Supreme Court Justice Ruth Bader Ginsburg died after five bouts with cancer.

Supreme Court Justice Ruth Bader Ginsburg Dies From Cancer

The addition of immunotherapy to radiotherapy increased the overall survival of patients with cancer who developed brain metastases, according to new research.

Adding Immunotherapy to Radiotherapy Increases Survival in Patients with Brain Metastases

CURE® compiled a roundup of five recent reports patients with skin cancer may have missed.

5 Reports on Skin Cancer Patients May Have Missed

Dr. Howard A. “Skip” Burris, III explains new advances in the Triple Negative Breast Cancer field.

An Expert Explains the Three Major Treatment Modalities in Triple Negative Breast Cancer

Save the date! We invite you to join CURE for our next monthly #CureConnect Tweet Chat on Thursday, September 24, at 1 p.m. EST, when we plan on discussing living with cancer, from mental health through treatment, to cancer-related pain and beyond.

Join Our Next #CureConnect Tweet Chat About Living with Cancer

Articles

Colon cancer and rectal cancer are diseases that younger generations need to take seriously. 

Colon and Rectal Cancer Can Be a Reality For Gen-X, Millennials, and Gen-Z

Cancer makes your mind wander in many strange directions. If ever you wanted to know what an emotional rollercoaster really felt like, get on the cancer coaster and go for a ride.

The Mind of Cancer

Susan M. O’Brien, M.D., one of the nation’s foremost leukemia experts, discusses the future of frontline therapies and upcoming clinical trials associated with chronic lymphocytic leukemia.



CURE® Speaking Out Video Series Supports Blood Cancer Awareness Month and World Lymphoma Awareness Day

Patients, caregivers, and families to gain virtual access to the latest topics in gastric cancer research from oncology experts.

Debbie's Dream Foundation Announces the Gastroesophageal Cancer Educational Virtual Symposium in Partnership with Massachusetts General Hospital Cancer Center

When James Landon received a mantle cell lymphoma (MCL) diagnosis in 2017, he was told his disease was “indolent,” meaning it was slow growing and didn’t need to be treated right away, especially since he was feeling fine.

But that changed in 2019. Landon, 50, an attorney in Tucson, Arizona, started to feel tired all the time. His physicians discovered that his white blood cell count was sky-high and his spleen was enlarged.

The first-line treatment for MCL has long been high doses of chemotherapy, often followed by a stem cell transplant. But when Landon traveled to The University of Texas MD Anderson Cancer
Center in Houston to explore his options, he was offered an alternative: an experimental regimen combining the drugs Imbruvica (ibrutinib) and Rituxan (rituximab). Imbruvica blocks a protein called Bruton tyrosine kinase (BTK), which is a driver of MCL, and Rituxan is an antibody that targets overactive B cells of the immune system that have been implicated in the disease.

Five months after starting the combination — four Imbruvica pills every morning and once-weekly infusions of Rituxan — Landon’s positron emission tomography (PET) scan showed no evidence of disease. If he stays clear, he’ll undergo a short course of chemotherapy and then move to a maintenance therapy of one year of Ibrutinib and two of Rituxan.

“Having this option has been fantastic, in my opinion, because the drugs so far have worked well for me, with no toxicity,” says Landon, who adds that he has plenty of energy to work full time and play with his 10-year-old son.

BTK inhibitors and immunotherapy are among the newer therapeutic options for patients with MCL that are greatly improving the outlook for long-term survival. In addition to these targeted drugs, Tecartus (brexucabtagene autoleucel) — the first cell-based gene therapy for MCL in patients who haven’t responded to or who have relapsed following other kinds of treatment — was approved by the Food and Drug Administration (FDA) in July and is a one-time personalized treatment made from patients’ own immune cells.

“We now have several good nonchemotherapy options for treating MCL,” says Dr. Anthony Nguyen, a professor at the University of Nevada, Las Vegas School of Medicine and a medical oncologist at Comprehensive Cancer Centers of Nevada. “We may be able to tell patients we can treat them without toxic chemotherapy, which can be reassuring, particularly for older patients.”

