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Breast Cancer Cancers Patient Stories triple negative (TNBC)

Lucy’s Grade 3 Triple-Negative Breast Cancer Story

Lucy’s Grade 3 Triple-Negative Breast Cancer Story

Lucy was diagnosed with breast cancer only 3 days after her 24th birthday.

Following Lucy’s mother’s second breast cancer diagnosis, both Lucy and her mom found out they had the BRCA1 mutation.

Lucy developed a lump in her breast the same year she found out she carried the BRCA1 gene. Although her doctors thought it was likely only fibrous tissue, Lucy advocated to keep pushing for tests. A biopsy revealed the lump was grade 3 triple-negative breast cancer.

Lucy then underwent fertility preservation, a clinical trial, chemotherapy, and a double mastectomy. Lucy shares processing the diagnosis, navigating hair loss and side effects, and finding support through her journey.

  • Name: Lucy E.
  • Diagnosis (DX):
    • Breast cancer
    • Grade 3
    • Triple negative
    • Stage 2/3
  • Age at DX: 24
  • Tests for DX:
    • Ultrasound
    • Biopsy
  • 1st Symptoms:
    • Lump in breast
  • Treatment:
    • Egg retrieval
    • Chemotherapy
      • Regimen 1
        • 4 cycles
        • Carboplatin every 3 weeks
        • Paclitaxel weekly
        • Olaparib, a daily pill
      • Regimen 2
        • 3 cycles
        • Epirubicin every 3 weeks
        • Cyclophosphamide every 3 weeks
    • Double mastectomy

This interview has been edited for clarity. This is not medical advice. Please consult with your healthcare provider for treatment decisions.


Pre-Diagnosis

Introduction to Lucy

In October I turned 25. I came to the University of Worcester to do English literature as my undergraduate degree. I fell in love with the place, so I stayed in Worcester, and I carried on to do my English master’s. I carried on to do that, and I actually graduated the month after I was diagnosed. 

Obviously reading is a big part. That’s why I love the place and Worcester itself and the surrounding areas. There’s just so much history for literature involved. It’s a great place for me to have done my degree. 

Before my diagnosis, I was a really big gymgoer. I’d recently started getting into the gym and going a few times a week. [I was] getting into running, which I used to hate, but I found I really loved it. That all changed with my diagnosis as well. 

I largely loved going out exploring, going for walks, [and seeing] new places with my boyfriend. We often went to Wales a few times. We just loved exploring the surrounding areas and going for days out places. I loved just going on adventures and things like that. 

I was playing the piano as well. Being at uni and staying here, I’ve not been able to do that as much, but when I go home, I love picking it up and trying to get back into it wherever possible.

Doing a degree, I found it hard to get into the reading now. When you’re kind of forced to be told what text you do, it kind of takes the fun out of it. I was part of a book club for a while. Obviously, life got in the way for my uni group and things. We’ve not carried that on [in] a while. I’m trying to find my love of reading again and get back into that as much as possible. 

BRCA1 gene 

My mom was diagnosed in 2019 for a second time with breast cancer. It’s then when she found out she had the BRCA1 gene. Knowing that it can be inherited 50-50 chance, I thought I want to know straight away whether I’ve got it. 

I think it was actually December 2020 [when] I had the blood test, and I found out January 2021. I received the results I had inherited the BRCA1 gene. I was due to start preventative measures — so annual scans, MRI scans — when I turned 25. 

What was the plan from the doctors?

I hadn’t started any scans yet because I was only 23 when I found out. I just had the blood test, and I’d had a call with a genetics counselor and a breast nurse. The only thing was, obviously, [to] tell me things with my lifestyle, exercise, [and] keep an eye out. I was on the combined contraceptive pill, and they just warned me to come off that and change to the mini pill instead. Until I turned 25, it was just be aware of myself and just monthly checks really.

Finding a lump

Around 2021, July [or] August, I started to feel a bit of a lump. It went and it kept coming back, and I thought, “Is it because I’ve now started doing more things at the gym, such as lifting? Is it something to do with that?” 

I was keeping an eye on it. I noticed something at the other side that kept coming and going as well. That happened for around 2-3 months. [I] didn’t really think too much [or] anything of it.

It was just a lump. Slight pain, but not too much. It didn’t really feel like what a typical cancer lump feels like. Around September, [the lump] had been there a bit longer than usual. When [my boyfriend] gets ill, he actually gets swollen lymph nodes. I said to him, “Do you mind just feeling it? Does this feel like what your lymph node feels like?” 

Normally, he’s [like], “I’ll just keep an eye on. It’s fine.” But he said, “No, Lucy, that doesn’t feel like it. You should tell your mom. Get your mom to feel it and get it checked at the doctor.” With him saying that, I thought, “I’m on something. It’s not right.” 

The next day I got my mom to check it. We thought it doesn’t feel like a cancerous lump, but obviously being high risk, having a 60 to 90% chance or higher chance of getting breast cancer, I thought, “I need to ring the doctors.” The next day, I rang the doctors.

Advocating for an appointment

[The doctors] were still doing a lot of telephone appointments, so I called. When I called, I said, “Can I have an appointment with the doctors?” They said, “Well, it’s only telephone appointments.” 

I was like, “I found a lump. I need to see them.” She was like, “Okay, well, we can do it in whatever time.” I made sure to tell them, “I am high risk. I have got the BRCA gene.” 

She said, “Okay, yes, you need to be seen.” She got me in for a few days later. I managed to see a doctor, and she checked it over. She didn’t think it was anything. She just thought it was fibrous tissue as well [and] didn’t think it felt like a cancer tumor. 

You can’t be too careful being high risk. They sent in a request for me at the hospital at the breast unit, just to have a scan and be checked over. That came within 2 weeks. Then I went to the breast unit [and] was checked over by the nurse initially. She thought it was fibrous tissue, but I still had a scan. 

Then he didn’t think it was anything. An ultrasound. He didn’t think it was anything to be worried about. On a scale of 1 to 5, he measured my scan at number 3, which is slightly abnormal, but nothing unusual and to be too worried about. But they did say because I’m BRCA1, they will take a biopsy. Luckily they did. Thank God they did take a biopsy.

Diagnosis

The breast cancer diagnosis

They told me I would get the results back [in 7 to 10 days], and the nurse told me it would be probably her or her other colleague, a nurse, that would give me my results. 

It was the Tuesday or Wednesday I had that, and then on the Monday, I got a call from the nurse saying, “Can you come in on the 13th? The surgeon wants to speak to you.” Hang on, it’s supposed to be the nurse that was speaking to me to give me my results. It’s now the surgeon. It can’t be good news. 

Of course, you do whatever you can. There’s that slight bit of hope, “It is fibrous tissue, but he just wants to talk about getting it surgically removed.” Yes, 3 days after my 24th birthday, I was diagnosed with breast cancer.

Were you expecting it to be breast cancer or nothing serious?

It was promising. I was trying to think, “Well, multiple medical professionals, like 3 medical professionals, have thought [it’s fibrous tissue].” I didn’t feel my mom’s cancer lump when she had hers, so I couldn’t really compare. My mom didn’t really think it was too [similar[, I don’t think

From what I can remember, my dad didn’t think it was similar to my mom’s. Of course, I was trying not to get my hopes up that it is, but of course, you’ve got that slight bit of hope. 

Until I had the results, I was trying not to think too much of it. I think I had this feeling, especially since I had the call from the nurse saying the surgeon wants to see you. Especially since that, I had this feeling it’s cancer. Why else would you want that?

What if you hadn’t gotten that biopsy?

It’s a scary thought because I kind of want to hope that they would have done a biopsy anyway. I have known people that they haven’t done biopsy [for], and luckily it’s not been cancer. But then you also do hear some horror stories of people that just kind of get a bit fobbed off, saying, “Oh, you’re too young for it to be cancer. It doesn’t feel like it.” They’re lucky if they get a scan. 

I made sure to push the fact that I had the BRCA mutation. Obviously, I was terrified, thinking, “If they want to do a biopsy, that means they think it might be cancer. But then if they don’t do a biopsy, what about if it still ended up being one and it’s missed?” 

I did say to my mom I hate the fact that she had cancer, but in a weird way, I said she kind of saved my life. If she wasn’t diagnosed a second time, she wouldn’t have known about having the BRCA gene. Then I wouldn’t have found out about it. In a weird sort of way, I told her that she’s kind of saved my life for that reason.

Lucy’s mom’s breast cancer diagnoses

The first time [my mom was diagnosed], I think it was in 1998. I was 7 months old. She got the all-clear. It was in 2019 she was diagnosed again, and she got the all-clear for a second time luckily. 

In 2020, I think she’d had a few complications, and there were a few scares. She was having more scans after, and it was only a few weeks before I was diagnosed that she got the full, “Right, you are definitely cancer-free.”

Processing the diagnosis

[They were] still doing precautions with COVID, [like] not allowing people into the hospital with you. Luckily, they said my mom could come in with me. The nurse had already told me at my initial appointment when I had my scan, whatever the results, my mom could be with me. 

Luckily, my mom was there. I just kind of remember my surgeon saying, “I’m sorry to tell you there is cancer being found in the cells and in the biopsy.” I think the first thing I said to my mom was, “Am I going to lose my hair?” 

I’d expected the result, for them to say you’ve got cancer with having to go in, but as I said, there’s that slight hope. It’s still such a shock to hear, especially only just turning 24, that you’ve got breast cancer. I remember saying to my mom, “Am I going to lose my hair?” and then thinking, “I don’t want to die.” We just both burst into tears.

Then luckily my dad was waiting in the car park. One of the nurses actually went and brought him in. Luckily, all 3 of us were able to be there together. It definitely took a while for it to sink in. 

I remember going to my boyfriend straight after, and as soon as I saw him, I just collapsed in his arms and just cried and obviously didn’t sleep at all that night. At that minute, as vain as it sounds, for me a big part of my appearance [was] my hair. 

After years and years, I just got it to a point that I loved and I was happy with. I remember thinking when my mom was diagnosed, one of the hardest parts if I was ever diagnosed would be losing my hair. It’s growing back luckily. There were other parts that I did think [about] later on, but it was just that initially for me.

»MORE: Patients share how they processed a cancer diagnosis

Losing the feeling of femininity

I think as well being told that I would most likely need, which I did end up having, a mastectomy or a double mastectomy. I think for me as well, though, that was also another large part of it. I know it’s not the be-all and end-all in life, but when I do eventually have kids, I had my heart set on breastfeeding or at least attempting to. 

Then having that taken away from me as well — so much of who I am [and] my femininity had been taken away from me. I think that’s what I was struggling to come to terms with initially.

Support from Lucy’s mother, who had also gone through breast cancer

As I said, I hate the fact that [my mom] had to go through it. Because she also had a double mastectomy, we went through the exact same treatment plan. We had the same chemo regime and everything. The only thing she didn’t go through that I did was fertility preservation. 

Having someone there that understood and knew how I was feeling, someone so close, it did help. If I was feeling down or feeling ill, she knew how I felt. Other people tried to understand, but obviously they’ve never been through it. Having someone so close to me who knew really did help.

Tests, Scans, & Fertility Preservation

What happened after diagnosis?

Everything happened really quick, really. I was just sent in for all these tests, all the scans, because they thought that it might have spread to my nodes. They said when I had the initial ultrasound, it did show that there was something there, but they obviously weren’t certain until I had further tests. 

I had another ultrasound and biopsy under my armpit to test for the nodes, which did come back positive for cancer in a few. I had a breast MRI scan to make sure it hadn’t spread to the other side and a mammogram, which luckily it hadn’t. I had a CT scan to make sure it hadn’t spread anywhere else [in] my body. 

Because of my age, I’m classed as a young adult still, so I was put in contact [with] the Teenage Cancer Trust. It was quite overwhelming because it was just within the next couple of weeks following my diagnosis. I just had all these people ringing me, telling me of what support’s out there. 

It was great to know about financial funding, talking to my Teenage Cancer nurse, talking to the Little Princess Trust about a wig. It was great to know what was out there, but just being told you’ve got cancer, then all these calls coming in, it was very, very overwhelming.

It all happened really quick. I had the scans within a short period of time. I then went for my fertility preservation, and then it was straight into chemo. Being diagnosed October the 13th to then starting chemo itself in December, there wasn’t a week that something wasn’t really happening.

What stage were you?

I know I was grade 3 and it’s triple negative. I’m not really sure what stage I was. I did ask my oncologist, but I think he said it was kind of late stage 2, early stage 3. It had gone to the nodes, but there were only a handful. 

I’m not quite sure how many nodes it’d actually gone to, but only a small handful, and it wasn’t that big. I think I was kind of in between. I never got a definite, “You’re this stage.”

Enjoying time between scans

For my birthday, my boyfriend had bought me tickets to go and see a West End show in London. Of course, when I was diagnosed, I thought, “Hang on, will I still be allowed to go to do this and go and see the show, go to London?” It was the end of October. 

My surgeon said, “Yes, when you’ve got in between the scans and everything, enjoy yourself. Make the most of it. Do whatever you can, because it’s going to be one of the toughest years of your life.” 

I tried to fit in things like that, going on a final night out. It was all very emotional, knowing I won’t be able to do anything like that again for a while, but I’m glad I was able to try and fit things in while I could.

Relationship with surgeon and care team

As soon as [my surgeon] walked in and he gave the news, I just instantly felt so at ease with him. A lot of the time, when you see surgeons or at least medical professionals, they’re just very stoic and on the computer notes. But no, he had nothing like that around him. You could tell he cared about his patient. I trusted him and his decisions immediately.

Did you feel like you could have that open relationship?

Oh, yeah, definitely. Not on that one day, but in the space of …  my initial appointment to my diagnosis till my next appointment with the surgeon. Just all of the nurses even said to my mom and dad, if they had any questions, even they could ring up, and they were happy to answer. I knew I was in really good hands from the whole team.

Fertility preservation

I knew [with] chemo there is the chance of going [into menopause] because it happened to my mom. The first time she went through chemo, it put her into a permanent menopause. It stopped her periods. I knew that was a possibility, but I didn’t really think about that at the time. 

They brought it up. I think they said, “You can go through fertility.” It wasn’t until after I thought, “Oh, yeah, I might not have kids, so I definitely want to go through the fertility preservation if possible.” 

It was also mentioned to me I could go on Zoladex injections throughout my chemo as well to put me into a medical-induced menopause to try and help increase my chances of my periods coming back after. 

I think before my diagnosis, the genetic counselor [said] that when I do eventually have children, because there is a 50% chance of passing the BRCA1 gene onto my young kids, there’s this special IVF route I could go down to try and make sure I don’t pass it on. 

I spoke to them about that as well when I went for my initial appointment to talk about the egg harvesting. I thought, “Yes, I can have eggs frozen now and use them when I do eventually want to get pregnant to try and go down this special route so I don’t pass the genes down.” It kind of worked out well.

Special IVF route

I don’t know the specifics. It was only really briefly explained to me quite recently after I was finished. It’s this type of genetic testing. For egg preservation, you can either have your eggs frozen or embryos. I had eggs frozen. What they would need to do is get the eggs fertile and turn them into embryos. 

Once they are embryos, they do this genetic test. I’m not quite sure what it’s called, but they can test for the BRCA gene. Any that have the BRCA gene, they can be discarded or I think used for scientific research and whatever they want to do with them. Then the ones that don’t have the gene I can then use to try and hopefully get pregnant with.

I could still go down the natural route if I wanted to in having kids. If I can help it, I really don’t want to pass this gene on because I don’t want to have a kid that turns [out to] have the gene. I know it wouldn’t be my fault, but I’d feel guilty knowing that I could have done something. 

I want to try and go down this route if possible. If not, I will go down the natural route. I’m not too sure fully what happens with it, but when the time comes, they told me to get in touch with a special type of genetics fertility clinic rather than just the general one, and then I can speak more to them then.

Treatment & Side Effects

What was your treatment regimen?

I was offered a part in a trial. I don’t know for definite, but I think [it’s looking at] triple negative if you’ve got the BRCA1 gene. I thought, “Yes, I’m going to do [it]. Obviously, not only helping research, but I’m going to just take whatever I can to try and get rid of this cancer.” I was on carboplatin and paclitaxel as my main course.

Alongside that, I had to take olaparib tablets every day for part of the trial, which was a kind of chemo tablet. I did that for 4 cycles. The carboplatin was once every 3 weeks at the beginning of each cycle, and the paclitaxel was every week. 

Then at the beginning of each cycle, it was a double infusion. Then after the 12 weeks — well, what should have been 12 weeks because I had the break because of my platelets — I went on to EC for 3 cycles, which was given every 3 weeks. That lasted 9 weeks. Yes.

What phase was the clinical trial?

I’m not too sure. I think it was maybe one of the later stages because I know they’d done initial trials with 2 tablets before, and then it went on to, “Right, this is the tablet that we want to use.” 

I could have either been put into the group that didn’t receive the tablet or I did receive it. I’m kind of glad I did receive the tablet, because for me, it felt like I’ve got another chemo on top of what I’m already being given.

Were you in the hospital for infusions and home for the pills? 

Yes. I took [olaparib] from day 3 of the cycle for about 12 days-ish maybe, give or take a few days. Was it 2 or 3 times a day? I can’t remember for certain. That was only throughout the first part of my chemo regime, though. As soon as I went on to EC, I stopped with the olaparib.

What side effects did you have?

I typically had my chemo infusions on a Thursday, and then it was the Monday and Tuesdays when it hit me quite hard. Fatigue. That’s throughout all of chemo. That’s been the biggest and consistent side effect. 

I was only actually sick once, and that wasn’t until EC, my second cycle, but I did feel sick. I felt quite dizzy and lightheaded a lot. Obviously, very weak. Hair loss, obviously. My platelets on EC, I think it must have been because I was just on 3 lots of chemo. My platelets dropped extremely low, so I did have to have a platelet transfusion. 

I was getting nosebleeds, bruising extremely easily. I didn’t even bump myself, and I was noticing the bruises. The main consistent [thing] was feeling a bit icky, a bit off, and just tiredness. 

I did also have a horrible taste in my mouth quite a lot, I think from the mixture of the saline solution that obviously I had a lot of throughout chemo. Also chemical taste, so that was making me feel sick quite a lot. 

When my platelets dropped as well, I was getting a lot of mouth ulcers. I had a really bad one at one point as well. For my first lot [of chemo], they reduced the dose as well. I was on a lower dose for my body to try and tolerate it.

I didn’t so much lose my appetite like a lot of people tend to do during chemo. I couldn’t eat large portions of food a lot. I was trying to eat small, but quite often. When I had the ulcers, it was just making it really hard to eat. I was having to nibble. I was given a mouthwash, which kind of helped, but luckily [the mouth sores] didn’t last too long.

What helped with side effects?

I drank a lot of water. Staying hydrated is the main thing. A lot of people can’t drink plain water, but I love water anyway. I didn’t have that issue. A lot of flavored water as well. Sugar free. I sucked on a lot of mints and things like lemon drops as well, which helped with the taste. 

Rest a lot, as much as you need to. Definitely listen to your body. Don’t overdo it. With the eating, just small, light things. They say a lot of time you start to hate the taste of your favorite foods, so I was hesitant to eat my favorite things. 

I love peanut butter, and so I was hesitant to have peanut butter sandwiches. I did actually start, during chemo, have the craving for them. Be careful with things you normally love, because a lot of the time people do come to start hating that food because they can’t tolerate it anymore. 

They do say use a lot of spices so things don’t taste as bland. I had stocked up on a lot of biscuits and health bars, so I just always had, whenever I went out, just something to nibble on if I started to feel a bit sick or felt I needed something.

Navigating hair loss

I started chemo, I think it was around the 2nd of December. My hair was initially down to my waist, so just before I started chemo, I had it cut shoulder-length so it wouldn’t be such a big shock when it did start to fall out. 

There is the option of cold capping, but I didn’t think that was for me. I didn’t want to, because a lot of people can’t tolerate it. I didn’t want to go through the potential headaches with it and being cold all the time. I just thought, “I’ll just embrace the hair loss. Whatever chemo gives me, I’ll take.” 

Then I think it was just before Christmas — so it must have been around a couple of weeks in — I started to notice the odd strand of hair coming out, but it wasn’t too noticeable. 

It wasn’t actually until I went out for a meal with my boyfriend and a couple of friends that — I was out for the meal. I touched my hair, and the first big clump came out. I tried not to ruin the night, but for me it kind of put a bit of a downer on the night. 

[Then there were] clumps every time I touched my hair, brushed it, washed it. I was trying to hold off until I went home for Christmas, so my dad could shave it for me. I think it was on the 20th, my boyfriend stopped at mine that night. I woke up the next morning, hardly sleeping because I was in so much pain from my head. 

I had a massive mat on the back of my head. I just knew. I was like, “Josh, it needs doing.” I went to his [place] that night. We went to his mom’s, and she just shaved it for me. That was on the 21st. Unfortunately, I didn’t make it till Christmas. 

I took a picture of that morning, the morning of the 21st. The difference in how much I’d lost just in that one day to the afternoon — I couldn’t have gone longer. It needed doing. I probably left it a bit too long to shave, because a lot of people do it a lot sooner than I did. It was the one thing I was just trying to hold off on. 

I didn’t cry. I was expecting to cry when it happened, but it kind of didn’t hit me until later on, a few days later. It was just kind of such a relief that the pain was no longer there. Obviously, I didn’t look as bad as I thought I was going to look. I hated it, but I was expecting to look a lot worse. I think it was just the relief that I didn’t have to cope with all the shedding anymore and the pain.

»MORE: Patients describe dealing with hair loss during cancer treatment

Remission & Mastectomy

What happened after your first treatment?

I would see my oncologist after every cycle anyway so he could review me, and I could let him know of side effects if there was anything. I didn’t have any other scans until halfway through. As I finished my first part of my chemo regime, I had an ultrasound just to see how it was progressing. 

That’s when they told me they couldn’t see the tumor itself. They could only find the marker. The lady who did it was actually really confused at first because she couldn’t find the tumor. She thought the marker had been placed in the wrong place, and she had to look back on the original scan to see that. 

Obviously, I’d had a really good response to that. Then it wasn’t until I finished all of my chemo. I then had my final breast MRI scan just as a final after-chemo check. I think it was around January, I had a kidney function test, which took all day. A blood test, but they had to keep monitoring it, taking multiple blood samples throughout the day.

I’m not sure if that was part of the trial or chemo. I’m not quite sure what that was about, really. I was just told I needed to go for it. It was after that when I found out that my platelets had dropped. I remember them taking the cannula out, putting my jacket back on, feeling my arm was wet, and just blood gushing down my arm. 

Luckily, I was seeing my oncologist the next day. He told me my pre-chemo bloods were a bit low still. Then he rushed me to have another blood test done, and that’s when he said they’ve dropped down to 12, which explains why the blood was running down my arm as much as it did. 

He just sent me for an immediate platelet transfusion. Then from then, luckily with being on lower dosage as well, the platelets went back up, and I was fine again. They were the only scans and tests I really had throughout chemo.

How did you feel knowing they couldn’t find cancer in your scans?

I remember coming out of the halfway ultrasound, and I just walked into the waiting room to my mom and just burst into tears. Obviously, I didn’t want to hope for anything until I’d had the confirmation from the nurse or oncologist, just knowing that. 

Then there’s also that I didn’t want to get my hopes up too much because there’s still little cells that could have been floating around my body that aren’t picked up on scans and only in the pathology. 

It looked like I’d had a really good response on both the halfway scan and the end-of-chemo scan. Everyone is expecting me to have a full response. But still, you don’t want to get your hopes up too much. I’d made it known to people that this isn’t definite. I won’t know it’s gone until I get the pathology results back after surgery.

Receiving the all-clear news

I finished chemo [the] end of April. A week later or so, I saw my surgeon. He told me of my options for surgery. Then a week later, I went to see him again and told him my decision. Then it was the 26th of May, I think, when I actually had my surgery. 

I think it was around the 15th of June when I went to see my surgeon again for my results. Because of COVID and it had just been a bank holiday (it had been the Queen’s Jubilee here), there was a bit of delay in the lab, so they only had my right-side results back, which came back all-clear, which we expected because cancer wasn’t at that side anyway. 

Then I got a call from oncology the next day, saying, “We’ve actually got your results back. Do you want to come and see your oncologist on Friday, the next day?” The 17th of June, I got my results back, saying I was all-clear and cancer-free.

I remember walking into the oncology suite, the chemo suite, and the nurse booked me in. Then I saw my trial nurse, and she didn’t realize I hadn’t already got my results. She said to me, “Oh, how are you feeling? How are you?” 

We said, “Well, really nervous, obviously.” She was like, “What? Why? It’s great news.” We’re like, “What, are they back?” She said, “Yeah, yeah, it’s all-clear.” Me and my mom just looked at each other in the middle of the waiting room and just cried and hugged each other. 

It was just relief. A bit awkward in front of all these patients waiting to go for chemo and everything, but just being told then and there, “You’re cancer-free.” My nurse didn’t understand why I was really nervous.

»MORE: Patients describe dealing with scanxiety and waiting for results

Double mastectomy and implant

I had the surgery 26th of May, and I received my results on the 17th of June.

It was quite stressful because my surgeon told me, “Right, these are your options.” Basically, “These are your options. It’s up to you, basically, which you want to go for.” He was saying, “These are your options. Come back in a week.” 

It was very stressful being told. In a way, it was good that I had some freedom of what I wanted to happen to my body. It was still a bit daunting being that, hang on, it’s such a big thing, and I’ve got to make this decision. It would be just so much easier if someone else made it for me. 

Me and my boyfriend did go away for the weekend as an end-of-chemo treat before my surgery. I tried to not think of these options. Just put all of that to the back of my mind. Just enjoy the time away together, and then focus more on it when I came back. 

It was just [telling my surgeon], “Right. This is my decision.” He said, “Yes, that’s fine. This is the date you’re going to for surgery.” Then I think it was, what, 2 weeks later maybe? I was like, “Oh, I don’t have as much time. I know it has to be in a certain timeframe for them from finishing chemo to surgery. Still, I don’t have as much time as I’m ready for.” 

It was just trying to prepare mentally for it and trying to figure out what I needed to take for surgery so it was all comfortable for when I got back. It was very daunting because up until that point, I’d had scams, appointments, and then suddenly there was this 2-week break of nothing. 

All I had was, “I’m having a double mastectomy. Yes, it was my choice to have the double and not just a single, but I only have 2 weeks left of my body.” It was just trying to make the most of doing things while I could, going out without putting myself too much at risk before surgery, and making the most of things and try not to think about it too much until the time came.

What were the options that you were given?

I definitely had to have my left breast removed because of the node involvement and being BRCA1 anyway. 

Because of radiotherapy, I wasn’t allowed to have reconstruction on the left side just yet. 

My other choices were: 

  • Just have the single mastectomy and that’s it 
  • Have a double mastectomy but no reconstruction on the right side and just stay flat until further reconstruction down the line. 
  • Have a double mastectomy, stay flat on the left side, but reconstruction implant on the right side 

My surgeon told me that he did speak to another surgeon, who said there’s no point in me having the right side done yet. I kind of pushed for it because as much as I hate having it done, I thought, “I’ve had cancer once at this age. I don’t want to risk having it again in the other side.” 

I definitely pushed for the double mastectomy. It was just the option of whether I wanted to stay flat on both sides or [have] the implant. I did go for the option of having an implant on the right side because when I have reconstruction for my left side, it’s sounding as if it’s going to have to be DIEP, so stomach tissue reconstruction. 

My surgeon did tell me there is the possible option, if there’s enough tissue there, of having the right side done as well, so having the implant swapped. I thought I might as well have the implant put in for now and get used to it in case, at the very worst, I can’t have it done. I am hoping I’m going to be able to have it done at both sides when it comes to it.

Reflections

The importance of self-advocacy

If you know something isn’t right with your body, especially if you know you might be slightly high risk, even if you don’t know you’ve got the gene (luckily enough I did), but even if you know you’ve got a family history of cancer, push for it. 

You hear a lot of stories where doctors [or] GPs think, “Oh, it’s fine; it won’t be this,” and they get pushed aside. There is no age limit. As I said before, cancer doesn’t discriminate against age. If you know something is not right with your body, push for tests further, even if it means getting second opinions [and] going somewhere else. Just don’t hesitate [if there are] any signs that something’s not right or usual [or] any slight change.

Reaching out to your support system

A lot of people might think, “Hang on, I’ve got something not right,” [and] keep it to themselves. Of course, you don’t want to spread it, just tell loads and loads of people, [and] spread it about and everything. 

If there’s something you’re unsure of, get someone else to check it. Even if you get someone else to check it, a loved one … no matter where on your body there’s something not right, don’t be shy or embarrassed. It’s your life at the end of the day. 

A lot of people are scared to get things checked out because they’re embarrassed about it, but the longer you leave it, the worse off it’ll be. Even if, say, a loved one checks [it] out and doesn’t think it’s anything, if you know it’s not right — you know your body — still get seen by a professional. 

I think they usually say there’s a 2-3-week rule. If something’s changed within your body and it’s not gone within 2 or 3 weeks, then that’s when you know you need to have it checked. No matter what it is, where it is on your body, don’t be embarrassed or shy to get it looked at.

Any last advice?

It is tough, extremely tough. Listen to your body. That’s the main thing. Do not overdo it, and rely on other people. If the help is there — friends, family — but you’re too embarrassed or you feel bad for taking the help, don’t. It is your health at the end of the day, and you need to get better, first and foremost. If people want to help [and] reach out to you to help out, take it.

How support helped you

Where I live, it’s like a studio apartment for young professionals and students. I’m still living in this accommodation studio apartment. Especially after my surgery, I knew I wouldn’t be able to do things like cook, clean, [or] even wash myself. I wouldn’t be able to do that on my own. 

If I wasn’t at my boyfriend’s, my mom came and stayed with me. I got her to help out with things. As embarrassing as it might be, I got her to help shower me down. I got my boyfriend to help wash and shower me down as well. Though it can be quite degrading, it’s not your fault, and you need the help at the end of the day. Don’t be embarrassed. If people want to help you and do things like that for you, take it.

What’s next after being told you’re cancer-free?

I am still having reviews with my oncologist. I think for the next year or 2, I’m going to be seeing him every 3 to 4 months so he can check me over [and] see how I’m getting on. It’s really reassuring because even though you’re cancer-free, there’s still that fear there: what about if it comes back? 

