Cardio-Oncology Helped Minimize Cancer Treatment Damage

In 2006, 39-year-old Rebecca Schrivener of Kearney, Missouri, received an unexpected, life-altering diagnosis.

"They told me, 'Yes' – it was breast cancer, it was definitely stage IV and it was not surgically treatable."

Schrivener is a wife and mother of 2 children with no history of cancer in her family. Her shocking diagnosis came after several rounds of tests following an ultrasound that detected tumors in her liver.

"My liver was swollen with tumors," Schrivener says. "They were pressing against my digestive track, causing heart burn and bloating. I was unable to eat."

Finding the source of her cancer proved challenging. "They scoped everything they could scope," she says. It wasn't until her husband's co-worker helped her get an appointment at the Mayo Clinic in Florida for a 3D mammogram that she learned the magnitude of her condition.

"When I left Mayo, it seemed like a pretty grim prognosis," Schrivener says. "They said surgery wasn't an option. They weren't sure how well the chemo was going to work."

Unaware of her treatment options in Kansas City, Schrivener and her husband were prepared to move to Florida so she could start chemotherapy. They were relieved to hear that state-of-the-art cancer care was very close to home.

"The staff at Mayo looked through physicians in the area who were members of the American Society of Clinical Oncology and said The University of Kansas Health System was a good option," Schrivener says.

When they arrived home, Schrivener's husband reached out to another co-worker who was also battling stage IV breast cancer and seeing Carol Fabian, MD, an oncology specialist at The University of Kansas Cancer Center. His co-worker asked for copies of Schrivener's scans and gave them to Dr. Fabian, who agreed to treat Schrivener.

"The doctor told me, 'I think this is very treatable,'" Schrivener says. "She had several other patients with a diagnosis similar to mine who had been living 10 years. That was such a relief to hear."

Schrivener was put on an aggressive treatment plan that included chemotherapy, a double mastectomy with reconstruction, hysterectomy and additional hormonal therapies to lower estrogen levels in her body. However, the medications had very serious consequences, specifically heart damage.

"I'd been on medication for not quite a year when I had my first dip in heart function," Schrivener says. "That's when Dr. Fabian spoke with a cardiologist and they decided to collaborate."

Schrivener met with cardiologist Charles Porter, MD, founder and medical director of the cardio-oncology program at The University of Kansas Health System. The cardio-oncology program provides specialized heart care to cancer patients whose cancer treatment affects their heart function. Schrivener was the first patient to take part in the program.

"Many cardiologists' immediate response is to say, 'Stop the cancer drug,'" Dr. Porter says. "But the drug is necessary. Termination of the cancer therapy is associated with progression of the disease. You want to blunt the ill effects of the drug on the heart while continuing to deliver the therapy."

Schrivener had already missed 1 dose of cancer treatment after her heart function declined. Dr. Porter prescribed a specific combination of heart medications to prevent her from having to miss another cancer treatment.

Schrivener has been undergoing cancer treatment for the past 9 years. She has experienced 4 additional declines in her heart function over this time, but Dr. Porter has been able to address these issues without stopping her cancer treatment.

Although she was declared "cancer-free" at one point, Schrivener's metastatic diagnosis requires that she be on some type of cancer therapy at all times due to the probability of recurrence. Three years ago, the cancer reappeared in her lymph nodes. Schrivener went through several different medications before finding the right combination of therapies to control the cancer.

"I'm really glad I came here," Schrivener says. "I tell the ladies in my support group that if they just have a little bump, they're probably fine going to a community hospital. But if they have something complicated or in an advanced stage, they've got to go somewhere like The University of Kansas Health System."

Today, Schrivener continues to live life as normally as possible. She receives cancer treatments every 3 weeks and takes hormonal and cardiac medications daily. Although she tires easily and feels as though her body "acts 10 or 15 years older than it really is," Schrivener says, "I'll put up with a lot to still be here."

This spring, she watched her eldest daughter, who was in 3^rd grade when Schrivener was diagnosed, graduate high school.

"I didn't think I would make it to this point," Schrivener says. "I let myself plan ahead knowing there's a possibility I won't fulfill those plans. But I just pretend that I will. And so far, that has worked."

The cardio-oncology program at The University of Kansas Health System in Kansas City was developed by cardiologist Charles Porter, MD, and oncologists at The University of Kansas Cancer Center.

Through this initiative, cancer patients whose medication causes unwanted cardiac side effects receive coordinated care between their cancer care team and a cardiologist.

"I see patients the same day or next, once a decline in heart function is noticed," says Dr. Porter. "They receive an immediate evaluation. Their treatment is very individualized. It's not a one-size-fits-all approach."