MCL is a subtype of non-Hodgkin lymphoma (NHL) that’s characterized by the overproduction of a protein called cyclin D1. In about 85% of patients, that overproduction is caused by a genetic abnormality called reciprocal chromosomal translocation, which can be detected with diagnostic testing of tumor samples. MCL accounts for about 6% of all NHL diagnoses and is more common in men than in women, according to the Leukemia & Lymphoma Society.

The standard first-line treatment for MCL is high-dose chemotherapy, often with a four-medicine regimen called hyper-CVAD, followed by a stem cell transplant with a patient’s own cells or with those from a donor. The regimen often puts patients into long-term remissions, but the side effects — including nausea, mouth ulcers and kidney damage — can be difficult or even dangerous, particularly for patients with other illnesses.

The newer medicines and cell therapy were approved by the FDA to treat patients with MCL who don’t respond to chemotherapy and transplants or who relapse. But as physicians gain more experience with these therapies, there’s a growing interest in using them earlier in the treatment process to not only improve the chances of long-term remissions, but also to improve the quality of life for patients by sparing them from harsh side effects.

The FDA approved the first BTK inhibitor to treat MCL, Imbruvica, in 2013, based on a study showing an overall response rate (meaning the disease responded to treatment) of 68% and a complete response rate (the disappearance of all signs of cancer) of 21%. The average period that patients lived without their disease progressing was more than a year, and side effects were mild stomach upset and fatigue.

The more recently approved BTK inhibitors Calquence (acalabrutinib) and Brukinsa (zanubrutinib) have improved on those response rates. Patients receiving Brukinsa in a late-stage trial, for example, had an overall response rate of 89% and a complete response rate of 59%.

Another targeted treatment, Venclexta (venetoclax) is also being studied in MCL. Venclexta targets the protein BCL2, which promotes cell survival and is abnormally elevated in MCL — helping to drive progression of the disease. In a small trial of Venclexta, 75% of patients with relapsed MCL responded to the drug, 21% of whom had complete responses. There’s even more interest in studying BCL2 inhibition in combination with BTK blockers. In a recent study of Venclexta combined with Imbruvica, the median progression-free survival time was 29 months.

“This is an extremely promising combination,” says Dr. Abhijeet Kumar, assistant professor in the division of hematology and oncology at the University of Arizona College of Medicine. Kumar is an investigator in an ongoing trial of Venclexta and Imbruvica in MCL.

There is, however, a risk of increased side effects when targeted treatments are combined. Imbruvica can cause bleeding, for example, and both drugs can lower neutrophil (a type of white blood cell) counts. Venclexta is also known to cause tumor lysis syndrome, a rapid release of tumor cells into the bloodstream that can endanger the kidneys and other organs. Still, so far, “the combination seems to be well-tolerated,” Kumar says.

Another two-drug treatment for MCL that has generated enthusiasm among oncologists treating the disease is dubbed “R-squared” because it combines Rituxan with Revlimid (lenalidomide), a drug that works by boosting the immune system’s T cells and natural killer cells, which work together to attack cancer.

In a study of R-squared in 38 patients with newly diagnosed MCL, the progression-free survival rate after three years was 80% and overall survival reached 90%. “The response is durable,” says Dr. Bijal Shah, an associate member in the department of malignant hematology at Moffitt Cancer Center and one of the study investigators. During the R-squared trial, patients typically stayed on the combination for three years and then took Revlimid alone as long as the disease remained stable.

Similar benefits have been seen with a combination of Velcade (bortezomib), Revlimid and chemotherapy, a regimen called VR-CAP. Velcade is a targeted drug that works by disrupting the growth of MCL cells and prompting them to die.

In a trial of patients with untreated MCL, adding Velcade to Revlimid and chemotherapy extended progression-free survival by 37%. The addition of Velcade more than doubled the median duration of response to 41 months.

Both R-squared and VR-CAP have moved into the frontline treatment setting, Shah says. “With that, we’re able to see really pronounced clinical benefits. We’ve seen very long remissions,” he says.

Several other combination strategies also are being investigated for MCL, including some that incorporate the drug Treanda (bendamustine), which works by causing DNA damage to cancer cells. In one study, combining Treanda with Rituxan improved progression-free survival rates over chemotherapy in patients with MCL or indolent NHL. More than 15 studies are now underway combining Treanda with Rituxan and other MCL treatments.