Any little pain [or] symptom, you think, “The cancer’s back. It’s here again.” It’s really reassuring that I’ve got that support and I’ve got him there. I’m going to be seeing him as much. 

My next thing is [that] in January, I’m seeing the plastic surgeon for my breast reconstruction. Hopefully, I’m going to get a better idea of the plan for that. Moving forward, it’s just focusing on moving on with my life again. As soon as my next surgery is out of the way, I can start to fully get on with my life again.

How do you feel about the upcoming surgery?

It’s reassuring. I wish I could have the surgery now. I wouldn’t say I’ve come to terms with it, but I’ve accepted what I’ve had done is slightly better. I still look down sometimes and hate the fact that I’m flat there and that I haven’t got real breast tissue in the right side as well. I hate the fact I’ve got an implant. 

I wish I could have the surgery now. I would not hesitate at the chance. I know I’ve got to recover fully from radiotherapy. I’ve got to be in the best shape possible first before I can have it done. I won’t say it’s not like looking forward to it, but I’m glad that it’s only a few weeks now until I see her and sort out what’s happening.

I think as soon as I know the plan more, then I can then start to think, “Okay, this is what’s happening. I can start to move on from this point. I can accept it from then on.” 

I’m going to have more scars on my body, which I’m not looking forward to. It’s my health, and I’d rather have the scars than not have the reconstruction. Scars fade.


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Categories
Medical Experts Oncologist Urological

Dr. Samuel Washington Latest Bladder Cancer Research & Treatments

Samuel Washington, MD, UCSF

Latest Bladder Cancer Research & Treatments

Dr. Samuel Washington is a urologist oncologist and assistant professor in-residence at the University of California, San Francisco. Dr. Washington’s research focuses on healthcare disparities.

In this conversation, he discusses how he became a doctor, the racial disparities in bladder cancer treatment and how to address those gaps.

  • Name: Dr. Samuel Washington III, MD, MAS
  • Roles:
    • Assistant Professor of Urology, UCSF
    • Goldberg-Benioff Endowed Professorship in Cancer Biology, USCF
  • Education:
    • 2007, UC Davis Bachelor of Science in Genetics, Minor in Latin
    • 2012, UCSF Medical School
    • 2018, UCSF Department of Urology, Residency
    • 2019, UCSF Master’s Degree in Clinical Research
    • 2020, UCSF Department of Urology, Urologic Oncology Fellowship

I commonly say no one’s intentionally contributing to disparities, but also very few of us are actively monitoring our own outcomes. We often see differences and attribute those entirely to the patient, [but] there could be things in our clinic or our clinical environment that we could impact.


Table Of Contents
  1. What drew you to practice medicine?
  2. How were you introduced to medicine?
  3. Underrepresentation in the number of Black physicians
  4. Muscle-invasive bladder cancer
  5. What does “who you are” mean in this context?
  6. Gaps and disparities in treatment
  7. What’s causing these differences in outcomes?
  8. What could be causing different treatment for White and Black patients with the same diagnosis?
  9. What cultural nuances affect the difference in treatment?
  10. Advice for patients
  11. What should patients do if they feel something isn’t fine when their doctor says it is?
  12. How to advocate for yourself with your doctor
  13. Other factors that can affect diagnosis and treatment
  14. It may take longer for older women, particularly women of color, to be diagnosed
  15. Psychological barrier of seeing blood in your urine
  16. If nothing’s changing, that’s a huge red flag that it’s not being addressed properly
  17. Addressing these issues
  18. Representation in clinical trials
  19. Upcoming research on bladder cancer

What drew you to practice medicine?

I was introduced to medicine when I was 7 years old, so I was one of those lucky ones that got early exposure. As a child, it was just the fascination of what people are doing. It hit all of the bases in terms of being a way to help people, but also a way to engage in an academic sense in something that was quite interesting. 

You’ll see a lot of us, particularly those in academics, there is an intellectual component to what we do that drives our research. The research drives the questions, and how to improve patient care feeds into the research in and of itself. It becomes this kind of self-fulfilling, self-enriching cycle.

How were you introduced to medicine?

I grew up in Houston and a town outside of Houston called Sugar Land, Texas.

No one in my immediate family was in medicine, but my mother had a friend who was a cardiothoracic surgeon. She was always trying to get us exposed early to different professions, and thankfully she was in a job that allowed us to do that. 

Once my family heard that, they kind of fostered that throughout. It became really trying to find ways to volunteer or get more exposure throughout my entire career up through college to understand what medicine looked like.

Underrepresentation in the number of Black physicians

I think even throughout medical school, we’re always told that Black patients are at greater risk of X, Y, or Z. It was just a way things were explained. We were supposed to memorize that these medicines work better in Black patients. Black patients were at greater risk of X, Y, and Z, and that’s just the way it is. 

I think when you start to question that and understand the why, rather than just being presented with observations, it becomes a little bit more interesting. You see where the large gaps are. Then for me personally, we talk about Black men being at increased risk of prostate cancer, for example. 

I’ve yet to see anything that could tell me what my personal risk is, myself being a Black man, a physician [with] higher education, formal education. The fact that we don’t have that, but we continue to talk about disparities just tells me there’s a lot we don’t know. Not much has been done to really flesh that out, generally speaking, within the field of urology. There’s a lot of area of improvement there that needs to be addressed.

Muscle-invasive bladder cancer

Disparities in the bladder cancer population

Overall, in general, we think of bladder cancer as either being muscle invasive, so growing into the muscle wall of the bladder — as I call the bladder kind of a balloon made out of muscle — versus non-muscle invasive, where it’s just on the surface or lining the inside of the bladder itself. 

Our treatments are different, depending on which group you’re in. We know that for patients for whom the bladder cancer has grown into the muscle, across the board, people are not getting what our guidelines say they should be getting. Depending on the cohort you’re thinking about, half of people will get some guideline-concordant treatment. 

There’s a question of guidelines being appropriate versus equitable, but we know that based on where you live, how far you are from a facility that treats bladder cancer routinely, [and] who you are are all things that can impact the quality of care and the type of care that you get. I think those are the key things that we see in bladder cancer that we hope to look at with some of our research.

What does “who you are” mean in this context?

It can mean a lot of things. A lot of the research that I’ve looked at is around race as a social construct, so not just biology and seeing that there’s a biological difference between these peoples and that that is the cause of the differences and outcomes that we’re seeing.

[We’re looking at] how society is framing these people, Black versus White, insured versus not, educated versus not. All these different identities impact one another to lead to these outcomes that we’re seeing that are differences between groups.

How many bladder cancer patients have muscle-invasive cancer?

When we look at the overall cohort, I would say, depending on what you’re looking at, 25%, around there, 20%.

More aggressive treatment and worse prognosis for muscle-invasive cancer

If we are talking about bladder cancer that’s grown into the muscle, that’s muscle invasive, the gold standard for the last 20, 30 years has been removal of the bladder and rerouting the urine through one of many different ways. 

What has been increasing in interest recently is trimodal therapy, which means using 3 different methods to preserve the bladder but still treat that aggressive bladder cancer. We know the type of treatment you get [and] how long it takes for you to get that treatment are all factors that impact your survival after diagnosis.

Recommended guidelines for muscle-invasive bladder cancer

I’d say broadly for muscle-invasive disease, our two options currently would either be radical cystectomy, which means surgery to remove the prostate and bladder and reroute the urine, versus trimodal therapy. It’s a combination of radiation, chemotherapy, and scraping out any residual cancer there may be to treat the cancer but leave the bladder in place. 

As part of that workup and evaluation, you should be getting scans to understand if all the cancer is just in the bladder or if it is moved outside the bladder. As part of that, you should be talking with a medical oncologist to understand if you can get chemotherapy beforehand or after to help treat the cancer in any small cells that may be in the bladder or outside. If those things aren’t happening, if you’re not getting guideline-concordant care, then we know we’re chipping away at your survival risk over time.

What other treatment could they be getting, and how does that affect the outcome?

What that means is if patients aren’t getting treatment within 90 days of their diagnosis, if they’re not getting guideline-concordant care, they’re getting care that may not cure or control the cancer. Functionally, what that means is they’re going to be at higher risk of the cancer spreading [and] higher risk of eventual mortality or death caused by the bladder cancer, which is what we want to avoid.

Gaps and disparities in treatment

What are the current gaps in guideline-based treatment?

Guidelines in general are a set of recommendations by our overarching governing body telling us, based on the most updated literature in research and the consensus statement of experts, what this patient should have based on the type of cancer or disease that they have. 

Those are what our guidelines are. It’s taking the mystery out of medicine, but it’s really kind of an algorithm. We find where these people fit in terms of the cancer staging and characteristics. Then we look at the guidelines, and they tell us what should offer the best outcomes for them.

Major governing bodies

There are a few — there’s our National American Urological Association, there’s the NCCN (National Comprehensive Cancer Network) — that are overarching organizations that accrue recommendations from experts in the literature to give evidence-based recommendations of what we should do.

Frequency of updates

Almost every year or every few years, particularly if there’s a new clinical trial or a new change that really changes the way that we practice in terms of a new study or a new drug.

Results of studies on treatment impact by race

From a study that we did using National Cancer registry data, we saw that when you start looking at not only disease characteristics but other non-clinical factors — so patients’ education, their insurance, so on and so forth — we saw that Black patients had 20 to 25% decreased odds or likelihood of getting guideline-concordant care compared to white counterparts with the same disease treated in the same location. 

You start to see differences like that across different groups. The issue is that it’s not uniform, so each group has a different relationship or association that we’re seeing there, and we don’t have a clear understanding of why that is.

What’s causing these differences in outcomes?

It’s a good question. Thankfully, there are large studies happening now focused on patient-reported outcomes, so what’s going on from the patient perspective. I would say what’s not happening now is what’s happening at the physician or the facility level. 

We have cancer registry data that is collected, organized, and reviewed by different research groups, but it doesn’t really tell us in a way that gives us feedback how our practice is performing. It doesn’t tell us, are there disparities at our practice? That requires a large infrastructure of a practice or an institution to be able to do that, and that’s not present everywhere yet.

What could be causing different treatment for White and Black patients with the same diagnosis?

Thankfully, over the last few years, we started to address structural issues related to differences in care, structural racism, [and] institutional barriers to care for some people. We’ve seen this come into play even with telehealth. Functionally, patients need to have a smartphone or a laptop in order to participate in telehealth. If you don’t have those, [if] you don’t have access to broadband, or reliable Internet, you can’t have the same outcomes. We’re not measuring any of this stuff. 

We also have to take a look at the providers themselves. I commonly say no one’s intentionally contributing to disparities, but also very few of us are actively monitoring our own outcomes. We often see differences and attribute those entirely to the patient, [but] there could be things in our clinic or our clinical environment that we could impact:

  • The educational materials that we use and the required health literacy level for that.
  • How we provide access to care for different patients. 
  • Are there things that could help patients in terms of transportation, social work, and so on and so forth? 

Those things are not commonly measured at the same level that we monitor cancer diagnoses.

What cultural nuances affect the difference in treatment?

I think part of it is an understandable, and I would argue justified, mistrust in the healthcare system, given the history that we’ve had in the approach that medicine has used to justify some societal pressures and patterns. 

I think what it comes down to often for patients that see me is for them, there is a shared life experience that we have that provides more comfort. That doesn’t mean that other practitioners that don’t look like them will not offer good care, but it does potentially provide a level of comfort that is not something that they’ve encountered before.

Instances of that that we’ve seen would even be prostate cancer screening, for example, in barbershops or in churches, bringing information to the patients, rather than us in our sterile clinical environment telling patients what they should have. 

It does impact patients’ perception of care. We’ve seen how it impacts patients’ reluctance with new medications [and] adherence to different protocols. It does have an impact. It’s just that we haven’t measured it all that well thus far.

Advice for patients

What are some tips for patients?

I would say, generally speaking, if you see blood in your urine at any point, I would ask that that be worked up. That could be either just repeating a test, but oftentimes if you’re seeing blood in your urine, you need to see a urologist. 

That’s kind of right up front in terms of not missing a timely diagnosis evaluation of potential cancer. If you have cancer that’s invading into the muscle, it’s worth asking, “Can I speak to someone that treats this routinely?” Because all urologists do not treat everything routinely. 

I think that it becomes an issue when you see someone who does bladder cancer management as their primary focus versus someone who treats 1 or 2 bladder cancer patients a year. Both are trying to help you, but the comfort [and] the level of expertise in the nuanced information may be different between those 2 providers.

What should patients do if they feel something isn’t fine when their doctor says it is?

I think it’s worth asking, “Why is it fine? What would make it not fine?” I just have to remind people that everyone’s doing this already. I commonly get questions about negative tests [and] about positive tests. People are asking for more information. They’re looking for more information. 

I think when people are worried about upsetting their doctor or getting the doctor mad for asking too many questions, that’s not really a thing. That’s already happening. I feel like people don’t understand that it’s happening all around us all the time in general anyway. It’s much more common than people would guess.

How to advocate for yourself with your doctor

I’d say the key things that I try to tell everyone are you need to feel comfortable with what’s happening. If you’re not feeling comfortable with the provider or the information, you need to feel comfortable. 

If that means asking more questions of that provider, if it means finding other ways to get more information like the Bladder Cancer Advocacy Network, if it means going through support groups or peer groups for others who’ve been down that road. Getting more information is key so you feel comfortable. 

Sometimes that’s a second opinion. Sometimes that’s just, “Hey, can I ask this doctor a few questions in an informal setting?” At the end of the day, you have to feel comfortable, so whatever it takes for that, because people are already doing it.

Other factors that can affect diagnosis and treatment

Generational differences in comfort level at the doctor

Depending on the generation, people’s background, [and] their comfort with health literature and all of the jargon we use, there’s different levels of how comfortable people will feel asking questions of the provider or asking for a second opinion in general. But that’s always an option. It’s covered by most insurances, and there are ways to ask questions in a manner that will not alienate your provider if that’s a concern.

It may take longer for older women, particularly women of color, to be diagnosed

I’d say women who are found to have repeated tests of blood in the urine or they see blood in the urine, sometimes these can be attributed to recurrent urinary tract infections. Whether or not there’s a positive urine culture [or] urine test showing bacteria, they will be routinely treated with antibiotics. 

But what is missing is the workup to make sure that it’s not a cancer that’s hiding there and causing the bleeding. That can lead to delays as people get treated with antibiotics, and you don’t see any change in the symptoms. It’s because we’re not treating it correctly.

Particularly in those settings, particularly in women who are past menopause, postmenopausal bleeding is most certainly a concern to make sure we don’t miss a cancer diagnosis or something else that may be going on. 

Psychological barrier of seeing blood in your urine

I would say I would feel incredibly worried if I saw blood in my urine. It takes a little bit of time and a little bit of effort to get past that and understand that is not something that’s normal. 

I always tell people I would rather you ask the question, get it evaluated, and catch something early or it be nothing than the other way around, delay things, and miss a timely diagnosis.

If nothing’s changing, that’s a huge red flag that it’s not being addressed properly

I tell everyone that we are just humans who practice medicine. We are not infallible. We don’t know everything. It goes against the idea of a physician knowing everything. There’s a lot we don’t know. 

I think at the end of the day, you need to make sure you know if there’s cancer or if there’s something else there. Understanding that a workup needs to be done and if you’re trying things and there’s no change, it’s time to reevaluate things.

Addressing these issues

What can we do to comprehensively address the inequity?

I think there are a few different facets to this. What is done currently, I would say, in some of the patients that I even see, when they are not getting satisfactory answers from their provider, they reach out to friends, or they ask, “Hey, can I see your doctor? Hey, do you know a doctor? Can I talk with that person?” 

That happens to me. It happens [to] my colleagues all the time. That’s a way to get more information. I think what needs to be happening kind of at a systems level is checks. We need to monitor these things. What is happening with patients? Are we seeing differences in outcomes in our own practice? 

I think intuitively all providers will say, “No, there’s not,” but we know that that’s not true. It’s not intentional, but no one’s looking. I think that when it comes to advocacy groups, advocating to be part of these research projects [and] focusing on projects that are relevant and pertinent to the patient, rather than just the investigator or the clinician, is important. 

I think when it comes on a regulatory standpoint, it’s very tough to pull that nuance into regulations without cherry-picking happening, so people kind of selecting or ignoring specific patients to buffer or pad their outcomes. There are a few different ways for us to improve it at different levels. At the end of the day, I think this is a multi-level issue that’s not just the patients. It’s not just providers, not just system.

Representation in clinical trials

There’s a whole different discussion of how clinical trials don’t reflect the population. How can we take information from a clinical trial and apply it to a population that wasn’t included in the study? 

I would argue my goal would be to find patients and treat them so patients don’t need a clinical trial. Their disease hasn’t progressed to the point where they need that. That’s a goal that I have and others have, but it’s a little bit different than the recent push to include representation in drug clinical trials, for example.

Have you had Black patients thankful to have a doctor who looks like them?

I get it not infrequently that a Black patient will just say that they’re happy to see me or someone that looks like me. It just reminds me that of the urologic workforce, it’s less than 3% of us, for all of urology, that are African-American [or] Black. [It’s] a much smaller percentage when you start to chip away and look at different subspecialties. 

Again, it’s a level of comfort and shared lived experience that some patients have. Multiple patients or just advocates come up to me and just say they’re glad that there’s someone that looks like them. They’ve never met a Black urologist or a Black urologic oncologist, and I think that matters. 

It may not be important for everyone, but I think for some patients, it is a game changer in their comfort with the care that they’re getting. It has absolutely nothing to do with the quality of the care I’m actually providing.

What can treatment providers do to make their patients more comfortable when they don’t have shared lived experiences? 

I think embracing shared decision-making in general. It’s become part of our guidelines. Everyone says it should happen. Understanding patients’ level of comfort with our jargon, understanding if patients have questions, asking them what other questions they have, [and] making sure that they truly understand what’s going on are little things that we can do. 

When you start to see patients who are lost to follow-up or missing appointments, simply asking them, “Is there something that can be helped? Or what barriers are you dealing with?”

[These] are questions that are not part of our questionnaires. They are not part of our clinical algorithm, but they’re very impactful for the care for the patient. I think asking those questions, which only takes another minute or two, can be hugely impactful.

Upcoming research on bladder cancer

I’d say that there’s a lot of ongoing research. I would tell patients who are interested in more information about bladder cancer, the treatments, support groups, and ongoing research, there are many outlets out there. 

Bladder Cancer Advocacy Network is one that is focused entirely on this. Also, just asking your provider, “Are there resources here that I can look at? Are there clinical trials or support groups or information?” [That’s] another thing that I would like to get across.


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Categories
Cancers Colon Colorectal Patient Stories

JJ’s Stage 4 Colorectal Cancer Story

JJ’s Stage 4 Colorectal Cancer Story

Despite no known family history of cancer, JJ was diagnosed with colorectal cancer at only 27 years old.

After brushing off abdominal pain for months, JJ went to the doctor, which led to an emergency CT scan and colonoscopy.

JJ found out his cancer was caused by Lynch syndrome, an inherited disorder that increases the risk of getting cancer. The doctors tried 5 different chemotherapy regiments, but they were all unsuccessful.

Finally, JJ joined a clinical trial that has kept his cancer from spreading further, beating the 25% odds of surviving past 5 years after diagnosis.

JJ shares the reality of being on lifelong chemotherapy, finding support in Man Up to Cancer, starting his advocacy journey, and the importance of listening to your body.

I’m beating the odds every single day I’m alive.

JJ S.

  • Name: JJ S.
  • Diagnosis (DX):
    • Colorectal cancer
      • Stage 2-3
      • Stage 4
  • 1st Symptoms:
    • Throbbing abdominal pain
    • Blood in stool
  • Age at DX: 27
  • Tests for DX:
    • CT scan
    • Colonoscopy
  • Treatment:
    • Surgery to remove tumor
    • FOLFOX chemotherapy
      • Fluorouracil (5-FU)
      • Oxaliplatin
      • Folinic acid
    • Pembrolizumab (Keytruda)
      • Infusions every 3 weeks

This article has been edited for clarity. This is not medical advice. Please consult with your healthcare provider for treatment decisions.


Pre-Diagnosis

Introduction to JJ

I’m JJ Singleton. I’m from a small town in western North Carolina. I usually just say I’m from near Asheville because everybody’s heard of Asheville. Nobody’s heard of Canton, North Carolina, which is a town of about 3,000 people. [I] grew up in a community of about 1,000 people, so [a] very small town, country oriented. 

I was a huge sports person. [I] grew up playing basketball, football, ran track, [and] played college football for 2 years before too many concussions made me quit.

Other than that, the only really good thing about me [is] I’m a huge nerd, like “Harry Potter,” “Lord of the Rings,” [and] “Star Wars.” I’m very unashamed [and] just admit that I love all of that, and it’s one of the joys of my life.

Then [with] “Star Wars,” I became a huge fan of it after I got sick. I associate falling in love with it as something that helped save my life. [It] allowed me to escape the whole cancer thing. 

[I] even got a tattoo of [the] phrase, “Never tell me the odds.” One of the authors actually even put my Instagram name in a book for “Star Wars.” It’s been a huge part of my life the last few years.

1st symptoms

It was around 2015, a little bit before that. After I got hurt playing football —  that was like 2008 — I just let myself go. I started eating a lot, quit working out (I lived in a gym while I was playing and athletic), [and] drank way too much in college. 

At the beginning of 2015, I was at 315 pounds, and I decided to get healthy again. I started going to CrossFit with one of my old football coaches, eating healthy, and started losing weight. 

Around Memorial Day of that year is the first time I felt a throbbing in my abdomen. Me, typical stubborn male, [thought] I pulled a muscle because I was doing Tuesday workouts, getting ready for a competition in August. 

All summer, I associated it [as being] a pulled muscle or my stomach was adjusting to a totally new diet with actually eating healthy. Through that summer, the pain would come and go. It would get worse. I was starting to have issues using the bathroom. 

I did the competition on August 1st. After that, my body crashed. I couldn’t eat, I couldn’t drink without becoming violently sick to my stomach, and I was losing about 5 pounds a week at that time because I just wasn’t able to eat. I was dehydrated every day. 

I would lay in bed and look at my symptoms, and the bottom was always colon cancer or cancer. I was just like, “That can’t can’t be me.” 

Then my mom made me go to the doctor, and by that point, I could put my shirt up against my stomach and you could see the tumor throb through the skin. As soon as the doctor looked at that, he was like, “You got to go get a scan right now.” That’s kind of where it all started.

The Diagnosis

How much time passed between your symptoms starting and going to the doctor?

It was from Memorial Day, so May to September 4th, because September 4th is when I went to the doctor and went through the scan. 

They said there was a mass, and then as soon as he said that back in the doctor’s office, all the dots connected from the last few months of what I was dealing with. Before I even had to go get a colonoscopy a few days later, because it was Labor Day weekend, I knew it was cancer.

What was that feeling?

It was just a feeling that it all made sense. Why I was going to bed at 7:00 when I was dead tired, [and] why I was having so much pain and not using the bathroom and losing weight. Just everything that I’d been going through that I had come up with some excuse for in my head. 

I grew up in a culture where we didn’t go to the doctor. I’ve been to the doctor to get sports physicals and then when I broke a finger in middle school. Other than that, I never really went to the doctor for anything because it just wasn’t something we did.

When [my mom] made me or told me I was going to the doctor, I knew I looked bad. I knew it must be really bad to get told that I was having to go the next day.

What happened after going to the doctor?

It was a whirlwind because, like I said, that was on the Friday of Labor Day weekend. By the time that day ended, I’d already had this colonoscopy scheduled for the Tuesday when everybody started back to work after Labor Day. 

I got to drink the prep on Labor Day there. Usually that’s one of these weekends I look forward to in the year the most because it’s the opening weekend of college football. Months before it, [I already] took a long weekend that weekend. 

Most people go to the lake or the beach. I sit in my living room and drink beer and watch college football all day. I didn’t watch one single game [because] I was in so much pain. I’d already told my family and people that I knew what it was. 

[I was] going through that and just feeling like, “How could I have cancer at 27 years old?” Then that Tuesday happened. It was [the] colonoscopy, meet with the surgeon the next day, and within a few days I was in the hospital for surgery.

My colon was about 95% blocked.

They said I was the youngest person that they had seen in a long time, just because we’re such a small area. They were like, “We don’t know why you’re so young with this massive tumor.” Then they’re like, “You should have come in months ago, as soon as you felt the pain.” 

I was like, “Well, now I know that, but back then I wasn’t thinking I ever needed a doctor.” 

Then they were like, “This has probably been growing in your colon for years to get to this big.” 

I was just in disbelief. I was just finally getting my life healthy.

Did you feel pain or anything before Memorial Day?

No, because the way it grew and the position it was, as soon as it got to that certain size is when I felt it. It was in there and growing. It kind of grew horizontally through the colon. Then it just started growing. 

It was slow growing until a certain point, and then it just started growing exponentially. As soon as it got big enough to where it started obstructing and pushing through the colon into the small intestines is when I started feeling the pain.

How did you process the diagnosis?

Very badly at first. I was in disbelief. I went numb. Even when I was going to tell my grandparents and my dad and stuff, I was just kind of like, “Okay, yeah, this is it, and I don’t know what’s going to go on.” 

Then as the days went by, I went into that kind of sports mindset I’ve had my whole life, like, “Okay, this is what they’re telling me. I’m going to do surgery, recover, 12 rounds of chemo, and then hopefully you’ll be done.” I had a game plan. 

I was just like, “I’m going to put my head down, put the blinders on, get through it, and then get my life back.” [That] was like the game plan for me then. I know looking back now that probably wasn’t the healthiest thing, because I was like, “I could shoulder it all. I don’t need help.” 

My family was there to help me, to take me to chemo, and be there at the hospital, but I was like, “I’m going to get through it. This is going to be a very small chapter in my life, and I’m going to go back to being who I am.”

»MORE: Patients share how they processed a cancer diagnosis

Treatment

Surgery and genetic testing

After I had the surgery, I ended up being in the hospital for 16 days because my body did not like to heal right. They had to go back in for a second surgery to make sure there was no leakage because I had bile that was just building up in my abdomen. 

That was the first sign that my body did not like surgeries and hospitals, because I’ve been in there way too much. After that, they were like, “You are so young. We want you to go to Duke just to see why you have this cancer.” There was no real family history of it. 

I went to Duke. They got me genetically tested. I have Lynch syndrome, which is the reason I got cancer so young. The reason we didn’t know anything about it is because we had such a sketchy family history in parts. 

My dad’s side of the family didn’t go to the doctors at all. My grandma had some brothers that died early. Then on my mom’s side, my grandma didn’t really know much of her family history just because back then they moved, and there were no records of it. Somewhere down the line it came through, and it just decided to pop up with [me].

Before 15 [or] 20 years ago, if anybody in the family died, they weren’t getting [any] autopsy or anything done. They were just putting them in the coffin, burying them, and that was it. 

I had no idea. Genetics has come so far.

Did you know about colorectal cancer?

Not at all. The only thing I’d ever really heard about it is older people got it, and all the TV sitcoms and stuff when people would make fun of people, [like] “I have to go get a colonoscopy.” That’s all my whole knowledge of it was before this.

Did you research or ask questions?

I asked questions. At that time, my mom was coming out to the doctors and stuff with me, so she would ask a lot of the questions. I realized quickly after a while in the doctors’ offices, I would just go numb. I’m like, “Tell me what I’m doing, and then y’all can talk about the questions.” I would research.

I never liked talking about my bowel movements or what was going on with my colon or anything like that. I’ve realized a lot of people are like that. That’s been one of the things, too, about breaking the stigma against colorectal cancer. You hear people all the time [who] have no issues talking about leukemia or breast cancer, but people don’t want to ask you about your bowel movements.

»MORE: An experienced colorectal cancer oncologist shares guidance to patients & caregivers, questions to ask

Having trouble asking for support

My family has always been supportive. They were like, “You can talk to us about anything.” Still, it’s like they didn’t really understand it because they’ve never been through it. 

At that time, I had no idea there were so many organizations and support [options] out there. Like I said, I had the blinders on. I wasn’t going to ask for help. I was just like, “I’m doing this.” My ignorance led me not to search for message boards and organizations at that time. [I] tried to shoulder it all myself.

Starting chemotherapy

After I got out — I got out around the beginning of October — they were like, “Take 6 weeks to heal.” That’s when I went to do the genetic testing. Then my oncologist in Asheville was really good friends with my one in Duke, so they kind of worked together as a team. 

[They] allowed me to do all my treatments 30 minutes away in Asheville instead of 5 hours away in Durham. They came up with a plan. They thought they had all the cancer out from the surgery. 

Let’s just go through the 12 rounds of FOLFOX, which is the normal first line of defense of colon cancer. We started that in November of 2015. I was not ready for chemo. You go through the whole education of like, “Okay, this is what chemo can do to you. This is what it’s going to feel like.” 

It’s all made by people who’ve never had it. I was like, “Okay, it’s going to feel like a bad hangover. I went through 5, almost 6 years of college. I know what that feels like.” [I] was totally wrong. [I] went in there that first time, and it knocked me for a loop. I was not expecting that kind of feeling.

Drugs in your chemotherapy regimen

The FOLFOX was the 5-FU, oxaliplatin, and [fluorouracil]. I can’t pronounce some of the drugs’ names. Oxaliplatin was the hard, harsh drug of that cocktail.

What side effects did you have?

I had horrible nausea there. Within 30 minutes of getting the drugs in there, I could start feeling my stomach do flips. [I] had diarrhea constantly [and] had no appetite. I had to force myself to eat a little bit or drink. 

Then with FOLFOX, it has a cold sensitivity. You can’t drink anything cold other than lukewarm temperatures, which I hated. It was a chore to drink room-temperature water for 3 or 4 days. I’ve had horrible mouth sores since the very beginning. 

My whole family, we’ve always had fever blisters and sores on our mouth, so bad genetics to begin with. Then you had chemo and the anxiety and stress that that brings. That was one of the things that has impacted me to this day.

It started by just having [what] almost felt like fever blisters on my lips. Then as the days went by, I would feel sores on the gumlines, and then my tongue would lose all its taste buds and feel raw. Then I would feel like I have strep throat with sores down my throat. 

