've got.
Continue and the psych educational network started developing and we are about two 2500 women at the moment. We've lost many due to death. But currently that's what we stand as and they are women with a primary diagnosis of breast cancer or metastatic breast cancer, you know, because about 30% of women with primary diagnosis, they want to develop incurable with.
Which is metastatic or what we refer to as secondary breast cancer. So throughout the years we developed again through voluntary work, this is all voluntary. Again the admin, my admin, women who volunteer to help out.
We are actively engaged in interacting with women and we have resilience building exercises for them on a daily basis every week.
And one of the main aims first was to raise awareness of the needs of women with breast cancer, such that this isn't fluffy in pink. And what whatnot there are these vulnerabilities.
But this is how we can address them. There's no point denying a statistic. There's no point denying to say, Oh no, it's the best we you you've beaten cancer you fought. This is not a battle to win or lose. By the way, we're not fighting.
Cancer. If we die of cancer, it's the medical system that has failed us. To be frank, you know we're not, you know. And so we shouldn't be blamed if I'm still alive and someone else has died of cancer. It doesn't mean I've won. And she has lost.
If you have an injury to your leg, if you have a leg removed, you know it doesn't mean that you have lost your battle with your leg. Does it with the injury on your leg and someone, someone else you didn't have his leg removed.
With the injury on it, he's won his battle. You know, this terminology is counter specific and it needs to be removed.
Nazanin Derakhshan 26:52
So women in BRiC have a collective voice, and the collective voice is all about raising awareness of the needs. You know, we've been to the government, we've.
You know, had many discussions with the health secretary and we've had, you know, quite a number of public engagement activities to raise awareness, but also to say how, you know, psychologist?
Like myself can help with oncology sectors so we can help the government by joining forces with oncology. You know the NHS, yes it has three.
You know, free treatment and free access, but it's all its needs, you know, it's heavily stripped off funds and breast cancer nurses or cancer nurses are absolutely swamped with dealing with patients.
And the oncologist as well. I mean, when you see your oncologist, you've got like 10 minutes or 15 minutes. You can't sit there and talk about your, you know, or your psychological issues. You know, they've got other things they. So it's not a.
It's not that exact, so, but people like myself, or if we can train people in psycho oncology, for example, which is the course that I'm going to be running from January actually at the NCIO and I can tell you.
Mo A 28:19
Nor should you have to, nor should you have to. Yeah, of course.
Nazanin Derakhshan 28:39
You more.
About this later, these courses can equip other you know, professions with an interesting cancer well-being to help oncology, you know, to help surgeons, oncologist, nurses, etcetera.
To practise more of a holistic approach, you know, people keep saying we're not our cancer, we're beyond our. We want to be beyond our camp. We don't just want to be a number and no one wants to treat them like numbers. But when you've got endless patients waiting to come and see you, I'm sorry you will become a number.
There at some point, and unless you get support from people.
Mo A 29:21
Of course, of course.
Nazanin Derakhshan 29:27
With training in psychology as applied to oncology, this system isn't going to change.
Mo A 29:38
Very interesting, very interesting. Actually, I would, I'd really like to hear more about the psycho oncology side of things because it seems as you said, well there needs to be a greater focus in the NHS, more funds being channelled in towards.
The holistic approach, people focusing on post side of cancer remission and obviously you did touch upon the linguistics of cancer as well, which is something that we need to think about how we can better address it change.
The mindset of people who are going through cancer, into people who will have a life after cancer and they're not actually, it doesn't depend on their own willpower necessarily, or their own inner magic. It's it just does come down to.
Through their clinical treatment and the resources that were given to them. But yeah, I suppose I'd like to talk a little bit more about the side of coming out of cancer. What would you see as the ideal situation in the NHS for people who?
Come out the other end of cancer who are coming out of remission, who want to reintegrate back into their own lives and sort of stabilise their own mental health.
Nazanin Derakhshan 31:06
None.
It will not always be this way if you're feeling down and rotten, you're not. You're not going to stay that way. And if you're feeling amazing and great, you're not going to stay that way. So it's a roller coaster. It's rolling with the roller coaster. Seek help. Do not feel.
So like you know, you're alone, there is support out there like support groups are really good, you know, and there are bits of misinformation here and there.