Even though targeted and combination treatments have extended survival times in MCL, most patients eventually relapse. Now there’s a new option for those patients: Tecartus, a personalized therapy made from a patient’s own immune cells. The one-time treatment was approved by the FDA to treat patients who have not responded or have relapsed following other kinds of treatment.

Tecartus is a chimeric antigen receptor (CAR)-T cell therapy similar to Yescarta (axicabtagene ciloleucel), a CAR-T cell therapy approved by the FDA in 2017 to treat some types of large B-cell lymphomas. Like Yescarta, Tecartus targets CD19, a protein that’s prevalent in cancerous B cells. Tecartus is made by extracting T cells from the blood of the patient with MCL and genetically modifying those cells to recognize and attack the cancer. In addition, the cells are put through an enrichment process designed to prevent them from wearing down before they are infused back into the patient.

In the clinical trial that led up to the approval, 87% of patients responded to Tecartus and 62% went into remission. Side effects, which included the immune overreaction known as cytokine release syndrome and neurological events, were manageable during the clinical trial, says Dr. Michael Wang, a professor in the department of lymphoma and myeloma at The University of Texas MD Anderson Cancer Center and one of the clinical trial investigators.

Experience with previously approved CAR-T cell treatments led to the widespread use of anti-inflammatory medications such as interleuken-6 inhibitors and steroids to treat cytokine release syndrome, Wang says. “We have a variety of supportive measures to manage the side effects,” he says.

With the approval of Tecartus, Wang says oncologists can envision a “flattening of the survival curve” in MCL. “It’s an option for people who become resistant to targeted therapies and chemotherapy,” he says. “It’s very possible we will be able to put some people into long- term remissions.”

Bob Brixner, a 20-year survivor of MCL, has been watching all the new developments with interest. When he received an MCL diagnosis in 2000, he had no choice but to endure chemotherapy followed by a stem cell transplant with his own cells. When he relapsed in 2004, he was prescribed a more intense chemotherapy regimen, followed by a stem cell transplant from an unrelated donor.

He’s grateful the second treatment put him in a long-term remission, but he still remembers the brutal side effects, which included extreme fatigue and a bout with pneumonia. “And with the transplants, my immune system didn’t come back 100%,” says Brixner, 70, a retired Chicago public schoolteacher. “Nowadays if I catch a cold, instead of lasting a week, it will last three.”

Brixner advises all newly diagnosed patients to ask a lot of questions about their treatment choices — and to get a second opinion. “I think it’s really important to be an informed patient,” he says, especially since there are so many new choices. “Some patients may not have to go through what I did,” he says. “I’m delighted.”

Exciting advances in treatment options for patients with mantle cell lymphoma are greatly improving the outlook for long-term remissions.

Advances in the Treatment of Mantle Cell Lymphoma are Greatly Improving the Long-Term Outlook for Patients

I, like most people, enjoy hearing birds sing and watching them fly. My parents had birdfeeders in the yard, and we would watch them all the time. However, I never knew how intelligent they were until I toured a bird sanctuary.

The shelter took sick and injured birds from all over the country and rehabilitated them. The presenter convinced me that birds are way more intelligent than given credit for. Scientists are studying them and what interested me the most, was how social they are and how they help each other out. I am one of those people who constantly say I like animals better than some people and now I can add birds to that list.

There is a unique type of bird that is mostly found in the southwest U.S. including Arizona, New Mexico, Kansas, and Texas. The Harris Hawk is a very sociable animal and hangs out in small family groups. They hunt together, keep watch for predators and even band together to raise the younger birds — it takes a village!

What I found most interesting is that they are what is known as “back stackers.” This movement can be compared to the pyramid setup in cheerleading. They stand on each other's backs if there isn’t enough room to perch, and three or four of them on top of each other look out over the arid desert watching for predators.

I think about how these creatures serve and help each other, and then I think about people. Admittedly there are some not so nice people in the world but as a cancer survivor, I have had many “stackers” to help me. I have stood on the backs of people who risked clinical trials to be sure the various chemotherapy treatments I received were safe. I have stood on the backs of the great doctors and nurses who sacrifice everything, even amid a dangerous pandemic, to help me. I have stood on the backs of other cancer survivors to inspire me. And I certainly have stood on the backs of family and friends and church people who support me. I also have attempted to provide a back for others to stand on too.

