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Old 10-22-2007, 12:12 PM   #1
Cynthia
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Please Help Me Prepare a Breast Cancer Talk

Friends,

I have been invited to give the keynote address next month to an offsite meeting of breast cancer researchers, doctors, nurses and politicians. The director of the research facility kicks off this annual event with a survivor talk in order to remind the audience why they do what they do. This year it's my turn.

I view this as a unique opportunity to speak to a group of healthcare professionals from the patient's perspective. However, while I will briefly share my own b/c story, I would like to deliver a representative message from all of us to all of them. Thus, I would greatly appreciate any input you care to provide. If you had the chance to address this kind of an audience, what would you want to say? Also, care to suggest a title for the talk?

Thanks to anyone who cares to offer some ideas.

Stay well,

Cynthia
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Cynthia
Diagnosed 9/03 @ 43 years (pre-menopausal)
Her2+++
4 nodes +; High Grade
ER+/PR+
Bilateral Mastectomy; Reconstruction
CAF x 6; Radiation; One Year Late Herceptin
Oophorectomy; Arimidex
Completed E75 Vaccine Trial; Completed E75 Vaccine Booster Series
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Old 10-22-2007, 03:39 PM   #2
Gina
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definitely put in a plug for regular pulling of Serum Her-2

and other tumor markers, like the CA 27.29, the Ca 15, the CA 125, and the CEA, at a minimum.

My two cents...smile...Enjoy the conference--this is a great way to let what patients want be heard.

Break a leg,
Gina
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Old 10-22-2007, 06:17 PM   #3
Becky
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Hi Cynthia

I look forward to seeing you again in San Antonio. If I were giving a talk, I would include something about the "Responsibility of Survivorship". Certainly you and Christine as well as others on this board and others who you know in your personal and professional life fit that mold. Taking a diagnosis and then later, turning a bad thing into good for others. Stepping up to the plate in helping others through it, self and patient advocacy. Even advocating more funding from government.

I feel very strongly about this aspect of the journey for me. Perhaps this could be useful in your lecture.
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Kind regards

Becky

Found lump via BSE
Diagnosed 8/04 at age 45
1.9cm tumor, ER+PR-, Her2 3+(rt side)
2 micromets to sentinel node
Stage 2A
left 3mm DCIS - low grade ER+PR+Her2 neg
lumpectomies 9/7/04
4DD AC followed by 4 DD taxol
Used Leukine instead of Neulasta
35 rads on right side only
4/05 started Tamoxifen
Started Herceptin 4 months after last Taxol due to
trial results and 2005 ASCO meeting & recommendations
Oophorectomy 8/05
Started Arimidex 9/05
Finished Herceptin (16 months) 9/06
Arimidex Only
Prolia every 6 months for osteopenia

NED 18 years!

Said Christopher Robin to Pooh: "You must remember this: You're braver than you believe and stronger than you seem and smarter than you think"
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Old 10-22-2007, 08:42 PM   #4
chrisy
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This is not scientific or anything, but what I'd say to that room full of politicians, researchers, and health care professionals is THANK YOU for giving us hope in the face of what used to be an immediate death sentence, and WE ARE COUNTING ON YOU TO FINISH THE JOB. QUICKLY, PLEASE. We are talking about saving people's lives.
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June 2002 extensive hi grade DCIS (pre-cancer-stage 0, clean sentinal node) Mastectomy/implant - no chemo, rads. "cured?"
9/2004 Diag: Stage IV extensive liver mets (!) ER/PR- Her2+++
10/04-3/05 Weekly Taxol/Carboplatin/Herceptin , complete response!
04/05 - 4/07 Herception every 3 wks, Continue NED
04/07 - recurrence to liver - 2 spots, starting tykerb/avastin trial
06/07 8/07 10/07 Scans show stable, continue on Tykerb/Avastin
01/08 Progression in liver
02/08 Begin (TDM1) trial
08/08 NED! It's Working! Continue on TDM1
02/09 Continue NED
02/10 Continue NED. 5/10 9/10 Scans NED 10/10 Scans NED
12/10 Scans not clear....4/11 Scans suggest progression 6/11 progression confirmed in liver
07/11 - 11/11 Herceptin/Xeloda -not working:(
12/11 Begin MM302 Phase I trial - bust:(
03/12 3rd times the charm? AKT trial

5/12 Scan shows reduction! 7/12 More reduction!!!!
8/12 Whoops...progression...trying for Perjeta/Herceptin (plus some more nasty chemo!)
9/12 Start Perjeta/Herceptin, chemo on hold due to infection/wound in leg, added on cycle 2 &3
11/12 Poops! progression in liver, Stop Perjeta/Taxo/Herc
11/12 Navelbine/Herce[ptin - try for a 3 cycles, no go.
2/13 Gemzar/Carbo/Herceptin - no go.
3/13 TACE procedure
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Old 10-22-2007, 10:54 PM   #5
Alice
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Cool

