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Vol. LXVII, No. 13
June 19, 2015

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Be ‘Your Own Advocate’
Radiologist Describes Cancer Treatment from Patient Perspective

Dr. Laura Liberman

Dr. Laura Liberman

“Sometimes I felt like I was in a play. I knew all the lines, but they had me reading the wrong part.” That’s how Dr. Laura Liberman described being a patient at the same hospital where she worked for nearly 20 years as a radiologist and cancer researcher.

Liberman is director of the Office of Faculty Development and attending radiologist in the breast imaging service at Memorial Sloan Kettering Cancer Center and professor of radiology at Weill Cornell Medical College. She recounted her experiences as a doctor turned patient during a Contemporary Clinical Medicine Great Teachers Grand Rounds lecture held recently in Lipsett Amphitheater.

Liberman began her career as an imaging radiologist at MSK. Her research focused on developing techniques for image-guided breast needle biopsies under stereotactic, ultrasound and MRI guidance, which would spare women from unnecessary surgery.

After working as a radiologist for 17 years, Liberman was diagnosed with stage IV lymphoma, a cancer of the lymph system. Doctors told her she had a 50 percent chance of remission. Seven days later, she started treatment.

“I observed so much of this as a physician,” she said. “And now I was seeing it as a patient.”

Over the course of her treatment, Liberman stayed in touch with her friends “because some people are there for you in ways that you can’t imagine.” She regularly emailed them about what she was going through.

At first, Liberman said, a cancer diagnosis can seem daunting because of everything that needs to be done. She advised those who face one to break it into a “series of manageable tasks.”

During her treatment, she discovered the importance of being “your own advocate.” When she first started chemotherapy, the surgeon placed an Ommaya reservoir under Liberman’s scalp. The reservoir is a quarter-sized, dome-shaped plastic device that is connected to a catheter. It delivers chemotherapy and allows physicians to draw samples of spinal fluid.

Before her procedure, she asked her oncologist what kind of anesthetic would be used. The oncologist replied that the area cannot be numbed.

“I pulled out a bottle of local anesthetic spray we used for breast interventional procedures. I said, ‘Well, actually, it can.’ And I sprayed,” she said.

After four Ommaya reservoir placement procedures, Liberman wrote a letter to her neurosurgeon advocating for the use of local anesthetics.

“Even a small amount of pain over a long course of treatment adds up. It gives patients with cancer yet one more thing to dread,” she wrote. “It’s our mission not only to cure cancer, but also to relieve suffering.”

She described her experience “not just as cancer, but an opportunity to get hats.” Before she started her treatment, Liberman went with her daughter to look at hats. She bought 15 of them.

“I got the hats because I like to look for silver linings. I wanted to teach my daughter that when life is hard, you can do things to make it better. The hats also gave me something wonderful to think about as I started chemo,” Liberman wrote in an email to a friend.

Liberman said, a cancer diagnosis can seem daunting because of everything that needs to be done. She advised those who face one to break it into a “series of manageable tasks.”

Liberman said, a cancer diagnosis can seem daunting because of everything that needs to be done. She advised those who face one to break it into a “series of manageable tasks.”

Photo: Bill Branson

She added that the hats helped bridge the awkward silences of friends who ran out of safe subjects to talk about. “There are only so many times they can say ‘you look great’ when you don’t. If they didn’t know what to say, I could ask, ‘Do you like my hat?’” she said.

Liberman said that one of the most difficult aspects of having cancer was when treatment was over.

“When you’re under treatment, you have your adrenaline pumping and you’re fighting. You have appointments. You have to be strong for your family. Then suddenly, it’s done,” she noted.

She said, “You have to find out what it is you can do and what it is you want to do. It’s very important to not compare what you’re doing now to what you did before.”

After her cancer went into remission, Liberman transitioned from research to teaching and mentoring. She took a position directing a program that fosters career development for faculty. In this role, she determines the needs of faculty and puts together initiatives that meet those needs.

She realized that many faculty wanted to learn more about new developments in cancer research. So she designed two courses “that conveyed information in a manner that was understandable, without being condescending.” Liberman invited MSK physician-scientists and translational researchers to speak about topics such as cancer biology, targeted therapy and immunotherapy. Students would read articles and then listen to a speaker who knew “the room was full of smart people who weren’t experts in the topic being discussed.”

Before each class, she read a poem to “illustrate the point of the lecture and get enthusiasm going.” The poems also give attendees “a way to remember things and engage in a way that they wouldn’t otherwise.”

Liberman concluded her talk with a slide of Jennifer Goodman Linn, someone whom Liberman said had made a difference. In 2004, Linn was diagnosed with a rare cancer at MSK. She wanted to raise money to support research on rare cancers, so Linn founded “Cycle for Survival,” a national indoor team cycling event.

This year, Liberman said, the event has already raised more than $24 million.

p53: Guardian of the Genome

Dear friends, gather round now, and listen to me—
I’ll tell you the story of p53.
Her job, like all Moms’, is exquisitely hard—
The genome’s integrity she has to guard.

Hypoxia and oncogene activation,
DNA damage caused by radiation,
Or drugs or carcinogens can be the bait—
And p53 will step up to the plate.

Another big stressor that turns her on so:
If nucleotide levels become very low.
She chooses defenses that serve the cell best:
Such downstream effects as cell cycle arrest,

Repair of the damage done to DNA,
Apoptosis (cell death), if there’s no other way.
Another thing p53 can exhibit:
Angiogenesis she can inhibit.

What lets this protein be a critical actor
In keepings cells safe? She’s a transcription factor
The sites to which she can bind seem to be legion—
300 genes, each in its promoter region.

So p53, in concert or alone
Is the fabulous guardian of the genome.
Let’s celebrate p53, the unsung
Brave mother bird who’s protecting her young.

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