So, cancer survivors, when you get down and discouraged as we all do, think of these birds that assist each other and the people who have helped you along your journey. It may make life just a little easier on those down days.

Then there are the days others need us. Look at the view like these great hawks do and help each other!

There are some amazing studies that show how certain birds help each other in times of need. For us cancer survivors, we should be like these birds and help each other more. 

Cancer Survivors, Be Like the Birds and Help Each Other

Chimeric Antigen Receptor(CAR)-T cell therapy is an exciting advancement for the treatment of multiple types of blood cancers, but it is not without risk.

CAR-T cell therapy works by removing a patient’s T cells, reengineering them to destroy cancer cells and then infusing them back into the patient’s body, thus improving outcomes for many patients. This process can result in an increased number of cytokines — molecules that mediate and regulate immunity and inflammation — into the blood stream. As a result, patients can experience side effects like fever, increased heart rate, difficulty breathing and low blood pressure.

Researchers at Moffitt Cancer Center recently conducted a study to identify possible risk fac- tors that could help a physician know if patients are more likely to have side effects before they receive CAR-T cell therapy. They analyzed 75 patients with large B-cell lymphoma who were treated with Yescarta (axicabtagene ciloleucel). Patients with an increased level of interleukin

6 (an inflammatory molecule) had higher rates of nervous system damage called neurotoxicity; cytokine release syndrome (a dangerous, inflammatory result of overactive T cells); and death. Also noted was a potential relationship between myeloid cells and regulatory T cells with cytokine release syndrome and neurotoxicity.

“Identifying which CAR-T patients may be more susceptible to those severe toxicities before therapy could allow us to better tailor their care to mediate or reduce those adverse reactions,” said Dr. Marco Davila, study corresponding author, associate member of the Blood and Marrow Transplant and Cellular Immunotherapy Department and medical director of Cell Therapies at Moffitt.

Ultimately, study researchers determined that further research on the side effects of CAR-T cell therapy is needed.

CAR-T Cell therapy is expanding in the field of blood cancers, but it comes with a host of side effects patients need to look out for. One study is looking to get ahead of the side effect curve for patients about to undergo CAR-T cell therapy. 

Study Seeks to Predict Those at Risk for CAR-T Cell Therapy Side Effects

My colleague, Elizabeth “Liz” Farrat, B.S.N., CCRN, has been a nurse at Memorial Sloan Kettering Cancer Center for over 15 years. She was re-deployed to the newly created critical care area during the COVID-19 pandemic, functioning as a resource registered nurse.

Liz had to teach critical care nursing to a staff who had never provided care for this patient population. She was always calm and patient while teaching about emergency scenarios. Liz was able to communicate the importance of connecting with each patient. She provided personal grooming items to make the patients who were sedated, intubated or on breathing tubes feel alive, although many were to die or become ventilator-dependent. She purchased razors, shaving cream and beard oil and created comfort.

Liz taught the importance of recognizing that each patient requires dignity throughout all procedures. While putting patients in a prone position, she ensured that each was comfortable before being paralyzed. She provided AROM (active range of motion exercises) by seating the patient with COVID at the side of the bed, working while wearing full personal protective equipment, sweat streaming down her body, even though we needed to limit our exposure time.

She showed the staff the importance of communication with iPad technology. Prior to intubation of one patient with COVID-19, she took the time to FaceTime with the woman’s husband, as this would be the last time they would speak. Liz held the patient’s hand and prayed with her prior to intubation. She brought the human touch to each nurse and patient.

Liz’s eyes are always smiling, and that didn’t change when she self-quarantined from her husband and two children, including a 9-year-old son who has autism. I could see daily how much she longed to see her family. She could have exempted herself from caring for people with COVID-19, but instead she did not hesitate to care for some of the sickest patients in history.