As there being politicians there, they may not know the stigma that breast cancer has in society. The seriousness that this is a true cancer and that it kills. I have met many people that think if you have a mastectomy that you are cured and they are not aware that it can and does metastasize. After all it is just a breast! I think that they need to be aware of this as well as with other types of cancer ie: testicular cancer. There are other types of cancer that have a much poorer prognosis but if you are the one that dies from it, the prognosis is the same, and the impact to your family is the same!
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Old 10-23-2007, 06:14 AM   #6
Sheila
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Cynthia
I think I would inject attitude.....because survival is all about attitude, in most things in life, but especially with cancer....make each day and moment in your life count....we are as humans all terminal...we are lucky enooiugh to be given a warning sign!
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Hugs & Blessings
Sheila
Diagnosed at age 49.99999 2/21/2002 via Mammography (Calcifications)
Core Biopsy 2/22/02
L. Mastectomy 2/25/2002
Stage 1, 0.7cm IDC, Node Neg from 19 nodes Her2+++ ER PR Neg
6/2003 Reconstruction W/ Tissue Expander, Silicone Implant
9/2003 Stage IV with Mets to Supraclavicular nodes
9/2003 Began Herceptin every 3 weeks
3/2006 Xeloda 2500mg/Herceptin for recurrence to neck nodes
3/2007 Added back the Xeloda with Herceptin for continued mets to nodes
5/2007 Taken Off Xeloda, no longer working
6/14/07 Taxol/Herceptin/Avastin
3/26 - 5/28/08 Taxol Holiday Whopeeeeeeeee
5/29 2008 Back on Taxol w Herceptin q 2 weeks
4/2009 Progression on Taxol & Paralyzed L Vocal Cord from Nodes Pressing on Nerve
5/2009 Begin Rx with Navelbine/Herceptin
11/09 Progression on Navelbine
Fought for and started Tykerb/Herceptin...nodes are melting!!!!!
2/2010 Back to Avastin/Herceptin
5/2010 Switched to Metronomic Chemo with Herceptin...Cytoxan and Methotrexate
Pericardial Window Surgery to Drain Pericardial Effusion
7/2010 Back to walking a mile a day...YEAH!!!!
9/2010 Nodes are back with a vengence in neck
Qualified for TDM-1 EAP
10/6/10 Begin my miracle drug, TDM-1
Mixed response, shrinking internal nodes, progression skin mets after 3 treatments
12/6/10 Started Halaven (Eribulen) /Herceptin excellent results in 2 treatments
2/2011 I CELEBRATE my 9 YEAR MARK!!!!!!!!!!!!!
7/5/11 begin Gemzar /Herceptin for node progression
2/8/2012 Gemzar stopped, Continue Herceptin
2/20/2012 Begin Tomo Radiation to Neck Nodes
2/21/2012 I CELEBRATE 10 YEARS
5/12/2012 BeganTaxotere/ Herceptin is my next miracle for new node progression
6/28/12 Stopped Taxotere due to pregression, Started Perjeta/Herceptin
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Old 10-23-2007, 08:05 AM   #7
Jean
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Education -

Education:
I believe education on many levels. Our dr. need to know that todays
women want to understand their bc. Treat All Of Me" My body and
brain.

Education for the newly dx patient. I have found that many woman
until they are dx. know very little about breast cancer until it hits home.
Even with the TV ads etc. many woman are still not having regular
mamograms. It is shocking but true. When most woman leave the
dx. office after their first dx. they are in shock. Professionals need
to understand that the patient will have and should have many questions.
I have found you have to pull out information from doctors. They do not
explain details very well. Maybe they mean well and do not wish to scare the patient - but there should be a introudction level for the newly dx.
woman. Explaining the different types of cancer - in order for them
to uderstand their own bc.

Education for the co-workers, loved ones, friends. After surgery
and healing - many feel it is behind the patient...not so, the mental
strain for the patient of worrying - "FEAR" with each new pain or ache
(which is more than likely nothing) but to the bc survivor there is the constant question, "is this a recurrance?" Doctors need to understand this fear and not push it off as not important. Even in the home - with loved ones, they become tired of hearing about cancer. They just want to move forward (and so does the patient) but that "FEAR" lingers. It needs
to be understood and certainly pay it some attention to ease it.
Most people just don't "GET IT" but the survivor understands the fear.

