Support in unexpected places

Elizabeth stands with Dr. Kevin Haughton, Providence physicianElizabeth McDonnel is an RN at Providence St. Peter Family Medicine Clinic in Olympia, Washington. She was also just diagnosed with breast cancer.

She didn’t tell her co-workers for awhile, not wanting to bring attention to herself. When they did find out she was overwhelmed by their support.

Most notably, they purchased (with their own money) pink lanyards to wear their name badges with. They also chose a day to all wear pink. When Elizabeth showed up that day and realized everyone was dressed in shades of pink she asked if they were celebrating breast cancer awareness month. They answered, “No, we’re celebrating you.”

“I was crying the entire day,” says Elizabeth. “I had no idea the depth of support that was in my clinic, my workplace. It’s comforting to know they are behind me.”

What about you? Have you received unexpected support from someplace you didn’t expect? We'd love to hear about it in the comments section!

Customized treatments enhance breast cancer care

Editor's Note: This article originally appeared in the September/October 2011 issue of Vital Signs.

Not all breast cancers are the same, and tailoring treatments for different types is becoming increasingly common in cancer care. This approach has improved cure rates in some patients and allowed others to avoid unnecessary treatments.

At Providence Regional Cancer Center, medical oncologists utilize various methods to customize therapies. Gene analysis is one technique, which may be used when it’s not clear if a patient’s particular form of breast cancer will benefit from chemotherapy.

“The gene analysis test we use looks at 21 genes and gives us an idea of whether the patient has a low, intermediate or high likelihood of recurrence,” said Maury Blitman, MD, medical oncologist at Providence Regional Cancer Center (pictured left.) “Patients with a high recurrence score will typically benefit from chemotherapy, while those with an intermediate or low recurrence score will not gain additional benefit over the hormonal therapy they have already been prescribed.”

For other breast cancer patients, including the 20 to 25 percent who have what’s known as HER2-positive cancer, “targeted” therapies have shown success. This type of breast cancer occurs when the HER2/neu gene mutates, which can result in cancer that is often less responsive to chemotherapy.

However, says Dr. Blitman, physicians now know that combining chemotherapy with Herceptin®, a drug that specifically targets a protein created by the HER2/neu gene, can improve treatment response and increase cure rates.

As cancer physicians and researchers continue to discover new ways of tailoring treatments, the possibility of curing breast cancer – or at least managing it as a chronic medical condition – is becoming reality.

Advice from Bob: A patient's top tips

Editor’s Note: The following article was developed by a Providence Regional Cancer System patient, Robert R. Largen and his wife/editor Rosemary Shold. Bob received a diagnosis of “stage four, non-smoking, Agent Orange induced, lung cancer on October 31, 2001.” Below are some of his top tips for how he personally manages his cancer. The views reflected below are his own. If you’d like add your own tips, please leave a note in the comments.

1. Have someone accompany you to any doctor’s appointments or consultations. This person will help you absorb all the information that comes at you. Take notes.
2. Repeat back to the nurse or doctor any instructions that are given to you. Follow the instructions as closely as you can.
3. If possible, have a health professional other than the treating doctors and nurses guide you through the process. (Editor’s Note: Bob has a daughter Catherine, who is also an RN. There are many resources like this in our community, please don’t be afraid to ask if you’d like to be directed to one).
4. Keep a daily log of your health. It is a helpful resource when the nurse and doctors ask, “How is the patient doing?” And, “When did the symptoms start?” We found that the combination of happiness for making it through the day and fearfulness for what tomorrow may bring made for very poor long term memory.
5. Do something each day to better the future for the family, e.g., estate planning, distribute possessions, contact your pastor, open or close bank accounts, etc.
6. Make each day count. Achieving what is essentially a positive attitude is difficult as it is easy to be drawn down in the morass of the situation. This activity requires extreme mental discipline.
7. Take advantage of any counseling offered by the hospital or clinic.
8. Develop a network of support. We sent out 45-50 letters informing people of my diagnosis. As a result, each day’s mail brought something for me to look forward to. (Editor’s Note: This is an excellent example of where an electronic network like Caring Bridge would be helpful, Providence is currently in the process of linking up with this resource.)
9. Try to keep as near normal routine as possible in a situation in which everything has changed. We celebrated my 75^th birthday with a card party. I received over 100 cards in the mail. Once again, each day’s mail brought something to look forward to.

Have your own tips? Leave us a note in the comments!

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What does a patient navigator do?

What do you do?
Believe it or not, I get this question a lot. “What does a patient navigator do?”

I’m the person that takes all the stuff that gets in the way, out of the way, so you can get the care you need.

I used to be a runner. I didn’t do hurdles, but I remember always thinking, how do they do that?

Imagine us standing at the starting line, staring down the track at the rows of hurdles. I know you’re wondering, “How do I get over these?” But then you hear me say, “Wait a second,” as I walk down the track and remove each hurdle before walking back to the starting line so we can walk down your path together.

But what does that really look like?
When I become your patient navigator I can see the clinic schedule as well as what drugs you are taking. This allows me to populate my calendar with dates I know, from experience, you will most likely be experiencing side-effects. In my opinion, side effects can be one of the most scary things...what’s “normal” and to be expected and what’s not?

We’ll talk about your treatment experience. If necessary, we’ll get you back into the doctor, which starts with another phone call I make to your doctor’s nurse.

Going through any change alone, let alone treating your cancer, is tough. That’s why I’m here. Don’t be afraid to call. I can help you work through the obstacles but I can also just talk. Sometimes it’s nice to just think out loud with someone. That someone is me.

Customized treatments can enhance breast cancer care

Not all breast cancers are the same, and tailoring treatments for different types is becoming increasingly common in cancer care. This approach has improved cure rates in some patients and allowed others to avoid unnecessary treatments.

At Providence Regional Cancer Center, we customize therapies in a variety of ways. Gene analysis is one technique, which may be used when it’s not clear if a patient’s particular form of breast cancer will benefit from chemotherapy.

The gene analysis test we use looks at 21 genes and gives us an idea of whether the patient has a low, intermediate or high likelihood of recurrence. Patients with a high recurrence score will typically benefit from chemotherapy, while people with an intermediate or low recurrence score will not gain additional benefit over the hormonal therapy they have already been prescribed.

For other breast cancer patients, including the 20 to 25 percent who have what’s known as HER2-positive cancer, “targeted” therapies have shown success. This type of breast cancer occurs when the HER2/neu gene mutates, which can result in cancer that is often less responsive to chemotherapy.

However, we now know that combining chemotherapy with Herceptin®, a drug that specifically targets a protein created by the HER2/neu gene, can improve treatment response and increase cure rates.

As cancer physicians, we are continuously looking for new ways to treat cancer, with the ultimate goal of curing it, or at least managing it as a chronic medical condition. In our practice at Providence Regional Cancer System, we have a special committee that reviews new treatments (for breast cancer as well as other cancers) which have recently been approved by the FDA.

This committee, called the Medication Management Team, includes doctors, nurses, pharmacists and other staff. The team evaluates new treatments and makes recommendations on how to implement them in the clinic as quickly and effectively as possible in order to help our patients.

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