I couldn’t eat anything other than soft foods. I’d been so used to that with eating after my surgery. I was so sick of it, and it was harder to get the proteins and the nutrients you needed to help your body recover. It just started a long journey of really not enjoying eating.

»MORE: Cancer patients share their treatment side effects

What helped with side effects?

They gave me some medicine to help with the neuropathy, and it kinda seemed to help a little bit. I still have neuropathy to this day. The nausea medicine [helped]. I started taking the pre-nausea meds the night before and kept [taking] it every 6 and 8 hours through 3 days, even if I wasn’t sick at the beginning, just to stay ahead of it. 

Then I started doing the edibles to help with the nausea. That was one of the few things that allowed me to be hungry and help with the nausea, because I was losing weight at first. Those were really the things that kind of helped.

Relapse and Clinical Trial

Relapse

[Chemo] was 6 months, 12 rounds of that. I finished around mid-April of 2016, and my scan was good right after that. I had a colonoscopy a couple of weeks later. It was clean, so I took a little vacation. [I] started back to work at the beginning of May.

About 2 weeks later — so it was about 6 weeks from the last chemo — I woke up [and] felt the throbbing in my abdomen again. This time I was at the doctor’s at like 6:30, waiting on [my surgeon] to pull in because I was like, “I’m not waiting again.” 

That kind of started the next couple of weeks of every kind of scan, biopsy, [and] a trip to Duke. We learned that the cancer came back, but it wasn’t my colon this time. It spread to my abdominal wall and lymph nodes throughout my body.

What stages were your diagnoses?

[The first diagnosis] was stage 2, borderline stage 3, because it spread through the colon, but it hadn’t spread into any lymph nodes. It hadn’t spread into my small intestines. It was just on the outside. 

They took around 80% of my colon and about 36 inches of my small intestine out just because that’s where the tumor had grown through. But I just had stage 2 then, and then it came back as terminal stage 4.

What was going through your head with your second diagnosis?

On the way to the doctor’s office, I tried to convince myself it’s scar tissue. I had such a major surgery. They cut me twice. Scar tissue built up and popped. I’ve heard that happen in people. I tried to convince myself that, but by the time I got to the doctor and I could feel the throbbing, it was so similar. It brought back all the memories of the summer before. 

I was just like, “I know this is back. I know.” At that point, my mindset was like, “Another 6 months of chemo.” Then I went to the doctor’s and the scans, and it wasn’t until I went to Duke around the second week of June when I realized and they told me. 

They’re like, “All right, there’s no cure for this now. You have this for life because of the way the tumor came back.” It’s not in a solid organ in the tumor. It wasn’t a solid tumor. It’s like a non-solid area of liquified tumor masses that we could not remove at this time. 

They’re like, “You’re going to be on chemo for life.” That’s when they were like, “You got to battle.” The odds were about 25% to make it 5 years. I was numb, went back to the hotel in Durham, and just kind of just sat in the shower because at that point, the tumor was growing. 

It was causing me severe back pain. My life at that point was pretty much laying on a heating pad, taking pain medicines, taking hot showers, and trying to get a couple hours of where I wasn’t in extreme pain. 

I was numb to the world. [I] couldn’t talk to people, couldn’t text even. I was getting messages. My mom was there [for the diagnosis]. I was like, “You tell people. Let them put it out there.” I couldn’t even pick up my phone to answer.

»MORE: Breaking the news of a diagnosis to loved ones

Getting through feeling numb

It took me a long time. Actually, it took me many years because after I got that, I was like, “Okay, I’m just going to go to treatment.” Through the next about 6 months until around November of 2016, it was just solid bad news. 

I would do a couple of rounds of that chemo, [get a] scan, [and it] wasn’t working. It was growing. I was in more pain. Same thing. By October, I literally wasn’t leaving my house except to go to doctor appointments. I was all day on the heating pad because my back was in so much pain. 

[I was] going through about a bottle of 100 pain pills in a week, and that wasn’t even taking the edge off. It allowed me maybe a couple of hours of sleep at night. I was hopeless, and then it got really bad. The cancer grew into my stomach where it empties into my intestines and closed it completely off. 

I went to the hospital because everything I was eating was sitting in my stomach until I threw it up. I spent almost a month in the hospital. Everything kind of happened really quick around then. 

Right before that happened, I made the decision to apply for a clinical trial because all the FDA-approved chemos didn’t work, and it was either hospice and dying or try this clinical trial. That was my only 2 options. 

They were like, “This is your last chance. If this doesn’t work, you’re too far gone. You will either be dead by the time we realize it didn’t work, or you’re going to die.” I was like, “Okay, we’ll go for it.” 

[I] realized how crazy clinical trials could be. The only thing I ever heard about was on TV and thinking I’m a lab experiment, which [is] totally wrong. [I] realized I have complete control of it, but realizing that I’m doing a drug that they don’t know the side effects for. I’m in there, filling out hundreds of pages of possible side effects, and I give my consent to all of them. [It] was a waking up moment.

The clinical trial

It was a phase 2 trial. They knew it worked. It was a drug. It was pembrolizumab, or Keytruda, which was the drug, and it worked in other cancers. The type of cancer that worked is where it’s mutated in the microsatellite, to get really technical. 

I was accepted into it, but it was a stage 2 trial, so I had to go and fill out everything. Before I could get my first infusion of it is when I got rushed to the hospital, where I couldn’t eat anything. The pain was so extreme, and I was losing weight again. I lost about 60 pounds in 2 months from everything. 

They put me in the hospital, and they’re like, “All right, we got to push back your treatment because we got to figure out some way.” They tried a feeding tube, and it just kind of balled up in my intestines, so they had to take all that out. 

It ended up they had to put drainage tubes into my stomach and my intestines to drain the bile and just the digestive fluids. I got fed through stuff called TPN and ended up being on that for 450 days. I went 450 days where I did not eat solid food. I didn’t eat anything. I got 15-hour infusions of that every single month.

Being on treatment for life

When that started in the hospital, they were like, okay. Then I started the clinical trial while I was in the hospital, and I’m still on that drug. It worked. I’m part of the very weird small percentage where it worked just enough to keep the cancer from spreading, but not like it does the 99% of people where it either cures it, [or] takes the cancer away. That’s why I’m on it for life or until it quits working.

It’s an infusion. I go there every 3 weeks right now to get infusions. Since that time, I’ve had spots pop up, where I’ll get drugs added to take them away, just depending on what pops up and what doesn’t. That’s my baseline because the mass of non-solid tumor in my abdomen, that’s what the immunotherapy is keeping from spreading again.

Processing the choice between hospice or a clinical trial

For me, it was a quick decision because I was like, “I don’t want to die right now.” At that point, I was still like, “I could still be doing this and fight.” At that point, all I wanted to do is live to the age of 30. If I could get another year and a half, I’ll be okay, so If this clinical trial can do that… 

In my head, I was like, “I can deal with the pain and the life I’m living right now at least another year.” I wasn’t even doing it for me. It was for friends [and] family, just so I could be there a little longer. That was my mindset of why I just automatically said, “Yeah, let’s do the clinical trial. I wasn’t wanting to go to the hospice and die in 2016 yet.

Did the clinical trial make you feel better?

Over the course of the next year, it was weird because the year I was on TPN, I had a pain pump, too, because the pain got so extreme. I couldn’t do anything. Over that 14 months, it shrank it enough to where it’s not the constant horrible pain. 

I still feel pain in my back, in my abdomen, every single day, but it’s something I can live with. [I can] still get up and go on a walk or go sit and watch a movie and be okay with it. When I think about it, it’s still there, and some days are worse than others.

Finding Support 

What helped you? 

All that help [from Man Up to Cancer] happened a few years later. That started about 2 years ago in 2020. From the time I started the clinical trial and went through that 14 months, that was the darkest time. 

I was laying in bed about 22 hours a day. This life was not living. [I] had dealt with a lot of suicidal thoughts [and] came very close to committing it and not being here. Luckily, there were a few people I would talk to online because I was on my phone or in bed all day. 

That helped, but I was still stubborn, like, “What do I matter? Why would anybody want to listen to me, a person from a town of 3,000 people? What experience do I have to help people?” 

I was just so deep in my own head and knocking my self-worth down and not believing anything good could come from it until about 2020, when I started having people and started kind of opening up. 

Then Joe Bullock, who’s the lead administrator of Man Up to Cancer with Trevor [Maxwell], asked me to join the group. I’d joined groups earlier, and I would leave within a week because it was just so much about this drug and this treatment and this. I was like, “I hear that all the time anyways. I don’t want to be in a group with it.” 

That group changed my life. I started [and] became comfortable talking to people. Through that group and Joe and Trevor, they got me to apply to an ambassadorship with Fight CRC, which I got. I was an ambassador there, and now I’m part of another organization called the Colon Club and Colon Cancer Coalition. 

It’s kind of snowballed really quickly over the last 2 years to where I’ve got to do amazing things, [like] go on travel that I’ve always wanted to do. It’s crazy how just saying yes to one thing and joining one group kind of snowballed into changing my whole life.

Man Up to Cancer

Man Up to Cancer is just a group. There’s a website, a podcast, and then a private Facebook group where you have to be a man and you’ve got to be dealing with cancer or be a caregiver to somebody with cancer. It’s just a place you can go there and be yourself. 

There’s so much stigma and everything to a man, like we’re supposed to shoulder everything. We’re not supposed to show emotions. Especially from the culture that I grew up in, that Southern Appalachian person, you’ve got to be tough. You’ve got to be the leader. Everybody, rely on yourself. 

You can just go in there, and you can be sad, be angry, be happy. It’s a free place to share the very dark humor that cancer patients have and not be judged for it, because other people don’t get it. You can talk about stuff that has nothing to do with cancer in there. 

It was just kind of like a group of friends that I had that actually understood what I was going through and then showed me that I wasn’t alone and there were people and groups that accepted people out there.

How did being open to support help you?

It’s helped me so much, between the groups, then admitting that I needed to go to therapy, and becoming an advocate for men getting professional help and therapy and then being in the groups and opening up. 

It’s made a total difference in my life because now I have a reason on these bad days — like tomorrow, when I’m feeling horrible from yesterday’s chemo and I don’t want to get out of bed, I can roll over and check my phone. If I’m in a down place, I can message somebody, and they’ll understand. 

Then I can be that person on the weeks in between chemos, where people can see what I’ve been through. That was a big thing, too, because a lot of people started following me the last year. They see me, and they’re like, “How can I ever become as open and okay with all this as you are?” 

Then I tell them, “I went through 5 years of this, where I was the exact opposite of what I am now.” Helping people get to that point a lot quicker than I did is a big thing.

Going to therapy

I started that before I joined any group. I realized that the thoughts I was having in my head about not wanting to live terrified me enough to where I needed help, just because I didn’t want to put that burden on other people of walking through the door and seeing something that I did. 

It just scared me enough to realize that I needed it, and be damned what anybody else that still has that stigma said about it. People tell me I’m strong, tough all the time, but the toughest thing or the bravest thing I ever did was admit to myself I needed help and I couldn’t do it alone.

I still deal with it every day, but it’s made me realize that mental health is not a start and end point. It is a very fluid kind of process. I can go through days or a week where I’m feeling horrible, and then you go through [it and] you talk. The next day, you might feel a little better. That’s okay. You don’t have to make improvements every single day.

Reflections

How are you doing now?

Actually, I just had my 3-month scans last week. [I] got the results 2 days before Christmas. Everything’s stable. The main tumor’s stable. I have spots that pop up. I have a couple of nodules in my lungs and some stuff that are too small to do anything about right now, so we just add those to the watch list. 

As of right now, I’m going to keep the same treatment I’m on for another 3 to 4 months until my next scan. It’s working. Still working. I just completed my 126th round of chemo immunotherapy treatments. We’re happy. 

The side effects suck, but they allow me to be alive, and I have them every 3 weeks. I usually get about 2 weeks of — I don’t say feel good because I never feel really good anymore — feeling okay enough to allow me to get out and do what I need to do. I can travel if I need to.

Finding comfort in “Star Wars”

It was during that 14 months of not eating. It was around February of 2017. There was a snowstorm here, [and it] knocked out the cable. I had nothing to watch. In the middle of the night, all I could hear was that TPN pump going. 

My uncle, who I lived in their basement apartment at the time, had recorded the 6 “Star Wars” movies. I’d watched bits and pieces of it, but I’d always been more “Harry Potter” and “Lord of the Rings.” I was like, “I’m going to watch it.” 

Next thing I know, I watched all 6 in a row. I looked back after I got done, and I was like, “That was the first 12-14-hour block where I wasn’t in my head so much and just thinking about what I’m dealing with.” 

That started where I watched all the movies, all the cartoon TV shows, and then I found out there were books. There’s hundreds of them, so I just started reading those. I would post a picture years ago of whatever book I was reading while I was getting a chemo treatment.

One of the authors, Claudia Gray — she’s my favorite “Star Wars” author — is seeing that. [She] started following me on Instagram. Fast-forward to last year, January, she had just released a new book I was going to buy, and I get an email or a DM being like, “What’s your address? I’m going to send you a signed copy of my new book.” 

That’s all I thought it was — late Christmas gift, just appreciation. I get it and I open it, and it’s like, “Turn to page 18 for a surprise.” I read it, and at first I thought the droid’s name — [because it’s] spelled out like not how I spell my Instagram name, it took me a minute — I’m like, “That sounds very familiar.” 

The next sentence has it exactly how I write it on my Instagram, and it made me proud. [It] took my breath away. I can look up on their official Wikipedia stuff on the internet, and it has it there. It was amazing and just something that I tell everybody about.

Chemo routine

I got, “Never tell me the odds,” tattooed on my arm just a few weeks ago. People notice I do those pre-chemo thoughts. That is the last thing or first thing on my mind right before I open the door to go into chemo every morning. 

But before that, I have the same routine every single chemo treatment. I go and get my Starbucks coffee. I get to the cancer center about an hour early, I sit in my car and drink it, and I read whatever “Star Wars” book I’m reading at that time. 

That just allows me 30-45 minutes of not thinking about what’s coming up next. Then I get done, close it, and the first thing that pops to my mind is what I talk about. Then I go get chemo.

Beating the 5-year odds

I did. I passed that a little over a year or about a year and a half ago. I’m beating the odds every single day I’m alive.

Advice for patients and caregivers

First thing is don’t isolate. Isolation can cause mental health issues, but it also will affect your physical [body] and the way to heal. That’s a big thing in Man Up to Cancer. You don’t want men to isolate because it actually dramatically decreases your chance to recover or to do as good on chemo. 

That is my big thing. Everybody knows that cancer is physical. You see the chemo effects and the physical effects. But for me, the mental part of it is something I was not expecting [and] did not have any knowledge about. It’s what threw me for more loops than anything. 

The fact that I can help people understand that it is going to be a physical battle. The mental part of it is going to throw you for a loop. You’re going to get depressed, feel alone, no matter if you’re in a group of 1,000 people. 

Cancer’s so individualized that everybody feels alone at some point, and just know that you’re not. There’s so many people and groups that you can find your little niche in it, and don’t be afraid to ask for help.

Listening to your body

Anything that feels off, anything that feels similar to what you’ve felt before, I’d say go directly back to the doctor. I’ve known a lot of people who’ve had horrible experiences with doctors not believing them. 

Demand a second opinion. Go to a second, third, fourth doctor. You know your body, and 99% of doctors have never been through cancer. They could do the medical side. You could read about it in textbooks, but they don’t know the feelings that we know. If you feel anything or if you see one symptom, it’s always better to be safe than sorry.


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Finding My Purpose After a Rare Brain Tumor | Cancer Friends

Finding My Purpose After a Rare Brain Tumor | Cancer Friends

Featuring Matthew Zachary

Hosted by Andrew and Esther Schorr, “Cancer Friends” highlights stories and lessons from cancer survivors and their support system. Find other “Cancer Friends” episodes on our video channel here!

The segment features Matthew, who was a 21-year-old college student and pianist when he started losing fine motor skills in his left hand. As his symptoms progressed, doctors discovered the reason why: an extremely rare brain tumor.

Matthew discusses the founding and growth of Stupid Cancer, a nonprofit that focuses on adolescent and young adult (AYA) cancer research and resources.

He also shares his experience of being a self-proclaimed provocateur in the cancer world, turning anger into action, and looking toward the future of preventing cancer.

This interview has been edited for clarity. This is not medical advice. Please consult with your healthcare provider for treatment decisions.


We deserve better. We want to live a little more. And why should we be treated differently?

Matthew Zachary

Introduction to Matthew

Andrew Schorr, The Patient Story: Hello, it’s Andrew Schorr and Esther Schorr again, back with “Cancer Friends,” our series. We want to introduce you to someone who’s been a friend in Cancer Land for a long time, Matthew Zachary, who joins us from New York City. Hi, Matthew.

Matthew Zachary: Hello. How are you?

Esther Schorr, The Patient Story: Great to see you.

Andrew, TPS: We’re doing good. Matthew, at age 21, [was] a college student in upstate New York, and really working full time as a music student on the piano. [He] had a problem he’ll describe that ended up being a brain tumor. 

It ended up transforming him in really helping thousands and thousands of people who have been or are even now young adults with cancer. We want to take you through what happened with Matthew and how it’s made a difference to so many people and what you do today. 

1st symptoms

Andrew, TPS: So, Matthew, let’s go back to when you were 21. What happened?

Matthew: Well, let’s go for the history lesson, shall we? This is an exercise in anthropology. I was classically trained from the age of 11. So 10 years later, I’m a college senior composing for film, television, orchestra, jazz band, whatever it was. I wanted to go to grad school. 

I wanted to be a film composer, and that was the plan, the job, the goal. Rarely does someone that young know what they want to be for the rest of their life, but that was kind of my fortune at the time. 

During summer break, everything was fine. [I] got back to school, and I immediately noticed — maybe this is just unique to being a pianist — that the fine motor coordination of my left hand wasn’t as great as I remember it to be. 

I couldn’t run my fingers up the keyboard as quickly as I remember, and yet my right hand was perfectly fine the way I remember. You’re young, dumb, stupid, 21. I’m like, “Oh, that’s weird. Whatever,” and that was kind of what happened. 

Over the course of the fall semester at Binghamton, it worsened to the point where — I’m a lefty — I couldn’t grip a pen and write. I could barely type with my left hand, like touch type. I was just poking like we do these days. I’m like, “Oh, that’s still weird.”

Seeing campus doctors

Matthew: I kept going to the doctors on campus, and they’re like, “Eh, you have carpal tunnel. Put your backpack on your other shoulder,” or, “Hmm, you might have early-onset multiple sclerosis,” or “Hmm, this could be, I don’t know, Epstein-Barr syndrome.” So this crazy litany of nonsense. 

It’s hard to blame them. You don’t think brain cancer. 21-year-old, pianist, left hand doesn’t work. Ultimately, then the headaches showed up, and then they started taking me seriously. That’s really where the shit hit the fan right after Thanksgiving. That’s how I went from, “I’m great,” to, “What the hell is happening?”

»MORE: Patients share how they processed a cancer diagnosis

Surgery to remove to brain tumor

Andrew, TPS: That turned out to be, in fact, a brain tumor. I know there was confusion about what kind of tumor it was and even then what to do about it. Describe a little bit of that.

Matthew: I went to my general practitioner, my pediatrician. I was 21, but I still saw my pediatrician. I came back, and I said, “I can’t do this [or] this.” 

He’s like, “All right, this is a problem. Go get an MRI.” Got the MRI, and then I went to the diner for lunch afterwards, got back, and there was a beeping answering machine — if you want to Google what that was, kids. 

It said, “Get back here. There’s something wrong with you.” So then I went to a neurologist, who thought I had this and this and this, and then he said, “No, you need to see a neurosurgeon.” 

The neurosurgeon said, “Oh, this is probably an astrocytoma,” which is not great. It’s maybe the least worst of them. But then they finally went in there, and they took it out. On January 10, ’96, was my eight-hour surgery.

Esther, TPS: This is brain surgery.

Matthew: A big, big, gigantic old-school craniotomy, tear your head open kind of stuff, like Russian gulag brain surgery stuff. It wasn’t pretty, and you’re awake the whole time. You’re kind of pseudo awake and not awake, but it’s just not fun. It’s a little better these days. 

An extremely rare type of tumor

Matthew: They took it out, the pathology came back, and I’m like, “It can’t possibly be this.” It wasn’t an astrocytoma. It was a medulloblastoma, which is unseen in people that were 21. It’s like an eight-year-old and younger [patient]. Congenital. You’re born with it. It’s called a primary neuroendocrine tumor, PNT. 

They’re like, “How the hell does this 21-year-old kid have a medulloblastoma?” They didn’t believe it. I was very lucky to have my dad’s best friend, my Uncle Jay, who I talk about a lot in all my talks. [He] happened to be one of the world’s leading genomicists at the time. 

He said, “Give me some chunks of this tumor. I’m going to ship them out around the world to confirm that this is what it is. And if it is, it’s impossible.” Turns out it was a version of what they thought it was. A medullo-mutant-blastoma, so to speak, that was nowhere in the history of recorded biology in brain tumors, so malignant nonetheless.

Esther, TPS: The rarest of the rare.

Matthew: Like there’s 200 medullos a year anyway, and I had the one in the whole world. I don’t know if it’s to date or not 27 years later, but that was the confusion that led to this, which added just more hedge-maze thinking on what to do with me because it was finally out of my head, but now what?

Undergoing radiation treatment

Andrew, TPS: The “what” became more than 30 radiation treatments.

Matthew: We’ve been working in this industry for a very long time, so it’s easy to lose sight of what it’s like to just be walking in the door for the first time. My dad was 46. I’m 48 now, so I can’t even comprehend what it’s like to have a 21-year-old son who might be dead in six months. 

[We thought] who do we talk to that even understands what this is? We landed on Dr. Jeffrey Allen, who is one of the leading pediatric neuro-oncologists in the world, at NYU. 

He did his best to come up with the calculus of what might work, but they convened a tumor board to really figure out what should we do with Matt?

Normally, a tumor board is comprised of leading collaborative medical professionals that kind of drop their egos at the door and decide what’s best for the patient and come back with recommendations. 

That’s what’s called a tumor board. What does my tumor board do? “We got no idea. Good luck. Go forth. Go do.” We settled — and I say settle because what did we know we were doing; we’re rolling the dice on these things — with 33 cranio-spinal treatments of, I don’t know, Chernobyl radiation, basically, down to my sacrum. 

Then they had this thing I think we take for granted today, which is a good problem to have. Today, it’s like a proton beam therapy or toma therapy, but 27 years ago it was called stereotactic radiosurgery. 

There was this 3D thing they were just inventing where they could target only where the tumor is and no surrounding tissue. That’s how it works today. You’re welcome, kids, that I was your guinea pig. That’s what we settled on: 33 of those from February 15th to March 30th with the weekends off.

»MORE: Read more about radiation treatment

Side effects of radiation

Andrew, TPS: How’d you do with that? How debilitating was it?

Matthew: It nearly killed me. But also, this was 1996, and there were no antiemetics, and there were no quality-of-life medications. You’re just burned and in pain, and you can’t eat. [You’re] throwing up 50 times a day.

Esther, TPS: And you’re young. 

Matthew: My immune system was there, but if I were maybe 80 or 90, I probably wouldn’t have done so well. I had an incalculable number of side effects that all kind of came in waves and lasted to this day, 27 years later. No one’s out of the woods. The gift that keeps on giving. 

I like to say that I lost my life, but I didn’t die.

But it was tragic. I kind of tell the story like it’s someone else’s story. It’s so far away from me, but I was treated like a piece of meat. I wasn’t a human. I was just like a lab rat being experimented on. That’s how I felt.

Feeling like the only young adult with cancer

Andrew, TPS: Something happened as you recovered from that. You go to a cancer clinic, and most of the people there have gray hair like me. Hardly anybody is your age. Something happened to you to say, “I want to do something about this.”

Matthew: I have the worst of both worlds. When I was going to any support groups or any conferences, it was all geriatrics. When I was seeing my doctor and at the hospital, getting radiation, [it] was all pediatrics. 

There was no one on any spectrum that was remotely my age, so I couldn’t relate to anyone or anything. I didn’t realize that it was possible there could be someone like me to look for, so I never just asked, “Where are the people that are like me?” I never asked that question because it didn’t even occur to me it was possible to ask that question.

Stupid Cancer

Esther, TPS: How did you get from there to what we already know happened, which is … you created a community of people like yourself.

Matthew: I feel like I’m a bit of a Forrest Gump. I just happened to bump into people along the way who happen to be these people, you included. I just found myself in the right place at the right time too many times. 

Then I wound up being able to rehabilitate myself and play piano again, but I didn’t get to go to grad school. I took a full-time job working in the agency world. Ironically, the healthcare agency, unbeknownst to me. I was working where I wound up being. 

I just started finally reclaiming the fact that I could compose and perform again. But I would probably never be a film composer. I was too sick. It took me years to even just be able to eat any food I wanted. I like to say that I lost my life, but I didn’t die, thanks to radiation. 

I declined chemo. That’s a whole other story. Turning down chemo in the ‘90s was like anathema, how dare you? But the whole point was, I was so focused on what was important to me, and my parents supported that. 

Along the way, I happened to get in touch with someone at my office who was doing a Relay for Life. Like, what the hell is that? All right, I’ll go to this thing. Of course, everyone’s my age, but they’re raising money. They’re not the patients there. 

What wound up really happening that transformed all of this — if I had to euphemistically trace the cord back to the outlet. I decided to write some music, to go into a studio, and record like 50 songs that I had written between ’94 and ’98. Before, during, and after cancer. 

I went out west. My friend had a studio. I tracked 51 songs in two days. He produced these CD’s for me. Back then you could self-produce them, make your own artwork. They’ll burn them for you. You pick them up in packs of 50. They’re pre-plastic-ed. Everything’s there. 

I just did that. As a lark, but I did it, in a way so I could give them to my doctors to thank them. But one of the doctors I gave it to, there was a sales rep from some company [who] showed up there.

The story goes: “Oh, what’s that?”

“That’s Matt, one of our patients. He was a teen adult” — whatever they called me back then — “pianist who was a brain cancer [patient] but plays again now.” “I’ll take this back. I’ll see what they can do.” 

That got me some strange video news release, I think for Roche at the time. I didn’t know what I was doing. I had a story. It was just me. A gentleman saw that piece and found me on a Columbia listserv for brain tumors that I happened to find. 

If there was any one person on this earth I could have met who would have been the default supernova to accelerate me into this rabbit hole, it was Craig Lustig. I went from not even knowing there was someone like me to meeting my doppelganger: a bald, Jewish, New York City-based, 20-something brain tumor survivor who went to Binghamton and was in my a cappella group.

»MORE: Patients describe dealing with hair loss during cancer treatment

Again, this was like 2000, ’01, ’02. And then the rest is history. Craig took me down this rabbit hole. He said, “You should be a cancer advocate.” To which I responded, “The hell is a cancer advocate?” And there we go.

Growth of Stupid Cancer

Andrew, TPS: [What happened] was a regular internet radio show, really attracting other young people around the world probably, and forming an organization eventually like a convention, if you want to call that, of people like that in Las Vegas. It mushroomed. Just describe that. It took off.

Esther, TPS: Also, talk about the confluence of timing here because now the internet’s around, right?

Matthew: I leaned on my advertising industry background [and] my creative background. I’m a brand guy. I like to build brands [because] I understand how to communicate with customers and consumers. Also, I understand how to get you to buy stuff and what logos look like and all the nerdy stuff that happens in the agencies. I had that skill. 

What I realized out of the depths of the alliance was there really were no agency creatives in that space. I didn’t really want to do policy work. I wasn’t an academic.

You can be angry about why this happened to you, but don’t ask why.
Ask, now that it has happened to you, what can you do … to make it less horrible for the next person that shows up. 

I didn’t really want to start a charity; I just wanted to figure out where I belong. The trigger to start Stupid Cancer was I finally found people like me.

That was the spark that got the organization started. It had to be a charity. I didn’t know anything else about it. But you’re right. I did it on purpose. It was intentional. It was meant to — back at the time, shock value wasn’t a thing before the internet because you didn’t know it existed. 

I had a talk radio show. We did live events. We had bar nights outside the hospital in 50 cities around the country. I think it just spoke to people in a way, because it gave them permission to be pissed. [It was] a community of people that understood what they’re going through, and a way to get behind something they didn’t know they needed to do.

Necessity of a provocateur in cancer advocacy

Andrew, TPS: Matthew, you’ve remained what you just labeled a provocateur. Why is that needed in this field? You take joy in doing it. It’s needed. How come?

Matthew: I’m not alone. There’s only a handful of people like me who are willing to.

Someone’s got to poke the stick. Someone’s got to poke the bear. Someone has to be willing to call out bullshit where bullshit is due to be called out without throwing too many people under the bus at the same time. 

I’m an entertainer. If you ask me who I am, I’m an entertainer. All I want to do is get on stage, play piano, and talk to people. That’s the core of who I am. 

But I take that entertainment and I am able to bring into what I want to talk about, the inanities, in a way that normal people understand. 

That isn’t multi-syllable jargony, jargony fridge-magnet bingo, because that’s the way healthcare works, and we don’t speak human. 

If someone doesn’t speak up on behalf of the little man or garner the respect of the American voters or give consumers and patients and caregivers a way to mess back against the system built by design to not help them. You can’t do that in a flaccid, placid demeanor.

Turning anger into action

Esther, TPS: Really, it rings very true that sometimes you have to just get angry enough to take action. What it sounds like to me was there’s anger and grief initially about being alone. Who is everybody? Where are the people that are like me? 

And then once you started finding people like you, there is the motivation to do something about it, to bring them together, [and] to take action. And that seems like what you’ve done in a lot of the things that you’ve pursued.

Matthew: A good example of what I did in 2007, the language coming out of the NCI, the NIH, the CDC, COG — all these acronyms that we can Google — was that something like survival health outcomes in adolescents [and] young adults were not increasing at par with longitudinal data against pediatric and older adults.

What that meant was, if you’re Gen Xer, you’re going to die way more than if you’re not. And I could say it that way, and people understood it when I said it that way, and that no one cares about young adult cancer except young adults with cancer. I was able to just make it that straightforward. 

