BREAST CANCER 10 YEARS ON

May 15th, 2013

 

My patient’s eyes lit up when she started talking about the rehab program she’d enrolled in. Those eyes had been dull up to that point, as she emerged from the chemo and radiation treatments she’s just finished.

 

Her breast cancer had been diagnosed less than a year ago. The routine mammography was suspicious, though not conclusive. An ultrasound supported that inconclusiveness – further testing was needed. The newly created rapid diagnostic centre at Princess Margaret Hospital in Toronto was contacted, and an appointment was arranged within two days. They performed a biopsy, and the woman and her husband sat before the surgeon one week later.

 

This is fast!

 

The cancer wasn’t a good one as breast cancers go. Even though she was menopausal, which is always good, the oncologist had recommended a mastectomy to be followed by chemotherapy and then radiation – all standard advice based on thousands of cases that had gone before. Treating doctors today use an online database when they discuss the treatment options with patients. While the odds of recurrence after surgery without any chemo were 50 per cent, those odds fell with the drugs to less than 30 per cent. Who wouldn’t step up?

 

Still, in the aftermath of hair loss, debilitating nausea, unremitting migraine-pattern headaches that couldn’t be quelled with her usual drugs because they compromised her liver, already hard at work with the chemo, you would think you’d be thrilled to see it end. But there was an edge to her musings. 

 

“And you’re not?” I queried.

 

“It’s more like what’s ahead now – nothing is the same and I don’t know what it is going to be.” Her hair had come back in with a tight curl, salted grey, but thick, and her weight had steadied.  I knew she had been flagged, worked up and treated with dispatch from that first suspicious mammogram. So fast, in fact, that I only saw her once throughout her entire treatment, which is a credit to getting it right at the treatment end. And here she was less than a year later, spit out the other end and somewhat dazed. That is, until she talked about that next step: her “rehab program.”

 

She has taken advantage of all the alternative and supportive therapies that the hospital offered. They all had acronyms. The one created by the late and much lamented Dr. Robert Buckman of Toronto was called Elixir,  a program focused on alternative strategies for patient support.

 

But the Health Initiative was the one she was thrilled with. It was an exercise program with a personal trainer three times a week, with the expectation that you would continue on your own beyond the course of your chemo. It has a group format much like the cardiac rehab programs for people recovering from heart attacks. In fact, both programs share the same location in the hospital. Along with the personal fitness assessments, there are nutritionists and nurse educators embedded in the program and at the ready for any questions or concerns. My patient was astounded at her fatigue and lack of endurance at the start and was sure that without the support of the program, she wouldn’t have mustered the energy to keep going.

 

The data on physical activity is impressive indeed, and I shared with my first patient the results of the University of Alberta study that showed a significant reduction in breast cancer recurrence from a program of intense physical activity, much like the one she was engaged in. More to the point, the researchers found that the harder the program, the more the women liked it; in other words, they could and did become hard-core about fitness. The aftermath of chemotherapy requires recuperation from heart battering much like that of heart muscle that has been damaged from a heart attack. The breast cancer rehab program, sharing physical space with the cardiac rehab program, is in good company.

 

Then, just days later, I said goodbye to another of my patients who died — too quick, too fast — with the same disease. She too had been flagged, tagged and treated with dispatch. The team was attentive and the care exemplary. If there was a difference between these two women in their experience of this great trial, it was clear in how this woman, an educator and sculptor, approached her cancer from the very start.

 

She had practised meditation and was a Buddhist by adult choice. She had been a founding member of a commune of artists, and her artistry had paralleled her other career as a special education teacher in Toronto’s public school system. Her colleagues at the wake spoke of the early years with her when their shared homeroom was what they amusingly called the photocopy room. “She did not suffer fools gladly,” they remarked.

 

And they acknowledged their own relief when they felt the measure of her respect. They cried as they spoke of her serenity in all things – endurance, they called it – but it was truly her habit of accepting tribulation with forbearance, and she applied it in equal measure to her breast cancer.

 

She, too, had made use of the Elixir program. She had gone back repeatedly for assistance in meditation and her yoga practice. She had volunteered as a research subject in a special memory loss investigation following chemo regimes because of her concern about resuming teaching. She’d participated in a group that dealt with reducing anxiety about cancer recurrence.

 

When I think about the number of supportive and alternative therapies that were in existence 10 years ago, I am heartened by how many programs there are today, and how easy it is to access them.

 

Ten years ago, Esther Myers, Toronto’s iconic Yoga teacher, recovering herself from cancer, brought the practice of Yoga into the Tammy Lentner Centre at Mt. Sinai. She followed that with a DVD on gentle Yoga for Breast Cancer survivors to take the message out of the hospital setting. That was groundbreaking stuff then. Now I’m reassured that these new programs underscore the inherent value of what used to be considered ‘soft’ measures to aid in treatment.

 

The chance of cancer recurring after chemotherapy and radiation was the same for both of these women –  about 10 per cent. But for the latter her cancer came back with lightning speed and aggression. As her life’s light dimmed, her friends said she painted her “room of her own’ a Mennonite dove gray, placed her chair in it along with a cozy blanket, installed a wide-screen TV, and curled up to watch it and let go.

 

One of her many sculptures at the service of remembrance was a blessing bowl turned upside down and reconfigured to be a slightly off-centred breast. But under the bowl, she had hung cascades of beads and crystals. The bottom of the stand held a small plaque on which she had written: “Healing hands, constant support, enduring care, thank you.”

 

As I’ve learned from seeing thousands of my patients live and die over the years, there are only 11 important words:

 

Please forgive me

 

I forgive you

 

I love you

 

Thank you

 

 

Dr. Jean

Marmoreo

 

Doctor. Writer. Athlete.

Advocate. Adventurer.