You are here: Home: Meet The Professors Vol. 3 Issue 3 2005: Editor's Office
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Editor’s Note  |
| Legacy of courage |
Case Presentation: A 29-year-old nursing student presents with chest discomfort and dyspnea on exertion several months after receiving neoadjuvant and adjuvant chemotherapy for ER/PR-negative, HER2-negative, locally advanced breast cancer. A CT scan of the abdomen and pelvis is ordered.
This was probably the most difficult discussion I’ve ever had with a patient. Her mother, who is a nurse at the hospital where we obtained the CT scan, called me on a Friday night to alert me to the results. I saw the patient, her husband and her mother in the office the next morning and disclosed that pleural metastases and a mediastinal mass were present, and that this would not be curable. I then disclosed to her that the CT scan also demonstrated that she appeared to be pregnant. The patient was shocked and frightened — not only for her own life, but for her baby’s life as well. This was her first pregnancy.
It was a remarkable moment in everyone’s life — the life of an oncologist, the life of a patient, the life of a husband and the life of a mother, seeing her daughter go through this.
— Scott D Lunin, MD |
Medical oncologist Scott Lunin ordered a CT scan on his young patient expecting that her new symptoms might reveal metastatic disease. While the documentation of pulmonary metastases was not unexpected, the presence in the pelvis of a 14-week-old fetus came as a shock to all.
Facing a dismal future battling what was now rapidly progressive, “triple-negative,” advanced breast cancer, the patient immediately focused on the well-being of her child. Of particular concern was that both mother and fetus had been recently exposed to chemotherapy and radiation treatment. A normal amniocentesis gave some reassurance, and the patient was committed and adamant: Termination of the pregnancy was not an option; she desperately wanted to see her child survive.
With the goal of taking the pregnancy to term, late-line chemotherapy was administered without response, but the patient and her child hung on, and at 30 weeks gestation, an apparently healthy son was delivered by Caesarian section. For several more months, the patient nurtured her child while receiving successive, ineffective cytotoxic agents. She finally died as the result of multiple cerebral metastases.
This was a bitterly fought battle that resulted in a not inconsequential victory for the patient, her family and Dr Lunin, who has found peace as a medical oncologist by offering patients his expertise and sincere empathy. During the recording session for this Meet The Professors program, I asked Scott whether he felt a sense of professional gratification in the care he provided to this extraordinary patient.
“As a father, a husband and an oncologist, this was a remarkable patient to treat,” he began. “The discussions we had about the potential damaging effects of chemotherapy and radiation treatment and the possibility of termination of the pregnancy were extraordinarily humbling for me, in addition to all the other humbling aspects of this case. To see that she went on to have a healthy baby boy who will survive her and essentially serve as her legacy was extraordinarily gratifying.
 “As an academic point, it also reminded me of the importance of discussing the issue of contraception and pregnancy with young women receiving chemotherapy. That, for me, was a real take-home message, because it’s something that I did not often talk about with my patients in the past. Now, I do. It was gratifying to see this patient’s mother, father and entire family unit come together. It was just one of those moments in medicine that is almost a miracle, in and of itself — that out of this tragedy came an enormous amount of hope through this 30-week baby boy.”
Dr Lunin’s case is the only one on our audio program that is not excerpted in the enclosed monograph. There is a message in this story, and to fully appreciate it, one must listen.
—Neil Love, MD
NLove@ResearchToPractice.net
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