Now we look at what ACA accomplished with all of its flaws. That was meritable from the young adult cancer movement. The long-term ped movement. ACA, the pre-existing condition, up to 26. Those two things were driven by people like me and hundreds of thousands of us that rallied around one idea. 

We deserve better. We want to live a little more. And why should we be treated differently? Why should we be cared for differently? Why should there not be standards and protocols for our age relevancy, just like everyone else? If you don’t give people a channel for that anger, you’re just going to stay angry.

Shift in research for young adults

Esther, TPS: I have one other question. From a practical standpoint, Matt, have you seen over these years of raising hell that the protocols have changed, that there’s research that’s focused on this sort of middle between pediatric and older? Have you seen that shift?

Matthew: I wanted to see if, what is it, 12 years later, we’d done anything that they wanted us to do. And we did all of it. 

It’s because we forced policies, we forced standards of care, we forced young adult cancer, age-appropriate relevancies, we forced fertility mandates, [and] we forced the ACA. 

Survival rates are higher proportionately to which cancers have better treatments these days, which is another conversation. Back then there were three things. Now there’s 40,000 things.

It’s less about how old you are and more what’s wrong with your genetics, which is even better because it’s not age. It’s not a derivative of how old you are. 

The answer is yes, I think we did a good job.

Not knowing what information to look for

Andrew, TPS: As we have young adults or their parents as well who may be watching, what would you say to them as individuals for their kind of operating system as they go through this today?

Matthew: Well, if you’re already watching this, you know it exists. The challenge, of course, is how do you know it exists in the first place? Because healthcare is — I’ve always said it’s like a supply-only store you don’t want to shop in.

You don’t think to know things, like I didn’t know there was someone else that was 22 with cancer. I had no idea.

Today, it’s probably a little easier to find those people. You search on different platforms, and thankfully, that’s maybe a good part of what social media can do to connect you with people. 

Self-advocacy

Matthew: I’m a cynic because it’s so easy to just say, “Be your own advocate.” Not everyone’s born with what I call congenital chutzpah. You don’t have that inside you. Where does the gumption come from? It might be through anger. It might be through just a disenchantment or disenfranchisement.

But most people don’t think to ask for a second opinion because … you’re scared. You don’t want to be there. You’re terrified. “Help me out. I just want to live,” is often what happens right now. 

I’d like to think there’s a little more pushback from younger generations who are now more aware of the subtle nuances way beyond the biology. What’s wrong with them? 

»MORE: How to be a self-advocate as a patient

Advice for parents navigating their child’s diagnosis

Andrew, TPS: What would you say to parents of young adults or how the young adult and the parent navigate this together in a positive way?

Matthew: Honestly, voice memo app on your phone is your best friend. Record everything because you can and your kid can’t. That’s a great life hack. 

Back then, my dad would scribble down on paper and translate to Word document on our Macintosh, the little gray one you toted around. Keep track of everything; record everything. 

Just a life hack: there’s a website called rev.com. It transcribes your voice memos to text. You can just record every conversation you’re ever in. You can take notes to yourself on your phone and just send those audio files. It’s like $0.99 every time you do it. 

We didn’t have that back then, but here’s a life hack for caregivers who may have more latitude to listen and record than their scared children, who want to get stuff done. 

That’s my biggest recommendation to caregivers: take advantage of what I didn’t have 27 years ago, because your strongest tool is knowledge, and you don’t know what’s happening when you’re all Charlie Brown teacher, listening to your care team saying X, Y, and Z.

Andrew, TPS: Thank you so much. Andrew and Esther with Cancer Friends. One of our dear cancer friends, Matthew Zachary. Thank you for [reading].

Matthew: Thank you, everyone.


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Cancers Lung Cancer Patient Stories Prostate Cancer

Mark’s Stage 4 Metastatic Prostate Cancer Story

Mark’s Stage 4 Metastatic Prostate Cancer Story

One day, Mark woke up unable to walk. After countless tests and scans, Mark was diagnosed with stage 4 prostate cancer. Additionally, the cancer had spread to his lungs and bones.

Mark shares how a positive mindset helped him through his cancer journey, how cancer has led him to be more grateful, and how he advocated for the treatment plan that worked best for him.

  • Name: Mark K.
  • Diagnosis (DX):
    • Prostate
    • Lung
    • Bone
  • Staging: 4
  • 1st Symptoms:
    • Inability to walk
  • Tests for DX:
    • MRIs
    • CAT scans
    • Biopsies
  • Treatment:
    • Chemotherapy
      • 6 rounds
    • Maintenance therapy
      • Monthly injection for lungs
      • Injection for bones every 3 months

This interview has been edited for clarity. This is not medical advice. Please consult with your healthcare provider for treatment decisions.


Pre-Diagnosis

Introduction to Mark

Prior to cancer, I was in great shape. I worked out at the gym 4 to 5 times a week, and I was really active. I was into sports, and I still used to play a little basketball. I used to be really into sport fishing and all that. 

When cancer hit, it really affected me physically, not mentally. It actually made me much stronger mentally. Physically, I still deal with things, but I’ve gotten a lot better. 

At my worst stage of cancer, I was barely able to walk across the room. It took me 10 to 15 minutes to walk across the room. It took me half an hour to take a shower. In 2021, I did not leave my room for 3 months. 

I just was in my room because I physically couldn’t [leave]. I had a hard time. I’d go downstairs some, but not that much. It was an effort just to take every step. That’s what’s changed. 

I’m just so thankful because we live in the hills. The very first time that I came down from my room after being in my room for 3 months, I opened up my front door, [and] it was just glorious. It was awesome. 

When you haven’t seen the sun for 3 months, it’s indescribable, absolutely indescribable. That very first time I was able to open my door and go outside, it was just different. The sky was bluer. The trees’ leaves were greener. The birds were chirping loudly. 

I just took everything in. You just notice and appreciate things so much more. That was my experience with that, and I still appreciate that to this day. I don’t take anything for granted.

Where do you live?

I live in Southern California, in the San Fernando Valley. [I was] born in Southern California, in Santa Monica, grew up in West Los Angeles, and moved to the Valley, which is 45 minutes away. I’ve been here all my life.

I have 2 daughters and they mean everything to me. My daughters are just so awesome. They were the driving force in my will to live.

1st symptoms

It started one day out of the blue in October of 2020. It just happened. Literally happened overnight. I woke up one morning, and I wasn’t able to walk. 

My wife took me to the doctor. He kind of patched me up to the point where at least I could move around a little bit. That’s when I started doing a deep dive into my health and everything like that. 

I knew something was wrong because they don’t put you through test after test after test after invasive test after inhumane, awful stuff without a reason. That’s when I knew something was really wrong because it just moved from one test to the other test. Initially 2 or 3 times a week, I was going through some type of procedure or something. 

That’s when I started doing my deep dive into everything. I was thinking to myself, “Man, when is this going to end?” Because it was almost never-ending. There were tests, MRIs, CAT scans, biopsies. You name it, and I went through it. That’s what happened there.

Was not being able to walk a consistent symptom?

Yeah, it did last. It slowed me a lot. From October 2020, not being able to walk one day, and then as time went on, in the winter and the spring of 2021, that’s when I was in my room [and] having a difficult time. I started 6 rounds of chemo shortly after that. That didn’t help with things either.

The Cancer Diagnosis

How long did it take to get a diagnosis?

It was a long time. It was probably 3 or 4 months. I don’t know the exact time amount, but it was a long time because it was just a gauntlet of test after test after test.

What was going through your mind during this?

What was going through my mind was, “I just want to get some answers.” There was no doubt in my mind that there was something really wrong, but I just didn’t know what. That was just where we were at. It was just, “Let’s do this; let’s do that.” 

Receiving the diagnosis

My oncologist called my wife and I into her office to give us the diagnosis. My wife took it one way, and I took it another way. My oncologist said, “Your cancer is so bad that I can’t cure you,” and she said, “I suggest that you get your affairs in order.” 

My wife is like, “We’ve got to do this. We got to do that. We’ve got to get these papers done.” 

I said, “Okay, I’ll do it.” Basically, I was kind of relieved that the oncologist told me that because I finally knew. 

She also told me, “Yes, you have stage 4 prostate, bone, and lung cancer.”

I said, “Okay.” By that time, I had been preparing my mind for a while because of all these tests. Basically, in my mind, I knew something was really wrong. I didn’t know what. By the time she gave me the diagnosis, mentally I was ready for it. 

From day one, I was just bound and determined. As far as I was concerned, dying was not an option. Period.

Mark K.

When she told me that, it basically set off a starting gun in my mind. I respect my oncologist, but I wasn’t about to buy into what she was telling me. I didn’t know how I was going to do it, but there was no doubt in my mind that somehow, some way, I was going to figure out how to win.

Telling loved ones about the diagnosis

I just told them. It was important for me to let people know and share it with people. [My family] were the first people I told. My older daughter, Lisa, the one who [stayed with me], said, “Okay, I’m going to come out and help you.” 

Then my other daughter, Connie, lives in Texas with her husband, Matt. She came out as much as she could. 

When you’re living it, our vision is outwards, so we see out. We don’t see ourselves. Even though I looked in the mirror, I didn’t realize the extent of what people saw me as. Lisa later told me that after seeing me that she was just really, really scared when she saw me. 

From day one, I was just bound and determined. As far as I was concerned, dying was not an option. Period.

Looking back, did you have any symptoms before not being able to walk?

I had [the cancer] for a while, but I think what happened was when you’re working hard like I do — I’d go to the gym, and I’d go there for an hour and a half. I didn’t go there to socialize. I went there to work out. I pushed myself every single time I went to the gym, and I made the most of it. 

When your body is that in tune for — I did that for decades, worked out that hard. Then when COVID hit, I wasn’t able to do that. I’m 64 now. I started to feel my age, and I started to feel things that I’d never felt before because I’d always worked out really hard. 

I knew that it was going to be some kind of problem because, yeah, when you’re working out that religiously and that hard, I knew that things are going to start showing up. I just kind of felt that.

Relationship with oncologist

[My oncologist] and I started off with a very contentious relationship. You have an appointment with your oncologist, and it lasts 15 minutes. I’d always bring a notebook in and a pen to write things down. She would say, “We’re going to do this, or we’re going to do that.” 

If it involved medication or anything like that, I would write it down. I would go research it, and I’d tell her that. I said, “Well, what do you want to do?” I’d want the names of everything. For instance, I wanted the exact name of the type of chemotherapy that she wanted to administer. 

I got the name of it, researched it, and found out all about it. It’s a type of chemotherapy that’s been around for a while. It basically was as safe as a chemotherapy can be. Some of the chemotherapy, in their description is, “Hey, this can kill you.” I wasn’t going to have any part of anything like that. 

One day I ran into my oncologist, and she was just so mad at me. Steam was coming out of her ears, and she says, “Why don’t you just do what I tell you to do?” 

I was just real calm and real quiet. I just said, “Because I want to know exactly what you want to do and what it’s going to do.” Since that time, I’ve been on time or early to every single appointment. I’ve made every single hospital visit, every single test. 

Over time, she realized how serious I was about living.

In fact, she wanted me to get on this medication. I said, “I don’t really want to do that.” She looked at me, thinking, “Here we go again.” I told her, “I’ll tell you what. I’ll make you a deal. If things go south, and the necessity arises that I need to take it, then I’ll take it. But I don’t want to take anything just to take something.” 

She goes, “Okay, that’s fair. That’s fair.” She looked at all my test results recently, and she said, “Everything is either better or at least the same.” That’s really great. She said, “Okay, I’m good with that.” I said, “Fine, I am, too.”

Treatment Plan

Starting treatment

When I started my journey, once I got my diagnosis, I treated my cancer probably 50% conventional and 50% alternative/natural. Again, I stress that this is what I did because this is what I wanted. 

For me, the chemotherapy played an important part in the fact that I needed to stop the rapid growth because it was in so many areas. It was in my prostate, it was in my bones, it was in my lungs, and probably in other places, too. 

Because the cancer was spreading so rapidly, I decided to go. I didn’t want to, but I decided to do the 6 rounds of chemotherapy. It took a lot for me to do that because I’m really familiar with the effects of chemotherapy and things like that. 

It’s non-discriminate. It goes after not only the cancer cells, but it goes after the good cells, too.

The first round that I took, I got so sick. I was sick for 4 days, and it was like being on a high that just wouldn’t go away. You couldn’t sleep it off. You’d wake up, and you’d feel just as bad or worse. 

»MORE: Cancer patients share their treatment side effects

I called up the guy at the lab, and I said, “Man, if I get that sick again on round 2, there’s just no way I’m going to keep doing this. It’s just miserable.” 

They said, “Just be patient. I think it will start kicking in on your second round.” That’s exactly what happened. From rounds 2 through 6, I was fine. Parts of my hair did fall out, but as far as the effects of feeling the chemotherapy, I was fine. That was good. 

In the meantime, I was changing everything about my diet. I was working that, along with what I was doing with the chemotherapy. A very good friend of mine is a nutritionist. Up until this particular time, I was a vegan, and I thought, “Man, I have the greatest diet and all this kind of stuff.”

He said to me, “I’m going to give you a diet. I would suggest you follow it, because if you do, then I think you’ll be around in a year. But if you don’t, I don’t know what’s going to happen to you.” 

That was a major, major thing for me to radically change everything about my diet. Here I am thinking, “I’m a vegan, and I’m healthy,” and all this kind of stuff, but why? If it’s that healthy for me, why do I have so much cancer? 

I pondered that for the longest time, but when your back’s against the wall — and my back was. I had to make some changes, and radical changes. I said, “Okay, give me the diet, and I’ll follow it.” To this day, I still follow it. 

I added wild salmon. I added organic chicken, organic turkey, and organic beef. Then I changed some of the other things as well. I do a lot with my diet. It’s very, very complex, but in my opinion, that is what has saved my life, and that’s why I’m around today.

The ironic thing about it was my body craved it. I started eating it, and it tasted so good. It was really delicious. Again, I was down to 123 pounds. My daughter comes in. She stayed with me for 2.5 months and was cooking meals for me, and she was cooking up to 5 full meals a day. 

She said that she would put a plate of food down, and I would eat it so fast she thought I was going to bite her hand.

I look back, and I would not have been able to put on the weight if I’d have stayed with my vegan diet. It just isn’t that way. By adding the protein and listening to him and doing other things — I’ve done a lot of other things — that’s what has made the difference for me.

What happened after your 6 rounds of chemo?

I did the 6 rounds of chemo. Concurrently with that, I started implementing my diet. I take a number of supplements. I was doing that every single day. Everything played an important role in all of this. 

What I’ve done is I’ve treated my whole being. Not only the physical, but also the mental as well. I was working with a hypnotherapist from Cyprus. She helped me a lot and taught me a lot of things that I had no idea about, [like] working with the subconscious mind. 

She told me that she looked forward to working with me because I already had the basis of the mindset necessary to accept everything that she was going to teach me. It’s worked out really, really well.

How are you doing now?

It’s going really well. When I started my cancer journey, my PSA for my prostate, which is the marker for prostate cancer, was almost 1,000. My oncologist said she had never seen anything remotely that high. 

What I basically did was I targeted the 3 main areas of my cancer: my prostate, my bone, and my lungs. As far as my prostate goes now, my PSA is down to 0.6 from almost 1,000. 

Then my lung cancer, I saw an actual scan of my lungs. There’s supposed to be 2 white entities, and these 2 white entities had black blobs floating through all of it. That’s the way I started my lung cancer journey. 

I’ve taken some things that have really, really helped in my lung cancer. My lungs are doing much better. I don’t know exactly where they’re at, but compared to when we started, they’re like light years better. 

The same thing with my bones. I still have some cancer in my bones, but the metastasis has stopped, and things have gotten much better. I haven’t used any prescription meds for pain at all through this whole journey. I do CBD and other things as well.

»MORE: CBD, Cancer & Treatment Side Effects

Are you on any maintenance therapy?

I do take an injection for bones once every 3 months, and then another monthly injection for my lungs as well. That’s about it. I do it with my diet and my supplements and my mental exercises and things like that.

Reflections

Importance of self-advocacy

It goes back to societal norms. We’re all taught that you always listen to your doctor. Then the second part of that is when people hear the word “cancer,” what do they automatically think? You’re going to die. Majority of people think that way. 

Those are things that we’re taught from a young age as a society. I talk to people all over the world, and all over the world, the perception is the same. Absolutely the same. 

I tremendously respect doctors, my oncologist, and everything like that. I give them respect. They do know what they’re doing with what they have in front of them. 

To me, 15 minutes, which is the treatment time that most patients receive, is not enough time to get to know that person. One of the main things when a person gets a diagnosis is does that oncologist really know the makeup of that person? Does that oncologist know how that person is going to react? 

My oncologist has come to know me over time, but at first, it was just basically telling me, “Shut up and get in line.” I wasn’t having that. I respect what she has said, but I wasn’t buying it as me. That’s not me. 

I didn’t know, when I started, what was going to happen, but I put in my mind that if there was any way possible on this earth, I was going to live. I look at the obituaries. I glance through them every day, and I said, “There’s no way my name is going to be there. No way.” 

The message that I share with as many people as I can is you need to be you in this journey. If you feel that you have the fight to do this — and it is a battle. There’s no doubt about it. The biggest battle that you’re going to have as a cancer patient is [mentally]. That’s the biggest battle. 

For me, I wouldn’t wish cancer on anyone, but cancer has changed my life for the better. It’s just opened my eyes to so many things. I appreciate things that I just took for granted. I took for granted so many things. 

I used to walk out my front door, and it was like I didn’t even think about anything. Now, I open my front door, I look outside, and I really, really love and appreciate the simple things. 

I reflect back and I realized that when you’re in your room for 3 months and you’re isolated like that, to have the ability to walk outside is such an incredible blessing and such a great thing.

My pet peeve is these doctors and oncologists give these diagnoses: “You have 6 months to live. You have a year to live.” People buy into that number, and it drives me out of my mind. I meet so many people, and I hear stories of relatives and friends who were given diagnoses, and they died almost to the day, so many to the day of the diagnosis. 

The mindset is so, so crucial and so, so important, because you do have the ability to plow through and make it.

»MORE: How to be a self-advocate as a patient

The mental battle against cancer

I want people to live. I want people to beat cancer. But the only way that you can beat cancer is if you don’t let it beat it up here [in your head]. Once you accept something less than living, then you’ve lost. Have that mentality with it, because there’s no doubt about it. This cancer is a battle. 

It’s a battle from all different directions. There are so many different things that a person needs to deal with. The two main things that you have to take care of is your mind and your body. It’s so critical to realize that. 

[For] so many people, there’s nothing wrong with [thinking], “Why did this happen to me? Why am I going through this?” But you cannot dwell on it. You have to dwell on how to make it better. How do I overcome this instead of feeling sorry for myself? 

Did I feel sorry for myself? Yeah, probably about an hour. The conclusion I came to was, “I’ve gotten cancer for a reason, and the reason is because I could handle it.” I knew I could handle it. God doesn’t put anything in front of you that you can’t handle. After that hour, I knew that somehow, some way, I was going to be able to break through.

I started my YouTube channel when I was really in bad shape. I’ve been able to put up a video every single week. I started my channel because I wanted to help one person, and the one person that I helped the most was me. 

These are the days that I wanted to be around for.

Mark K.

Last message for patients and caregivers

If you get diagnosed, whatever you’re afflicted with — whether it’s heart disease, cancer, or autoimmune disease — the journeys are different. But in a lot of ways, they’re the same because in order to get better, the mind is so critical, and [so is] actually really believing that you can get better. If you don’t believe that you can get better, nobody else is going to believe that. 

It’s your life. When you go to the doctor and they tell you, “You have 6 months to live,” they are concerned about you, I’m sure. But who’s going to care more about your life, you or your doctor? It’s you. That right there should tell you that it’s on you to do everything that you can to find the answers so that you can keep living your life and making a great life. 

I’m just so, so happy every single day. I’m so fortunate to meet so many incredible people. At this point, there’s no doubt in my mind I’m going to be around for a while. [My daughter’s wedding] was back in October. I was just looking out and reflecting. It was up at her mother-in-law’s ranch up in Santa Maria. It was really, really great, but the thing that was so awesome was the fact that I just reflected, “These are the days that I wanted to be around for.”


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Categories
Bladder Cancer Cancers Patient Stories

Ebony’s Stage N2 Muscle-Invasive Bladder Cancer Story

Ebony’s Stage N2 Muscle-Invasive Bladder Cancer Story

Ebony was only 45 years old when she was diagnosed with stage N2 bladder cancer. Having lost her own father at a young age, she had to process the fear of not being there for her 3 sons.

She then underwent MVAC chemotherapy and an 8-hour surgery to remove her bladder. As part of this surgery, part of Ebony’s small intestines were used to create a neobladder.

Ebony shares her cancer journey, including taking control of her hair loss, the experience of African Americans in the medical system, the importance of self-advocacy and support, and using her story to be a light for others.

  • Name: Ebony G.
  • 1st Symptoms:
    • Microscopic amount of blood in urine
    • Increased to visible amount of blood
    • Pain when urinating
    • Weight gain in midsection
  • Diagnosis (DX): Urothelial muscle-invasive bladder cancer
  • Staging: N2
    • This means the cancer has spread to 2 or more lymph nodes in the region
  • Tests for (DX):
    • CT scans
    • Checking IUD for issues
    • Cystoscopy
    • Biopsy
  • Treatment:
    • MVAC chemotherapy
      • Methotrexate, vinblastine sulfate, doxorubicin hydrochloride (Adriamycin), and cisplatin
      • 6 infusions, biweekly
    • Surgery
      • Removal of the bladder
      • Neobladder

Table Of Contents
  1. Introduction and First Symptoms
  2. Finally Getting Diagnosed
  3. Next Steps After Diagnosis
  4. Hair Loss
  5. Treatment and Recovery
  6. Finding Support and Advice
  7. Reflections

This interview has been edited for clarity. This is not medical advice. Consult with your healthcare provider for treatment decisions.


Introduction and First Symptoms

Tell us about yourself

Hi, my name is Ebony, and I was 45 when I was diagnosed with bladder cancer.

I am married. I have 3 sons. I am an engineer by day. I just want to live my best life like everyone else. Those are the biggest things. I really want to live my best life and help others do the same.

What were your first symptoms?

My initial symptom was after a visit with my annual gynecologist, and they noticed that there was blood in my urine [at] a microscopic level. I couldn’t even see it, but a microscopic level of blood in my urine. They referred me to a urologist to try to look into what was going on. [It] kind of freaked me out. 

That’s how it started over 2 years ago, pre-COVID actually. I proceeded with the urologist. They couldn’t find anything. I had different scans [and] different scopes that were performed and initially couldn’t find anything. 

He said, “We’ll just keep you on a schedule. You’ll just keep coming every 6 months, and we’ll check on you.” I didn’t have any other red flags. Generally very healthy. [I] never went to the doctor except for my physicals. [I was] not on any other medication, [and I had] no high blood pressure, cholesterol, diabetes, no other health issues. [I] was pretty active. 

The doctor was kind of like, “We’re not seeing any smoking gun, so we’ll just keep watching you.” That’s how it started. [I] didn’t have any pain [and] no other symptoms.

Looking for potential causes

We looked at several things. We initially thought it was a UTI, so I was prescribed an antibiotic and then thought, “Okay, we’re good to go.” It kept going, so then the next thing was, “Okay, let’s check your IUD. Go back to your gynecologist, check the placement of your ID, [and] make sure that that’s in place.” 

[I] did that. [The] gynecologist was like, “Yep, it’s good. No problems.” Then they thought we have to confirm what the source of the blood was. Is it just menopausal stuff going on? What’s going on? 

I’ve read and studied that most women are misdiagnosed because I guess our bodies are a little complicated. People go grasp for the initial things that may be probable, but all of those things were batting zero. 

He referred me to a kidney doctor to look at the functions of my kidneys, and all was well. I went back to the urologist, and they were like, “Well, we’ll just keep an eye on you.” That eye on me was a check every 6 months.

What scope did they perform?

I can’t remember the technical term right now, but it was a scope where they basically filled my bladder with liquid and checked. It kind of would magnify if there was anything going on in my bladder. 

There wasn’t anything to be found. Generally, it made me feel like I needed to urinate. [It] wasn’t the most comfortable feeling. That was one of the initial scopes, and then also a CT.

How were you feeling through this process?

I wanted to trust my doctors to believe that they would know what was wrong. When the doctor was telling me, “Well, we don’t know,” I was like, “Okay, if you don’t know, yeah, I’m a bit concerned.” 

He even told me at one point, “There are some people that over time, as they get older, their bodies function differently, and maybe that’s just you. I was like, “No bueno. No, I’ve never had this as a problem.” 

I remember telling my husband, “I feel like the woman with the issue of blood, like biblically. It just won’t stop. I don’t understand.” At that point, a year passes, and now I can actually see the blood when I went to the bathroom. 

Now it’s more prevalent, and my doctor is still saying, “Maybe this is just what your body’s going to do.” I was like, “This can’t be likely. This can’t make sense.”

I even started gaining weight, particularly in my midsection. I remember thinking I never gain weight in my midsection. With each of my boys, I gained 60 pounds when I was pregnant. But every time, I always gained weight in my hips and thighs. 

For me to gain it in my tummy area, I was like, “This doesn’t seem right.” But even the nurse at the practice was like, “You’re in your upper-40s, mid-40s. Maybe that’s just what’s happening. You’re just gaining weight in a different way. I was like, “Yeah, no.” 

I was very concerned because they couldn’t figure out what was going on after a year and a half. It got to the point where I was like, “If they don’t find something this time —” fast-forward, that was September 2021, ” — I’m going to someone else.” I also at that point had had the IUD removed. [I was] just trying to remove every possible potential cause, and we still couldn’t find anything.

Can you list those emotions you were feeling during this?

Confusion. Despair at some points because I just really didn’t know. I was wondering if there was some underlying something. I was Googling things [and] trying to figure [it] out. [I was] just kind of confused and lost as to how the professionals don’t know. 

Honestly, I had never heard of bladder cancer. It never occurred to me as something to delve more into. To be honest, I don’t ever recall my urologist saying, “If you see this additional sign, then maybe we should dig more, or let me know.” I was very concerned and stressed about what this could be.

Finally Getting Diagnosed

How did you finally get a diagnosis?

The other thing was I’m not sick typically, and I remember actually coming down with COVID [in] August of 2021. Everybody was catching COVID, but still, I was like, “I’m never sick, and now all of a sudden, here we are.” 

Then I actually started feeling pain when I urinated. I was supposed to go to the urologist [for] my normal 6-month check that August. Due to him being on vacation, we rescheduled the appointment. When we rescheduled the appointment, then I ended up with COVID, and so that appointment was pushed off to October. 

I went in again, and he said, “You know what? We’ll go ahead and do another CT. Then we’ll see from there.” We did another CT in October. Then he called me in his office, and he’s like, “Something’s abnormal here. We’re going to need to have a surgical procedure because I see something.” 

He also did that scope, the same scope that he did that year prior. In that scope, he saw something, which freaked me out. Then he’s like, “I actually need to see you in surgery in the next 2 weeks.” 

I was like, “What? 2 weeks? Surgery?” My last surgery was, at that point, probably 12 [or] 13 years ago when I’d had my last C-section. 

We had the abnormal CT, the extra scope that was abnormal, and then the surgical procedure to biopsy this growth that he saw to see more of what was going on.

Processing the possibility of cancer

That was in person. For that appointment to talk about doing the surgery (prior to the biopsy), I was by myself. He did [describe it as a growth or tumor], and I instantly thought cancer. 

I was like a ball of tears, and the nurse that was with me said, “You’re going to be okay.” She was extremely comforting. This was a different nurse. She’s like, “I’ve been through this before. You’re going to be just fine.” 

But at that moment, I remember thinking, “I’m going to die. What is this? How did we catapult from, ‘Not only it doesn’t seem like much, [but] this is probably what you’re going to always just deal with, because this is just the way your body is functioning,’ to, ‘We need you to have surgery in 2 weeks and dig further to understand what’s going on.’” 

It was pretty traumatic by myself in the office, but the nurse tried to reassure me and tell me, “You’re going to be okay.”

What was the value of having someone trying to comfort you?

Honestly, I didn’t believe her, but it was a bit comforting to know that someone had been through something similar. I didn’t have my wits about me to ask more detail of exactly what she meant that she’d been through it, and I haven’t seen her since. 

After that few weeks, the urologist ended up referring me to a surgical urologist, one of the top urologists in the area, to proceed with my treatment. While it was a bit comforting, I was still like, “Yeah, I don’t know that you can relate to what I’m going through. I don’t even know how you know what I’m going through. Did you really have this procedure?”

Did you feel a shift when you found out it could be cancer?

There were 2 shifts. That was one shift because I remember thinking, “I’ve trusted you for a year and a half to try to find something, and what was it about everything that has gone on in the past year and a half where you didn’t find anything?” 

Of course, we trust doctors [and] trust that people are going to do things in our best interest. But I began to wonder what other signs were there that maybe you overlooked. I honestly was a bit angry because I thought, “I’ve been coming to you for a year and a half, and you haven’t seen anything. Now, all of a sudden, I need to be in surgery in 2 weeks.” 

That was one shift, and then the second shift was when he told me specifically after the surgery that the growth was confirmed to be cancerous and that he wanted to refer me to someone else that could better help me.

Undergoing a biopsy on the growth

November 11th last year (2021) was when I had the surgery. I was extremely scared because even with my 3 C-sections, I was very alert in what was going on. At this point, I’m like, “Oh, you’re going to take me under?” 

I’m just a bit paranoid about, like, am I going to come out okay? Then the fact that you have had a challenging time diagnosing me, and now you’re about to take me under to try to figure out what this is. I was Googling left and right [and] Googling the report to try to figure out, “What does this mean?” 

That was on November 11th. Then we had plans for Thanksgiving to go visit family. I remember thinking, “You should be able to tell me what the results are almost instantly, even if it’s a week.” 

But it was November 29th, 2021, before I found out that it was cancerous. The crazy thing was, in the meantime, I got this random text from another hospital not even in the state that was something about checking into the cancer center.

[It] freaked me out because at this point, it was in between me having the surgery and getting the results. I remember texting my husband, “Oh my God, does this mean I have cancer?”

But it was a total random text from a hospital not even in the state that we live in. He was like, “Ebony, don’t worry about it. That’s just a random text. It’s nothing.” But I was like, “This is way coincidental.”