Fran
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Stage 1, Grade 1, 3/30/05
Lumpectomy 4/15/05 - 6MM IDC
Node Neg. (Sentinel node)
ER+ 90% / PR-, Her2+++ by FISH
Ki-67 40%
Arimidex 5/05
Radiation 32 trt, 5/30/05
Oncotype DX test 4/17/06, 31% high risk
TOPO 11 neg. 4/06
Stopped Arimidex 5/06
TCH 5/06, 6 treatments
Herceptin 5/06 - for 1 yr.
9/06 Completed chemo
Started Femara Sept. 2006
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Old 10-23-2007, 11:44 AM   #8
AlaskaAngel
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In reading the posts on different breast cancer forums, even with all the info out there about breast cancer, it still "sounds" to me as though for many diagnosed with bc there is still one "piece" missing.... I think some of the larger cancer centers are better about addressing it, but on the whole I think more needs to be done. The "piece" I am talking about is that each patient, just after diagnosis and maybe even before talking with an oncologist, should be offered the opportunity for an up-to-date basic class specifically on breast cancer. Not a 1-hour crash course with a busy doctor, but something spread out over a couple of different sessions, so that a person has time to learn the vocabulary and remember it, and have the time to think up their own questions. I know there are some online tools like the Mayo Clinic introduction, but as someone who works in the medical field I know unfortunately that most of the medical personnel who deal (at least initially) with breast cancer patients are either not aware of those tools or are not actively advising the patient where to look to use them.

I remember telling my onc when I got to Seattle to see him that I'd read online from Alaska about a video the center offered that I felt would be helpful, and that I wondered if I could see it. Instead of letting me know that there was a large cancer resource center I could visit to find the video, he just said "yes" but buzzed on without telling me where to go to find it. As it turned out, the resource center was located close to the main lobby of the cancer center with no clear signs posted to direct anyone how to find it.

Ideally the class would include the opportunity to visit any cancer resource center, or at least some basic handouts listing some key resources.

AlaskaAngel
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Old 10-23-2007, 12:32 PM   #9
StephN
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Thumbs up Bedside manner

Some good ideas here to cull out.

For me, I would like to get in a word about "bedside manner."

There have been SO MANY women who have posted here on how unsatisfactorily they have been treated either by someone on their care team or in the infusion suites. This is not the usual case, but gentle reminders might lessen these devestating encounters.

Our emotions are peaked and we "tip over" easily when fatigued and under a long treatment siege. A careless act or word can have such a huge impact on a patient.

The other half of that is that when we bring some ideas that are not in the mix for our treatment or questions, that the care team take time to listen and respond. We are not little kids in kindergarten who are unable to understand anything about this disease.

Thanks, and I know you will do a SUPER job with your keynote speech.
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"When I hear music, I fear no danger. I am invulnerable. I see no foe. I am related to the earliest times, and to the latest." H.D. Thoreau
Live in the moment.

MY STORY SO FAR ~~~~
Found suspicious lump 9/2000
Lumpectomy, then node dissection and port placement
Stage IIB, 8 pos nodes of 18, Grade 3, ER & PR -
Adriamycin 12 weekly, taxotere 4 rounds
36 rads - very little burning
3 mos after rads liver full of tumors, Stage IV Jan 2002, one spot on sternum
Weekly Taxol, Navelbine, Herceptin for 27 rounds to NED!
2003 & 2004 no active disease - 3 weekly Herceptin + Zometa
Jan 2005 two mets to brain - Gamma Knife on Jan 18
All clear until treated cerebellum spot showing activity on Jan 2006 brain MRI & brain PET
Brain surgery on Feb 9, 2006 - no cancer, 100% radiation necrosis - tumor was still dying
Continue as NED while on Herceptin & quarterly Zometa
Fall-2006 - off Zometa - watching one small brain spot (scar?)
2007 - spot/scar in brain stable - finished anticoagulation therapy for clot along my port-a-catheter - 3 angioplasties to unblock vena cava
2008 - Brain and body still NED! Port removed and scans in Dec.
Dec 2008 - stop Herceptin - Vaccine Trial at U of W begun in Oct. of 2011
STILL NED everywhere in Feb 2014 - on wing & prayer
7/14 - Started twice yearly Zometa for my bones
Jan. 2015 checkup still shows NED
2015 Neuropathy in feet - otherwise all OK - still NED.
Same news for 2016 and all of 2017.
Nov of 2017 - had small skin cancer removed from my face. Will have Zometa end of Jan. 2018.
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Old 10-23-2007, 12:33 PM   #10
Carolyns
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Cynthia, Thanks for doing this.

I am a single mom, head of household, working full time with stage IV mets.

Group health insurance portability would be my plea. It would seem to me that if you have been covered by a group policy all of your healthy life that you should be able to maintain that coverage once you get sick. Cobra policies are better than nothing but I believe that more can be done for people that get sick before age 65 when Medicare kicks in.