And our country to persevere and find the right type of information, I'm not quite sure which route would be best to take, but sometimes you just got to believe in yourself.
And know that you know you aren't beyond your cancer, even though you know you've been treated like it. Accounts the patients you know. And it takes time right now as we speak, it's 12 years.
But I think over 12 years is my own diagnosis and people, people say steady things to me like, you know, when I was going through treatment, things like if cancer was to happen to anyone, you're the best person it could happen to.
Oh, so and then you know, afterwards, while you've been in cancer, you know, looked at you, you've gone back into work. And I wasn't. I was feeling pretty.
Mo A 32:40
Oh, no. Oh gosh, yeah.
Nazanin Derakhshan 32:56
Low in my self-confidence and even you know, given that I was a full professor a year before I was diagnosed and people have high expectations of me to go in and you know, get back on track and.
Although I wanted to show myself and them I could, the reality of it was that I couldn't, you know, and I and I felt like a failure. A lot of the time that I failed my profession. I failed my knowledge, etcetera. Why am I not rising this challenge? Why is it that it's three years after?
My chemotherapy and my radiotherapy and I still feel like, you know, I'm out of breath and my chest hurts. After speaking for half an hour in the lecture theatre.
And through time forgetting material. And I remember the first lecture I ever gave actually was. I couldn't hear myself lecturing. I couldn't hear my voice, and I had to keep asking students. Didn't I just say this?
Mo A 34:04
Oh wow.
Nazanin Derakhshan 34:05
I couldn't hear what and it took about five years until I could laugh wholeheartedly. People used to say you'll have a very hearty laugh, but I couldn't laugh for about 5 years afterwards.
But you know, but I can laugh now. And you know it. It's embracing those hard times. But also knowledge is really important and that's why I I've developed my oncology course. So the second one oncology.
Course is a course. It is a very short course, actually, the CPD course continued professional development. A10 week course aimed at any health professional with an interest in psychology and oncology. You know that.
Wide background students, surgeons, registrars, oncologist, nurses, researchers, anyone who is interested in the person behind the cancer, you know.
And I think that the more we promote these calls, the better aware and the more knowledgeable we are, even cancer patients you know can and it's not just breast cancer, it's.
In all counsellors.
Beef up your knowledge. You know there are some good books out there. There are also a lot of self help books but you know, I asked a friend I'd shop around to get a good book that can make you feel empowered. Quite a lot of the time when you read stuff, you kind of feel, oh, God, it's bringing me more down and I'm feeling awful after
You need upbeat books. You need material that can lift you. You know, we're not denying the horrible stuff, but not what we're doing. We know they exist, but we're looking beyond.
OK, that doesn't define us so uplifting. And stay away from positivity, you know, because that brings you down a lot of the time we hear this, you know what cancer patients have now caused positivity effects.
It's very depressing, you know, that's kind of seeing the world through.
Roast into glasses all the time when we know that's not true for us, so.
It's easy to feel disheartened when you feel you can't move forward. You can't go on, you know, survivorship can be tough. In fact, there is this saying that the.
That really lie after active treatment. So it you know it, the challenges really are then that's when you need the most help in survivorship, not whilst you're going through treatment because you've got the.
Medical team there with you. But then you're kind of on your own trying to figure out who you are come to terms with your kind of new normal, that they stay and talk, you know, find like minded people and talk.
Talk. Talk about your feelings about your experiences and yeah, embrace changes.
Mo A 38:01
Excellent. Well, that's excellent. I was going to ask a question on briefly on informed consent, but I believe you've touched on many of the issues really about that, that topic because I was going to briefly talk about how when we talk about informed consent especially in a clinical.
Or medical sense. We talk about being able to have the capacity to understand all the information and you did touch upon how obviously breast cancer patients are feeling overwhelmed. They're feeling guilty, they're feeling hundreds of different emotions at the same time, and so it is quite a lot to expect from somebody in that situation to be able to properly process all of the treatment plans, understand what they're going through, and I mean, based on what the things that you said.
Talking with Cancer support groups or with members of the BRIC Centre or any sort of educate proper education that they can go through, whether through courses or.
Researching articles or any sort of reliable information, but what would you say to somebody who is in that situation who is just first been diagnosed with cancer and is feeling extremely overwhelmed, has no idea what's about to happen?
