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June 18, 2018

This Leader in Case Management Shares her Story of Survival

BY Angel MedFlight

June is Cancer Survivor Awareness Month. Laura Ostrowsky opens up with us about her recent battle against cancer and what she wants other patients and case managers to know. Laura is a former CMSA board member, a thought leader and Director of Case Management at the Memorial Sloan Kettering Cancer Center.

1. How did you first learn of your cancer? What led to your diagnosis?

My GYN found a concerning lump during my annual exam and referred me for mammography and ultrasound. The following week I had a mammogram and an ultrasound and was immediately scheduled for a biopsy later that same day. I received a phone call the following day that the biopsy was positive for invasive lobular carcinoma and told I should make an appointment with a breast surgeon.

2. What was your initial reaction?

In the past I have had repeat mammograms as well as a biopsy without a cancer diagnosis, so part of me was expecting the same negative result. On the other hand, I remember thinking that at some point they would find something.

I work in a department made up primarily of women and a significant number of the staff members have had breast cancer. I remember a couple of years ago when yet another staff member was diagnosed, I turned to a colleague and said, “maybe it’s time we take our breasts and get out of here.” When I received the diagnosis, I reminded her of that conversation and said I guess I should have listened to my own advice.

So, my reaction was that it was inevitable, only a matter of time, that it was my turn. Unfortunately, every year it seems that it is one of us, and this year it was me. The prevalence of breast cancer in the population is one in 8 women, and my department falls right in line with that statistic.

3. How do you think your background at Memorial Sloan Kettering changed your perception of treatment?

People who work at Memorial are basically divided into two groups. There are those who fear every lump, bump, cough or ache is cancer, and those who think that since we work here we are untouchable. I don’t fit into either category. I don’t think everything is cancer and while I never felt immune I did think that by eating well, getting plenty of exercise and living a good life I was minimizing my chances.

It can be hard when you are diagnosed, knowing the full extent of cancer and having seen and worked with the worst case scenarios, (especially when your experience is primarily inpatient). However, we know we have access to the best care available and that cure is often an outcome.

I was able to get an appointment with my doctor of choice, the one that has done most of our Case Managers’ breast surgeries. She was kind, thorough and encouraging. Both my breast surgeon and my oncologist were very careful to not only explain all my options, test results, surgical care and treatment plan, but to also make it very clear that I had done all the right things by having annual exams, regular mammograms, etc. It was important to them to let me know that I had done my part, and now the ball was in their court.

It was a strangely supportive and generous message, probably designed to comfort me – it did a little. When you are the patient it can be hard to absorb the information but having heard much of it before was helpful.

4. As a Case Manager, what was it like being the patient and being on the ‘other side’ of the situation

It’s never easy being a patient. It’s a “job” you don’t want. It’s important to remember that just because you work in healthcare doesn’t mean you have to be better or stronger or smarter than the average patient. You also shouldn’t “go it alone.”

My sister accompanied me to appointments and took notes and asked questions. A couple of my team members also offered the same services. It’s easy when you work here to think this is just part of your routine and you can take care of everything yourself. That’s not necessary, and not a good idea.

I have had surgery before and the lumpectomy was relatively easy with a short recovery time. I was back at work in a little over 2 weeks. As I kept telling everyone, for cancer this was pretty much a non-event. Despite knowing I had cancer I never really felt like a cancer patient until I started radiation treatment. I went through four weeks of radiation, (20 treatments total, five days per week for four weeks). I think that was the hardest part although I didn’t realize that until the last day of radiation.

Sitting in the waiting room wearing my ID badge and sometimes a lab coat, I was still a patient like all the other patients. I continued to work through the four weeks. Running up to the radiation oncology suite and counting down my treatments.

5. What gave you hope?

My tumor was relatively small and it was probably spotted early enough although that couldn’t be confirmed until after surgery. I had great doctors, great medical coverage (no financial fears and this is something that can’t be minimized), supportive friends and family. I also had the attitude that everything was O.K. until I heard otherwise. I was on board with the plan: lumpectomy followed by radiation. Chemo was an unknown until surgery, pathology and oncotype testing. ( Oncotype DX® is a tumor profiling test that helps determine the benefit of using chemotherapy in addition to hormone therapy for some estrogen receptor-positive (ER-positive) breast cancers.)

Confidence in my doctors and in Memorial kept me going. My tumor turned out to be ER positive and HER2 negative. Margins were clear as were the four lymph nodes removed at the time of surgery. My oncotype score was low and therefore chemo was not indicated. I was basically cured with radiation just to make sure.

6. What would you like patients who are still in treatment to know?

Take it a day at a time. Put one foot in front of the other and keep on going. Be kind to yourself, listen to your body, rest, don’t push…

I think I was in denial or at least on autopilot through most of the 4-5 months from diagnosis through end of treatment. I am still on medication, aromatase inhibitors to prevent or minimize recurrence, so I am not completely treatment-free. But I have no active treatment like chemo or radiation.

I found setting milestones helpful, so I would think one treatment down, 19 to go, then 25% completed, tracking my progress and looking ahead.

Raise Your Awareness

Need more info? The National Cancer Survivor's Day site has resources to support cancer survivors.

7. How did your recovery change the way you look at your life and work, (if at all)?

I am not sure that it did. I am certainly relieved to be done with radiation and to have dodged the chemo bullet. I do think about what I want to do with the rest of my life, but I am at a stage where it is time for a change anyway.

8. How did you feel when you learned your cancer was cured?

Getting the surgery results and knowing that I did not have metastatic breast cancer was a huge relief, but the whole experience was somewhat surreal. I had ambulatory surgery, was home by midafternoon, got good news at my followup appointment with the surgeon as well as my initial meeting with my oncologist.

I am grateful to my gynecologist who found the “lump” and sent me for a mammogram five months ahead of schedule.

There is a bell in the radiation suite that patients are encouraged to ring when they complete treatment. It doesn’t seem like a big deal, but the closer I got the more I wanted to ring that bell.

After my last treatment I went out to the waiting area and rang that bell three times in keeping with the tradition and then completely surprised myself by bursting into tears. The patients in the waiting room applauded, the receptionist hugged me, I dried my tears and went back to work. The importance of that type of act or milestone can’t be underestimated.

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