Waiting for the biopsy results

It was like 6 in the evening when I received the text. I couldn’t call the doctor’s office because it was after doctor’s hours, so after the working hours. I remember calling the doctor’s office the next day, saying, “Hey, I got this random text. Does this mean that this tumor was deemed to be cancerous?” 

The receptionist was like, “Oh, no, no, no, that’s not even affiliated with our practice.” But I was like, “Of all the times to get this random text… Is this the Lord preparing me for what’s about to come?” I’m thinking all the worst. 

Nevertheless, we went to visit family for Thanksgiving, but the entire time, in the back of my mind I was like, “Am I going to get this result? When am I going to get the result? And is the result going to be one of my biggest fears?” 

Fast-forward to November 29th. They called me in to come get the results. I remember thinking, “Okay, the fact that they’ve called me in can’t be good.” My husband went with me for that appointment, and that’s when I first saw the verbiage on the report to say that I had a high-grade urothelial, muscular-invasive bladder cancer. 

I was like, “What? What does this mean? What stage? What?” I remember that was the second shift, where I was just devastated. I don’t know that I’ve ever cried like that after getting those results.

»MORE: Patients describe dealing with scanxiety and waiting for results

What was your official diagnosis?

They diagnosed me with stage 2 urothelial muscular-invasive bladder cancer. I want to say it was staged N2 because a couple of my lymph nodes were impacted.

Next Steps After Diagnosis

Processing the full diagnosis

I remember my eyes just welling up. I couldn’t even read what was on the paper just because I was so emotional from what the diagnosis was. He was optimistic and trying to be encouraging in that visit. 

I just remember thinking, “What if I hadn’t come back? I’m listening to you all, and you’re saying, ‘Oh, well, it should be fine. Your body’s just maybe designed to work this way.’ What if I hadn’t come back? What if I didn’t prioritize this visit based off of some of the other verbiage that y’all were sharing with me, yet me telling you something doesn’t seem right? What if I hadn’t come back? Now you’re telling me that I’ve got this aggressive tumor growing in my body, and now you’re telling me you’re going to refer me to someone else because it’s a little more complicated than what you thought. Really?”

Losing a parent at a young age

Imagine this. I’m a 45-year-old woman, married with 3 kids. Our sons at the time were 20, 13, and 14. When I was a senior in high school, my father passed. 

When I heard the diagnosis, I instantly thought, ‘Here we go. I’m not going to be around for my children.’

It was a pretty quick sickness. I remember thinking, “He’s going to recover just fine.” But I didn’t know the seriousness of what was going on. I was devastated when he died my senior year in high school. There’s always been a part of me that has wondered, “What if that happens to me? What if my boys are left without me?” 

»MORE: Parents describe how they handled cancer with their kids

I’ve gone through pretty much my whole adult life missing that presence. He wasn’t able to meet my husband. He wasn’t able to meet the boys. He wasn’t able to offer insight on different things. I wasn’t able to ask him questions like, “Daddy, what do you think about this? What do you think about that?” Just input that I would have loved to have received. 

Worrying about leaving your kids behind

I’ve always wondered and prayed that that would not be my outcome. When I heard the diagnosis, I instantly thought, “Here we go. I’m not going to be around for my children. What are the things that I’ll be able to do so they’ll remember me, they’ll know me, [and] they’ll know my feelings for them? What can I quickly try to do where they will have fond memories of me?” 

They’re still very young, and honestly, there are a lot of memories that I don’t have of my dad because I was young. My instant thought was, “Oh, my God.” I honestly was a bit angry with God. 

I’ve had to do a lot of personal work to get beyond missing that presence of my dad and wanting him to be proud and wanting to accomplish certain things. That’s been a lot for me. To think that they would potentially be catapulted into this same space was extremely devastating and challenging for me. 

I just remember my instant thought was, “How much time do I have? How much time do I have?” I didn’t know anyone with bladder cancer. I’m a bit of a fluke. The doctors would say, “You’re a unicorn. You’re checking all the boxes, [by] trying to live a healthy lifestyle. Yet here we are. You’ve never smoked. You’re not an older white male, yet here we are.” 

It was extremely devastating for me because I remember thinking that my children are going to grow up without their mom. That was a space that I’ve always not wanted to be in because I hated having to experience it myself.

Telling your children about the diagnosis

I’m trying to think how we even came to how we were going to share, because I didn’t want them to worry. We decided not to share much. Initially, we weren’t going to share really much at all because my first appointment with the other urologist, it sounded like, “You’ll still keep your hair. Your hair may thin a little.” 

I was planning to continue to work. I was really trying to kind of maintain that normalcy. Fast-forward [to] when we met with the hematologist. He was like, “Oh, no, boo-boo, you’re gonna lose all your hair,” which was extremely devastating. “You’re going to have chemotherapy or infusions every other week. After the second infusion, it’ll be extremely challenging for you.” 

Hearing all those things made me say, “Okay, we probably need to share something.” My husband honestly did all the talking when we shared. I’m extremely emotional, and I’m a big crybaby. He was the one that shared. We didn’t discuss details of staging. We weren’t intending to, but the oldest one, who was 20, was instantly like, “Okay, what stage is it?” 

We just talked as a family. This is the deal. This is what’s going on, but we will get through this. Like I said, he did all the talking because I would have been a blubbering mess. He did all the talking, and I honestly think that was the best part of it, that he was the one that kind of put a positive spin on it all for them.

How did your urologist describe the results to you?

It was a very short appointment. I remember him asking me if I had any questions, but I was like, “Yeah, I got all the questions, but I don’t know what questions to ask.” I don’t know if he was just struck by the amount of emotion that I was expressing. 

It was just more of a, “I’m going to connect you to someone else that is going to help you better than I can.” I remember thinking, “Well, dang.” I was just so overwhelmed. I didn’t know what questions to ask. I had a ton of questions, but I really didn’t even know. 

Of course, some of the main questions were, “How serious is this?” There was not any discussion at that time of treatment. No discussion about any of that. I didn’t really get into all of that discussion until I met with my other urologist.

Receiving treatment at Duke Raleigh Hospital

All of my treatments after that point were primarily through Duke Hospital in Raleigh, North Carolina. Honestly, that was probably one of the best decisions for me. It’s great because the treatment was relatively close to us, so we didn’t have to travel far. 

After that diagnosis, there was a slew of appointments. I can’t even tell you how many appointments. Every day, it felt like I was at another appointment, and it was a whirlwind of appointments. 

That surprised me because I had to go to different doctors for them to check my heart, to check my liver, to check all these different organs. The hematologist knew what my body was about to have to undergo. They were trying to make sure that my organs were going to be able to withstand all of these really harsh treatments that I was about to start taking. 

Most of my treatments were at Duke Raleigh. The hematologist and urologist worked hand in hand to enlighten us on what was about to happen.

Ebony with part of her team at Duke Raleigh.
Receiving a binder of information to prepare you

My first appointment with the urologist was accompanied with this huge binder, this 3-inch binder of tons of information, including a section on hospice care. 

All of it was about the medications that I was going to have to take, the potential types of urinary diversion, you name it. That binder was the gospel for me for the next several months. [It was] a little daunting to get that binder. Then there was another little pamphlet that had pictures of people, I guess, that had bladder cancer. 

I remember thinking on the cover of that little pamphlet, “None of the people that have been diagnosed with this look like me.” There may have been one woman on the picture, but she wasn’t African American. Everyone on that pamphlet looked older and not like me, but I was like, “Okay, here we go.”

Was the pamphlet comforting, or what did you feel looking at it?

I looked at the different types of urinary diversions when I opened it, and I remember thinking, “Wait a minute.” I was actually kind of vain at the time. I was like, “Wait a minute. What is this? Does this mean I’m going to be left with a bag outside of my body? Does this mean I’m going to lose my hair?” 

I was physically trying to think through what the impact was going to be. I remember talking to the urologist initially, and he said, “This is the new and improved one.” I remember him saying, “Your hair will likely thin,” and so I remember thinking, “Okay, I can manage that because I had a ton of hair.” 

I was okay. Then right after his appointment, I had the appointment with the hematologist [the] same day. The hematologist was like, “You’re going to lose all of your hair.” 

I just was devastated at the thought of, ‘How am I going to manage not having hair?’

I went from, “Okay, I think I can manage this,” to, “Like all of it, all of it?” He’s like, “Yeah, no, without a doubt, you’re going to lose all of your hair.” Again, I [was] just devastated, bawling in the doctor’s office. [I] can’t even read the material that they’re handing to me. 

We didn’t tell the boys at that point. It wasn’t until for sure we knew I’m going to be physically impacted. I’m not going to be able to hide it per se. That’s when we decided to share with them.

Hair Loss

The importance of hair as a Black woman

As a black woman, actually it takes a long time for our hair to get to the lengths that we enjoy. My crown, as I call it. There’s a lot of pride and joy in my hair. Actually, for about 7 or 8 years, I had decided to become natural, so not having any chemical products in my hair, not having any relaxers to relax my curl pattern. 

I had really worked hard to grow those chemicals out of my hair. [I would] keep cutting the hair and just growing out for it to be at its natural state. To get to this point, where it’s 8 years in the game of being what we call ourselves naturalistas, to find out now it’s all going to come out. Like, what? 

Then I’m thinking to myself, “Is it going to grow back?” You hear stories, and you see people where it does grow back. I was like, “What does that mean for me? Is it really going to grow back?” 

I just was devastated at the thought of, “How am I going to manage not having hair?” That was honestly the tip of all of the side effects that were going to come from it, but the initial thought was no hair. I’ve worked really hard to become a naturalista and take pride in this crown that I wear, and here we are.

It was incredibly devastating.

Can you describe the impacts with lack of control with identity?

I was really disappointed when I found out. I have a bit of a social media presence, too. I like to be out there and sharing with people how they can live as their best selves, how to motivate people, [and how to] encourage people. 

I’m like, “Now everybody’s going to know. It’s not going to be my own personal battle, because I refuse to let this stop me from still being an encouraging force to people in my circle.” 

I remember thinking, “Lord, I don’t know why you’ve given me this, but I’m going to choose to believe that it’s because you trust that I can still be a light despite whatever is going on.” 

I refused. I’m not going to allow this to minimize my presence on social media. I’m not going to allow this to minimize the peace that I bring in my home. I’m not going to allow this to be that. 

I remember talking to one of my sorority sisters, and she’s a breast cancer survivor. She suggested to me, “Ebony, I just challenge you, maybe you want to go ahead and cut it, because at least that part you have control over.” 

I never had my hair in a short style, and I was like, “You know what? I think I will.” My first chemo infusion was December 22nd, and my birthday’s January 10th. My second infusion was going to be January 5th. I remember the hematologist saying, “After your second infusion is when your hair will likely come out.” 

I remember thinking, “I’m going to be optimistic. It’s not going to happen for me in my second infusion.” I can’t remember the actual date, but between December 22nd and January 5th, I was like, “I’m getting my hair cut.” 

I remember texting a close friend who owns a salon and was like, “Hey, I need you to cut my hair.” She was like, “What? You sure?” At the time, I didn’t tell her what was going on. When I actually made it for the appointment, I let her know, and she was like, “Oh my God, are you sure? We don’t have to cut it. We can just wait and see. Maybe it’ll just thin.” 

I was like, “No, I’m ready to cut it.” It was a very short style. That was one of the best feelings that I had. I remember thinking that I was going to be emotional during the cut, but I wasn’t, because I remember thinking, “I’m going to enjoy this, because based on what the doctor is saying, I’m not going to be able to enjoy it for long.” 

I remember getting it cut and coming home that night, and my husband started crying because he was like, “You’re really having to do this. Here we go. But we’ve got this. We’ve got this. We’re going to conquer the day.” 

»MORE: Patients describe dealing with hair loss during cancer treatment

That was something he constantly said to me: “Conquer the day.” I’m a creature of habit. I will look far in the future and think, “Oh, but what if, what if, what if?” He said, “Uh-uh, conquer the day. Stay like a hitch. We’re going to stay right here, between right here and here. We’re just going to conquer the day.” 

Getting my hair cut was huge for me in controlling the process. I want to say for my birthday, I still had some hair. I used to wear a scarf around my head just to kind of protect my boys from seeing. Literally every day, I would wake up, [and] there would be hair on the scarf [and] hair on the pillow. It got to the point where I was like, “I’ll just shave it.” Because, again, that was me exercising my control in this situation.

Your husband shaved your head

Yeah, he did. Honestly, that was the best. I remember him thinking, “We can take you somewhere else and get a cut.” I was like, “No.” I thought I was going to be emotional, honestly, in that phase. But I wasn’t. It was honestly freeing because I didn’t have to worry. 

Ebony decided to shave her head.

It was coming out in handfuls. It also was denaturing my curl pattern, so my hair was sticking up on the side of my head. It was just not the most attractive. When he agreed to shave it, it was liberating because I knew, at least now, I’m not going to have to deal with seeing it come out. Seeing it come out was the worst part. 

Once it was all shaved, I still wore a scarf around my head initially. Then we had a meeting downstairs at the kitchen table. My husband told the boys, “I just wanted to let you know we shaved your mom’s head and wanted to share with you what it looks like.” 

We showed the boys. I took the scarf off, and I wondered “What are they going to think?” My oldest son was like, “Wakanda forever,” which was the best feeling, because I was like, “You know what? Yes. Wakanda forever.”

What did that moment mean to you?

I totally was thinking, “I’ve lost something. I’ve lost a lot, and my boys are going to look at me like I look abnormal.” But when my oldest was like, “Wakanda forever,” I honestly remember thinking [about] the movie. It took me back to the movie and how the women whose heads were shaved look like queens. [They] looked like royalty. 

There was nothing that I saw in them that was a loss. He probably doesn’t realize it, but when he said that to me, it equated to me like, “Honey, there is nothing here that is a loss. You are still a queen regardless.” Like I said, he probably doesn’t realize it, but for me, that was reassurance that that’s what he saw.

Treatment and Recovery

What was your chemo regimen?

I would go every 2 weeks, every Wednesday, and I had 4 different drugs. The acronym was MVAC, and it was 4 different drugs. I would go in for my blood work at like 8 in the morning, and then they would administer the chemo. 

None of it was administered at the same time. There was a series. I can’t remember the order specifically, but there were some drugs that were administered. One of them people affectionately call it the “Red Devil,” and I was like, “Nah, that’s the blood of Jesus.” Anyway, I would try to be very optimistic when I went in there. 

When I would see the nurses, they were all suited up with things to protect them from the same chemo, the meds that they’re giving me. I’m like, “This isn’t a good sign.” They would start administering the chemo, [along] with some of the meds. 

There were 2 meds that were known to cause neuropathy, and so we would ice my hands and feet while the med was being administered, which was a bit challenging as well because it’s cold. I would sit with my hands in ice and my feet in ice for as long as I could bear it, then take it out for a few minutes, and then submerge everything again for as long as I could while those meds were being administered.

Generally, I would hope for a window seat because I was always surprised at how many people were undergoing care in the infusion center. All of it was in the same place, all still in Duke Raleigh. I would go upstairs to get my blood work [and] go upstairs to get a checkup. 

They would tell me about how my blood work was looking, and then I would go back downstairs for the infusions. I would pretty much be there all day until like 3 or 4 in the afternoon. Some gracious souls would bring us food. 

One of my close friends set up a meal train for us. People had signed up, and they knew every Wednesday she’s going to have her infusions. People would bring food for dinner on Wednesday nights. That was every other Wednesday for 6 infusions. 

It ended up being 12 weeks. From the beginning of December — so through Christmas, my anniversary, my birthday, Valentine’s, all these big markers for me, I was having to go through all of these treatments — until the beginning of March.

How did your doctor describe the treatment regimen to you?

The urologist talked mostly about what the entire treatment would look like. The urologist talked beginning to end. The hematologist specifically talked about my chemo. I knew that there would be some type of surgery at the end of all this. 

Actually, what they told me was, “You’ll probably do 2 to 4 infusions.” On the day of my second infusion, my chemo doctor was like, “You’re doing really well with this. We’ll actually go ahead and continue, and you’ll have 6 infusions.” 

I came in thinking, “I’m halfway. I’m going to get through today. That’s going to be halfway.” Then he was like, “No, boo-boo, we’re going to sign you up for 4 more.” That was another emotional day because I remember thinking, “Wait a minute. You’re telling me I’m doing well?” 

He was like, “Well, yeah, that means your body is tolerating this. We are intending to zap this cancer as much as possible before you have surgery.” Again, that was devastating because I was just like, “I thought we were doing good. We’re close to the finish.” 

What the urologist explained to me was that once I was done with my infusion, then we would have to have a surgical procedure. That surgical procedure would absolutely mean the removal of my bladder because of the type of cancer that I had. 

Once it was very clear that the tumor had gotten to the muscle wall of my bladder, the bladder has to come out. There’s potential spread to other organs. We were very concerned about that. I had to do additional scans to see how far potentially it spread. 

Those additional scans confirmed that it only spread to lymph nodes in the immediate area. At that time, the urologist thought we may actually have to proceed with a hysterectomy in addition to bladder removal, in addition to whatever urinary diversion they would have to do.

I remember thinking, “Can’t we get a bladder? Like, can I get something donated from somebody? Surely, I don’t have to lose [it].” It seems pretty extreme. 

I remember another breast cancer survivor telling me, “Ebony, at least it’s not breast cancer.” I remember thinking, “Girlfriend, no shade on whatever else you went through, but I’m about to lose a bladder. I’m about to potentially have to wear a bag outside of my body.” We don’t even know yet what the outcome is going to be, and I can make a choice. 

The other concern I had with my doctor [was], “Wait a minute, how many women have you done the surgery on? I know you typically do this on older white men, but how many have you done [like] this? I need to see statistics.” The engineer was coming out in me at that point, and I was very concerned because I was reading, Googling.

I asked the doctor, “Is there a support group that I can connect with?” The nurse said, “There is, but honestly, Ebony, the people that are going to be in that support group that’s through this medical center are likely not going to look like you. You’re not going to be able to relate to [them].” 

I was like, “Another day, another devastating assessment.” But then my husband was like, “Chase on the case.” I never even thought about this because I was so emotionally triggered. He looked on social media and found a group for me of women with bladder cancer, which was huge. 

While there are no doctors or medical professionals in there, it was just comforting to me to know there are other women out there. It was a very small group, but there were other women out there. I can go look at their posts [and] see what treatment they chose. 

There were 3 different types, 3 different potential urinary diversion surgeries that I could have. [I was] just trying to figure out what their quality of life was after their surgery. That was a little bit more about what he shared and how we connected the dots on what I wanted to do.

Importance of hearing from people you can relate to

The doctor can say all day, “You’re going to lose your hair, but it’s going to grow back. Your nails are going to turn black, but they’re going to grow back.” 

It’s so incredibly helpful to know that there is someone else, a woman like you who’s probably married, who has kids, [and] who’s concerned about the effects of chemotherapy on her reproductive organs. 

I wanted to see if people were able to return to their previous level of quality of life. You have a doctor saying, “You’re going to be fine.” Hearing someone else say, “Look at me. Yes, I’m fine. Yes, I can still run. Yes, I can still go to the swimming pool.” That was extremely comforting.

What were your options for removing your bladder?

There were a few options, actually. As far as what science dictates, there are 3 different options. My surgeon made it very clear that he did 2, that there were 2 options. 

I could have the bag outside of the body. There’s a more technical term for it, but I can’t remember. In my brain, I was like, “Okay, that’s the option. Bag outside of my body that I would need to empty.” 

Then there was an Indiana pouch, which my doctor didn’t do, and then there was the neobladder, which is what I decided to go with. The key thing that he let me know was even if I decided on the neobladder, in the surgery, they would have to determine if my body was the best candidate to undergo specifically the neobladder diversion. 

I’m skipping way ahead, but even literally right before the surgery, like a day [or] 2 days before the surgery, I was marked for the procedure that would make me have to wear a bag outside of my body. I had a physical marking on my belly because they actually wanted to see how I sit, like the folds of my tummy, in the case that my intestines weren’t deemed viable.

The neobladder consists of taking a portion of your intestines, your small intestines, and creating a new bladder. If they determined in the middle of surgery that that small portion of my intestines was not viable to be used as a bladder, then that meant that they would have to punt and go back to the bag-outside-of-the-body option. 

I would not know until I woke up from surgery what I ended up with. My prayer was neobladder. That was ultimately what I decided to go with, but he also made it very, very clear that the neobladder surgery is incredibly invasive and much more involved and a longer recovery time. 

I was like, “Yeah, no, that’s what I want. We’re going to figure this out.” After researching and seeing the image, he also made it very clear that a lot of people, like from surveys, 50-50 will say that their quality of life is back to where it was before the surgery. 

Ebony on the day of the surgery.

It’s pretty much split down the board. Some people love the neobladder. Some people love the other diversion (ostomy). I decided to go the neobladder route. That’s an 8-hour surgery because they have to do 3 different things: remove your bladder, take some of your intestines, create a new bladder, and then reconnect everything.

How long was the surgery?

It was 8 hours. It may have been a little bit longer for me. My husband told me recently, that apparently when they do the surgery — I didn’t remember this data point — you’re inverted. 

My surgery was a robotic procedure. There are 5 incisions on my belly now to do all of that, and it blows my mind sometimes. I’m like, “That’s all? For all that you just did in my body, 5 small incisions?” 

They inverted me, apparently, during the surgery. When I came out of the surgery, I was incredibly swollen. It kind of really concerned my husband. They were like, “That’s normal. She’s just been inverted. Yada, yada, yada.” The surgery itself was between 8 and 9 hours.

Recovering from the surgery

In all the materials [and] that huge binder, it talked about so many things. It talked about the meds that I was taking. I’ll definitely talk about the continence piece, but I was taking so many meds and steroids to circumvent the side effects of the chemo. That was just one thing already. 

There were other sections in the binder to talk about what could happen after the surgery. One of those things was you could be hypercontinent [and] lose all ability to control how you use the bathroom. Those were the fears that I had.

Then also [it covered] how it could impact your sexual relationships, your sexual relationship with your spouse. I just remember thinking, “Okay, look, this is a whole lot more than what I initially bargained for.” 

I would find myself stressing for what the outcome would be. That’s when my husband would come back and say, “Right here. We’re going to conquer the day. We’re just going to conquer the day.”  

I was extremely concerned about [if] I [was] going to have to wear products to manage through the day. I work in a manufacturing facility. I was wondering how my clothes are going to fit. Am I going to have to have additional things to use the bathroom? Am I going to have to change what I wear? I usually would wear fitted things, and so now am I going to have to have this bag that’s going to dictate [that]? Am I still going to be what I thought was attractive? You name it. I thought all those thoughts.

Recovery in terms of sexual health

Some of my biggest fears started with the chemo because I also started experiencing hot flashes. There were instructions as far as after you have chemotherapy to not engage in sexual relationship because of the chemo and potentially endangering your spouse or whatever. 

I remember thinking, “As a woman, am I going to be able to help you meet your needs? Are you going to be disappointed still being married to me? Because now this ‘for better or worse’ is looking a whole lot worse than when we started 16 years ago.” 

He reassures me even now, “Bae, the same guy that helped you through this cancer is going to be with us as we work through getting you back to where you feel comfortable with different things.” He doesn’t pressure me. It’s just more of a, “I’m patient. I’m here.” That’s been extremely comforting as I try to figure out how to get my body to work.

How long has it been since the surgery?

The surgery was March 30th. I was in the hospital until April 27th. I came home for 4 days and then was back in the hospital with sepsis for another week and a half. That was extremely challenging. 

I knew the doctor said the recovery period would be difficult. Even still, when I came home, I still had bags hanging from my kidneys because we were trying to figure out my kidney. My right kidney decided, “I don’t know if I want to work right.” That was a bit challenging. 

I had a nephrostomy tube and an external bag that I would wear to help drain urine out of my right kidney. That was all the way until June 19th. I wasn’t feeling very attractive. [I] wasn’t feeling like my best person. That [was] on top of a lot of bone pain from the chemotherapy. 

My husband tried his best. He was home with me the entire time. He took leave from his job. Literally from December until June, we didn’t go back. Both of us went back to work the week of Independence Day. He was with me the entire time. 

It was funny because when we went back to work, our sons were like, “Wait, you’re going back to work?” It was incredibly comforting to me to be able to be home when they came home from school. Even though I wasn’t feeling up to cooking, [it was comforting] for us to still eat dinners as family when I felt able to do so. It’s been a lot. 

My husband kept encouraging me to try to stay active as much as possible. That activity sometimes was just walking. Literally, when I came home from the hospital, it was walking for 10 minutes, walking around the house with the physical therapist, just to halfway get my mobility back after atrophy from being in the hospital for so long and having issues with my heart also while I was in the hospital. 

He’s been extremely patient from a standpoint of, “I’m just here with you to figure it all out.” That’s been incredibly reassuring.

Finding Support and Advice

Importance of finding other patients who you have more in common with

Looking in that social media group, [I was] trying to just scroll and see who I can relate to. Even still, as I was scrolling, while there were women in the group, because it’s a group for women with bladder cancer, there weren’t any African American women. I hadn’t found one until on the day of my first chemotherapy infusion. 

I have some sorority sisters that actually went and found the representative colors for bladder cancer. I didn’t even know there was a ribbon for bladder cancer. I knew about the pink ribbon for breast cancer. I didn’t even think that there are ribbons for different cancers. 

They had Googled, I guess, on the side and found out what the colors were: blue, gold, and a royal purple. They knew that I was going in for my first infusion. In our separate chat on the day of my infusion, they start posting pictures. They all have on some version of blue, gold, and purple. 

I’m like, “I don’t understand,” because our college colors are blue and gold. I was like, “I’m not getting it. I don’t understand.” It wasn’t until someone said, “We’ve got on our colors for you, Ebony,” and then they sent the ribbon. 

I was like, “Oh my gosh.” I was so flattered, and I was just sharing with them, “Hey, y’all, this is my first infusion day, if y’all can be in prayer.” Not only were they in prayer; they all decided to be on a united front and share that with me. 

I collected all of their pictures, put them in a collage, and shared it in this social media group with the women to say, “I’m just so grateful for my sorority sisters, who are standing in agreement with me today.” 

There’s a hand gesture that we use, too, to indicate our sorority. From that picture LaSonya found, [it[ turns out LaSonya is part of the same sorority. [She] was like, “OMG, hi, sorority sister. We’re here together.” 

That was so encouraging because I was looking for someone that looked like me. I’d scoured Instagram, trying to find different hashtags, [but I] hadn’t found anything or anyone that looked like me that was fighting and winning at bladder cancer. To find her was huge for me, because it’s like, “Yes, we can absolutely identify on even more levels.”

What does having LaSonya mean in your life?

It’s so hard. Number one, nobody wants to get diagnosed. No one wants to hear the dreaded C, right? Of course, not to downplay breast cancer. You see a lot of stories. I’ve unfortunately had a lot of friends that have been diagnosed with breast cancer. 

Because more friends have been diagnosed with breast cancer, you instantly have someone that you can think of that you can say, “Hey, here’s my friend such-and-such. If you have any questions or any parts you want to relate to, she’s here. You can connect with her.” 

With bladder cancer, I couldn’t find one soul that I could say, “Hey, what are you doing? How are you feeling about losing your hair? Are you going to wear a wig?” Just all that. Honestly, it wasn’t like there were that many different questions that I would ask her. 

It just was an instant, “You know everything that I’m feeling. You can relate specifically to the loss of hair. You can relate specifically to darkening complexions.” [The chemotherapy] also made certain parts of my skin darker

“You can relate specifically to all those things. You’re taking likely the same medications that I’m taking.” She was actually like a month ahead of me in her journey, so I was watching her as she was going through her journey and how optimistic she still was. I was like, “Okay, you can do this, Ebony. You can do this.” That was huge for me.

Becoming a light for others

I want people to know you’re not the only one. I have fought through this. Unfortunately, there are going to be people out there — I mean, I had people coming up to me and telling me, “Some of the side effects of chemotherapy are your food is going to taste like metals. You’re not going to want to do yada, yada, yada.” 

Then I said, “How do you know this?” “My husband died from it.” Thanks, I don’t want to hear those stories. I want to be the evidence, the example. I try to tell people, “I do consider myself a miracle, and if you’re ever looking for the evidence to help encourage you, let me be your evidence. Your current-day 2022 evidence that you can fight this and win.”

Knowledge and advice from other women

One of the doctors in the practice, I remember reaching out to her and saying, “Wait a minute. He’s done this surgery on men. Am I going to be good?” She’s like, “Oh, absolutely.” She actually ended up giving me another name of another doctor within Duke that I could also reach out to. 

I did not end up reaching out to the other doctor because the practice really comforted me. This practice, honestly, has spoiled me. I don’t even know if I want to go back to a regular doctor because they seem to be so genuinely concerned about my welfare [and] genuinely wanting to help me. 

One of the things that comes with when you have the neobladder is self-catheterization. Everyone’s outcome may be different. Some people may only have to catheterize at night. Some people may have to self-catheterize during the day. 

I remember not even knowing that my urine came out of a different hole. I didn’t know. Having the nurse share with me, “I will help you find your urethra. You can try it at first. Here’s the DVD. You can look this up.” 

I remember propping, being in the bathroom for the first time and having the laptop with the DVD loaded, trying to get a mirror, trying to get this catheter, and trying to figure out where to stick it. I felt like I’d struck gold when I finally was able to empty my bladder with this catheter.

It was helpful because she talked with me. I said, “Are there any things that I can do prior to surgery to help in this recovery?” She talked about strengthening my pelvic floor by doing the Kegel exercises. I hadn’t heard anything about Kegel exercises since I was pregnant like 13 years ago. I was like, “Okay, that I can do.” 

Then she talked to me about finding my urethra prior to the surgery, because likely after the surgery, I would be in pain, which was another great piece. I kept putting it off. I literally found my urethra maybe 2 days before surgery. I was like, “Okay, you’re a grown woman. You’ve done things. You’ve birthed 3 children. You should be able to do this.” I had to psych myself up [and] have the pep talk. 

It was very helpful to have women in the practice that could help me work through that. I said that I was marked for the urostomy bag. We even talked about different types of panties or undergarments, bathing suits, just different things that would make me feel comfortable with my quality of life if that was the route that we ended up with. 

