Facing Breast Cancer with Courage

October 31, 2014

THERE ARE NOT MANY PEOPLE WHO HAVE GOOD THINGS TO SAY ABOUT CANCER. THEN AGAIN, THERE ARE NOT MANY PEOPLE LIKE ETHEL SMITH. 

Smith, 52, is a lifelong San Fernando Valley resident. She married Curtis Smith, her high school sweetheart, in 1979, settled down in Lakeview Terrace and had two sons. For the past 20 years she’s been a full-time recruiter, often helping recruit people looking for work among her family and church friends at New Zion Christian Fellowship in San Fernando. Each Sunday she sang with New Zion’s praise team.

Despite being a determined and outgoing woman, Smith says she was hiding something that a bout with cancer last year helped reveal. “Before, I was the cowardly lion, like in The Wizard of Oz,” she explains. “I was afraid of everything. With breast cancer, my fear had to go. I had to have faith. There would be no more hiding behind Dorothy.”

Instead, there were important decisions to make and an illness to confront. Smith found the resources she needed among the health care professionals at Providence Health & Services, Southern California.

Patients like Smith benefit from emotional and practical support in addition to excellent medical care, says Nancy Kolanz, RN, a nurse navigator at Providence Little Company of Mary Medical Center Torrance. Kolanz and other breast cancer nurse navigators are usually the first medical professionals whom newly diagnosed patients see.

“There’s a certain anxiety that comes along with the word ‘cancer’—it can be overwhelming and paralyzing,” says Kolanz. “My job is to make sure nobody is confused and alone here.”

Kolanz spends time with patients and their families to answer questions and explain medical options. She also schedules necessary appointments with specialists, often streamlining the diagnosis-to-treatment process and trying to shorten the time spent waiting for care. 

“When you’re getting medical treat­ment, it’s about having faith in your plan and the people providing service to you. I may help patients get to this place much faster,” she explains.

Smith, who was treated at Providence Holy Cross Medical Center in Mission Hills, agrees that Providence’s team approach instills confidence in patients. “Everybody who was a part of my team—the nurses, the anesthesiologist, the surgeons, even the receptionists—made a difference in my health. I needed what they offered: collaboration and unwavering support and encouragement.”

Of course leading-edge treatment also helped. Advances in breast cancer treatment have improved the outlook for many patients, says Moshe Faynsod, MD, surgical oncologist at Providence Little Company of Mary Medical Center San Pedro.

“Targeted medications, better digital imaging and advances in surgical treatments have meant better outcomes in general, even for women with more aggressive cancer,” says Dr. Faynsod.

For example, hormonal therapy with selective estrogen receptor modulators (called SERMs) and aromatase inhibitors has become standard treatment for women with a type of cancer called estrogen receptor-positive breast cancer. These medications either interfere with tumor growth by preventing estrogen from binding to the estrogen receptor or block estrogen production in the body.

Surgically, Dr. Faynsod says breast-preserving techniques also are now standard. Incisions have become smaller and, in general, conservative approaches with less tissue removal are favored. “Digital imaging really has helped in this area. We now are able to get a much clearer, more comprehensive picture of the condition and what needs to be done,” he says.
Sometimes a newer strategy, neoadjuvant chemotherapy (chemo before surgery), is employed. “At times this reduces the tumor enough so we can perform a breast-preserving lumpectomy instead of a mastectomy,” he explains. “Today the focus is on not only eradicating the cancer but also preserving the maximum amount of breast tissue when it’s appropriate and safe.”

Another surgical advance is referred to as a “direct-to-implant” procedure, a process that allows for complete reconstruction during the same surgery as a mastectomy.

“It’s not for everyone, but for some patients this is clearly a great option,” explains Maggie DiNome, MD, assistant professor of the John Wayne Cancer Institute and acting director of the Margie Petersen Breast Center at Providence Saint John’s Health Center in Santa Monica. 

Traditionally a mastectomy is performed along with the first stage of the implant reconstruction—the expander placement—in the first surgery. This is followed several months later by the second stage of reconstruction, the implant exchange. 
Between the two surgeries, the balloon-like expander is gradually filled with saline to create the space for the implant. This requires multiple doctor visits, discomfort from the repeated expansion and a second surgery. With the direct-to-implant approach, the implant is placed directly in the space created behind the pectoral muscle immediately following 
the mastectomy.

“One drawback is that we’re limited by breast size and patient anatomy,” explains Dr. DiNome. Still, many patients are thrilled with the results and happy not to go through any additional medical procedures. Because the nipple and areola often are saved, Dr. DiNome says many direct-to-implant breast cancer patients leave surgery with a near-natural cosmetic result. “For the right candidate, this allows them to get back to a normal life more quickly.”

Ethel Smith initially had two lumpecto-mies on her right breast and six rounds of chemotherapy, but ultimately she required a mastectomy. Afterward she also endured radiation every day for seven weeks.

“Sometimes I really wanted to throw in the towel,” she admits. “I was weak, my skin and fingernails changed, everything tasted horrible, I had sores in my mouth, I lost all of my hair.”

Instead of giving up, though, she used music to lift her spirits and as a form of meditation. She sang the inspiring church songs she loves. She even composed her own song of gratitude and had her nephew develop an instrumental beat to go with it. When she physically couldn’t sing, she used her iPod to listen to the music. 

She repeatedly envisioned herself healthy and strong. And though she was struggling, she looked for opportunities to help other cancer patients she met. She offered encouragement, advice and once even went to the drugstore to buy the aloe vera and lotion that eased her skin discomfort so she could give it to another radiation patient who couldn’t afford it.

Most importantly, says Smith, she became absolutely fierce about her mental outlook. “I discovered something: The mind is an incredibly powerful resource. There were many days when I literally had conversations with myself. I would say, ‘Fear, you cannot come here. Depression, you can’t live here! Sorry, but I have nothing to wear to any pity party!’ I simply wouldn’t succumb mentally, and I think that has helped get me through this.”

Encouraged and supported by her family, including sons Curtis and Michael, she forced herself to eat well and exercise, even if it was sometimes only a 10-minute walk. The type of strategies Smith embraced intuitively, says Dr. DiNome, are what Providence profes­sionals encourage in all patients.

“We know that when we combine top-notch treatment with truly healthy lifestyle choices and integrative strategies, we have the most powerful tools for healing,” says Dr. DiNome, who is embarking on a clinical trial using acupuncture to improve medication adherence and outcomes in certain types of breast cancer patients. Her center also has introduced yoga and nutritional counseling. 

“Physically, emotionally, mentally, spiritually, cancer changed me,” says Smith. “That scared little lion? That’s not who I am today. I got my courage. But still, I always hope that other women will not have to go through what I did.”

As much as she appreciates silver linings, Dr. DiNome agrees. “We really are at the forefront here with breast cancer research, treatment and even innovative healing strategies. As we move forward, I see a future of far more community outreach and patient-oriented research. We’ll be working harder to get the message out that lifestyle changes such as regular exercise, diet and stress reduction make a difference in breast cancer risk. We believe in education and empowerment in women’s health, and if we can convey that and reduce an individual’s risk for cancer development, that’s exactly what we want.”