Team Effort Against Breast Cancer

Article sourced from Rush University Medical Center

jackie-thiessen-storyJackie Theisen first felt the lump in her breast while nursing her nine month-old daughter. “I figured it was related to breast feeding,” she says. “But over time, it kept growing.”

A mammogram led to an ultrasound, which led to a biopsy that confirmed Theisen had breast cancer. At age 34, with three young children, Theisen was shocked and frightened for both herself and her family.

“She was distraught,” says nurse coordinator Madeline McIntosh, RN, who answered the phone when Theisen called Rush’s Coleman Foundation Comprehensive Breast Cancer Clinic. “She wasn’t sure how to make sense of what was going on.”

“I was in tears on the phone,” Theisen says. “Madeline instantly put me at ease and took the time to let me tell my story.”

McIntosh also set in motion Rush’s team-based approach to care, setting up Theisen’s appointment with a host of breast cancer specialists from Rush: medical oncologist Melody Cobleigh, MD; surgical oncologist Andrea Madrigrano, MD; and radiation oncologist Katherine Griem, MD. McIntosh and Teri Dougherty, APN, a nurse practitioner, were also at the introductory meeting.

“They brought a whole team together,” says Theisen’s husband Jeff. “That really made a huge difference for us. We all sat around a table and discussed what was going to happen.”

By the end of that meeting, Theisen had a treatment plan. “It was an amazing feeling to walk out and know ‘This is the date that this all starts. We’ve got these people on our side who are going to make this better.’”

‘None of us is as smart as all of us’

The team-based approach practiced at Rush’s comprehensive breast center helps ensure that the patient’s care is coordinated. “It’s really important for your team to be on the same page,” Cobleigh says. “The worst thing is to go to a physician who tells you one thing and refers you to another physician who tells you a different thing. We sit down together as a team and present a uniform, agreed-upon set of treatment options.”

With this approach, patients also benefit from the collective wisdom of multiple experts. In the words of Rush’s Philip D. Bonomi, MD, a lung cancer oncologist at Rush, “None of us is as smart as all of us.”

“We learn that over and over at the breast center,” Cobleigh says. “Medicine is so complicated today that it’s impossible for any single physician to know everything. We see the patient and review the patient’s records together, and all of us catch different things because we’re coming at it from different angles.”

At Rush, a breast cancer patient’s core team typically includes a medical oncologist who oversees the patient’s drug therapy, a surgical oncologist who performs any breast surgery, and the radiation oncologist who manages radiation therapy. In addition, patients benefit from the knowledge and expertise of other medical specialists, including radiologists, pathologists, plastic surgeons, and geneticists.

A major referral hospital, Rush is home to experts in most clinical subspecialties who can be consulted on specific concerns. For instance, if a patient has or is at risk for heart disease, a Rush cardio-oncologist will step in to make recommendations on how to prevent any harm to the heart during treatment. Or patients who are worried about how treatment might affect their ability to get pregnant can speak with a reproductive endocrinologist.

Recognizing the importance of the mind-body connection to health, clinicians at Rush also encourage breast cancer patients to take advantage of Rush’s Cancer Integrative Medicine Program, which offers massage therapy, acupuncture, psychotherapy, and other alternative therapies designed to complement traditional treatments.

Nurses also are a crucial part of the cancer team: “We have absolutely outstanding nurses,” Cobleigh says, adding that Rush nurses have been nationally recognized with the Magnet designation for nursing excellence four times. “They round out the patient experience.”

‘You’re going to be OK’

When Theisen received her initial diagnosis at a different medical center, she was told she had metaplastic breast cancer, a rare form of the disease. However, when Rush pathologists reviewed Theisen’s labs, they found she had a more treatable form of breast cancer.

“In my first encounter with Jackie, she looked me in the eyes and asked if she was going to make it,” remembers surgical oncologist Madrigrano. “I looked her straight back and was able to say, “Jackie, your disease is very treatable and it’s very curable.”

Hearing those words “felt like a million pounds lifted off my back,” Theisen says.

The first step in Theisen’s treatment plan was a double mastectomy, or surgical removal of both breasts. “When a woman is facing breast cancer surgery, one of the biggest concerns is that the surgery will leave her disfigured or with a misshapen breast,” Madrigrano says. “Typically, we’ll work very closely with our plastic surgeons, not only to give patients a good outcome from a cancer perspective, but also to leave the patient with a really good cosmetic result.” In Theisen’s case, the care team collaborated with Anuja Antony, MD, MPH, a plastic surgeon at Rush who performed Theisen’s breast reconstruction.

‘I still know it’s you’

Following surgery, Theisen went through 16 weeks of chemotherapy. “Before she started her chemotherapy, Jackie had a teaching session with Teri Dougherty, my wonderful nurse practitioner-partner, who explained step-by-step everything that would happen,” Cobleigh says. “For instance, Teri talked to Jackie about where to get a wig to wear when she was temporarily without hair.”

Many breast cancer patients also undergo radiation therapy. This treatment typically requires six to eight weeks of almost daily radiation to the affected breast(s).

To show their support during Theisen’s treatment, her husband and two sons shaved their heads so she didn’t have to feel like the only hair-less person in the family. “My youngest son says, ‘I still know it’s you [without hair] just like you still know it’s me.’ That just melted me,” Theisen says.

“They really cared …”

Another reason Theisen and her husband chose Rush over other Chicago-area hospitals is the staff’s empathy and kindness. Theisen remembers being able to call, email or text her physicians and nurses 24/7 with any questions or concerns.

“I felt like they really cared about me as a person,” she says. “They were compassionate. That was a big difference.”

That personal connection was so strong that Theisen saved some of Cobleigh’s email messages and re-read them to help her get through difficult times during her treatment.

It’s been more than two years since her diagnosis, and Theisen is now back to her busy family life. Her once-frequent trips to Rush now are reduced to seeing Cobleigh and Madrigrano for annual follow-up evaluations. But she still feels a part of her Rush team, sharing photos of her family at Christmas.

“It’s so inspiring to have the kind of relationship with your patients that they want to celebrate the holidays with you,” Dougherty says.