Susan Maddalena, 68, was raised in a ranching family. “We went from one green pasture to another,” she said. “I have many memories of running cattle in the Sierra Valley and enjoying the outdoors. It’s been a lifelong love.”
So it’s no surprise the outdoor enthusiast chose the scenic and close-knit Portola, Calif., area as her retirement home.
“We love this place and the slow pace of life,” she said. “We love the mountains, all four seasons, and we have a ranch in Sierraville. It’s a beautiful life.”
The beauty and serenity of her existence was interrupted in late 2010, when she had fl u symptoms that led to an emergency room visit.
“I woke up my husband at 12:30 a.m., it was so bad,” she said. “I told him we needed to go to the hospital.”
Within a few days, however, she had a diagnosis that she said caught her by surprise.
“It was cancer,” she recalled. “I was prepared for an intestinal blockage, but not cancer. Even if they had said diabetes, I would have been prepared for that — I’m from a family of diabetics.”
But this was peritoneal cancer, a rare cancer that develops in the peritoneum, a thin, delicate sheet that lines the inside wall of the abdomen and covers the uterus an extends over the bladder and rectum.
Peritoneal cancer looks and behaves like ovarian cancer, but the ovaries are minimally involved — though the two types of cancers often are treated the same way.
“I thought, ‘Whoa. Me? Cancer?’” she recalled of her initial reaction to the diagnosis. “I know everyone probably says the same thing, you just never expect to hear it.”
She immediately consulted with Peter Lim, MD, FACOG, Medical Director of Gynecologic Oncology at Renown Institute for Cancer. Within a few days, Dr. Lim performed abdominal surgery to remove the cancer.
“There was a mass attached to the small intestine, and they removed about a foot that apparently I didn’t need,” she laughed. “But then a CT scan after surgery revealed two little spots were left.
There’s just no guarantee that you’ll get everything in these procedures.”
Chemotherapy was the next step, she said. But she would soon learn of an opportunity that would give her access to the latest treatment protocol.
“Dr. Lim told me about a clinical trial,” she said, referring to GOG 0262. The initials in the trial name refer to the Gynecological Oncology Group, which is a National Cancer Institute-based nonprofit entity that has been studying cancer for four decades.
“The intent of the GOG is to set the standard of therapy for gynecological cancers,” Dr. Lim said. “Over the course of the last 40 years, through the GOG, we have learned a significant amount about treatment for ovarian cancer.”
Dr. Lim noted that he has been involved with the organization for 20 years, and has seen the evolution of ovarian cancer treatment based on its advances.
“This trial has the potential to change the way we treat cancer in the future,” Dr. Lim said. He noted that in this study, the dose schedule and concentration of chemotherapy drugs is in focus. GOG 0262 is studying two different dose schedules of paclitaxel, a standard chemotherapy drug, to determine outcomes in patients with stage III or stage IV ovarian epithelial cancer, primary peritoneal cancer or fallopian tube cancer.
One trial group receives 175 mg/m2 of paclitaxel every three weeks; one trial group receives it weekly at 80 mg/m2. Because the second group ends up receiving a greater concentration of the drug over the course of the three weeks (240 mg/m2), it is called the “dose dense” group.
Ultimately, the study may suggest whether reducing the time between chemotherapy doses and increasing concentration decreases tumor cell survival.
“The Japanese conducted a similar trial a few years ago, finding the outcome favoring the dose-dense delivery,” Dr. Lim said. “So we’re seeing if we can confirm these results.”
Dr. Lim said one of the primary advantages to participation in a clinical trial is the constant monitoring that is involved; not only are patients receiving the standard of care, but they are also being carefully tracked, with progress measured more regularly than if they were not involved in a trial.
“Women who choose to participate should understand that all trials involve very strict guidelines,” Dr. Lim said. “We watch them closely.”
Maddalena elected to participate after hearing of the benefits; she was randomized into the dose-dense treatment group.
“I was a little disappointed just because I live an hour from Reno, so every three weeks would have been more convenient for my schedule,” she said of the 18-week commitment. “But it has really gone by so quickly.”
The time has flown, she said, in part because of a promise she made to herself early on. “I decided I would never count how many treatments I have left,” she said.
But in early June, she reached her final weekly treatment date.
“I’m very proud to have participated in this study,” Maddalena said. “Just knowing that I may help someone else down the road is rewarding. Having people in my life who’ve helped me — like my husband Don — has made all the difference in the world.”
She said Don has allowed her to keep focused, happily taking her every Tuesday at 9 a.m. for her treatment then taking her home to rest.
“He’s almost overbearing, he’s so supportive,” she said. “Fortunately, I really haven’t had a lot of fatigue with the chemo, yet he always looks at me with that look, asking, ‘Aren’t you supposed to be resting?’”
But she admitted that having someone to share the journey with has allowed her to focus on healing.
“One day every week is cancer day — it’s the only day we think about my cancer or talk about it,” she said. “The rest is our time — Don’s and my time. And we’re looking forward to a time in the not-so-distant future when all the time is our time.
More patient stories