In addition, Liz opened her home to me for a month so that we could care for the patients together. On her off days, she prepared meals for her neighbor who had lost his job and whose family tested positive for COVID-19. She also prepared meals for other nurses who needed to feel love after a 12-hour shift. Liz’s energy is one of love, and all who came in contact with her could feel it daily.

We can’t provide nursing care from a distance, nor can we fear the unknown. By providing a physical or spiritual touch daily, Liz makes our challenges easier to face.

In the winning essay for the Finest Hour award, Evangelina SantaTeresa, CCRN, details how the human touch makes all the difference for award winner Elizabeth “Liz” Farrat, B.S.N., CCRN at Memorial Sloan Kettering Cancer Center. 

The Human Touch

Save the date! We invite you to join CURE for our next monthly #CureConnect Tweet Chat on Thursday, September 24, at 1 p.m. EST, when we plan on discussing living with cancer, from mental health through treatment, to cancer-related pain and beyond.



Each month, we host a #CUREConnect Tweet Chat to bring together patients with cancer, survivors, advocates, caregivers & treatment providers to promote collaboration within the community. The chats take place on Twitter on the last Thursday of every month, at 1 p.m. EST.

During the chat, we'll be asking the following questions:

Anxiety and depression are common challenges patients face while living with cancer. Have you experienced these issues? And if so, how do you cope with them?

During treatment, anxiety and pain can often become problematic for patients with cancer. How do you cope with cancer- or treatment-related pain?

Clinical trials offer a chance to try experimental treatments and move the state of science forward. What do you wish you knew more about clinical trials?

Good nutrition can help patients with cancer manage treatment-related side effects and even reduce the risk of recurrence – but it can be difficult to maintain a healthy diet. What are some tips or tricks you have to keep your appetite healthy while living with cancer?

Cancer can throw a person’s life into turmoil and take the focus off a patient’s career for a time. If you worked through treatment, how did you manage to balance life between cancer and your career?

Never participated in a Tweet Chat before? It’s simple!

Log in to your Twitter account on the date and time of the chat and search for “#CureConnect” to find the conversation. You can also search for CURE Magazine and see the questions on our feed.

Make sure you’re filtering your search results by “Latest” to see questions – and other participants’ answers! – in real time.

Every few minutes, we’ll Tweet questions that we invite you to respond to using #CureConnect. You can also join the discussion by watching the hashtag to see other responses. See a response you want to add to? Reply with #CureConnect!

Don’t forget to add #CureConnect to each response you share so others can see your tweets and chat with you too!

 accounts, CURE® asks its readers to share their thoughts with the #CureConnect discussion question. This past week, we asked: “Have you experienced cognitive dysfunction as a result of cancer treatment? How do you deal with it?”

“I can’t sit and read for long anymore, so I often use audiobooks.” – S.T.

“It's been 13 years since my treatment and I still have short-term memory issues as well as focus issues. My brain seems to jump around when I'm trying to read or focus on a task. It's gotten better, but I use lists and work around my limitations.” – G.A.

“I have difficulty reading and comprehending anything lengthy, like a book. I generally can't remember what I've read when I pick up the book again. It's very frustrating because I've always been a reader and was a literature major in college. It's impossible to separate what is due to treatment and what is due to aging.” – R.G.

“I am three years out and I struggle with my speech and remembering things. It is really bad. I am doing crossword puzzles now, which helps some.” – M.D.

“Brain fog since 2003. I can forget what I was doing if I get distracted. I also say complete sentences backwards if I get excited.” – R.P-P.

“I am four years out from last chemo — I lose names and sometimes can’t find the right word. I also will ‘know something’ but don’t know how I know it: whether I read it, saw it on the news, someone told me, etc. This could be from chemo, could be from aging, or a combo of both.” – K.M.

“Neurocognitive deficits led to my early retirement from medicine 15 years after a second round of head and neck radiation. I was afraid I’d forget something important and it was hard to keep up with the pace and literature. Now I listen to audiobooks more often than reading and I make lists of things I need to do or buy. I always set a timer when I cook after several minor mishaps. I try to do one thing at a time as I may forget something important. I don’t load the day with activities because it will take a while to recover from the resultant fatigue. Retirement made everything a little better.” – S.T.

