Dr. Stephanie L. Graff is a breast medical oncologist. She is the director of the Breast Cancer Program at Sarah Cannon Cancer Institute at HCA Midwest Health and the associate director of the Breast Cancer Research Program at Sarah Cannon Research Institute. She serves on the ASCO Research Community Forum. Dr. Graff is on Twitter @DrSGraff.
Dr. Kelly Shanahan is a board-certified OB/GYN living with metastatic breast cancer. She practiced for 25 years. Dr. Shanahan is the former medical director of METUP, volunteers and reviews grants for Metavivor, is a consumer reviewer for the Department of Defense breast cancer research program, and is participating in the AACR Scientist-Survivorship program. She is a member of the Metastatic Breast Cancer Alliance and Global Advanced Breast Cancer Alliance. Dr. Shanahan is on Twitter @Stage4Kelly.
Stephanie Graff (SG): Tell me about your cancer diagnosis and background.
Kelly Shanahan (KS): I was diagnosed with early-stage breast cancer in 2008. I had a bilateral total skin-sparing mastectomy and was back in my office seeing patients in 2 weeks. I don’t think anybody would have recommended that I do that. I didn’t really ask my surgeon. I was in solo private practice. I ended up with a positive lymph node and received chemotherapy. I worked all through chemotherapy. I scheduled my chemotherapy on Thursdays. I operated all day Friday, popped over between cases for my medications. I would be sick Saturday and Sunday and be back in the office Monday. Lots of patients work through chemo. The financial impact and length of time necessitates it.
I was diagnosed with metastatic disease on my birthday in 2013, after I had been having back pain for several months. Cancer never crossed my mind. Never. There are advantages to being a physician-patient. I had my MRI and PET scan done, then I ran and grabbed a cup of coffee, and went right back to go over my scans with the radiologist. I knew my diagnosis instantly.
SG: What does a doctor say to a doctor in that situation? It is a real struggle.
KS: I saw my oncologist within 2 hours of my diagnosis. I walked into his office, and he looked me in the eye and said, “I know you know the statistics. You are not a statistic.” The only reason I knew the statistic was because I left radiology and went to my car and googled “mortality statistics with metastatic breast cancer.” I think what he said was really important: that despite everything I knew, despite statistics, each one of us is [a unique individual]. I really appreciated that.
I was never told about the risk of recurrence, the risk of late recurrence in particular. I was never told about treatment side effects.
SG: That is a prevalent theme on the topic of caring for physician-patients. Physicians directing care tend to assume that physician-patients know side effects, drug interactions, and signs or symptoms that need to be reported.
KS: When I developed my back pain, I was walking up stairs and sneezed. I instantly had severe pain, and I thought, “I pulled a muscle.” When it didn’t get better, I thought I had herniated a disk. Cancer didn’t cross my mind.
SG: What did giving up the practice of medicine mean to you?
KS: I was no longer able to do surgery. Giving up surgery was giving up a huge part of my identity. From the time I finished medical school until motherhood, medicine was my whole identity. Having a child split my identity—part mom, part doctor. I was a really good surgeon. I loved surgery. I was respected for my surgical skills. Having to stop was hard. Not just the emotional standpoint of losing my identity, but it came with a significant financial burden.
It was hard. Obstetrics and gynecology wasn’t just what I did, it was who I am. You actually were one of the people who said to me, “You are still a doctor.”
KS: I would say, “I used to be a doctor.” It took me a long time to say “yes.”
Then I found advocacy. I went to a patient event and, for the first time, met other people with metastatic disease and saw them doing advocacy. It has given me a whole new purpose. I feel like I am still making a contribution to society, and it is just as important.
SG: The metastatic breast cancer community in particular is a very engaged and well-educated community. I know that sometimes a big barrier is access to information. Do you want to comment on that?
KS: So many articles are published behind paywalls. If you don’t have a subscription, access to the article costs money. The patient community follows experts on Twitter, attends scientific meetings, have Google alerts set for their disease—they want to know. I want to read the full article. We may know more about what is up and coming in our disease. I am laser focused on bone-only estrogen receptor-positive (ER+) metastatic breast cancer. I am so thankful for open-access journals. I am so thankful for the peers and colleagues who share those articles with me. All patients need more access.
SG: Do you see being a physician-patient as an impairment or as an advantage?
KS: I think it is a disadvantage. I think the assumptions about my medical knowledge and my ability to work the systems hurt me. When I mention back pain or neuropathy, no one offers me physical therapy. They assume I’ll ask if I want it or need it.
SG: Looking back at the physicians who have provided care for you, if you were going to come up with a rule book, what would you say?
KS: Treat me like you do everyone else. Treat everyone like it could be you.
SG: What traits do you look for in the physician/physician-patient relationship?
KS: 1. Honesty 2. Partnership 3. Compassion.
I want my doctor to be 100% honest with me. I want to know everything. I want them to listen, I want them to respect my questions. I want to be human. There needs to be more humanity in medicine.
SG: Yes. That is really beautiful and true. That’s what anyone would want.
This interview was conducted in advance of the 2018 ASCO Annual Meeting in preparation for an Education Session on Monday, June 4, called “When Cancer Hits Close to Home: Treating Colleagues and Loved Ones.” Read the entire interview on ASCO Connection.