You don’t know, again, until you wake up out of surgery. [It was great] having those women present to help me find my urethra [and] to help me work through those emotions of what happens if I do have to have a hysterectomy, which I didn’t. What happens if? All the ifs. That was extremely helpful.

Advice for dealing with a neobladder

Know that you don’t have to do everything. As women, we’re used to doing everything. Let your body heal. Don’t be in a hurry to do all the things. Make sure that you stay active, even on days that you don’t want to. 

Have an accountability partner that will help you stay active. Even if it’s walking 10 minutes a day, and then, in the following week, you’re walking 12 minutes and 15 minutes. Having someone meet you to say, “Okay, girlfriend, let’s go walk.” That activity was huge for me, even if nothing more than just getting out. 

I had a playlist that was also encouraging to me. On those days that were rough for me, I would put that playlist on, and that would typically help me feel better. Those were some of the main things. 

From a vain sense, because I keep talking about vanity, I had several loose dresses for me because I had that extra bag. I remember one of the first things when I went home from the hospital was, because I wasn’t expecting to have this extra bag, but I just wanted to go to Target. I remember not having clothes. Some of my dresses were shorter prior to, and so I needed a midi length that was loose.

I remember going to Walmart and just having dresses to wear where I still felt pretty. I also had comfortable shoes as well. My husband [and I] ordered some extra sneakers because despite all of the extra things to try to prevent neuropathy, I still have neuropathy in my feet. 

Initially, I just needed comfortable sneakers to be able to get around. Not going overboard and buying a ton of stuff, but having a couple of things where you still feel cute. It’s funny because after you have a baby, they tell you you’re not going to lose all the weight immediately, and they tell you to have comfy clothing. 

That, for me, was extremely helpful, and having those couple dresses to be able to [go] if I just wanted to ride to Walmart, because that’s literally what we were doing half the time. 

Then when I built up the stamina to walk a little more, literally, we would walk to Target of all places, and then just walk through the aisles with the buggy to help stabilize me. My youngest son was like, “Why Target?” I was like, “Everybody loves Target.”

You got your popcorn. You got your Starbucks. You got just a normalcy. I wouldn’t even buy anything most days. Just walking around, feeling somewhat normal, was helpful for me.

Transitioning to the neobladder

There are tons of concerns because you could potentially have a UTI. I guess we’re highly susceptible to UTIs. I had issues with my kidneys. There were a lot of complications with that, but the biggest thing as far as recovery was training my neobladder. 

Now you’ve got this neobladder. It can only hold so much, and so you have to train it. There was a schedule that was also in that binder that was shared with me on how to empty [it]. I would have to empty my bladder on a certain cadence. 

I remember the first time I tried to do it, it took me a minute to kind of get the sensation down to understand how I actually empty it. It’s hard to describe, but I remember thinking, “Okay, Kegel exercise. Kegel, okay.” 

It was the relaxation. Doing the exercise itself and relaxing the muscle is what helped me. That’s how I would use the bathroom. Anyway, there was a schedule for that. Every 2 or 3 hours, I would initially be trying to empty my bladder. 

Then that period of time extended overnight. I would try to always catheter before I went to bed. I would also wear a pad when I went to sleep because I was nervous about wetting the bed. I don’t have to do that now. I do wake up in the middle of the night still to empty my bladder. Sometimes that includes a catheter at night just because it takes me time to empty the bladder. 

Even now, sometimes, I’m a bit paranoid if I go to a public restroom, even at work. This is something I’m still working through. When I go to the bathroom at work, I have so many meetings that are back to back. 

I can go in a stall, and another woman can come in the stall. She can empty her bladder and be done. Literally, I’m in there trying to do exercises to empty my bladder. I always wonder, “Is the person next to me thinking, ‘What’s going on over there?'” I’m still working through that, but I’m comforted in knowing that I’m alive. I need not worry about what someone else is thinking is going on in my stall. 

I’m grappling with, “Do I want to tell my manager?” Sometimes I may be late for a meeting because I’m emptying my bladder. I haven’t had that conversation because I’m trying to work through that. 

Sometimes, because there are meetings after meetings after meetings, I don’t have [time]. I have to literally make the time to go empty my bladder. That’s a bit of a challenge for me because if it gets too full, there’s potential for infection and all the things. I’m still working through that. 

When I’m home, it’s easy. I can just go to the bathroom [and] not worry about how long I’m in there emptying my bladder. I still, straight up, have a hard time finding my urethra without a mirror. The nurse reassured me eventually it’ll be like a tampon. It’ll be where you can find it without even looking. 

I’m looking forward to that day, because honestly, it is a challenge. It’s things that you don’t think about. When I travel and I’m in the hotel room — this may be TMI. I don’t know. When I’m in the bathroom at home, I have a self-standing mirror that will help me find what I need to find so that I can fully empty my bladder. 

When you travel, you don’t typically have a self-standing mirror, so you’re either trying to prop your leg up or trying to find your phone, but you don’t have that many hands. You literally need a third hand to use the catheter, have something to locate the catheter, and then aim. It’s a challenge, but I’m working through that, and I am just conquering the day.

Reflections

How important is self-advocacy?

At the end of the day, no one knows your body like you do. In hindsight, I wish I’d possibly gone somewhere else sooner. I just challenge everyone out there. At the end of the day, doctors are doctors, but they are practicing medicine. They’re practicing, so they will not know everything. You know your body more than anyone else.

All I can challenge anyone out there that’s debating or [wondering], “Is there something wrong? Should I do more?” Yes, you absolutely should. Don’t debate. Don’t delay. Don’t let months go by before you inquire or search more. 

Again, always remember that you know your body more than anyone else. Don’t be fearful of what the outcome can be, because the sooner you find whatever is going on, the sooner you can start treatment, the sooner you can do the life-saving work so that you can be around for those that love you.

»MORE: How to be a self-advocate as a patient

Healthcare system and the experiences of African Americans

It’s unfortunate that this is the case. I know for African Americans, we don’t see a lot of ourselves in a positive light. We don’t see us conquering things on a basis. What we do see is negative outcomes. 

We see a lot of loss or, “It’s just the way it is. This is just the way it’s going to be [and] the way it’s always been. No one’s going to help you. No one really cares about you. You can be lost, and people would care less.” If you can’t afford something, you’re doomed to whatever you can piece together. 

When you’ve seen that for generations — sometimes, [for] people who are not African American, it’s hard to relate. But when all you see is something negative, when all you see is, “This is the outcome. This is just the way it’s supposed to be,” it is extremely hard. 

Again, I know it may not make sense. It’s extremely hard, though, for you to envision that someone does care. It’s extremely hard for you to envision that you can win. You can beat this. You can succeed. This is in every area. 

I think what the medical industry can do is to put more faces in the forefront of people who are doing well, who are receiving the treatment, who have found their way, [and] who are winners. 

Put people out there not only from people who have won the fight, but put people out there who are open and willing to help people win the fight. We need to see that the system cares about us. We need to see that, because for decades, we’ve seen so many systems that don’t.

Do you still question why this happened to you?

No. It’s crazy because it’s just been a year. It honestly hasn’t even been a year since the diagnosis. I keep like looking at my watch like, “Okay, no, it hasn’t even been a year. What a year it’s been.” 

Maybe it’s Pollyanna-ish, but my belief is that God trusted me to go through this and be positive regardless. To go through this and show people how to overcome in the face of death. To go through this and show people that I did and they can, too. 

There are times when I’m like, “I don’t like certain things.” I don’t like the whole catheter thing. I don’t like the aches in my body. But again, I remind myself, “Grace, girl. It’s not even been a year.” 

I’ve had so many people message me since I shared on social media last December. They’ve either shared that they’ve received a diagnosis, not necessarily bladder cancer, but they’ve received another cancer diagnosis. They’ve been motivated by what I’ve shared. 

I remember thinking when I was going through, “Lord, just get me through the surgery. Let me just get through.” It seemed like it was so far between November 29th and March 30th. It seems so far, and I still had no idea all the craziness that was going to happen after March 30th. 

I just was like, “Just get me through to the end.” I thought the end was going to be, “Let’s get through the surgery, and you’re going to be good.” I had a friend share with me recently, “Ebony, maybe that was just the beginning, like the beginning of helping other people [and] the beginning of changing lives. The beginning.” 

Again, I wanted to be like, “Whoa, okay, let me live my life now.” I’m looking at it now more so like, “Okay. God, me and you, we’re going to share.” I’m one that’s open to sharing. I could be wrong, but sometimes I think that he thought he could trust me to share the journey and be an encouragement to others.

What is your last message to readers?

I debated over how much I wanted to share on Instagram, to be honest, because I was like, “That’s a little bit open. People can find anything.” I remember thinking, “I couldn’t find anyone when I was looking. I’m searching all the hashtags, [but I] couldn’t find anyone.” 

In general, what I would share with people is I know we have a lot of things that we go through in life. I used to think my weeks were rough prior to this, and I’m like, “Psh, that ain’t nothing compared. You’ve been there, done that.” 

Anyway, I think it’s important for people to recognize that whatever they’re going through — it might not be a cancer battle. It could be a divorce, it could be depression, it could be job loss, layoff, or issues with your kids. It can be so many things. 

Whatever you’re going through, you don’t have to put everything on social media, but know that social media could be a tool to help change the life of someone that you don’t even know just because you were willing to be transparent enough to say, “Hey, I’m making it through this, and I believe you can, too.” 

Whatever it is, whatever you have going on, if you can, share a bit of it. I know people say social media is fake or it’s not the real deal, but I think that there are people out there that if we continue to share the real deal and share how we’re making it, it can help others. 

I truly do believe that’s why we’re here: to help each other and not just kind of live in a silo. If there was anything I would share, that would be to just know that you have a voice, you have a light, and to let your light shine because it will absolutely help someone else.


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Special thanks again to Janssen for its support of our independent patient education content. The Patient Story retains full editorial control.

More Bladder Cancer Stories

Vickie D.

Vickie D.



Symptoms: Intermittent pain in the gut and burning sesnsation
Treatment: Chemotherapy (dd-MVAC) and cystectomy (bladder removal surgery)

Margo W.



1st Symptoms: Blood in urine



Treatment: Chemotherapy (methotrexate, vinblastine, doxorubicin and cisplatin) and radical cystectomy
LaSonya D. feature profile

LaSonya D.



Symptom: Blood in urine
Treatment: BCG immunotherapy, cystectomy (bladder removal surgery)
LaSonya D. feature profile
LaSonya D., Bladder Cancer Diagnosis: High-Grade Bladder Cancer Symptoms: Clumps of blood in urine Treatment: Surgery, bladder removal, urinary diversion
Karen R. feature photo

Karen R.



Symptoms: Recurrent UTIs
Treatment: BCG immunotherapy

Ebony G.



1st Symptoms: Blood in urine, weight gain



Treatment: MVAC chemotherapy, bladder removal surgery, neobladder

Diagnosis and Treatment for Bladder Cancer

Learn about the diagnosis and treatment process from bladder cancer survivors and medical experts. Discover diagnosis and treatment options./p>


Bladder Cancer Series



Bladder cancer patients Ebony & LaSonya talk about their cancer journey, including their first symptoms, how they processed their diagnosis, treatment options, and how they found support. Dr. Samuel Washington, a urologic surgeon, also gives an overview of bladder cancer and its treatments.

Bladder Cancer Causes & Symptoms

Understand common bladder cancer causes, urine color, symptoms, and treatments as described by real patients./p>

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Schorrs

Feeling Loveable Again | Cancer Friends

Feeling Loveable Again | Cancer Friends

Featuring Annette La Fontaine

Hosted by Andrew and Esther Schorr, “Cancer Friends” highlights stories and lessons from cancer survivors and their support system. For more “Cancer Friends” episodes, you can find them on our video channel here!

This segment focuses on Annette La Fontaine, who was diagnosed with breast cancer in 2021. A series of events left her feeling broken and unlovable. However, support from Annette’s children and friends helped her through treatment and a bilateral mastectomy.

Annette shares how stress may have contributed to her health problems, how she was a part of her treatment decisions, and how she moved from feeling unlovable to feeling like the universe has unloaded love on her.

This interview has been edited for clarity. This is not medical advice. Please consult with your healthcare provider for treatment decisions.


During that dark time, that initial time, I could not have even foreseen how I am now. I’m happy. I’m super comfortable in my body. I’ve actually come to love this body again. 

Annette La Fontaine


Introduction to Annette

Andrew, The Patient Story: Hello, it’s Andrew Schorr in San Diego with my wife.

Esther, The Patient Story: Esther Schorr.

Andrew, TPS: This is another episode of our regular program, Cancer Friends. Thank you for joining us. Here is a friend, and that is Annette La Fontaine, who joins us from nearby in Leucadia, California, part of San Diego County. The reason we know her is because now she’s our massage therapist.

Esther, TPS: Oh, my God, we love Annette.

Andrew, TPS: We’ve begun to learn Annette’s story and we wanted to share it with you. Annette, thanks for being with us.

Annette: Yes, my pleasure. Thank you for having me today.

Stressors in life

Andrew, TPS: I’ll just give a little background. Annette has had some real stresses in her life. She had a marriage to a man who [Annette describes] as difficult, with bipolar disease [and] some drug issues. Eventually you separated.

Then with 3 children, 2 of them became quite ill. Your daughter developed Hodgkin lymphoma as a teenager. While she’s fine now, that was a big stressor.

Annette: Huge stressor.

Andrew, TPS: I can’t even imagine a child with cancer. Your athletic son, 1 of your 2, became really debilitated, and [it] turned out to be Crohn’s disease with a bleeding disorder. Bad news, right?

Annette: Difficult combo.

Andrew, TPS: How stressful was your life? You eventually became a breast cancer patient. We’re going to talk about that. Would you say that stress was really, really deep for you?

Annette: My integrative doctor says to me that cortisol is my worst enemy. I bathed in cortisol for probably close to a decade. Life brought me many hardships and challenges. We all survived it. We all got through it, but I think it takes a toll on you. 

I don’t know if it’s causational, but I think it’s definitely part of my journey that allowed this to erupt in my life. [2020] was a very stressful year. Then in 2021, I was diagnosed and I think my body just gave up the ghost. It was a lot.

Esther, TPS: Just for folks who may not know, when you refer to cortisol, that is the process or the chemistry that happens when somebody is under extreme stress. I know from reading, there is a medical physiological connection between high stress, releasing cortisol and what happens. 

Annette: It changes our physiology. It has a real effect on us. Measurable effects.

Being diagnosed with cancer

Esther, TPS: What happened?

Annette: I found a lump. I can’t even say I was doing a self-exam. I was just showering. I had a very lean body mass and it was very evident. Suddenly, overnight, there was a lump. It was in my breast, and that’s not a good place to find a lump. 

I panicked a little bit. I was getting ready to go out on a dinner date. I called my girlfriend, and I said, “Should I stay home and freak out, or should I go on this date?” She said, “Well, if you have cancer, you might as well go out and enjoy your life. Go to dinner.”

It turned out I did have cancer. 

Andrew, TPS: What type of breast cancer did you find out you had?

Annette: I had ductal breast cancer. I was estrogen/progesterone positive, HER2 negative and that’s the thing that you want to have come back.

Deciding next steps

Andrew, TPS: You talk to the breast cancer doctors. The doctors are saying, “What do you want to do?”

Annette: Yeah, and I said, “I don’t want to have cancer. That’s my choice.” They were like, “Okay, how do you want to get there?” I was through Scripps [MD Anderson Cancer Center], and they came to me as a team. They said, “We’re going to get you through this. We’re very good at what we do.” 

They assign you a navigator. I’d never heard of it, but a navigator is somebody who helps you navigate this process, because you are deer in the headlights. You don’t know what’s going on. It’s a lot of details. It’s a lot of coordinating. They help you get through this process. 

They approached me that they were very good at what they did. That gave me confidence to hear them state that out loud. This person was my go-to person for all of my questions, and I had a lot of them. I was very thankful for her and she was very responsive.

On the other side of it, I wasn’t completely happy with all of my care. There were some things that didn’t go well, but throughout all of that process, I was able to communicate with my doctors and get through all of the issues that did arise. I feel like I had good care, and in the end I decided I wouldn’t have time [for a second opinion]. 

During my diagnosis, I found out I was going to be a grandmother. I just was like, “I’m going to just go big. I’m just going to do bilateral. I have had my kids. I’m post menopausal. I’m going to just do a bilateral because I think that gives me the best chance of survival.”

Andrew, TPS: I understand you put everything in a flowchart for you to try to get to a decision.

Annette: Yes, because I was shocked they wanted me to be participating in the decision for my treatment. I thought that was kind of funny. I don’t know. How do you know? How am I going to know? 

Yes, I made a flowchart. I just started doing research, talking to people, talking to doctors, [and] going online. I ultimately did make a flowchart. My flowchart started with, “Just ignore it and do nothing and hope for the best.” That didn’t have great outcomes. [It went] all the way to a radical bilateral mastectomy. I would be one step back from that. I had a skin-sparing bilateral mastectomy.

Andrew, TPS: And ultimately two reconstruction surgeries [and] an implant. 

Dealing with the emotions of a diagnosis

Andrew, TPS: Let’s talk about the emotional side. There had been a car accident. You had that, and you’re being wheeled in for surgery. What was going on in your head as far as your life and relationships?

Annette: I think at that stage, I was just overwhelmed. I was not keeping it together. I was crying all the time. I’m probably going to cry now. I was with a man in what I thought was a great relationship. [After] my diagnosis, he ended it because he had lost his first wife to triple-negative [breast cancer]. He watched her die a slow, horrific death, and he didn’t want to go through it again. 

We’d been in this car accident. I went to an orthopedic doctor, who said my cancer treatment took precedence over fixing the injury I sustained. [He] sent me off to do my cancer treatment. The first thing up was this bilateral mastectomy. 

I was physically broken, mentally, spiritually, heartbroken, all the ways a human could be broken. And COVID. Go to the hospital alone to have to subject my body to mutilation so that I could continue to try and live. 

It was dark and scary. I tried to pray and meditate, and none of my tools worked. For a period of time, I was just overwhelmed. I was not well. My heart rate was insanely high for probably 2 weeks, and it was just a hard time. I don’t know how I got through it.

»MORE: Patients share how they processed a cancer diagnosis

Support through the journey

Esther, TPS: How did you get through it?

Annette: My kids were near. My kids were very comforting. My kids had been through medical trauma themselves, so it was very interesting to hear them parent me back [and] to mirror my parenting back to me. 

They held me [and] told me, “It’s okay. We’ll get through it together. We got this. We do hard things together.” They kept me together. It was kind of a surreal experience to reflect back when I said things to them. To have them kind of bring that care to me was lovely. 

I have a great network of girlfriends that are like my sisters. They just started coming, and they brought food, pillows, coffee, prayer beads, and hugs. Sometimes I’d come home, and there would just be a little treat at my gates. Just sweetness.

Feeling unlovable

Andrew, TPS: Annette, I know as you were being wheeled in, you had this feeling, “Will anyone ever love me again in a relationship?” Because the man you had been involved with couldn’t handle it.

Annette: And you know what that made me feel? I had cancer, but I felt diseased. I felt like it was so gross, this man didn’t want to be with me. It pushed back my heart so hard. 

It wasn’t just that he broke up with me, which would have been sad. He broke up with me because I was defective in some way. Something was wrong with me, and I took that in deeply. That hurt. 

Then in that scenario, to go in and have my breast removed. One of the identifying features as a woman is being removed. I’m going to have scars. I wasn’t 100% [sure] at that time that I was going to rebuild. 

Who would love me? I didn’t know if I could love myself. Would I love me? Would I ever love my body again? I certainly didn’t think a man would ever love me again. I thought that was over.

How did you get to where you are now?

Esther, TPS: All very real, honest emotion. It’s completely understandable that you would feel that way. We now know you now. Where did you go from that Annette and that mindset to where you are now? How did you do that?

Annette: During that dark time, that initial time, I could not have even foreseen how I am now. I’m happy. I’m super comfortable in my body. I’ve actually come to love this body again. 

I have a man in my life that loves this body. He’s never known my body any other way. He thinks it’s great. To get from that point to this point was a lot of work. It was a lot of work. It just creates a lot of existential thought about who you are. Who am I? What does it mean to be me, to be a woman, or to be lovable? I had to do kind of a deep dive.

Andrew, TPS: I understand you see a therapist, who’s helped you dig into all the trauma you went through to kind of sit with it to get past it.

Annette: Yes. We’ve done a lot of work. Much laughter about it. Also many tears. I got through the initial medical stop [and was] moving forward. Eventually, I circled back to have this orthopedic work done that I had to postpone. In that work, I had to be in a couple of surgical procedures, and I lost it. I had a meltdown. 

It wasn’t because of what was happening. It was because it had triggered my surgical stuff for my cancer. In that moment, I kind of had this out-of-body experience, like, “Oh, I’m in a room full of doctors, and I am falling apart right now.”

In that moment, I was like, “I think maybe I need to get some help. I think that there’s more trauma in here that I need to work through.”

Finding love again

Andrew, TPS: You alluded to meeting someone.

Annette: Yes.

Andrew, TPS: Tell us about that and how you actually met someone.

Annette: I was at a gathering of women. We tend to gather on full moons because we live in North County, San Diego. Everybody was sort of passing around their phones. They’re all on a dating app called Bumble. 

I was pretty fresh off my third and final surgery, and I thought maybe later in the year, I maybe would start thinking about dating. But I downloaded the app. One of the women in the room grabbed my phone [and] just did my profile. 

I started swiping just out of curiosity, and there was a gentleman who just caught my eye. He was very dapper. We messaged a little bit, and that evolved into a first date. On that first date, we were really hitting it off. We just had a lovely conversation. I love his energy and demeanor. 

I got it in my head, like, “Should I tell him I have cancer?” This was a big thing in my life, and here I am on a date, having not thought this through. I just blurted it out to him in our conversation. I said, “Here’s this journey I was on recently,” and he listened. He made eye contact, he was kind, and he asked a couple of questions. He was so sweet.

At the end of my story, he kind of paused. He said, “About 4 years ago, I had cancer, too.” He had prostate cancer, and his whole journey was, “Am I going to be lovable? Am I going to be functional? Who am I as a man, if that’s impactful to him?” 

It turned out that he came through whole. I came through whole. It was kind of a bonding experience for us because we were both like, “Oh my God, me too.” We comfortably talked about it. I could not have foreseen that date. It’s been kind of magic.

Esther, TPS: What a wonderful surprise after all the ups and downs. What a wonderful surprise to find somebody who got it, understood it, [and[ saw you for the wonderful person you are.

Annette: That was in March. We’re in November now. He’s been so supportive to me. I think he’s helped me feel whole in my body, too. He just loves me. He doesn’t see the scars. That doesn’t matter to him. It makes me feel more myself and lovable again.

What advice do you have for others?

Andrew, TPS: Annette, for all the people watching and listening. Mostly cancer patients, some family members as well. Some of them have gone through the depths of down feelings and struggle that you’ve talked about, and they want to get to a better place. What advice do you have because you’ve gone on this rollercoaster? 

We’re delighted that you have this relationship now. You’ve done this work. You feel good in yourself. We’re delighted to have you as our massage therapist and get to know you better. What do you want to leave people with? Maybe some suggestions of how they can get there, too.

Annette: There are a lot of resources available to people. When you’re going through treatment, there are groups that you can join. There are social workers, therapists, your network of friends, family, your spiritual life. 

I couldn’t do the group meetings. I tried a couple of different things, but I couldn’t look at a room full of people who are so impacted and had so much heavy content. I couldn’t do that, but I could see that a lot of people garnered a lot of benefit from that. 

One of the things that started to pull me out of the deep darkness was another cancer survivor reached out to me. She became my cancer mentor. A drain popped out, and I was bleeding all over the place. I called her. 

She would do this thing. “All right. We’re going to take a couple of deep breaths.” She just knew. She knew the language I spoke, and she could calm me down. She’d been through all of it. She’d been through all of it, so she knew. She knew my emotional content. 

She helped me step through kind of day by day. I felt like that was really valuable. So many people love and support you. You’re going to be okay. We’re here for you. All of those positive things. It’s really helpful to get in the nitty-gritty with somebody who’s been there, who’s been where you are. 

They tell you, “I hear you. That’s hard, but we’re going to get through this one day. We’re going to get through this day and then the next day.” You’re kind of in a 12-step program. It’s good to have somebody who shares a common experience with you, in my opinion.

Advice for single women with cancer

Andrew, TPS: As you had told us, you wondered at the very lowest point, “Would anybody ever love you again?” Now someone does. What advice would you, give to single women in particular, or even single men, where they can have hope that they could find a successful relationship?

Annette: Having the experiences that I’ve had, it became clarifying to relationships. That man that broke up with me, God bless him. Thank you. That was ultimately a good thing. 

Moving forward, I had to filter relationships through different lenses. What is important to me? All of this stuff is just a bag of bones. It wasn’t important. [Realizing this] helped me refocus what I wanted in a relationship. It had a lot less to do with the physical stuff, and it had more to do with somebody’s heart, their character, and their spirit. 

A spiritual process is very important to me. I’m more of a Buddhist. [The man that I met] has a different spiritual journey, but he has a spiritual journey. We were able to and continue to connect about that. 

Yes, you’re going to be different. Your body is going to change. It is going to be different. You are lovable. You always have been, always will be. I am love. We are all love. You just have to find people you can connect with that. 

I was afraid I was going to be unlovable. The universe has unloaded love on me from my family, from my friends, and eventually from this man. I was afraid I would not be lovable. That was just my pain talking. That was not reality. 

It just takes a while to move through that and to find that love and to feel at peace again. It just takes the time it takes. We all just have to process it in the time and in the way that gets us to the end goal.

Andrew, TPS: Right, but it is there. 

Taking daily medicine

Andrew, TPS: The good news is you are very vibrant. Your kids are doing well. You have a loving relationship. We wish you only good times and love. We’ll all have challenges going forward. You take a medicine to limit your risk of recurrence.

Annette: Yes.

Andrew, TPS: Like many women who’ve been treated for breast cancer have. You always worry, “Is there another shoe that’ll drop?”

Annette: Absolutely. The friend that was my cancer mentor, she stopped talking to me for a while at some stage. Her cancer had come back and metastasized. She is now fighting for her life. She just did not want to share that with me at that stage of my journey. 

I did not want to take the aromatase inhibitor for 3 to 5 years or however long it was. I dragged my feet and dragged my feet because it has side effects. I mentioned I had side effects when I did start taking it, and then I stopped it. 

I take that pill every day now, and I’m happy about it. I take that pill, and it reaffirms my will to live every day. It reaffirms that I’m a survivor. I got from that place to this place. Every day when I take that pill, I don’t think about the negative parts of it and the side effects. I think that’s me being a fighter still. I want to live. Some of that medication does definitely have side effects and complications, but well worth it.

Andrew, TPS: So well said. I take a daily cancer medicine, too. I do feel it’s my will to live.

Annette: Your life-affirming ritual.

Conclusion

Andrew, TPS: Thank you so much for sharing your story, your journey. It’s great that you’re in a better place.

Annette: Thank you both so much. You are a blessing in my life. Thank you.


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Go With The Good | Cancer Friends

Go With The Good | Cancer Friends

Featuring Katie and Pete Mang

“Cancer Friends,” hosted by Andrew and Esther Schorr, highlights stories and lessons from cancer survivors and their support system. For more “Cancer Friends” episodes, watch on our video channel here!

This segment focuses on Pete and Katie Mang, a young couple whose lives turned upside down after Pete was diagnosed with glioblastoma, a rare brain tumor. Faced with the burden of uncertainty for their family, they decided to always focus on the good.

Navigating financial toxicity and treatments was difficult, so they created Go With The Good to help other families find resources and support after a cancer diagnosis. Pete and Katie share the lessons they’ve learned along the way, including how they approach parenting with an uncertain cancer diagnosis, living with gratitude and finding support for the caregiver.

This interview has been edited for clarity. This is not medical advice. Please consult with your healthcare provider for treatment decisions.


A bit of the blessing of the uncertainty is it has had us focus on what’s really important.

Katie Mang

Every single time that we do something as a family with the kids, it’s special no matter what we do.

Pete Mang


Introduction to Katie and Pete Mang

Andrew Schorr, The Patient Story: Hello and welcome to The Patient Story and Cancer Friends. I’m Andrew Schorr, with my dear wife and partner, Esther Schorr. 

As a couple, we’d like to introduce you to another couple in Hudson, Ohio, and that is Pete and Katie Mang. First of all, thank you for joining us.

Katie: Thank you for having us.

Andrew, TPS: They have quite a story. For a number of years now, Pete’s been dealing with one of the most serious cancers, glioblastoma, also known as GBM. It’s usually older people [in their] 60s [or] 70s who have it. Pete, you were diagnosed at what age?

Pete: I would have been 34.

Andrew, TPS: Wow. So very young. We’re going to tell you the story of them, how it happened, being a young couple with 2 little boys, and eventually deciding, based on what they learned, to start a foundation to give back to people who are affected by a brain tumor.

Pete’s cancer diagnosis

Esther Schorr, The Patient Story: Katie, can you talk a little bit about how Pete was diagnosed?

Katie: In summer of 2018, it was a normal workday. I was driving home, and I got a phone call from Pete’s architecture firm, where he worked, that he had a seizure and was not communicating properly. 

They had called an ambulance to take him to the county hospital, where I met him. [I] found out that on the commute there he had two grand mal seizures in the commute to the hospital. After several tests — and we weren’t quite able to get the seizures completely under control — they determined it was a brain tumor. 

[It was] something that was a complete surprise to us with no family history and [with] Pete [having an] excellent health background. We consulted with a family friend who happens to be a physician, and he suggested we transfer to another hospital that had a cancer and brain tumor center. 

That took a little bit of a fight with the hospital system, but we got it done. He then ended up at the Cleveland Clinic, and he was in the ICU for a brief period of time, trying to get the seizures under control. 

»MORE: Patients share how they processed a cancer diagnosis

Awake craniotomy

Katie: Then for nearly 2 weeks, he stayed there until he had an awake craniotomy.

Andrew, TPS: What is that?

Pete: That was having surgery in your brain while being awake. They ask you questions, you have to answer those questions, and they figure out where they need to do the surgery at.

Andrew, TPS: What’d they ask you?