“I write everything down and that helps. I have a lot of trouble with word finding which can be frustrating. When I'm tired or stressed it's worse. I'm an oncology nurse, so unfortunately tired and stressed is kind of my normal. So, I deal with it the best I can. It's been seven years and it seems like it's getting worse as I age, not improving as I get further out from treatment.” – M.S.

On social media, CURE® recently asked its readers to share how they deal with the cognitive dysfunction that can come about from cancer treatment.

How Do You Deal With Cognitive Dysfunction as a Result of Cancer Treatment?

Khevin Barnes is a Male Breast Cancer survivor, magician and speaker. He is currently writing, composing and producing a comedy stage musical about Male Breast Cancer Awareness. He travels wherever he is invited to speak to (and do a little magic for) men and women about breast cancer. www.BreastCancerSpeaker.com www.MaleBreastCancerSurvivor.com

I understand how guy’s with breast cancer can feel overlooked or ignored. After all, I’m one of them.Ours can be a lonely disease. We’ve been making our case publicly for a long time now, and I’m pleased to see the progress that’s been made, but there is a challenging road ahead for those of us with this obscure disorder.

Where men are concerned, it may be easy to get lost in the sea of pink that envelops breast cancer; to feel disregarded and snubbed by the medical community, the pharmaceutical industry and even our friends and family members who see the cancer in male breasts as some sort of aberration of a much too common and pervasive illness.

None of this is our fault of course. Or is it? In sheer numbers and statistics, we are a miniscule part of the cancer club; representing a mere 1% of all breast cancer cases. But when all is said and done, the biggest problem as I see it is not that we’re overlooked or ignored; we are simply undiscovered. At the same time, we are the one’s endowed with the capacity to find that bump in the road, or in this case, the bump in our breast that stops us cold on the highway of life.

Most people don’t connect men with breast cancer. And why would they? Far too few health care professionals suggest that the gentlemen among us probe our chests for anything amiss, and society has created a decidedly feminine connection to human breasts. We can’t change that. But the problem doesn’t lie with women or doctors or even society. The problem is men. The problem is us.

Imagine a man, somewhere on your list of acquaintances, spending the day laying shingles on the construction site; hopping on the Harley and speeding home; blowing through a few beers and stepping into the shower to wash off the dust and grease and — check his pecks. This, by the way, is the very stereotype that prevents early detection and kills men. This is the kind of thinking that takes perfectly healthy men and renders them invisible.

This is the world of the “undiscovered.”

The point is, you are no less masculine because you have breasts and no less susceptible to the ravages of breast cancer than your female friends. Like so many men I know who are advocates for early detection in male breast cancer, I too am determined to bring our group into plain view; to not only make us visible where a breast is concerned but to make us indivisible where our quest is concerned.

Voices bring awareness and that in turn brings us out of the shadows and puts us on the grid. This may take some time, but if you are diagnosed with cancer, time doesn’t seem to take up so much space anymore. The time is now. The minute we are survivors of cancer of any kind and at any stage, we become estranged from what might seem like the regular world. Life is no longer reliable, and our future is no longer secure. Early detection can change that.

Thirty seconds in the shower. That’s the time it takes to put on your shoes or pet your cat. That’s about how long it took to read the last two paragraphs in this story. And that may be all the time you need to save your life.

The greatest obstacle facing men with breast cancer may be … ourselves.

The Bad Boys of Breast Cancer

Vomiting is a common side effect of many cancer treatments and can lead to dental decay. However, there are steps that patients can take after throwing up to protect their teeth, explained Patricia Mulvaney-Roth, a nurse and lead clinical educator at Molloy College.

“Dental erosion is a complex clinical condition that is not well-known by lay people or by non-dental health professionals,” Mulvaney-Roth said, explaining that erosion occurs when dental hard tissue erodes.

Erosion can happen as a result of drinking excess soft drinks or alcohol, or by the mixing of hydrochloric acid from gastric juices formed by the stomach lining – what happens when a person vomits.

Mulvaney-Roth and her team recently reviewed 14 studies regarding vomiting-related dental erosion and presented their findings at the Oncology Nursing Society (ONS) Bridge virtual conference. Notably, four studies outlined the benefit of rinsing with water or saltwater after a vomiting episode and five studies said that commercial mouthwashes containing fluoride can help.