If you lose your job it is hard to find another one once word gets out that you are Stage IV. I need my insurance now more than ever.

Carolyn
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Old 10-23-2007, 01:02 PM   #11
Cynthia
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Wow, thanks to all of you have taken the time to write. I greatly appreciate your input and will be sure to work the bulk of your suggestions into my talk (and try like mad not to exceed my 25 minute timeframe).

I will let you know what I end up saying after the fact, and will pass on to you whatever feedback I receive.

Please keep your suggestions coming if you care to add them. I truly value your input.

Best,

Cynthia
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Cynthia
Diagnosed 9/03 @ 43 years (pre-menopausal)
Her2+++
4 nodes +; High Grade
ER+/PR+
Bilateral Mastectomy; Reconstruction
CAF x 6; Radiation; One Year Late Herceptin
Oophorectomy; Arimidex
Completed E75 Vaccine Trial; Completed E75 Vaccine Booster Series
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Old 10-23-2007, 09:21 PM   #12
Bev
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I guess I would, from my perspective, regardless how you you complete recommended mammo's, you still need to do do self exams. Perhaps, breast MRI's should be required at age 40 for dense women. Mammo just doesn't pick up many. Bev
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Old 10-24-2007, 09:17 AM   #13
Hopeful
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My two pet peeves, for your consideration:

1. Whether we like it or not, treating bc is a business (a big one in terms of $$) and patients should be treated like human beings, not processed like sausage. Doctors need to look beyond statistics to the patient, and by that I mean the WHOLE patient, not just the bc - after all, it isn't the cancer that walked in the room and asked for tx, it is the person who has cancer. Keep the focus on patients as individuals with feelings.

2. QOL is too often sacrificed, and needlessly, in bc tx. Keep in mind that survivors want to do more than just survive - we want to LIVE, and that means being able to maintain good QOL at all phases of tx to the fullest extent possible. Information, clear, concise and COMPLETE about all likely side effects of all tx should be communicated so the patient is not shocked when they happen, and also the means to cope with them.

Thanks for doing this, and best of luck to you with your speech. Will anyone be recording it?

Hopeful
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Old 10-24-2007, 09:34 AM   #14
dhealey
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I agree the oncs need to look at our quality of life. I want quality over quanity. If I can't do the things I love, what's the point. The also need to make MRI's of the brain standard care after treatment of early bc when positive for her2. Herceptin and chemo don't pass the blood barriers of the neck leaving our brains unprotected.
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Debbie in North Carolina
Diag 10/2006-high grade invasive ductal carcinoma- mastectomy L breast
2.5 cm tumor ER/PR pos-Her2+++
4 rounds A/C, 4 rounds Taxol
Herceptin every 3 weeks until Jan. 2008
6/18/07 prophylatic mastectomy R breast
8/2007 started aromasin/stopped arimidex (side effects)
12/07 stopped aromasin due to side effects (now what?)
Finished herceptin 1/8/08
started tamoxifen for 2 years then will switch to femera
allergic to tamoxifen started femera 4/2008
June 20, 2008 portacath removed
Learnig to live life to the fullest!
Stopped Femera due to side effects
July 28, 2008 start trial for breast cancer vaccine
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Old 10-24-2007, 07:15 PM   #15
AbbyDawg
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This is what I would tell them:

The most compassionate and validating thing I have heard since my DX of breast cancer last year is something I was told by my oncologist at my first three-month checkup. Like so many of us, I had a diagnosis, a double mastectomy, and chemo all before my brain and heart even had time to catch up with reality. Then all of a sudden you are on your own without your oncologist and chemo nurses and lab work for three months.

At my first 3-month checkup I said to my oncologist, "It seems like every time I see a bruise, even though my head knows I bumped my arm the day before, when I see it the first thing I think of is cancer. If I stub my toe and the next day my toe hurts, even though I clearly remember stubbing my toe, before logic sets in, the first thing I think of is cancer. Am I being a hypocondriac ... or do I need therapy ... or what?"

She smiled, gently put her hand on my arm, and quietly said, "Ohhhh, not at all ... you're being normal. Imagine I am holding the most beautiful gift-wrapped package you have ever seen ... with the most elegant ribbons. And when I hand you the package ... it explodes in your hands. The next time someone hands you a package, don't you think it would be the most natural thing to flinch until you knew it was safe? Your life was that package and three months ago it blew up in your face. It is the most normal and human thing for you to flinch."

To me that was the definiton of a compassionate, understanding, and non-judgmental response. I will never forget that tender image.

And, of course, it is another reason why I am convinced that Dr. Barbara Bowers of Mpls, MN is THE finest oncologist in the world. She is just as concerned with my heart and soul as she is with my cancer.

AbbyDawg
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