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'Trial' Run: Treating Cancer Differently

Debbie Dunlap

In January 2009, Debbie Dunlap felt a lump in her breast. She immediately went to the hospital where her Ob/Gyn practiced, hoping to find answers to her questions and peace of mind for her fears. But when her first visit was over, she knew about as much as she did before it began – not enough.

“I had to wait two agonizing weeks before a mammogram and sonogram confirmed that the lump was ‘highly suspicious of a malignancy,’” Debbie says. “They recommended a biopsy, but told me that it would be about a week before they could get me in.” At that point, Debbie turned to UT Southwestern’s Harold C. Simmons Cancer Center.

In a single day, the staff at Simmons Cancer Center had arranged for the pick-up of her imaging from the other hospital, scheduled a same-day appointment, and performed a needle biopsy.

“Talk about fast work!” Debbie says.

And that, says Debbie, “was the beginning of my discovery that the people of the Simmons Cancer Center go above and beyond the norm.”

Calm and Compassionate

Debbie’s initial meeting was with Ralph Wynn, M.D., Associate Professor of Radiology at UT Southwestern and Medical Director of breast imaging services at the Simmons Cancer Center. Debbie was impressed, not only by the prompt attention but also by his kindness.

“I must say, Dr. Wynn is one of the nicest doctors I’ve ever met,” she says. “For someone in his position, who has to be the bearer so often of bad news, he is amazingly calm and compassionate. While explaining exactly what he thought the pathology would show – and he was right – he made me more reassured that my cancer was treatable.”

Dr. Wynn believes his role in patient care is reflected in the maxim, “it’s not just a job, it’s a journey,” an idea he carries over from his own long-time personal practice in yoga. “In general, the journey is about accepting the lack of permanence and accepting the days you get,” he says. “Cancer patients have a new sense that what’s going on right now is what’s important.”

Dr. Wynn referred Debbie to Simmons colleagues to serve as her oncologist (Barbara Haley, M.D., Professor of Internal Medicine at UT Southwestern and a medical oncologist at the Simmons Center) and as her oncological surgeon (Marilyn Leitch, M.D., Professor of Surgery at UT Southwestern and Medical Director, UT Southwestern Center for Breast Care).

Clinical Trials and the Future of Cancer Care

Debbie was diagnosed with Stage IIB invasive ductal carcinoma. Conventional therapy calls for the removal of the tumor before chemotherapy, but due to her type of breast cancer and its large size, Debbie was able to join a clinical study as part of her UT Southwestern care. Because Simmons Cancer Center has a National Cancer Institute designation, UT Southwestern patients often meet criteria for treatment programs that may be unavailable elsewhere. “My plan of treatment,” she says, “was what is called neoadjuvant therapy—all of my chemotherapy and the infusion of the drug Herceptin would begin before removing the tumor.”

“[Debbie] went from Stage II to Stage I thanks to the treatment she got before surgery,” Dr. Leitch says. “The tumor responded dramatically to the study chemotherapy so that she was able to save her breast and have lumpectomy surgery.” To complete her treatment, explains Dr. Leitch, “Debbie went on to receive radiation treatment to her breast, as we do with all lumpectomy patients, and started an anti-hormone medicine.”

The mere fact that I have come to know my team of doctors so well through the management of my cancer is a great indication that the slogan UT Southwestern has adopted is more than just a tagline. They really do treat cancer differently, and I’m forever grateful.”

– Debbie Dunlap

So by participating in a clinical trial, Dr. Leitch says, “Debbie received benefit in her options for treatment, and she is also helping the women with breast cancer who will follow her.” However, both in Debbie’s case and more generally, Dr. Leitch says, “Once the treatment is finished, there’s a sigh of relief, but there’s also ongoing follow-up.” Echoing Dr. Wynn’s philosophy, Dr. Leitch says, “The final phase of treatment is not the end of the journey.”

Debbie’s surgery at the Simmons Cancer Center was the 14th surgical procedure of her life, so she knew a little something about what was coming. Her positive personality even prompted her to start making a list of “Good things about cancer.” Some were ironic – weight loss, shortened grooming time, “never a bad hair day.” But she also grew to appreciate truly special times in her life—spending more time with her husband (and college sweetheart), Bill, traveling to Georgia to celebrate her father’s 85th birthday, celebrating birthdays of multiple grandchildren—including, literally, the birth day of her newest grandson, Press.

“We spend a lot of time with patients motivating them, and that wasn’t necessary with [Debbie],” Dr. Haley says. “She loves her life, her family, her kids. She’s always very compliant—a very good patient. It’s a pleasure to know her as a patient – and as a friend.”

The feeling is mutual. As Debbie says, “I loved both my oncology surgeon, Dr. Leitch, and my oncologist, Dr. Haley.” In fact, she says, “I absolutely adore Dr. Haley, am still seeing her, and am in a new clinical study, to further decrease the chance of breast cancer recurrence.”

Debbie says, “The mere fact that I have come to know my team of doctors so well through the management of my cancer is a great indication that the slogan UT Southwestern has adopted is more than just a tagline. They really do treat cancer differently, and I’m forever grateful.”

Read more about Debbie’s journey in the blog she kept while going through treatment, from February through December of 2009: http://www.caringbridge.org/visit/debbiedunlap/mystory.