MIAMI _ Judith Cornille survived breast cancer. The lumpectomy. The radiation.
The utter shock.
But even as she recovered from treatment, her mind was on the future: Now what?
"Everyone was telling me to get on with my life, but I was still reeling
emotionally," recalled Cornille. "This wasn't what I had planned."
Cornille, 65, was lucky. She enrolled in the new Breast Cancer Survivorship
Clinic at the University of Miami's Sylvester Comprehensive Cancer Center, a
3-month-old program that supplements routine care provided by a breast
oncologist with a multidisciplinary approach to managing the long-term effects
of cancer and the side effects of treatment. The program offers nutritional
counseling, physical rehab and fitness training, psychiatric counseling and
integrated medicine, including acupuncture, yoga and tai chi.
"It's like a GPS after treatment," Cornille said. "It helps me to know what I
should expect and what I can do to feel better. It does a lot for the psyche."
The Breast Cancer Survivorship Clinic is part of a growing movement within the
healthcare system to help survivors adjust to their new life, post cancer. As
more of them lead longer, healthier lives, hospitals are reorganizing their
services by offering a one-stop shop that gathers together various disciplines.
"We're moving toward a collaborative model," said Dr. Beatriz Currier, who heads
up the psychiatric part of the clinic. "We are all tackling the symptom from our
different expertise and a major asset is that everything is centralized."
For years, breast cancer patients were released with little guidance on how to
deal with post-treatment issues, everything from depression to weight gain, to
sleep problems and sexual dysfunction. But that is changing as more patients of
all cancers survive.
There are almost 14 million cancer survivors in the United States and that
number is projected to increase by 31 percent, to almost 18 million, by 2022,
according to the National Cancer Institute.
The medical community has realized such encouraging numbers demand follow-up
guidelines to ease the lives _ and the worries _ of these former patients.
That's why the influential Institute of Medicine issued a report in 2005
recommending that all patients, after completing treatment, receive a
survivorship care plan (SCP), a blueprint that helps a survivor steer her way
through the maze that is post-treatment life.
A care plan includes both a record of care the patient has received and a
follow-up plan about psychosocial effects of treatment, prevention of new
cancers and surveillance of recurrent cancers, among other things.
The American College of Surgeons considers these survivorship plans such an
important part of post-treatment cancer care that in 2011 its Commission on
Cancer announced that it would require all of its accredited facilities _ where
about 70 percent of new cancer patients are treated _ to provide these plans to
all patients by 2015.
Because breast cancer survivors comprise the largest percentage of survivors, 22
percent, it was a natural step for local hospitals to begin implementing SCPs
"They have a spectrum of issues but they are also more open, more motivated to
deal with them," Currier said.
At the Sylvester clinic, the initial visit includes a two-hour screening to
determine the issues a patient is facing. If, for example, she suffers from
fatigue, she might see the psychiatrist, exercise physiologist or nutritionist,
perhaps even an integrated medicine specialist for acupuncture or yoga. All
these disciplines can offer help.
The Breast Cancer Survivorship Clinic sees about five new patients a week.
It is now open only to Sylvester patients, but Currier says it might one day
open to other breast cancer patients who have been treated in other cities and
Cornille's first appointment was with the exercise physiologist. Eager to get
her life back on track, she had tried the gym on her own, but her efforts were
short-lived "I was on the elliptical for five minutes and my legs were like
jelly," she recalled.
So she registered with the U Survive & Thrive program at the survivorship
clinic, where exercise physiologist Stacy Cutrono tailored an exercise routine
and followed her through 16 supervised sessions. Cornille said she was "very
encouraged" to see her endurance and strength improve on every visit to the gym.
"It starts as hand-holding than it takes off," Cutrono said. "They take what I
teach them and they go from there."
Heidi Rowland, a 57-year-old breast cancer survivor, has seen both Cutrono and
the nutritionist for follow-up care. In a couple of months she will visit
Currier for a cognitive assessment. These appointments are in addition to her
follow-ups with the breast oncologist.
"To have to see several physicians who don't talk to each other and are in
different places would be very stressful," she said. "It would be daunting, so
it's great to have everyone gathered in one place and everyone talking to each
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Other local hospitals have launched survivorship care plans for their breast
cancer patients. Advanced Medical Specialties oncologist Dr. Grace Wang, who
chairs the Commission on Cancer (COC) committee for Baptist Health, has worked
on the survivorship plan template the hospital gives to survivors for more than
a year. To those guidelines she plans to add a list of available community
resources, as well as a financial component because cancer "can cause financial
distress to so many of our patients."
Wang sees SCPs as a vital part of "a team effort" to reduce the recurrence of
cancer and offer support to survivors so they can comply with post-treatment
"You're educating and keeping them on task about what they should be doing," she
At the Memorial Center Institute in Broward, psychiatrist Patrick Reynolds, who
heads a multidisciplinary oncology support system, has been supervising the
rollout of the SCPs for breast cancer patients. Like other centers, Memorial
plans to add other cancer survivors in the future.
"In the past people fell through the cracks," he said. "The pieces were there,
but the care tended to be fragmented. What we're doing now is formalizing the
process so survivors don't get lost in the follow-up."
(c)2013 The Miami Herald
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