On her first day as a Dana-Farber patient, Margaret Winchester had a chance encounter that helped set the tone for her ovarian cancer journey.
She had just met with surgical oncologist Ross Berkowitz, MD, of the Susan F. Smith Center for Women's Cancers (SSC), and stepped into the ladies' room. A woman inside commented on the unusually long wait to see her physician that day.
"I'm probably the reason you had to wait," Winchester replied. "Today's my first time here.
"We had a cry together, and she told me a little about her cancer experience," Winchester recalls. "It helped ease my anxiety."
That kind of support and compassion, combined with the Institute's cutting-edge approach to cancer care and research, compelled Winchester to choose Dana-Farber after she was diagnosed with advanced (stage IIIC) ovarian cancer in 2008.
A 58-year-old child welfare lawyer from Leominster, Mass., Winchester started her treatment with surgery, conducted by Dr. Berkowitz and his team at Dana-Farber/Brigham and Women's Cancer Center. They removed her ovaries, uterus, and as much tumor as possible from her abdomen, where the cancer had spread.
After weighing treatment options with Ursula Matulonis, MD, medical director of Gynecologic Oncology in the SSC, Winchester joined a clinical trial. It involved taking three drugs – carboplatin and paclitaxel delivered directly to her abdomen, and bevacizumab given through a vein. Since then, Winchester's doctors have used a technique called cryoablation to freeze some small ovarian tumors that have recurred, and she recently began another clinical trial.
Says Dr. Matulonis, "We are so grateful for women like Margaret who take part in clinical trials; they are critical in helping us develop new treatments that are targeted against ovarian cancer and other gynecologic cancers."
Winchester's husband, Norman, a retired reserve police officer, was dealing with a recurrence of squamous cell carcinoma on his ear while his wife was in treatment. He now receives care at Dana-Farber, too.
Acupuncture and a support group have helped Margaret Winchester cope with the physical and emotional effects of her disease. But continuing her work as Managing Attorney of the Children and Family Law Program of the Committee for Public Counsel Services in Worcester, Mass., has been a "saving grace," she says.
"Working gives me a sense of normalcy and focus, even if I'm more tired than before. It helps me stop worrying about every ache or pain, accept this as a chronic illness, and try to go on with my life."
She is also intent on raising awareness about ovarian cancer, considered a silent cancer because it's frequently not caught until an advanced stage. Her gynecologist had attributed her symptoms of bloating, constipation, and menstrual changes to normal menopause or aging, but after Winchester felt a pain in her side while doing Pilates, her primary-care physician ordered a CT scan that showed a mass.
"Women who have symptoms should ask their doctors for tests," urges Winchester, who has distributed bookmarks with ovarian cancer warning signs. "Listen to your body. Maybe it's nothing, and if so, that's great. But if it's ovarian cancer, the earlier you catch it, the better."
When Pam Zwemer turned 50 in 2008, she listed 50 things she wanted to try in her milestone year. Among them were ride a helicopter, taste the Japanese beverage sake, and attend a political rally.
Definitely not on her wish list: Discover that her breast cancer, in remission for several years, had spread to her bones.
"For me, 2008 was a kick in the gut," recalls Zwemer, a high-school math teacher from Chesapeake, Va.
Her oncologist suggested a consultation with Eric Winer, MD, director of the Breast Oncology Center in the Susan F. Smith Center for Women's Cancers, and she chose to stay in contact with Dana-Farber. She began traveling to the Institute every six months for checkups and went back on tamoxifen, a drug she had taken for five years after her treatment for breast cancer in 2000. Things seemed to be going well.
But when news came last year that cancer cells had migrated to her stomach lining, Zwemer joined a breast cancer clinical trial under Dr. Winer's care. It is exploring the side effects of two oral medications, letrozole (a hormonal therapy that reduces estrogen production) and BKM120, thought to overcome the cancer's resistance to hormonal therapy.
"I feel so blessed to be coming to Dana-Farber," Zwemer says. "Whatever new research comes out, I feel I'll be right there for it."
Zwemer's treatment schedule reflects her dedication to her students at Oscar Smith High School in Chesapeake, where she chairs the math department and teaches geometry, statistics, and other subjects. She typically travels to Boston once a month on Wednesday afternoons. She sees her care team on Thursday and flies home that night so she can teach on Friday.
"I try to be a role model for my students," she says. "Having stage IV breast cancer is only part of my identity. I'm still me."
Determined to help in some way, her school community hosted a spaghetti supper that raised more than $9,000 for Zwemer's travel expenses. Her lodging in Boston is free (and fun) because she stays with her son, a medical resident at Boston Children's Hospital, and daughter-in-law, who live near Dana-Farber.
Zwemer marvels at Dr. Winer's approach. "He connects incredibly well with people," she notes. "I feel comforted by his presence; when he smiles, I know I'm in good hands." Dr. Winer coordinates with Zwemer's oncologist in Virginia, Michael E. Lee, MD.
"Regular communication between a patient's referring doctor and our team is critical," Dr. Winer says. "It leads to the best care for the patient, and it enhances the referring doctor's practice and our own."
Zwemer remembers emailing Dr. Winer the night she learned the cancer had invaded her stomach, and how they exchanged messages about next steps. "At 10:30 p.m., there he was on my screen," she recalls, choking up. "That touched me."
Knowing about treatment options reassures Zwemer, who carries a white binder filled with test results, appointment notes, and caregivers' business cards. She says she is the kind of person who needs a plan, and having one feels good.
Turning Point 2012
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