Pete: I remember [them] asking about the alphabet [and] some other questions that normally you would know. They figure out how far they need to go with the surgery as they’re talking to you.

Andrew, TPS: The goal is to cut out, for you, a golf ball-sized tumor, but not healthy tissue [so that you can] perform as much function as possible, right?

Pete: Correct. They want to get out as much as they can.

Katie: Based on where the tumor was located, speech was the primary concern, both in receptive and expressive speech, being able to retain the information and express it. Luckily, they were able to because of the craniotomy.

Andrew, TPS: Pete, you’ve told me sometimes you have to search for words or how to get the words out.

Pete: Right.

Treatment and symptoms

Andrew, TPS: You did have various therapy, but you got blasted, Pete, with first surgery, a lot of radiation, Gamma Knife, [which is] targeted radiation, [and] chemo. We’re talking about over 4 years. That must have been quite an ordeal.

Pete: There was always something we were doing at the clinic. There was always something.

Katie: Then the symptom management, too, that goes with that. It’s not just you go to the clinic, and it’s done. It’s taking care of the fatigue, nausea, and comfort care at home with it as well.

Esther, TPS: Now, Pete, what’s happening at the moment as far as your health?

Andrew, TPS: There’s a clinical trial. Tell us about all that.

Pete: Correct. I’m on a first phase trial, and I’ve actually been on that trial for over 2 years now. It’s an immunotherapy. I’m up doing this treatment twice a week. Usually, that day, I’m tired once I get home, so it gets hard sometimes.

Andrew, TPS: It’s remarkable, but we should mention you were telling us that you were on the treadmill jogging just a few minutes ago.

Pete: Right, absolutely.

Parenting with a cancer diagnosis

Andrew, TPS: Katie, this is a family event with younger people.

Esther: And younger children.

Andrew, TPS: And young children. Talk about that a little bit [and] how you cope. This [was] a major shocker that day you rushed to the emergency room. Your husband was having surgery. Explaining whatever you did to the children, the family, and coping yourself, and then doing that over several years now.

Katie: When this all happened, our kids were 2 and 5. [It was the] summer before our oldest started kindergarten. We had just moved into a new home about 6 months before that, and we were dependent on dual income [and] coparenting. We were both busy professionals. 

Everything kind of got flipped upside down in one day. I took some time off of work. With the kids being so young at the time of diagnosis, we kept things very age appropriate. “Dad’s in the hospital. Dad’s not going to be home for a little bit. When he does get home, here’s the things. His hair might be gone. He might be tired.” 

Our 5-year-old caught on to a lot more of it, where our 2-year-old doesn’t really know anything different. He’s now turning 7 next month, and then [the older one will be] a 10-year-old. They kind of have grown up, and we’ve reeducated and provided different levels of age-appropriate communication, also tailored to their personalities. 

To have 2 kids in the same family be so different requires a little bit of different levels and types of communication with them, too. Being that they’re still young, they don’t know the full story. What we have learned is this disease is incredibly unpredictable. 

To be on a clinical trial for 2 years, having treatment 2 years before that, [so] 4 years total. We couldn’t have guessed any of that. The burden of that uncertainty is a little too much to put on the kids. 

They have what we would consider an age-appropriate understanding of the differences in our life since then, like how we handle things as a family differently. We consulted with our pediatrician on how to talk and handle with this, especially right after it happened. The pandemic happened in the midst of all this, too.

Pete: Then I started the trial. 

Katie: With young kids being at home and being exposed to a lot of this, while going through this as well. We’ve consulted with the pediatrician. We’ve consulted with a child life counselor. Every year, I let the teachers know this is our family situation. We have excellent guidance counselors in our school, and they’re always aware of our situation. 

It’s a little awkward, but every year at the beginning of the school year, I send an email to the principal. They know me by now, but I explain what’s going on here, too. 

We’re lucky that we have navigated who needs to know in our children’s lives to provide the circle of support that’s age appropriate [and] that’s flexible. We have a plan in place if something bad were to happen. We just have to push the button, and everybody knows how to respond appropriately.

»MORE: Parents describe how they handled cancer with their kids

Support for the caregiver

Esther, TPS: Katie, obviously, this is a huge project for anybody. A family journey. You’re the key care partner here. How have you been able to cope with all this? What’s been the support that you get? You just described all this great support that you rallied for Pete [and] for your kids. How about you? What are you doing for yourself?

Katie: Over the last 4 years, I have built my personal support toolbox, but it’s taken a lot of trial and error to get to that point. I am very lucky to have a great network of family support in this area. I rely heavily on my close circle of confidants: my mom, my sister, a couple of close friends. 

I also know if I need to talk to my doctor or therapist. I’m not shy about it. I think one of the things that’s helped both of us is we are both really realistic about what’s happening. We talk about that, and we’re very open. 

I can come to Pete and say, “I’m having a bad day, and it’s because an MRI is coming up,” or, “I’m having a bad day because I’m stressed.” There’s no guilt in that, [which] maybe I felt early on. Pete’s super supportive.

Pete: We’re doing this together. The diagnosis is me, but it’s the whole family. We do this together.

Go With The Good Foundation

Esther, TPS: You’ve done something else together that you discussed. You mentioned to us that you started a foundation.

Katie: The day we got Pete’s diagnosis — because you don’t know right away. We have a brain tumor. Then there’s going to be surgery. Then they’re going to have a biopsy, and then 3 weeks later, you’re going to come back for a diagnosis and a plan. 

At that point, we learned that this is glioblastoma. That’s a shock. Doesn’t matter that we’ve just been through all of this, and now the diagnosis is the shock. One of the things that really came out — I don’t know if it was that night or the next day, but we kind of talked about how we’re going to handle this from a mindset standpoint. 

Pete said, “We’re going to go with the good.” Out of every situation, we’re going to find a couple of the key pieces of good, whether that’s having grace in the situation, getting a piece of good news or a good MRI, or just we had some chocolate and wine, and that was good.

Pete: Exactly. There’s always something good to look at. Like you said, we went to the restaurant and got a good dinner or something. Those little things add up, and so that’s where Go With The Good became [something].

Esther, TPS: Please explain what it’s for. What does the foundation do?

Pete: The base of the foundation is the focus is on young adults, families potentially, who have a brain tumor diagnosis. From a financial standpoint, it becomes difficult from that diagnosis. 

There’s a lot of information that we’ve learned throughout this 4 years and through research and everything. There was a lot that we’ve learned that some of these other families may not have learned. The goal was to pass this information to them and financially help them from that diagnosis.

Andrew, TPS: What a beautiful thing.

What key lessons have you learned?

Andrew, TPS: Katie, what are some of the key lessons learned?

Katie: That it would have been good to know going into this that brain cancer is, depending on different reports, the most or second-most expensive cancer to treat. Not only because of the extensive and expensive treatment, but all the treatments that go around it, like speech therapy, occupational therapy, seizure medications, [and] all those things. 

It would have been good to know what we were getting into. We want to pass that on not as something to scare you, but knowledge is power. You need to know where you stand in this, how and when to navigate, and where to find support for insurance disputes. 

All of the therapies I just described, there’s a line item in insurance for every single one of them. Learning the insurance system and also knowing when to pull in help has been valuable, both in peace of mind, but also our wallets. 

Also, knowing who to go to for the various types of support. If you didn’t know some of these resources could be found for free or inexpensive, you would pay a lot of money for help in a lot of these things, whether it is a legal dispute, care, or services. 

For one example, we were able through family reach to get free financial consultation. I was considering paying for that, and then we were able to get this at no cost, pro bono. [We also got] someone who understood our situation as a young couple trying to navigate the financial ups and downs with an uncertain diagnosis. 

Then we didn’t know that we could get brain-tumor-specific support through the network and clinical trial navigation services support with Medicare and Social Security.

Pete: Like you said, the seizure medication is very expensive, and we were able to find these groups that were able to really help financially on the costs of these medications.

Katie: We’re talking thousands of dollars a month.

Andrew, TPS: I can’t even imagine. What is the website address, Katie?

Katie: It’s GoWithTheGood.org. We just launched this year, so keep checking back as things keep getting updated.

Esther, TPS: The other big resource you mentioned was the Family Reach Foundation.

Andrew, TPS: Family Reach Foundation helped you, and they’re a great organization. 

The burden of uncertainty

Andrew, TPS: You used a phrase earlier, Katie, and I wanted to ask both of you how you deal with it. You said, “The burden of uncertainty.” 

First, Pete, how do you deal with the burden of uncertainty? Katie touched on how [glioblastoma is] so unpredictable, [as well as] what course it’s going to take and when. How do you deal with that?

Pete: To be honest, I’m not quite sure. The words aren’t coming to me right now as part of the aphasia. Finding some of these words are hard right now, to be honest.

Katie: I think the thing that you and I have both talked about [regarding] the uncertainty is making the most in the moment.

Pete: Right. 

Katie: Being very mindful and present in the moment, as well as prioritizing what’s important to us in the moment. We have made major changes to our life in terms of how we spend our time, how we do our careers, how we spend time with our kids, [and] how we make family decisions. Not just because of the uncertainty, but a bit of the blessing of the uncertainty is it has had us focus on what’s really important.

Pete: With the uncertainty, for me, having 2 young kids, I enjoy that time. I think that’s where I come from. Every single time that we do something as a family with the kids, it’s special no matter what we do.

Andrew, TPS: You mentioned you’re in a clinical trial with an immunotherapy. In a number of cancers, immunotherapy has been rewriting the history [and] the journey of people with what otherwise would have been cancers that would shorten somebody’s life dramatically. 

It sounds like in the moment, you’re giving back a lot, and you’re treasuring the time you have together. That’s a beautiful thing, too.

Living with gratitude

Esther, TPS: You talked about gratitude, and I think at the root of what you’re talking about is gratitude for the time you have together with your children. [I think you’re] spreading that essence of the way people should live their life, no matter what their situation is. 

In some ways, maybe that is the little tiny silver lining in people touched with cancer. It does give you pause to be grateful for the time that you have together. You sometimes don’t appreciate that.

Pete: Right.

Andrew, TPS: Not going to run for the bus or the train. You’re going to live in the moment.

Katie: What do we say? You’ve said this so many times. You’re like, “We don’t need to sweat the small stuff.” We let a lot just roll off it.

Pete: I go slow. Go slow with it. Why rush through things, you know?

Andrew, TPS: That’s the point. Slow down the cancer journey. You want to be cured. We all want to be cured. I’m a 2-time cancer survivor. We want to be cured, but short of that, while we’re undergoing treatment, enjoy what we can.

Esther, TPS: The things other than treatment.

Pete: Exactly.

Conclusion

Andrew, TPS: I’m sure they know your name well at the Cleveland Clinic.

Pete: Oh, yeah.

Katie: Frequent flyer. They were sending around a retirement card.

Pete: The guy was leaving, one of the nurses, and all the nurses signed it. They came and were like, “Hey, Pete, can you sign the card for us, too?” Because I’ve gotten to personally know some of these nurses. I know their kids, and I know what sports they’re doing.

Andrew, TPS: We wish you all the best. Thank you for sharing time with us. Good luck with the foundation and how you’re giving back. Certainly with your treatment, Pete, we wish you all the best. Katie and Pete Mang in Hudson, Ohio. Thanks for being with us. 


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Loriana Hernandez-Aldama’s Cancer Story | Cancer Friends

Loriana Hernandez-Aldama’s Cancer Story

Cancer Friends Series with Andrew & Esther Schorr

The Patient Story’s series “Cancer Friends” features Andrew and Esther Schorr. They co-founded a resource for other cancer patients and caregivers to help them through their diagnosis and treatment (Patient Power).

Explore our”Cancer Friends” series on our video channel here!

This segment focuses on Loriana Hernandez-Aldama, a 2-time cancer survivor who founded ArmorUp for LIFE. Loriana was an Emmy Award-winning broadcast anchor when she was diagnosed with acute myeloid leukemia. After a yearlong fight in the hospital, she was later diagnosed with breast cancer.

Now, Loriana is a patient advocate and the founder of ArmorUp for LIFE, a nonprofit focused on giving all patients the same access to better treatment options and tools. Loriana is also an advocate for prehabilitation, or taking steps to make our bodies healthier and more equipped to fight cancer.

This interview has been edited for clarity. This is not medical advice. Please consult with your healthcare provider for treatment decisions.


I cannot sit back and not do anything. I have to help others. If I live, I will serve.

Loriana Hernandez-Aldama


Introduction to Loriana Hernandez-Aldama

Esther Schorr, The Patient Story: Hi, there. This is Esther Schorr with The Patient Story, and I am privileged today to be speaking with a wonderful, wonderful patient advocate and speaker. 

Loriana Hernandez-Aldama is an Emmy Award-winning journalist. She is also a 2-time cancer survivor. She’s a national advocate and speaker, and she’s the founder of ArmorUp for LIFE. Loriana, welcome. I’m so glad that you’re able to give us this time to talk today.

Loriana Hernandez-Aldama: Thank you. I always say I’m so happy to be alive [and] to be able to have these conversations that are so needed to help other patients. Thank you for having me, and thank you for thinking of me.

Esther, TPS: I’m glad you’re here, too.

Loriana: I’m so happy to be here and have my feet on the ground.

Acute Myeloid Leukemia and Breast Cancer Diagnoses

Esther, TPS: Loriana, let’s just talk a little bit about your cancer journey. I know it’s been a long and checkered one. What happened?

Loriana: I was living the life as a high-profile news anchor based in Austin, Texas, doing national fitness and medical stories. In an instant, after dismissing many warning signs that I now advocate about, I was in the midst of trying to have a second baby and then found out that I had AML (acute myeloid leukemia). 

I was misdiagnosed twice. [I] ended up getting on a plane thanks to connections that I had [and] ended up at Johns Hopkins for the fight of my life for an entire year battling AML leukemia. 

That was real quarantine, separated from my then 2-year-old son. That journey lasted a year. It didn’t work. I needed a bone marrow transplant, so it extended my time away from my son. It’s been a rocky, very tumultuous recovery. 

Then 5 years to the day post bone marrow transplant, I found out I had breast cancer. They were telling me, “We probably gave you the gift of time, not the gift of life.” 

Because I had no other bone marrow match in the registry, being Latina, my sister was my match. In the genetic markers, she gave me a marker called CHIP. CHIP is a newly discovered genetic marker, which means you’re going to get heart disease. 

They gave me back the leukemia marker, and then I got breast cancer. They think it’s either from the full-body radiation or from my sister’s DNA. How do we know that? My sister currently has breast cancer as we speak.

Gift of Time

Loriana: There are tradeoffs with everything. We talk about medicine. It did give me the gift of time. I hope that time is to watch my son grow up and live a long, long life so I can continue to advocate and enjoy my family.

But it has been a very rocky journey. All of that journey, as I was sharing with you, led to a lot of depression and PTSD. Being a journalist, I said, “I cannot sit back and not do anything. I have to help others. If I live, I will serve.” I am living in pain a lot [and] struggling a lot, but I am continuing to serve and really amplify the patient voice.

Coping with the Prolonged Hospitalization

Esther, TPS: How did you and your loved ones cope with this prolonged hospitalization? You went on a complicated treatment journey. You mentioned being in the hospital for a year. How did you cope with that? 

Loriana: I look back, and sometimes I wonder, “How did we do it?” What I did was I went into reporter mode, and I started to allocate and delegate roles. I created what I call a pit crew. I actually had to take out a spreadsheet and choose roles just like your church or synagogue [does].

[It was] like, “This person is going to help with my mother and find childcare. This person is going to help with our bills, help me make sure they get paid on time, or help me launch a GoFundMe. This person’s role is for meals.” I really started allocating roles based on what people’s strengths and weaknesses were in a spreadsheet. 

I had an advantage. I had the privilege in the sense that I don’t come from a privileged family, but I had connections as a high-profile news anchor. I had a huge pit crew and a huge spreadsheet. When you think of other patients like maybe my sister, who doesn’t have a lot of connections, it’s hard for your circle to help if you have no circle.

»MORE: Mental and emotional support when leaving the hospital

Waving the Flag for Help

Esther, TPS: It sounds like project management was a big piece of that. Whether you have that skill or there’s somebody in your pit crew, it’s getting organized. How am I going to manage this?

Loriana: I say to patients all the time, “You have to wave the flag and ask for help.” Even my sister, as she’s gone through this breast cancer, she’s like, “I’m not an extrovert like you. I can’t ask for help. I’m too ashamed.” 

[I’m] saying you have to wave the flag. If you don’t wave the flag, you’re going to put extra burden on me. I can’t make all your meals, and I can’t take it all because I have my own problems, too. I encourage everyone. What I did was create a pit crew of my own support system. 

Hospitals now — as I advocate, as you advocate — are starting to learn that we need to build better support systems, but you also have to not rely solely on them. You have to be an equal partner in your own success and be your own hero, in a sense, by humbling yourself and asking for help — whether that is financial help, getting your house clean, getting a meal — because you cannot do it alone. 

You have to be your own hero by waving the flag. I had to ask so many people for help — I still do — many times. We could not have done that. My husband ended up losing his job at the end of the 1 year of sleeping at my side and trying to hold down a job that we didn’t want him to lose. 

That set him back professionally, [and] we almost lost our house. We’ve gone through a lot. Financial toxicity is huge. My best advice to patients is the minute you get that diagnosis, really lay out what your needs are and how to delegate. If you go to church, think of how they do it in church. So-and-so is working. You have somebody who’s working there [and somebody] who’s in the band. 

Whose strengths can you lean on? Section it out so that not one person carries that whole burden. That’s really how we got through it. When I had breast cancer in 2020, that was even harder to ask for help because nobody could come to my house and help.

You have to find ways to do it and find out what advocacy organizations can help you as well.

Most Important Support

Esther, TPS: Out of that whole universe, in your particular situation, what of all those things were the most important support for you? 

It’s all important, but if you had to talk about a few things that somebody who’s newly diagnosed needs to focus on — I need these things — what were the things that came to the surface that were the most helpful to you and your family?

Loriana: Unfortunately, it was the GoFundMe, and a GoFundMe is not a plan. We don’t think of that when we think of preparing for illness [or] when we do retirement plans and other plans. We needed a GoFundMe, or we were going to lose our house. 

I needed that money to help my 75-year-old mother raise my 2-year-old son for a year. The GoFundMe was so important, and we need to work on a better way to support patients because I was really caught in a unique situation. I always say if you’re not underserved when you start with cancer, you might be when you’re done because the bills start to mount. 

I didn’t qualify for anything because they were basing it on my salary as a news anchor. I had no help, but we had no income. After spending a year in the hospital, you’re thinking hundreds of thousands of dollars [of debt]. We qualified for nothing. We had to rely on friends with a GoFundMe. Everybody should raise money in some capacity, and it’s okay to do that.

Esther, TPS: Don’t be embarrassed.

Loriana: No, you should not. I always say to people, “You never know when my story will be your story, and somebody else’s story could be their family’s story.” If you pay it forward, if you skip one coffee at a Starbucks and you donate $5 to someone’s GoFundMe, it may come back to you. It will come back to you in some other way. 

The GoFundMe was helpful. Find someone for childcare if you have children. Reach out to childcare facilities and say, “I have cancer, or my niece has cancer. Can you offer a reduced rate?” 

And they did. They offered a reduced rate for my son to go to school. Because my 75-year-old mother couldn’t take care of him all day, we had him there till 5, and then she needed extra help at night. I would say those are the two biggest things. I was in the hospital, so meals at that time weren’t helpful, but if you’re home —

Esther, TPS: They might not have been that good, but they were meals.

Loriana: I didn’t eat it. I gave money to the nurses, who were also my heroes, to go. They would go to Whole Foods and other clean eating grocery stores to pick up groceries for me. Who expects to be hospitalized for an entire year? 

»MORE: Tips on food and drinks to help during chemotherapy

There are many ways. You can have someone clean your house for you so you can spend more time with your loved ones. There’s so many ways that support can happen. Then support can happen even after. When you go into survivorship, you need a break, but you’re too broke.

Esther, TPS: So what do you do?

Loriana: I’m still working on that part. 

Importance of Prehabilitation

Loriana: We are working at ArmorUp for LIFE. We’re working on creating some programs where I found those voids. I mentioned pit crews for patients. We’re also working on eventually creating some retreats, where we can create ambassadors. 

You’re visualizing in the hospital that you’re going to get out, and you are going to get out. You are going to return to health, but in the process you have to prioritize your own well-being. If you don’t, you don’t want a secondary cancer. You don’t want to complicate the comorbidities that the chemo had. 

I’m involved now in a lot of research at MD Anderson and the Mays Cancer Center, and there’s a lot of research looking at the stress and the connection to cancer. Then they’re breaking it down even deeper to the stress and connection to cancer or cancer recurrence for cancer survivors. 

They’re getting patients and survivors into trials and having them doing therapeutic yoga and breathing and lowering their cortisol levels. They have a lower rate of recurrence of cancer, which is powerful.

One of the big things I advocate on is prehabilitation, prehab, preparing your body for illness.

ArmorUp for LIFE

Esther, TPS: Talk to me about ArmorUp. This is ArmorUp. Tell us about ArmorUp for LIFE.

Loriana: ArmorUp for LIFE is my nonprofit that I launched from my bedside because I reported from my bedside during my journey, being a network medical reporter. I just said, “This story is bigger than me. I’m learning so much from these doctors that is not getting shared with patients.” 

One of the biggest things I learned was that you have to prepare your body for illness. I said, “Why? How did I end up here as the clean-eating, green-drinking yoga enthusiast? They said, “Because guess what? Bad things can still happen to you. What sets you apart is how you showed up, and you showed up fit for this fight. Our hands are tied with so many patients here.” 

They said, “The more fit you go into illness, the better you present to us as a medical team, the better your position to prevail.” I had 25% chance of survival, but they said, “Look, you have all 25. I have people on this hall who have 25% chance of survival or should, and they’re not fit enough to get the chemo [at the] same dose as you. Now they have 10 or 12.” 

My message began saying, “Okay, we’re going to call this the 3 P protocol to be possible: prepare, present, prevail. You have to prepare your body for illness so you could present well to your medical team and position yourself to prevail.” 

Preparing can start the day of diagnosis. It can start in the midst of your treatment. It can start well before you ever got diagnosed, if you have other people in your family and you know you have the genetic markers for it. It’s called prehab, prehabilitation.

Increasing Positive Outcomes

Esther, TPS: Being healthy is prehabilitation to begin with.

Loriana: Right. We’re prehabbing — you, me, Andrew, [and] everybody we know. We’re prehabbing every day with the decisions we make. When I learned that, that was like a really eureka moment that I have to get this message out. The more you go in, the better you present, the better your position to prevail. 

That means your patient outcome, your chance of survival, goes up when you walk, when you stay mobile — mobility matters — [and] when you focus on risk reduction and lowering your stress levels. All of this plays a role in how well you go through treatment and your success rate. 

Talking to patients, I would say it’s never too late to get started to start reducing your stress, even though you’re in the midst of turmoil. Let’s try to find time to meditate and take some deep breathing and lower your cortisol levels, because there are studies that show [stress] can cause a recurrence. 

You don’t want to end up like me, where I’ve had 2 cancers. I’m always praying that there’s no third, that there’s another shoe going to drop. We have to really, in the midst of the chaos, still take care of our health and make decisions to eat right and exercise.

It can make a difference. Like they told me, you have all 25% chance because you’re getting exercise. You’re eating clean. You’re meditating. That is a huge component of your patient outcome and your success.

Esther, TPS: You’re stacking the deck, is really what you’re trying to do. Stack the deck so that should lightning strike, you’re not in the worst position. You’re in the best position to survive. 

Self-Advocacy

Esther, TPS: You’ve really covered what propelled you to do as well as you have in your illness and your journey. I know, too, that you spend most of your time now being an advocate for other patients [and] raising their voice. 

In this whole system of taking care of patients, who else has to hear this beside the patient? You can scream in an empty room, and nobody hears you. I know that the work you do is training patients. 

There’s this other piece that I hear from patients all the time: “My doctor’s not listening to me. My medical team doesn’t get it. The pharmaceutical companies may or may not have the drug I need.” Can you talk a little bit about how a patient can navigate some of that to their advantage?

Loriana: Yes, you have to be your own advocate. There is a fourth unofficial P, and it’s called being a pain in the neck. You really have to be pushy, push for answers, and be your own hero and advocate when you’re asking what other voices need to hear this. 

That’s why I go and talk to conferences. The pharma companies need to hear this. Your providers need to hear it. The nurses need to hear it. Everybody who’s involved in this whole ecosystem. That’s why I call it a pit crew so much with ArmorUp for LIFE, because we need a team invested in our success to successfully get us to the finish line. 

That means that our provider needs to lean in and listen and ask questions like, “How do you have transportation to get to this clinical trial?” Or ask about your family history or ask about your comorbidities. 

Like for me, I have baggage. When I was going through treatment for breast cancer, I tried to explain, “I’m a unicorn. I had leukemia, I had a transplant, and I don’t even have my own DNA. You need to talk to my leukemia doctor. You cannot operate in a silo. Call him up. Find out what is best.” 

I felt like I had to be a reporter doing email intros. I said, “This is so much work. It should not be this hard to survive.” I say that the providers need to listen. They need to listen. I understand that they’re busy with charting, there’s a shortage, and they only have 15 minutes.

To the patient, bring in bullet points. Help get them the most information in those 15 minutes. To the provider, be aware of your implicit bias. I know that you need to ask the patient more questions than just, “How are you feeling?” or, “Your counts are good.” 

It needs to go, “Do you have transportation? Do you have childcare? What’s getting in the way and keeping you from coming to this treatment that you need or keeping you from taking this drug?” 

We have the providers. We have the pharmaceutical companies, and the pharmaceutical companies have a lot of patient support programs. They’re called PSPs. Who knew? I never knew about that. I told them at the conference I was just at. How would I have any idea that all this work exists? Nobody said.

I was on 40 drugs from probably so many different companies. To patients, if you are having trouble, there are programs that pharmaceutical companies have that you can say, “I’m on this particular company’s drug.” Call [them].  

They may have a nurse navigator who could talk to you, but really we all need to come together, collaborate, and let each other know we’re here for you. It comes down to communication and knowing what’s available.

Esther, TPS: True that, and from some recent personal experience I’ve experienced. Being a care partner, not with my husband, but with my aging mother, where the system you’re talking about wasn’t listening. 

It really was literally a 2×4 that had to be taken on by me and my siblings to get people to listen. I think people have to realize that our systems, especially in the U.S., are complex enough that unfortunately it falls to the patient and their pit crew to try to make those communications happen. 

Second Opinions & Shared Decision-Making

Esther, TPS: I think you’re really right, Loriana, that there’s a lot of onus on the patient and their pit crew to do a lot of this. I think that a lot of people just aren’t prepared for that. [It’s] one more burden they have to take on to get the best care they need.

Loriana: It has to be shared decision-making. If you’re a patient and you’re listening, you can’t just say — I mean, you could be at the best institution or in a rural community. You can’t just take that one person’s answer as the Bible for you.

I would say get a second opinion even when you like the first. I loved my first opinion. They said I didn’t have cancer. But I still didn’t feel right, so I got another opinion. They said I didn’t have cancer. It took my fertility doctor to tell me I had AML leukemia. [After] the 2 doctors who misdiagnosed me, I said, “That’s it. I’m going to Johns Hopkins. They know what they’re doing there. They have to save my life.”

Esther, TPS: The additional opinions and being clear whether the person you’re talking to is really listening.

Loriana: Absolutely. Be very clear with your doctor what barriers you have in place: childcare, transportation, finances. Ask him or her what resources [are available]. Can they connect you to the patient navigator? If you’re not getting answers, keep going up the chain. 

Ask the chain of command. Ask for the financial navigator. We’re starting to hear more navigators now. They’re taxed. They don’t have enough help, but keep asking and keep pushing. Eventually somebody is going to help you. Don’t just take one opinion and think that that is the best opinion for you.

Helping Underserved Communities

Esther, TPS: Let’s switch gears for a second. There’s a whole other area of the work that you do — and it’s part of who you are — as a Hispanic health advocate. 

What do you see as the biggest challenges in meeting the needs of some of the underserved communities? Whether they’re Hispanic, black, or poor, rural white communities. It’s not just a matter of a minority. It’s really more the communities that aren’t getting what they need. What are the biggest challenges right now?

Loriana: Yes, there are so many communities who are underserved [and] who certainly need help. They get left out. So many times we hear at conferences about these high-level institutions. I kept saying, “If there were patient voids at the top, what’s happening in our rural communities when it’s one doctor, with not getting a second opinion, and that’s the only doctor you have access to?” 

One of the biggest voids, I will say, in the Latino cancer community — I spoke at their conference earlier this year, and they’re expecting a 142% increase in cancer cases just among Latinos. This year among Latinos, they also say that the number-one killer for Latinos is cancer. Again, there are other startling statistics for other underserved communities. I just happen to know those off the top of my head. 

One thing I say is we’re talking a lot about diversity in clinical trials, and that’s great. I’m glad that it is now a hashtag and a trend. But if we can’t get our communities, like my Latino community, to get into a screening because they don’t want to know, they’re in denial, for whatever reason they’re not going, and there’s trust issues, [then] they’re not even going to make it to a clinical trial. 

»MORE: Learn more about the process of clinical trials from one program director

We need to not put all of our eggs in one basket about clinical trials, which are important, and having diversity and fitting more people in. [We need to] focus on the voids in the Latino community, the black community, the Asian community, the Indian community, the lesbian-gay community, [and] all these communities that have certain cultural competencies and different reasons that they don’t go into screenings because there’s trust issues. [We need to] focus on getting them into screenings and build trust at every point along the way in the journey. Then we have them here for the clinical trials.

Esther, TPS: Not treat the symptom; treat the cause.

Loriana: We are more than just our disease. Look at the whole ecosystem, the whole patient, who they are, where they come from, and why that’s a barrier. How do we get them into more screenings? We have to build trust. You can’t just come at them out of nowhere. 

It’s just like, “Bam, here, want a clinical trial?” No. Where were you in my community? That’s why we’re hearing about some advocacy going on in churches and barbershops, where there is trust. That’s where I find all the voids.

First Steps for Advocacy

Esther, TPS: Let’s say one is a newly diagnosed patient or a survivor that is [reading] this. They say, “Okay, I want to raise my voice. I want to be involved in paying it forward.” How do they do that? Where do they start?