But they just need, as in, should they talk to somebody who's already been through those situations? Should they talk to another professional before they fully, or should they just take their time? What is your suggestion? Because obviously cancer can move quickly, but.
But you still need to have time to make your decisions.
Nazanin Derakhshan 39:49
Yeah. Yeah, it's really this is a delicate issue. It's so pertinent at the moment, in fact, and many of us are concerned and confronted with this, you know, the informed consent.
Treatment plans, knowledge about various treatment plans, etcetera, so.
The truth is that we want information on the options of treatment, OK. And oncologists are very good and surgeons as well. I mean most of them that I've come across.
Mo A 40:49
Sure.
Nazanin Derakhshan 40:50
Give them kudos for this. They're trying their best years and years ago it was like, oh, OK, well, is it, you know, surgery, chemotherapy, radiotherapy or no. Now there are risk assessments for recurrence.
Prognosis etcetera. They do various tests and what they're trying to do is to make the treatment plan as personalised to you as possible. OK. My first and foremost recommendation is.
You go with the feeling you have with your medical team, right? You're in conversation. Yeah. There's a lot to taking, but you will have options to this.
Scott, if you're not sure, get a second opinion. It's not a problem, OK? However, in the majority of the cases, the medical team knows best to put your trust in them. It's not to say there's no fault. Mistakes happen.
All the time, but they try to minimise. If you feel you're not happy that oh, you're, you know, the language isn't appropriate. You can't make that connection. Just ask when you go and see a therapist and think you know what I absolutely cannot get on with.
With this therapist, I know it's not going to go anywhere there this, that, that and you speak someone else. This is about you. This is not about the medical team. This is not about the therapist. You need to find what's best for you.
And advocate for yourself. This is what we don't do, especially as women. We don't advocate for ourselves so much, and I have seen women kind of just.
Going along with the delays that they're experiencing in treatment, you know and then like what you say earlier that cancer can progress quickly and if not taken seriously, you can be in danger of.
And things. So it's a it's a Whirlpool out there, but just go for it. Don't worry about the fact that you, you're upsetting people or you're going behind their backs.
Or no, this is about you getting the best treatment and, you know, advocating for yourself. Keep going on and on and on and on. There. I cannot deny discrimination in the system. There is discrimination in the system.
System, but not at anyone's fault. It's the system, you know, and it's not any particular person to point the finger at. You know, sometimes you know you'll have to follow protocol.
And you don't when you don't want to.
Don't take things badly at heart, but you know you will find the right treatment with the right people, with the right group and honestly put your faith and trust in the people who will treat you because they will be with you along the way and.
Yeah, you can get a lot of information from support groups, but be careful with support groups because sometimes you know you can have experience of bringing you down and giving you the wrong information depends on the support group monitored.
Not moderated. Moderated. Who runs the who's in there? You know, these are all the things that I have acquired through experience, to be honest.
And that's kind of the advice I'm giving to you, but.
I do know like at the moment, for prostate cancer, for example, and bowel cancer, there is some new treatment. There's some really exciting developments actually happening right now as we speak where you don't have to have the harsh treatment that we used to have.
Before, but because there have been so much development and progress that you're presented with a less tougher option, but that doesn't mean it's less effective. I think that this is what I've been seeing lately in in oncology.
Settings that you know you kind of want to throw everything at the counter and you want to.
You know, burn it and get it out of your system and you think, oh, really, if I don't have this, like, a more regressive chemotherapy, then it would be better for me. And if they think so, it's been filed and tested. It's gone through clinical trials.
Mo A 46:18
Sure, sure, sure.
Nazanin Derakhshan 46:18
So yes, yeah.
There's no right or wrong answer for this, it's just, you know, the wealth of experience that we've gathered throughout the years, but also knowing that, you know, coming from a science background from a scientific background. You it helps and I think helps.
Mo A 46:49
Sure. Excellent. Well, thank you very much for all of your insights today. It's been wonderful to hear about your own experience in particular, but also about all the wonderful work that you've been doing and all the advocacy that you're doing. And you have been doing for a long time for people.
Who have breast cancer and long may it continue. Thank you very much for coming onto my show and hopefully we'll have you on again soon.
Nazanin Derakhshan 47:15
Thank you.
OK, no worries. Thank you. Good luck.