From Mark Levine, the Doc with Pink Tights
History of the Breast Cancer Group Part 3
Read part 2
(Oh my god…It’s a nurse)
In a previous chapter of my musings, I described the emergence of Dr. Tim Whelan, radiation oncologist, as a leader of the JCC Breast Cancer Disease Site Group (DSG). Tim very ably led the DSG for many years during the 1990s. In the future, I plan to write a chapter about his accomplishments. However, now I am going to skip forward to discuss a very important evolution in our breast cancer team.
It was nearing the end of the 20th century; Jennifer Wiernikowski worked alongside Tim as a primary care nurse in his clinical practice. In addition, between 1998 and 2002 she was the DSG Coordinator while Tim was the Chair.
She was responsible for ensuring that all aspects of the site group’s activities ran smoothly. She was skilled, very talented, and respected by both patients and staff. She also managed to organize Tim, which was not an easy task.
Tim and I figured that Jennifer would be a great leader of the breast cancer group. We had noticed that another nurse was leading the neuro-oncology team and it appeared to be working quite well. In 2003 I nominated Jennifer as the Chair of the Breast Cancer DSG. This was supported by the cancer centre CEO.
At the time there were approximately 80 participants in our site group, an interdisciplinary mix from across the region. The team met every Tuesday at 8 a.m. to discuss difficult cases and to set policy. At that time in the cancer centre, I have to confess, there was a “power” gradient between doctors and nurses. Thus, it was considered revolutionary to recommend a nurse as Chair of the site group.
I recently met with Jennifer and we reminisced about her time as Chair of the Breast Cancer DSG from 2003-2007. She recalls that a big challenge early on was when the results of the research studies on the role of post-operative Herceptin in Her2 positive breast cancer became available.
About 20 percent of breast cancers have excessive amounts of the onco-protein Her2, which is associated with rapid growth of the cancer. Her2 is measured on the initial biopsy of breast cancer tissue and in patients where there is too much Her2, Herceptin is given and it is able to target the Her2 leading to the death of the cancer cell.
The results of the trials were very impressive and the Ontario Government funded the drug in a very timely manner. It was relatively easy to make a decision to treat newly presenting Her2 positive patients, but what about patients who had their surgery three months ago or six months ago whose tumour tissue was not tested for Her2?
It seemed that the right thing to do was to go back and test the tumour tissue stored in the pathology department for patients who had had breast cancer surgery in recent months. Jennifer recalls having to go to see the Senior Vice-President at Hamilton Health Sciences in charge of the laboratories and clinical services to present a proposal for funding to support testing for Her2 on old cases. Her proposal was accepted and testing was done.
Jennifer recalls that during those exciting years as Chair of the Breast Cancer DSG, she had lots of responsibility. She established policies and had an active role in supporting research. She remembers the exciting research that the site group was performing.
The MA5 clinical trial, for example, compared a novel intensive CEF drug combination regimen with standard CMF combination in women with node-positive breast cancer. The results defined how Canadian women with node-positive breast cancer were treated for a decade.
In addition, Jennifer played a very important role in advancing the Decision Board research at the centre. The Decision Board was a visual aid which improved communication and decision making between oncologist and patient in several clinical situations, such as chemotherapy or not for node-negative breast cancer, and mastectomy versus lumpectomy for removal of a breast cancer.
In some ways it was quite revolutionary, as it was based on the premise of shared decision making between patient and oncologist rather than the previous paradigm of the physician telling the patient what to do.
Jennifer’s memories of her time spent as the site group Chair are warm and positive. She felt that at the time “the sky was the limit” and we all had lots of fun.