Additionally, many patients may want to brush their teeth soon after throwing up. However, that, too can lead to dental erosion because teeth are softest for the hour after vomiting.

“[There are] some important things to look at here. A patient’s own oral hygiene self-care can mistakenly worsen dental erosion, tooth sensitivity and tooth breakage, because they’re running to brush their teeth after a vomiting episode,” Mulvaney-Roth said.

“If dental erosion is left unchecked, certain cancer patients who survived the cancer illness phase can eventually suffer long-term mandibular and maxillary problems. Once lost, enamel cannot be replaced.”

Mulvaney-Roth emphasized that both patients and health care providers need to be better educated on dental health, especially for patients with cancer who may be prone to vomiting as a result of their cancer treatment.

“Patient education should include [discussing] rinsing your mouth with plain water, a salt mixture, or mouthwash with fluoride after vomiting to reduce dental erosion. Using a tongue cleaner is recommended after the vomiting to remove the acid from the tongue.”

An oncology nurse outlines ways that patients can prevent dental erosion after a vomiting episode. 

Think Before You Brush: Dental Hygiene After Vomiting

You have a new cancer diagnosis that stops you in your tracks. You are sick, afraid, vulnerable and in pain when you come to the cancer center at Temple University Hospital. The first advocate you will meet on your cancer journey is your nurse navigator, Maria Rodriguez, B.S.N., RN. Fortunately, she has been expecting you and researching your case. Maria is an integral part of the plan, and she is ready to help you every step of the way to obtain care.

Nurse navigators like Maria break through barriers to obtaining care. What makes Maria different is that she looks beyond your diagnosis and treats you like a human being. Great nurses heal the sick, soothe the spirit and treat illness. Maria also honors what makes you an individual. The cancer center at Temple University Hospital in North Philadelphia is in an area rich in diversity. We have a large population of Hispanic patients. Prior to Maria’s arrival, these patients fell through the cracks.

They needed services, but they did not have an advocate to make sure they received that care. Because she is Hispanic, Maria understands the fears and myths associated with cancer in this community and is able to explain them to clinicians and physicians. She provides a clear picture of what’s being communicated to both the patient and the medical providers, generating trust.

Although Maria is fluent in Spanish, she took the steps beyond her job requirement to become a dual-role medical interpreter to make sure she used and translated the correct words and messages to our Spanish-speaking patients, who come from various countries. She handles her role with integrity, ensuring that bad news is delivered with compassion and sensitivity. As a testament to how well she is loved, numerous patient photos and mementos, with many notes of appreciation and thanks, adorn her office.

Maria also made our cancer center’s yearly holiday-meal food drive for patients more inclusive. Foods like boxed stuffing, gravy and cranberry sauce are common on American holiday tables. However, Maria made sure that the drive included culturally specific culinary items for the traditional Hispanic holiday feast, such as “sofrito,” rice, certain seasonings and “tembleque,” a traditional dessert, to be distributed to families in need. The center’s patients and families greatly appreciated these familiar and welcoming items.

Maria also spearheaded the Feliz Navidad celebration. This program featured the Christmas traditions of Spanish-speaking countries, including nostalgic songs and cuisine cooked by the patients and staff. Meaningful gifts including hats, scarves and Christmas ornaments were distributed. The patients were very thankful, appreciative and overjoyed that the cancer center’s staff took the time to make them happy. This event allowed them to forget about the seriousness of their illness for a moment. Overheard during the joyous and festive celebration was a nursing col- league’s remark that “Maria is the best thing that ever happened to our patients.” I agree, because she has the ability to reach out and meet patients where they are mentally and emotionally. She shines above others because of her warm hospitality and inviting nature.

Although caring takes its toll on Maria, she never shows that to her patients. She always finds the time to make people laugh. She has a joie de vivre that helps patients focus on healing, and her infectious laughter is a balm in stressful situations. Maria can make you laugh when you want to cry.

