In the midst of the quiet panic, a steady hand squeezed Sampson’s arm ...
Inside Room 9 on the Multidisciplinary Level of Louisville’s James Graham Brown Cancer Center, a writer and a photographer were allowed a glimpse inside a very personal, very private moment in a cancer patient’s life.
Joyce Sampson and her daughter had just arrived from Indiana. Sampson knew she had breast cancer, but she didn’t know if she would need to undergo chemotherapy. Oncologist Dr. Beth Riley gave her the news.
“We got the test back … and it is high. So you do need chemotherapy,” Riley said.
Sampson’s daughter responded for her mother, “We kind of figured that.”
Joyce Sampson couldn’t talk—her emotions got the best of her. Meanwhile, everyone in the room, even the intrusive writer and photographer, was running into one another, desperately trying to find a tissue, desperately trying to be of help.
In the midst of the quiet panic, a steady hand squeezed Sampson’s arm, while the other hand reached out for the needed tissue. Those comforting hands belong to Barbara Kruse, the director of multidisciplinary clinics and supportive services for the Brown Cancer Center, which is part of UofL Health Care. She didn’t utter a word and directed Sampson’s attention to Riley.
“So let’s talk about what type of chemotherapy we’re going to do,” Riley said.
With that cue, Kruse and the others took their leave and Sampson’s daughter, a nurse and Riley remained to discuss the treatment plan.
Although it seemed like a harsh outcome at first, Kruse explained the silver lining.
“There’s a special test now [Oncotype DX] that looks at the biology of the tumor … we were really surprised that her score came back high. It was much more aggressive than we originally thought,” Kruse said. “Yes, this is a type of tumor that will respond to chemotherapy. So is the idea of getting chemotherapy a bad thing? No. The idea of getting chemotherapy is a good thing because if we didn’t have this test, she probably wouldn’t have gotten chemotherapy.”
Yet, even Kruse admitted that while the prognosis is good, it is still a scary time for Sampson and her family.
“It is emotional,” Kruse said. “If you talk about it every day, it gets easy to say it. It’s our jobs to make this transition and to help them with the process of it.”
Exactly how does Kruse help with that transition? She oversees a team of nurse and patient navigators who help coordinate each patient’s individual care, from the moment the patient comes into contact with the Brown Cancer Center to recovery and beyond. The clinics include blood and marrow transplantation; breast cancer; brain and spine tumor; gastrointestinal; genito-urinary; gynecologic oncology; head and neck; lung; and skin cancer and melanoma.
Just an hour before the visit with Sampson, Kruse was leading a team meeting with medical oncologists, radiation oncologists, psychiatrists, psychologists, geneticists, surgeons, radiologists, social workers and chaplains. During that hour-long meeting, the group discussed the illness of five patients and their therapies. Test results were displayed on the projector screen. Scans of tumors were shown to explain each patient’s case. Discussions among most of those surrounding the oblong table centered on how best to tackle each patient’s care. Then, armed with the information gathered and decisions made, the medical professionals dispersed to take care of their patients.
“This multidisciplinary approach attracts people who want second opinions. It attracts people whose disease has progressed, so they’re looking for something different. It attracts people who have a controversial diagnosis, so they go to one doctor and somebody else tells them something else,” Kruse said. “So this team approach can give them a consensus plan, a treatment plan that says, ‘Yes, the surgeon agrees, the radiation oncologist agrees, the medical oncologist agrees, the pathologist agrees and the breast radiologist agrees.’ Those are the main disciplines, and we all agree that you should be treated this way versus one person’s plan.”
But it’s not just the physical concerns addressed. That’s where the ancillary support comes in.
“So you see all these people who were sitting here—the geneticist, the social worker, the clinical trials person, the psychologist, the psychiatrist—all of those joined together because maybe there are social issues, or their financial issues can make a difference in the team consensus,” she said.
Once a consensus is reached, the nurse navigator assigned to each patient then coordinates among the patient and his or her required caregivers.
“They make sure [the patient] sees the surgeon and then, when the patient is finished with the surgeon, [the patient] goes to the medical oncologist or maybe they decide they need to see two doctors at one time, depending on what the case is,” Kruse said. “So if it’s a partial mastectomy, [the patient] might see the surgeon and the radiologist on the same day. If it’s a large tumor and they’re thinking they might need to do chemotherapy first to shrink the tumor, [the patient] might see the medical oncologist and the surgeon the same day.”
Most of that is done on the multidisciplinary floor, where Kruse spends the majority of her time. At one point, she can be seen talking to doctors, and the next moment she is asking about what’s on a certain patient’s schedule. Or maybe she is discussing the spiritual needs of a patient with the chaplain, Kathy Constanzo.
“The patients love this because they know it’s not just one doctor and one nurse taking care of them,” Constanzo said. “It’s a team, and it’s really individualized.”
The team also reassures patients that the left hand does, in fact, know what the right hand is doing.
“It’s a great place for patients,” said Renita Murphy, a medical assistant who works closely with Kruse on the floor. “Everybody goes beyond their job description.”
While the job description calls for supportive care, it may not call for going out of one’s way to comfort a patient’s spouse as he watches his wife painfully stand on the scale in the nurse’s station.
“How are you doing? Are you okay?” Kruse asked, breaking away from a doctor to stand with a patient’s husband who only nods as she pats his arm. Kruse knows exactly when to talk and when not to say a word. Having spent her 35-year career in oncology and obtaining a master’s degree in counseling for chronic illness, she has seen the evolution of cancer treatment and recovery expand to touch those important to a patient.
“In the past, when patients got cancer it wasn’t discussed as much,” Kruse said. “Now we realize, especially with breast cancer, we have so many young women with children. So we can take the family to the resource center and teach them how to talk to their children about the disease—to be honest and to be direct and to be simple, because we don’t want this cancer to invade every waking moment of the family.”
The M. Krista Loyd Resource Center in the Brown Cancer Center also provides art therapy, music therapy, journaling and even prosthetics and wigs for the patients. Patients can delve into literature covering their specific cancer, learn about proper nutrition during this difficult time, or even get a massage or try out Reiki stress reduction methods.
The center is another tool in Kruse’s belt that she can pull out to help those fighting the disease and assist the navigators under her management charged with being “the glue” in a patient’s care continuum.
“There are a lot of neat things that go on here every day,” Kruse said. “No story should just be one person. It’s not a one-person approach in any fashion.”