Loriana: The first, quickest thing you can do is start raising your voice by yourself through social media, because that’s something everybody has access to. I would start thinking of when you share your post, share not just what happened to you. 

It doesn’t have to be an angry post. [It can be] something about what you went through and what the takeaways are. You can post that through social media just to share, like, “Hey, you should get this screening. Did you get your screening, did you get your mammogram, and did you get your colonoscopy?” 

That can eventually grow, but then also reach out to organizations for areas that you’re passionate about. [Maybe] it’s prostate cancer or leukemia. Is it breast cancer, or is it overall just all cancers? Wherever you want to get involved and reach out and say, “I want to help in some way.”

Esther, TPS: They do that in the medical center, too. I would surmise that they have patient survivors that go and visit other patients to try to support them.

Loriana: There are so many ways to get involved. Again, the quickest and easiest way to get started, as it grows and as you reach out to others, is through social media.

Advice for Advocates

Esther, TPS: Listening to other people who are trying to figure out their path toward health, potentially for advocating for other people, and as they advocate for themselves, what advice would you give them?

Loriana: There is so much that I want to say right now.

Esther, TPS: I know you just gave a lot of advice.

Loriana: First, I do want to mention some things that we are launching, which are very important, because it is going to help people. In February, we’re launching a prehabilitation awareness month because it never existed. It’s so important. We’re calling it PREhabilitation Nation. 

I talked about prehabbing. That prehabilitation that I mentioned is something we can all be doing. If we can help risk reduce, which is prehabilitation, in our underserved communities, they can present better and be better positioned to prevail. 

That means maybe where you would not have qualified for intensive chemo, if you show up in a more fit state, maybe you can, which can change your outcome and help you survive cancer. That’s one big campaign that we’re working on. 

I just encourage patients all the time that you have to get involved and ask questions. You just can’t take what the doctor says, he or she, no matter how brilliant they may be, as that’s the final say. 

Even when I fly now to Johns Hopkins and see my oncologist who saved my life, once he says, “Your counts are good,” I want to skip out the door and sing “Zip-A-Dee-Doo-Dah” out the door. But I forget. Wait a minute. I have all these other problems. 

Go in with notes, remember, and help connect the dots. Who do I need to see? If you’re a cancer patient, do you have a cardio oncologist? The chemo is going to impact your heart. You need a baseline. Do you have a dermatologist oncologist? If you’re a woman, do you have a GYN oncologist? Do you have an immunologist? 

You have to start building your own pit crew. I say to patients, get empowered, ask questions, and even on a good day at the doctor’s office, ask more questions and find out who else you need to be connected to.

Esther, TPS: And bring a henchman if you need to.

Loriana: Yes, absolutely. During COVID, that was hard during the pandemic. Now, with Zoom especially, you can easily do that. If you could do telemedicine on a call, you can have somebody who might be more health literate than you. 

Even if you’re health literate, when you’re in a time of crisis, you don’t remember everything. Once they give you some bad news, you don’t hear another word after that. You need somebody who can be there with you to take notes, to recap, [and] to ask if you can record the conversation. I just can’t stress enough that you have to be your own advocate. You can’t count on the system to do it all for you because they don’t have all the tools to do it.

Conclusion

Esther, TPS: Loriana, thank you so much for all of your energy and your insights. Your energy is amazing.

Loriana: I’m a little high-strung. Can you tell? I’m just happy to be here and be alive.

Esther, TPS: Not at all. It’s really inspirational, because what you said about preparing for a unique journey is really what it’s all about. It just takes a lot for somebody to go through it. You got to pull it all up from the inside. It’s hard work to survive. 

Loriana: I say that as I struggle, and I’m very transparent about my depression and PTSD. Some days it’s so hard, and I have to remember that we all have purpose. For me [or] anybody who’s going through struggles, if you don’t feel like you have purpose, find advocacy, because that helps me with my depression. 

I went from living the life to fighting for my life and so lost, wanting to take my own life because there were no tools and survivorship for me. My news director reached out to me, gave me purpose, and helped me get started. 

If you give someone purpose, you feel like the world needs you. Even if you’re suffering [from] depression, you’re less likely to check out because you know the lives you can impact. So I’m glad. Esther, we need a whole big room. We need a stage. We need to take our show on the road.

Esther, TPS: Loriana Hernandez-Aldama, thank you so much for sharing your story with our Cancer Friends community. This is Esther Schorr, and wishing all of you the very best of health.


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Categories
Clinical Trials Medical Experts Nurse

What is a Clinical Trial Really?

What is a Clinical Trial Really?

Busting Top Myths About Cancer Clinical Trials

There are so many myths surrounding clinical trials. Many question, “Will I get a placebo? What is the cost of a clinical trial?” To bring some clarity to an often confusing, myth-riddled topic, The Patient Story and The Leukemia & Lymphoma Society (LLS) have teamed up to discuss what a clinical trial is, the phases of a clinical trial, and how to figure out the logistics of paperwork, tests/scans, and finances.

The Leukemia & Lymphoma Society (LLS) is a global leader in the fight against cancer. LLS funds lifesaving blood cancer research around the world, provides free information and support services, and is the voice for all blood cancer patients seeking access to quality, affordable, coordinated care.

The Clinical Trial Support Center (CTSC) is a free service provided by the LLS to help patients find clinical trials, find financial support and to overcome barriers.

In this conversation, Domenica, a cancer survivor who has participated in clinical trials, opens up about her experience, her fears and concerns, and explains how it helped save her life.

She’s joined by Crissy Kus, a CTSC Nurse Navigator, who worked side by side with Domenica to find and join clinical trials, and CTSC Director Leah Szumita, an expert in clinical trials.

Thank you to Crissy, Domenica, and Leah for sharing your stories and expertise!

This story is adapted from a webinar held on November 9, 2022. A copy of the slideshow presented is available at the end of the article.

This interview has been edited for clarity. This is not medical advice. Please consult with your healthcare provider for treatment decisions.


Introductions

Crissy

Crissy: I’m Crissy. I’m located in the Midwest. I’ve been a nurse for a little over 10 years, and I started out my career at the bedside. [I was] working with blood cancer patients and stem cell transplant patients from [the] time of diagnosis of a new blood cancer through stem cell transplant and many years beyond. 

I have sort of worked in a few different spaces in the blood cancer world, most recently in CAR-T cell therapy and in clinical trial coordination. I’ve been with LLS for about a year and a half, but all of my background, from bedside to my job now, really gives me [a] good understanding of the unique challenges and vulnerability that patients are in from the time they’re diagnosed and throughout their journey.

Domenica 

Domenica: I feel so good to be able to share my story. Before my diagnosis of CLL in 2009, I had a very successful career in entertainment and in the media. I was a show host. [I was] in various TV shows, a radio host, a professional singer/songwriter, journalist for lifestyle segments and an actress. I was [living] my dream, and I was feeling so accomplished with myself. 

Then you get the diagnosis, and everything changes. I was first diagnosed in 2009. It changes the outlook of your life, and you begin to think [about] something you maybe never thought would happen to you. At that point, I was in watch and wait, and I continued working. 

Then came one cancer after the other. I worked through those years and treatments, but in 2017, [I] began very, very intense treatments. I had different cancers and [went through] not only chemo but also radiation. [At that point] I couldn’t do it anymore. I just concentrated [on] getting cured, to try to find the cure and to be strong. That is when I decided to leave everything and just [began] to fight.

Leah

Leah: I have been a nurse for just about 20 years. For the first 15 years of my nursing career, I was at the same Boston teaching hospital, where I spent half the time in the medical ICU taking care of hemog patients, particularly bone marrow transplant patients. Then the second half of my time there, I was a nurse educator and clinical nurse specialist in cardiology and vascular surgery. [It was a] very different world. 

I came to LA just about 5 years ago in the Clinical Trial Support Center, and this team has grown so much in such a short amount of time. I feel really privileged to be part of this team. We’re a team of 11 nurse navigators with incredible nursing expertise in hematology and oncology. We work directly with patients, their families, and healthcare providers to help identify potential clinical trials and then overcome the barriers to enrollment.

Clinical Trial Information

Domenica, how did you learn about clinical trials?

Domenica: In my case, my doctor is the one [who brought it up]. I knew about clinical trials, but I didn’t think I was going to be a candidate or that I was going to participate in a clinical trial. I moved from Mount Sinai Medical Center, and the doctor told me, “Listen, you have to go to Sylvester. I’m going to introduce you to a doctor, because they have lots of clinical trials. They have another kind of treatment that we don’t have.” 

I appreciated that so much. When I got to Sylvester, the doctor talked to me about clinical trials. [I not only had] CLL, but at that time, it transformed into a diffuse large B-cell lymphoma and Richter transformation. 

That is very aggressive and very difficult. I thought it was a great opportunity to be able to participate in something that is so new and something that can bring you hope to continue to fight.

Domenica, what questions did you have before participating in a clinical trial?

Domenica: The first time, you say, “Okay, what is going on? What is going to happen? What are you going to feel? Are you going to get a placebo?” Because that’s the typical thing that everyone says: “You’re going to get a placebo. You are going to be a guinea pig, etc., etc.” All the comments of your friends and family or whatever. 

When I brought that question to my doctor, he told me, “In cancer, there are no placebos.” I felt much more comfortable because usually, if it’s another kind of illness, another kind of situation, they do placebos. In cancer, no. I felt much more comfortable going ahead and signing for the clinical trial. I think that that’s a great experience, knowing that you’re not going to be a guinea pig.

One [of my other] questions was, “What was the phase?” To be a little bit more sure what was going to happen and [to know] what I was getting into.

Leah, what top concerns do you hear from patients?

Leah: When we’re working with patients or family members, there are many different concerns like Domenica had, and there are many myths and misconceptions about clinical trials. A big part of what we do is help to educate and really clarify what clinical trials are.

As Domenica said, it’s really important to emphasize that first and foremost, safety is the number-one priority in any clinical trial. For a cancer clinical trial, a patient will never only receive a placebo. It would be completely unethical for a patient to receive only a placebo when there is other active therapy that could be given.

CTSC out at dinner.

What happens is sometimes in later-phase clinical trials, there may be a placebo used, but it will always be in combination with whatever is considered the best approved therapy. Another misconception is when clinical trials are talked about, patients sometimes assume that must mean there is no hope for them. 

Leah and her family.

Something else I really want to emphasize is that there are clinical trials for every stage of illness, whether it’s for patients who are newly diagnosed and have not yet received treatment, [or] if it’s for patients whose disease has not responded or come back after treatment. There are also clinical trials for people who are on maintenance therapy, into remission, and well into survivorship. 

What we really work to do is to destigmatize the word “clinical trials.” We want clinical trials to be discussed at the time of diagnosis and during change in treatment plans as a potential option. It may not be the option for everyone at that moment, but the more we talk about clinical trials as an option, it’ll increase the awareness. It will increase the number of patients who enroll. 

I think another really important thing to share is that 20% of cancer clinical trials in our country close not because the treatment didn’t work, but because they never get enough people to enroll. We really need to dispel these myths, these concerns, and increase awareness about what clinical trials really are.

There are very strict inclusion/exclusion criteria for clinical trials that involve prior lines of therapy. Again, the theme here is that cancer clinical trial participation is really the key step in advancing treatment, and it’s how we’re going to help bring treatments that work for people to the rest of the population. We really want the people who are participating in the trial to be representative of our diverse population. There are lots of really important aspects of increasing awareness.

Domenica, how did your doctor describe the clinical trial to you?

Domenica: When I spoke to the doctor, [he] explained everything about the clinical trial — how [it] works, all the things you have to do, the different tests, the different phases and of course, how you can be accepted or not.

As I said, I never went into a clinical trial and I never knew. Besides that, regarding the phases, I also think it’s very important. For me, it was very important to know that in my case, that first clinical trial and also the second one were in phase 2. I felt much more comfortable in a phase 2 trial than in a phase 1.

Leah, what are the phases of a clinical trial?

Leah: It’s a rigorous process. What’s important to understand is that any therapy that’s approved today, whether it’s chemotherapy or a different cancer therapy or even something over the counter that you can go pick up at CVS and Walgreens, at one point [it] was in a clinical trial. 

Before a clinical trial even starts, the research begins in the lab setting. Researchers take either a new treatment, or maybe it’s a combination of drugs that have never been put together before, and they test it in either Petri dish or animals to really see if that is safe and promising in that setting. 

If it is, it can go through the very arduous process of becoming a formal clinical trial. The first phase of clinical trial, a phase 1, is considered first in human. It’s a very small number of patients, usually around 30. The goal of a phase 1 clinical trial is to determine what is the optimal dose, the highest dose with the least amount of side effects. Within that small group of patients, researchers give a group of patients a certain dose, and then if that is well tolerated, [they] give a different group of patients a higher dose and keep doing that until they determine what that optimal dose is. 

After they’ve determined that, it can move into a phase 2 clinical trial. This phase has slightly more patients, somewhere around 100 or so. At this point, researchers say, “Okay, we have this new treatment that is safe, but does it actually work the way we had hoped?” Every clinical trial is set up differently in terms of what outcome measures it’s striving to meet.

It might be overall survival. It may be complete remission. It may be managing side effects or improving quality of life. Researchers are going to take this new optimal dose and give it to these patients to see if they can meet their outcomes. If they do, then that clinical trial can move on to a phase 3. 

There are many more phase 1 and phase 2 clinical trials than there are phase 3 for a couple of reasons. First, 20% of clinical trials unfortunately closed because they never had enough patients enroll. But then there are certain trials that closed because they didn’t determine that optimal dose, or they didn’t meet their outcome measures. 

If a clinical trial does make it through those first 2 phases, it can go into a phase 3 clinical trial, which is where there are 2 groups of patients. The first group gets whatever is this new treatment, and then the other group of patients gets whatever is considered the best approved therapy. 

At this point, researchers want to know, “Okay, is our new treatment as good, if not better, than what’s considered the gold standard or the approved therapy?” If it is, it can then pursue FDA approval.

Phase 4 trials are when something has gone through the prior steps and becomes FDA approved. There can be a more long-term analysis of side effects and effectiveness, and that would be considered a phase 4 trial.

Domenica, how did your doctor recommend going somewhere else?

Domenica: I appreciated that so much and thank him so much because he saw it, and he knew he couldn’t do anything else for me. We started with the R-CHOP. That is the typical treatment for diffuse large B-cell lymphoma, and unfortunately it didn’t work after the third or fourth round of chemo, and that was it. 

I moved to Sylvester Cancer Center, and the doctor told me about the clinical trials. It was a great discovery. At the beginning, I was going to do CAR-T, and that is why he sent me to Sylvester. But then when I got to Sylvester, the doctor said, “No, let’s wait for CAR-T and let’s try this clinical trial.” 

Domenica, how did your doctors work together as a team?

Domenica: Something I didn’t mention before, [is getting a] second opinion. I think it’s very important because when you have this kind of cancer, if it’s so rare, it’s always good to have a second opinion to balance and see what’s going on in different centers. I have another doctor also in Memorial Sloan Kettering and he’s great, too.

Luckily, all the treatments we’ve been doing in Sylvester, they [all] agree. They always talk to each other and they communicate. They work as a team. That, I think, is super important for the patient.

At the beginning, when I was thinking about a second opinion, I said, “Oh my God, the doctor is going to be offended. I don’t know if I can do this.” But I said, “Well, listen, it’s my life.” 

So I spoke to him. He told me, “Please, go ahead. If I was in your side, I would do exactly the same.” That kind of support of the doctors is so important for the patient — that you feel comfortable not only with your doctor, but in this case also having a second opinion.

Crissy, what resources are there to help guide patients?

Crissy: Right off the bat, I have to obviously mention LLS and the Clinical Trial Support Center. Our service is a 1-to-1 nurse-patient relationship. The majority of my patients, I work with for many weeks, months, and some even years. I’ve been working with Domenica for over a year. 

It’s really unique to every patient and what their needs are. There are many other resources out there, too. There are other foundations you can reach out to for help and guidance.

The biggest thing I always tell patients is, you are your own advocate. It’s your life, not your doctor’s life, not your nurse’s life. It’s your life and so you have to be the one [who] advocates for yourself.

I want to point out [that] something I hear from a lot of patients is, “I don’t know if I want to send this trial search to my doctor. I don’t know if I want to share with them I’m looking elsewhere, or I’m scared to ask my doctor for a second opinion at another center.” 

I’ve been working in cancer treatment for 10 years and I think you’d be hard-pressed to find a physician who is offended by that, because today’s patients are more informed than ever. Physicians appreciate that. Physicians are more than happy to help their patients seek second opinions elsewhere. 

I think if you are with a physician who isn’t, that says something in and of itself and that maybe that relationship isn’t right for you. If you’re with a physician who doesn’t want what’s best for you, to get a second opinion somewhere else, I don’t know that that’s someone I would personally want on my team.

Clinical trial paperwork

Domenica: It was overwhelming at the beginning. The paperwork, as you said, [it’s thick]. To tell you the truth, I didn’t read the whole thing. I kind of went through [it], but I didn’t have [any] other option. I wanted to get into this clinical trial, so I signed the papers.

Crissy: One thing I always did when I was helping consent patients to clinical trials was, I always gave them the paperwork beforehand any time it was possible. Certainly, there are instances where a patient comes in, and you’re consenting them the day you found out that they progressed or they’re diagnosed.

However, in the majority of instances, we knew about a patient potentially coming in for a consult for a clinical trial, or we were switching gears and treatment. The day or two leading up to their visit, I would send them a copy of the consent. I always advise, “Read this over. Bring your highlighter. Write down questions. A lot of this is going to feel like there’s medical terminology, and it’s too much to understand. Highlight that, circle it, ask. Come with your questions.” Ask the question, “Can I get a copy of this before I sign it, and look it over?”

The other thing I stress to patients is while that is a very daunting and intimidating form, you can change your mind about participating at any time. Whether you sign the document there with your physician [or] you walk out of the clinic and say, “Oh, I change my mind. I don’t want to do all of that.”

You can change your mind at any point. Like I said, immediately after the visit, a week after the visit, 6 months, a year later. You can change your mind about participation in a clinical trial at any time. 

The third big thing I like to advise patients to do is take someone with you to that visit. If it’s the visit to discuss the clinical trial, if it’s the visit to consent for the clinical trial, bring someone with you because you as the patient are going to be receiving so much information that you’re almost always going to walk out of that visit like, “Oh, I forgot to ask this, this, and this that I wanted to ask.” 

If you bring someone with you, they know those questions you wanted to ask. They’re at the top of their mind and they bring them up. They’re also really good note takers. They might hear something you didn’t hear.

What kinds of treatments, tests and scans happen during the clinical trial?

Domenica: It’s overwhelming because there are so many tests involved. Of course, the typical blood test with all the specifics and PET-CT scans. You go through a bone marrow biopsy. I want to tell you something very interesting, because in the second clinical trial, they did a bone marrow biopsy and they didn’t find the Richter [transformation]. 

They called me and they said, “Well, if we don’t find it, I don’t think you can be in the clinical trial.” I freaked out, of course, but then they did a biopsy in another area in the breast. That is where I had the Richter, and they found it. They really work on finding all the things they need to follow the protocol of the clinical trial. That way, you can join. It’s incredible because then after that, you have to go every week. 

That’s something I think everyone [needs] to know you have to go through: maybe the first and the second month [or] every week to do the follow-ups, the blood tests, [and] see how your body’s reacting with this new medicine that you have. After that, then it goes like once a month. I think it’s great because you feel that they are looking after you and you know what is happening inside your body. It’s very important.

Crissy, why do clinical trials need to do so many tests and scans?

Crissy: A lot of times, the sponsor of a clinical trial needs fresh samples. Imaging needs to be done within so many days. Oftentimes it’s like 14 to 28 days. Patients told me, “Oh, I just had a scan.” It’s like, “Well, but it was 38 days and they require it within 28.” 

Another reason they do this is so every single patient who’s on that clinical trial is worked up in the same exact way. [That way,] you’re comparing apples to apples and saying every patient got the same workup, the same treatment, [and] the same management on the clinical trial. 

The [number-one] reason they do all of this rigorous testing is to keep patients safe. They want to make sure everything is as streamlined, the same and as safe as possible for every single patient. Another reason they do all of this testing is so that we can get more drugs to more patients.

That requires rigorous testing to make sure everyone is as equally fit and healthy to participate so that the clinical trial goes through as quickly and smoothly as possible. [Then] they can submit for FDA approval and get that drug on the market so that hundreds and thousands more patients can have access to it. 

Clinical trial side effects

Domenica: The chemo, the radiation [and] everything is so hard [on] your body. When I found out that the clinical trial was a pill with very little side effects, it was a relief because definitely you don’t want to feel bad. For myself in particular, I didn’t have any side effects.

I lost my hair I don’t know how many times. It came back so many times. With this as a target therapy, it’s a completely different way of approaching your illness. I think this is a great way to join the future, because for me, this is the future. It’s a future of hope for all of us that have blood cancers and other cancers.

Travel and logistics for a clinical trial

Leah: Oftentimes, a clinical trial will take someone away from home frequently or for an extended period of time. Most clinical trials are happening in the large academic centers. For folks who don’t live in those areas, you’re talking about a lot of logistics to figure out. 

I tell people all the time, “Wanting to enroll in a clinical trial and actually enrolling is not a straight path.” There are just so many bumps in the road, and these logistics and finances are two huge bumps in the road. When we talk about the finances related to clinical trials, there’s really three buckets of cost. 

The first bucket of cost is whatever is being studied, so either a new drug, a combination of drugs, a transplant or a CAR-T therapy. That new treatment being studied is typically covered. The cost of that is covered by whoever’s sponsoring the trial

Then you have the second bucket of cost, which is all the other healthcare-related costs — the scans, the bone marrow biopsies, labs, IV fluids or antibiotics when needed — need to either be billed to insurance or paid for out-of-pocket, which can be a significant cost.

The third bucket of cost are all of the other expenses related to participation: travel, airfare, carfare, gas, food, lodging for you and for a caregiver. The majority of that will be out-of-pocket expense. One of the questions we arm our patients with is, to go back to the study team and ask if the sponsor or the site has any money to help support covering for food, lodging, travel, etc. 

What we have found is that oftentimes it takes building a patchwork quilt of resources to get people to a point where they can participate in that clinical trial. At LLS, we have some really incredible financial support programs for patients. We also look outside at other advocacy organizations to really try to build together a plan to make it possible. A challenge is certainly when patients don’t have health insurance. Many times a clinical trial, unfortunately, is not an option for the reasons that I mentioned.

What I want to also emphasize is that a clinical trial is not for everyone, for a multitude of different reasons. But if someone comes to our department interested in learning more and through that process, there’s a different type of treatment that is in their next best interest, whether it’s pursuing standard of care confidently or getting a medication through off-label or compassionate use, that nurse navigator is there to help you overcome whatever barriers there are to that treatment. 

As nurses, we can be very savvy. It’s a little bit of detective work sometimes trying to piece together a plan to help somebody get to that optimal treatment, but this team is so able and ready to do that.

I think this is a great way to join the future, because for me, this is the future. It’s a future of hope for all of us that have blood cancers and other cancers.

Domenica

What was your experience with clinicaltrials.gov?

Domenica: I went to the site and it was crazy. There are I don’t know how many clinical trials for different cancers and different things, so you get lost. This is when Crissy comes and saves you. It’s amazing, but she knows everything. She knows all the clinical trials that are coming. 

Domenica with her husband, Jeff.

One thing that is very important that I also like to address is you always have to be ahead of the game. Don’t stay with this clinical trial. My husband and I used to call Crissy and say, “Okay, Crissy, we’re here, but what could be next?” Because you don’t know if it’s going to work. You don’t know how long it’s going to work. You always want to be prepared. Crissy is like a guardian angel because she does everything and makes finding the new clinical trial much easier. 

Crissy: I want to say I am very thankful and blessed and honored to work with Domenica and her husband. They are incredible to work with. I get so excited every time my phone rings and I see that it’s them or they’re emailing me. Sometimes it’s to ask questions about her side effects she’s experiencing.

Sometimes it’s to update me on their trips to Peru or wherever cool place they’re traveling. Sometimes it’s to check in on how I’m doing. That’s kind of the beauty of this relationship in this service. Every relationship is totally different with patients, but patients get out of it what they want. 

I do want to touch back on clinicaltrials.gov to reassure patients if you’ve ever been on that website and you felt down about yourself having trouble navigating it, understanding what they were saying — I just want to tell you that in my last job, I worked at a really large academic institution in a stem cell transplant clinic, and I helped physicians, some of the most brilliant physicians I’ve ever worked with, navigate that website at least weekly when they were looking for trials for their patients.

They had a lot of difficulty looking for what trials their patients might be eligible for on that website. Don’t feel down about yourself if you’re having a hard time navigating that. That’s really what our team is here to help patients do. [It’s] to not have to navigate that process on their own and everything else that comes with exploring clinical trials [and] participating in clinical trials

[It’s] to really hold your hand throughout that process, virtually or over the phone, to support you and guide you to make the best decisions for yourself through shared decision-making. Me helping you, you sharing the information with your physician and your family, and coming up with what is best for you and your situation. 

I do want to encourage patients, too, if you’re interested in seeking our services, we’d be happy to help you navigate this very overwhelming territory.

Up until just a few years ago, our team was actually using clinicaltrials.gov to do our personalized searches for patients. It was felt that it was a tedious process that could definitely be streamlined and improved and so LLS poured a lot of resources into creating a proprietary database that only our team has access to. 

It’s a website that sort of sits on top of clinicaltrials.gov and updates every 24 hours. To put simply, if it’s on clinicaltrials.gov, it’s also in our database. But then our database gives nurses and nurse practitioners who are on our team the ability to augment that information, update it, keep it more up to date, and really just put a lot more information about logistics. 

If there’s published data or even unpublished data, we house that information in there. The more we know about a trial, the better we can help patients understand it, and the more we can help them figure out if it’s a good fit for them. 

We’re constantly having meetings with physicians who are managing clinical trials, pharmaceutical sponsors of clinical trials, and the trial teams at sites to learn about the logistics. Is it a drug that a patient gets every week for 6 months, or is it a treatment that a patient gets once but they have to stay locally for 30 days? Is there lodging and travel assistance available?

Is there any published data in this space? Has there been any changes to the study that maybe aren’t on clinicaltrials.gov? Maybe they’re not enrolling this type of lymphoma anymore, but they are [with] this type of lymphoma. We are always constantly updating that site so all of our team has access to that information so we can better serve patients.

Domenica, you’re headed for another clinical trial

Domenica: Yes. I was lucky to find another clinical trial that the doctor introduced me to. [I’m] going to start the tests and everything maybe in a couple of weeks. I hope, it’s a successful clinical trial. 

For me, a clinical trial means hope and many people don’t think about that. They think about the chemical part or the bothersome [things] caused by traveling or getting the tests or the follow-ups and everything. 

But this is something that can give you hope to continue living and to continue fighting. I definitely don’t have any doubt. If there is another one, I will be in [it], because in my case, this is the only hope that I have.

Q&A from the Webinar

Q&A: Do you help outside the US? 

Leah: The Clinical Trial Support Center at LLS works with patients in the US and Canada. I do want to emphasize we’re a completely free service as well. The challenge for international patients to receive care through a clinical trial in the US is related to finances and also establishing a place to be and visas. It’s a very complicated thing. 

When we look at just the financial aspect of it, if someone does not have health insurance coverage, whether it’s commercial insurance or Medicare or Medicaid, the cost of the clinical trial will be out-of-pocket. We’re talking hundreds of thousands of dollars for the majority of clinical trials. 

There are several healthcare institutions in the United States that do provide care for clinical trials, regardless of insurance coverage. That would be the National Institutes of Health in Bethesda, Maryland, and St Jude’s for children. They only offer certain clinical trials. It can be challenging to also qualify for those clinical trials. By and large, for patients to come to the United States to participate in a clinical trial, it would be significantly expensive.

Q&A: How has the pandemic affected clinical trial administration?

Leah: One of the realities of COVID, and we’re still in this ongoing state of COVID, is that for many blood cancer patients, they actually have worse outcomes with COVID. There needs to be lots of provisions in place for these patients to safely travel. 

First, I would encourage anybody to talk to their healthcare provider about boosters and COVID vaccines, because that’s a very important thing. We do know many of these folks are at increased risk with traveling. What we are trying to do is help advocate both in the policy space and when we’re meeting with sponsors to try to bring some of that care in a clinical trial closer to the patient. 

One thing we did see in light of COVID is that some of these consults can be done virtually. That’s a great question to ask right from the start. Can some of the visits be done virtually? That would be a great option as well. 

The other reality of COVID is that everything is that much more expensive. All the barriers to clinical trials that existed before COVID are still here. They’re just worse. It really takes that much more effort to try to get the resources to help people safely participate in a clinical trial.

Q&A: During the clinical, does the patient continue with regular visits with his or her oncologist?

Crissy: Anything that’s considered study-specific has to be done at the study site. If there’s study-specific scans, bone marrow biopsies, labs, something like that that needs to be drawn, or even a physical exam to be done with the physician, that has to take place at the trial site. 

That’s something that is communicated up front when discussing the clinical trial. Your primary physician at your local oncology clinic is involved still and can see you in between those study visits, but anything that’s study-specific has to be done at the trial site.

Q&A: How do I overcome the fear of choosing incorrectly between a clinical trial and standard treatment?

Crissy: This is where a really strong physician-patient relationship comes into play. It’s really important to trust your physician. Trusting their judgment and their advice and arming yourself with as much information as you can to make the best decision. 

Q&A: Was it hard to choose the clinical trial, Domenica?

Domenica: For me it was, “This is the way to go,” because of the rare cancer I have. I tried all the conventional treatments. Nothing worked. The last clinical trial that Crissy mentioned, I went on a trip, and I couldn’t believe I was having a normal life. I was hiking the mountains with my husband, 12,000 feet above sea level. I felt so strong and I couldn’t believe it and [it was] because of a clinical trial. 

With the other treatments, besides [the fact] they didn’t work, you feel completely bad in every sense of the word. I really encourage people to try the clinical trial of course, with the support of your doctor. The less side effects you read the drug has, the better, because you want quality of life. Otherwise, it’s unbearable.


Webinar Slideshow


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