As an experienced triage nurse, Maria can quickly decipher when patients require emergency care necessitating a lifesaving rapid response. Many times, patients come to the cancer center with advanced stages of disease and visible signs of progression. An example of her compassion and nursing skills was seen when a patient with head and neck cancer and a tracheostomy was waiting for an appointment with his physician. Maria quickly identified the patient’s swollen lips and protruding tongue and knew that angioedema was likely the cause of his presentation. Quick action was taken with the rapid response team to address his symptoms. If it were not for Maria’s intervention, his airway would likely have collapsed, putting his life at risk.

Many times, patients require resources to help them during treatments, like skin cream to tolerate the effects of the chemotherapy agent Erbitux (cetuximab) or a hat on a cold winter day after they have lost their hair due to treatments. Patients come to Maria, and she makes sure the resources go where they are needed the most.

® Extraordinary Healer® Award because she truly exemplifies what it means to be a compassionate and skilled nurse. Her competence across all cultures and her desire to go the extra mile for all our patients demonstrate her selflessness. She gives of herself without thought of a reward or accolades. Our patients love her, and the cancer center would not be as successful without her kindness, thoughtfulness and compassion. She serves as a role model for others because of her selflessness, and, as a result, our patients are well served.

You have a new cancer diagnosis that stops you in your tracks. You are sick, afraid, vulnerable and in pain when you come to the cancer center at Temple University Hospital. The first advocate you will meet on your cancer journey is your nurse navigator

The Best Thing That Ever Happened, Advocating For the Patient

The call that raised the hair on my arms, which is the one I least expected, came at 7:30 a.m. during a sales meeting.

It was during the spring in 2007. At the time, I sold real estate for the Hilton Corporation. I remember the morning vividly. That Tuesday, the sunrise shot pinks and purples across the sky as I drove the 15 miles to work.

I wasn’t in my chair for more than a few moments when my phone rang. Caller ID showed it was Karen, which the sister next to me in age. Karen is the organizer, the accountant, the person who delivers all the news, good or bad, to our large family. I wondered why she was calling me. “This can’t be good,” I can remember thinking. I stepped out of the conference room to take the call.

Karen’s voice was thick and deep. “Pamela, start praying for Claire right now. She’s in the ER and not doing well.”

Before my sister called me, I knew something was happening with my eight-year-old niece, Claire, because my brother, Dan, had called questioning me about my eye disease.

I was born with Brown syndrome, which is a rare condition that affects the muscles in my head. I only see with one eye at a time. Dan mentioned during that call that one of Claire’s eyes would not focus. However, I was born with my disease, and Claire’s was recent. Dan and his wife, Colleen, had taken Claire to an ophthalmologist, but the doctor had no explanation for her condition.

Then shortly after that, Claire started falling. She was such a clown though, everyone thought her behavior was her being a silly eight-year-old, and that her stumbles and spills meant she was kidding around. Dan and Colleen called her an “oops” child. They had no intention of having a fourth child but when Claire entered the world, with her brilliant blue eyes and sunny disposition, she had everyone eating out of the palm of her hand.

That morning, as I stood in the cold hallway at work in Orlando, listening to Karen who lived in Boynton Beach, Claire was having seizures in a hospital somewhere in Dallas.

“Pamela, she may not make it out. They are removing fluid from her brain now,” Karen said. Her words sounding far away and echoey.

A few days later, Claire was diagnosed with diffuse intrinsic pontine glioma, a highly aggressive brain tumor, also known as DIPG. If there is such a thing as worst of the worst cancer, this is it. DIPG grows at the base of the brain stem, which controls many of the body’s vital functions such as breathing, blood pressure, and heart rate. This type of cancer is inoperable because of its location in the brain. Treatment is not for a cure but to give the patient more time. Claire was given six months to live.

Claire was taken to every doctor and clinical trial possible.

But ultimately, her little body could not rid itself of the tumor that raged in her. She went to heaven on December 6, 2009. No parent should ever have to endure losing a child to cancer, or any way. I couldn’t imagine if it were my son, James. I struggled with how to console Dan and Colleen, so I did what my mom taught me, and I prayed.

Her favorite term, “we’ll find a way to make it better” was not for teenage breakups anymore. Life was happening. This time it was for those left devastatingly heartbroken.

Thank you for reading. My memoir, “Midlife Cancer Crisis,” will be published on October 15, 2020. Visit my website www.cancerfreeliving.life for more information.

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