Treating the cancer from diagnosis to survivorship

CEDAR RAPIDS — Maria Bowman was out running one day last summer when she experienced some pain that was unusual for her normal exercise routine. When she got home she found a lump on her breast.

Three weeks later she was diagnosed with stage-three breast cancer.

From there Bowman, 46, went through multiple surgeries — a bilateral mastectomy and reconstruction surgeries — months of chemo therapy and radiation therapy.

'It was hell,' she said. 'It was the worst time of my life.'

The chemo therapy made her very sick — she couldn't eat or drink — and she was exhausted, both mentally and physically.

'It was hard to envision me sitting here right now,' she said on a sunny May day at Mercy Medical Center's Hall-Perrine Cancer Center. She was getting an herceptin infusion — a targeted therapy for aggressive breast cancers.

Bowman credits her doctors, nurses and husband, Damon, for getting her through that period. But she also relied on Hall-Perrine's survivorship services to ease aches, get her back into an exercise routine and help her figure out life after cancer.

'I sat there for a whole month, just mentally confused,' Bowman said. 'I didn't know what to do. I saw the nurses so often' but didn't once treatment stopped.

'I had chemo brain. I just sat in a complete fog. Moving forward was really a challenge.'

As early detection methods and cancer treatment continue to improve, survival rates increase and people live many years after their initial diagnosis, experts say that survivorship services have also grown in importance.

'In 2015, the (Centers for Disease Control and Prevention) estimated there were 14 million cancer survivors in the U.S. alone. That number will rise to 19 million in 2024,' said Stephanie Phillips, oncology survivorship nurse practitioner at Hall-Perrine. 'People are living longer. We are better at treating the disease. There's a lot we can do for folks.'

Both Mercy and UnityPoint Health-St. Luke's Hospital offer comprehensive survivorship services from specialized dietitians and tailored exercise programs to social workers and support groups.

Just last year Mercy began giving all Hall-Perrine patients a treatment summary, Phillips said, in addition to discussing possible long-term effects of treatment, follow-up care and referrals to other resources.

'From the diagnosis to the treatment, it's a quick process,' Phillips said. 'There is an educational component but it can be overwhelming to deal with in the middle of a diagnosis. Then you go through treatment, you go to chemo where you see people multiple times in a month sometimes. Then we say 'Congrats, you're done,' and you don't see those people anymore.'

Survivorship services are meant to help patients find their new normal, experts said — does a patient need to call their oncologist if they get the flu? The cancer is gone, but the patient is feeling anxious or depressed, is this normal? Is there a diet and exercise routine that can help a patient reduce other cancer risks?

When Bowman was sitting in her fog, she spoke with a Mercy social worker who gave her the motivation and support she needed.

'I was concerned about the future,' she said. 'But every day I'm getting better and better.'

She participated in the Thrive Therapy fitness and wellness program — which gives patients a free 10-week membership to the YMCA as well as an initial assessment, where a physical therapist evaluates an individual's limitations and exercise ability.

Getting back into the habit of running has been hard for Bowman. Before her diagnosis, she was running seven or eight miles several times a week. Now, it's painful and hurts, she said. But she's getting stronger.

She also took advantage of Hall-Perrine's infrared light therapy — used to treat pain and poor circulation — and occupational therapy services when she was dealing with lymphatic cording — ropelike structures that develop under the skin of the inner arm.

'It's an uplifting place'

Jo Moore, 80, had Melanoma 25 years ago and was diagnosed with colon cancer three years ago. After her doctor removed the mass, he suggested she go to the Helen G. Nassif Community Cancer Center of Iowa, at the Physicians' Clinic of Iowa.

She met with an oncology-certified dietitian and goes weekly to a Tai Chi class with other cancer survivors and patients. She's changed her diet, she said, from her Missouri-deep-fried roots to one that includes more vegetable and fewer potatoes.

The exercise group supports one another, she said — they ask one another about children, grandchildren, oncology appointments and treatment.

'I look forward to it,' Moore said. 'It's an uplifting place.'

The community cancer center began offering its cancer wellness program in 2008, after Jane Borg of Cedar Rapids lost her battle with breast cancer. Her family donated the initial gift to start the program, said Nancy Hagensick, an oncology social worker.

'She lived longer with cancer than what people expected — she worked at wellness, nutrition and exercise,' Hagensick said.

The community cancer center works with cancer exercise specialists, massage therapists, reflexology professionals, a certified sex therapist and body-image specialist, and psychologists to work with patients, she added. Family and caregiver are able to access all services as well, and St. Luke's offers a quarterly retreat for caregivers.

Hagensick sad there are many times she'll go to a patient's chemo therapy appointment to talk with them, and the patient suggests she instead speak to a spouse or family member attending the appointment instead.

'We want to provide emotional support during and after treatment,' Hagensick said. 'There are changes to the body and your outlook on life changes.'

Moore's cancer may be gone, but her anxiety isn't. The community cancer center has offered her some peace of mind, she said.

'I've had cancer twice,' she said, explaining she's worried it could come back. 'I'm glad to know I can come here for support if it does.'