June is National Cancer Survivor Month, a time to honor and celebrate individuals who have faced cancer and emerged as survivors. Survivorship is more than just about living after treatment – it’s an examination of the patient’s progress over time, from diagnosis through treatment and beyond. It looks at all aspects of their life including the physical, mental, emotional, social and financial effects that surviving cancer can have on a person. It serves as a reminder of the strength, resilience and determination that our patients demonstrate every day.
We recently talked with two former Fred Hutchinson Cancer Center – Proton Therapy patients about their survivorship experience.
Patient Spotlight 1: Triumph over triple-negative breast cancer
Tina Christian-Lenson is a Black woman under the age of 50 — a member of two populations that are most commonly diagnosed with triple-negative breast cancer (TNBC). She was treated with chemotherapy, surgery, and radiation when she was diagnosed with this aggressive type of cancer in 2018.
According to Fred Hutch breast radiation oncologist, Janice Kim, MD, TNBC differs from other types of invasive breast cancer because it tends to grow and spread faster, has fewer treatment options and its prognoses tend to be worse. Because it is common in women younger than 40, many TNBC patients have young families, which often adds another layer of difficulty when discussing survivorship.
However, there have recently been huge strides in triple-negative research and immunotherapies like pembrolizumab (Keytruda ®), used together with chemotherapy, before surgery and radiation. While research continues, conversations about strategies for treatment and survivorship issues with TNBC patients are more common than before.
“Patients are living longer with breast cancer, and they are being cured of breast cancer. The number of survivors is increasing, which as a provider, is so exciting to hear,” Kim explains. “But with TNBC survivors being around for another 15, 20 or 30 years, we want to be extra cognizant of potential harms and be sure we’re not causing any long-term side effects during treatment.”
That’s where the precision of proton therapy can make a difference – and why Tina advocated to receive proton therapy rather than “traditional” or photon radiation. She wanted to limit the potential side effects of radiation, which would be compounded by the risks associated with chemotherapy and surgery.
From her research and speaking to Kim, Tina knew that proton therapy was a safe and effective treatment option for her diagnosis, but her insurance carrier initially denied coverage. Undeterred, she and her family decided to manage the cost of care without insurance. After her treatment, Tina appealed the denial. She was able to successfully overturn her case and got her carrier to cover her treatment. Reflecting on that time, Tina says focusing on insurance logistics caused her to tune out issues with her mental health.
“After all the treatment was over, I was finally able to check in with myself emotionally. Prior to that, I just had to focus on getting over the hurdles to receive the treatment I wanted. It wasn’t until after my treatment was complete that I realized all the problems I was dealing with, like trouble sleeping or anxiety, were symptoms of depression,” Tina shares.
Tina began journaling to track her emotions and switched to part-time work to help cope. Kim agrees with this strategy. While physical recovery is important, Kim also emphasizes the importance of the mental recovery aspect of survivorship, which often can take a lot longer to reclaim.
“A big part of recovery is being able to find that time for yourself to allow yourself to heal,” says Tina. “I have to keep reminding myself that I just went through a lot and it all just takes time.”
Part of what helped Tina regain a sense of normalcy after treatment was her new home. In 2019, Tina and her family purchased land on the San Juan Islands in Washington state, and in 2023, they broke ground on their new house. “We had this dream of coming to the San Juan Islands and building a home. That vision was something I could look forward to when I was feeling down,” she says.
Patients who are experiencing mental or emotional distress are encouraged to reach out with questions or concerns to their care team. Support is available to those who are struggling during or after treatment. Please call us at 206.606.1030 for assistance.
Patient Spotlight 2: Conquering pediatric medulloblastoma
Ryder Bundy was 10 years old when he was diagnosed with medulloblastoma, one of the most common cancerous brain tumors in children. As the first COVID-19 lockdowns began in 2020, Ryder started having intense migraines, dizzy spells and double vision. After a mass was found in his brain, Ryder was quickly airlifted from his home in Saint George, Utah, to a hospital in Salt Lake City. There, he was diagnosed with medulloblastoma and underwent surgery to have it removed.
Following Ryder’s surgery, the Bundy family was referred to Seattle to receive proton radiation at Fred Hutch. Radiation therapy is a common secondary treatment after surgery to ensure that all the cancer cells have been removed, but children’s bodies are more sensitive to radiation than adults’ bodies. This puts them at higher risk for serious short- and long-term side effects, like growth and development problems or secondary tumors (cancers that are caused by treatment) later in life. Because proton therapy is precisely targeted, it can work well for treating cancer in children by limiting the amount of healthy, growing tissue that is exposed to radiation during treatment.
According to Ryder’s radiation oncologist, Ralph Ermoian, MD, about 85% of patients with average-risk medulloblastoma are expected to be long-term survivors with no recurrence in the future.
“Because so many of our patients are going to be long-term survivors, we’re thinking about the impact of the cancer treatment on their lives 20, 30, 50 or 70 years later,” Ermoian says. “Protons benefits many adults, but we’re particularly thinking about those long-term effects of radiation on our pediatric patients.”
Ryder’s most prominent side effect after treatment was fatigue. His dad, Monty, called Ryder a “natural athlete” who is particularly drawn to baseball. To see him go from an energetic 10-year-old to being worn down by treatment took a toll on the whole family. And for Ryder, as an athlete, transitioning back to an active lifestyle has presented mental and emotional challenges. The family reminds Ryder to be forgiving with himself while working to regain his athletic abilities.
“We tell him all the time that cancer is not fair, and it’s OK to be frustrated and upset,” Monty says. “But we also realize that he is blessed with his health, so all we can do is keep working on improving.”
Now, nearly two years after completing treatment, Ryder is back in school full-time and playing baseball year-round. He plays third base and shortstop and currently has the highest batting average on his team. Although he is healthy and strong, both Ryder and his dad think his endurance and stamina will only continue to grow in the next year. Monty is relieved to watch Ryder be a “normal kid again,” which has helped tremendously in improving his mental health.
“Pediatric patients tend to be really robust in recovering from treatment,” Ermoian explains. “They start with a clean slate, whereas even adults with no underlying health conditions often can’t tolerate the same amount of radiation that a child can.”
As part of his follow-up, every three months Ryder receives an MRI and does routine blood and hormone tests. They have received nothing but good news on his recovery, and Ryder’s summer plans are full of visits to the lake, camping, baseball, a trip to San Francisco and celebrating his 14th birthday.
“I became really good friends with the nurses, and everyone was so nice,” Ryder says. Monty chimes in, “We can’t thank them enough for the way they welcomed our family in. They went above and beyond for us, and it made such a big difference.”
“Hearing how well Ryder is doing is the best part of my job and we’re so excited for him,” Ermoian says.
Both Tina and Ryder emphasize the importance of hope and taking things day by day. The benefits of proton therapy and long-term considerations for breast cancer and pediatric cancer survivors have enabled these two former patients to fully enjoy their passions and dreams.
