According to the American Cancer Society (ACS), lung cancer is the second most common form of cancer for both men and women. In 2020 alone, the ACS estimates there will be about 228,000 new cases of and 135,000 deaths from the disease. While these statistics are sobering, new initiatives and forms of treatment are prolonging the lives of many lung cancer warriors. For this Lung Cancer Awareness Month, we interviewed one of them.
Meet Sanda Cohen, a pediatrician and non-smoker. With a family history of breast cancer and a predisposition to skin cancer, Cohen had prepared herself for those diagnoses in the future. But lung cancer came as a total shock. Here, she shares how a new immunotherapy treatment has been able to prolong her life and give her a new sense of good health.
How would you describe your cancer story?
I would describe my cancer as the lowest of lows. I would never have expected to be diagnosed with lung cancer in my lifetime since I never smoked or lived with a smoker or even spent much time with any smokers! But I have been fortunate to have also experienced some associated highs that I believe are a result of modern technology, a truly great health team, and some remarkable advances in medicine. My results would not have been possible more than five years ago. I have always worked in health care and I can truly say I am now experiencing it differently, from a patient’s viewpoint. I think I have been a model patient through these last almost two years!
When did your lingering cough begin?
I began with a cough in the middle of October of 2018. This was not surprising since I have seasonal allergies and live in Kentucky and get a cough most years at this time. I began my usual allergy medicines which seemed to help initially. I was also somewhat fatigued, but I had been busy at work (as a pediatrician) and had quite a lot going on in my personal life. It was probably the middle of November before I noted that my cough was not only no better, but actually worse. I found myself buying and using a lot of cough drops which is not something I had really done previously.
When did you become concerned?
The month of November was extremely busy. My mother-in-law had passed away and we had been busy with her funeral and arranging her memorial service. I also had a baby shower for my daughter-in-law and Thanksgiving dinner for 30 people. I became concerned the Saturday after Thanksgiving when I became short of breath with doing routine household chores. I had not had any chest pain and had never coughed up blood, but I had noted a few times some mild tenderness in my right shoulder. I never had a fever. The shortness of breath was new for me as I had always been very healthy with no history of any lung disease. My husband and I decided to go to the emergency department since it was the holiday weekend.
What were you thinking when you were diagnosed?
I was truly expecting a diagnosis possibly of pneumonia. I had the respiratory symptoms and as a physician working with sick children, certainly was exposed to various viruses. I had a chest X-ray and blood work done. Then, because of the X-ray results, I was told I needed a lung CT. That was a little concerning, but I would not say I was overly suspicious even at that point. The results of the CT were apparently confusing as it was initially read as a large pneumonia. The true findings became apparent after the official reading from the radiologist. I was referred for hospital admission. I would say I never experienced any denial, having been given my CT results to view for myself. However, I was definitely shocked. I had truly thought if I was ever diagnosed with cancer it would be breast (family history) or skin (family history and being very fair skinned).
Did your time as a physician prepare you for your diagnosis or treatment?
I would say being a physician was helpful with the diagnosis and the treatment. But nothing can prepare you really for your first bronchoscopy and first thoracentesis. The next two weeks were filled with numerous doctor appointments and blood tests and PET/MRI scans and genetic testing (this was new to me). I had to have a port placed so I could receive my chemotherapy. From the day of diagnosis to the first treatment was 11 days. Since my diagnosis was for stage IV adenocarcinoma—but not outside of the chest—there was an urgency to begin all the treatment quickly. I was very fortunate to be PD-L1 positive, which meant I was a candidate for Keytruda. Keytruda is an immunotherapy drug which is given initially with chemotherapy and in some patients given alone.
Tell us about your breakthrough treatment. What is it and what was it like for you to take it?
I received the diagnosis and because of a large, malignant pleural effusion, I was given 4-6 months or possibly 6-9 months (depending on the doctor) to live, unless my genetic testing showed I was a candidate for a targeted therapy or immunotherapy. I was able to start Keytruda, which I think has been the difference in my personal story. I also received five treatments of SBRT (radiation) when I completed the six months of chemotherapy. I am almost at my two-year mark, and from what I have been told, this is incredible. There is nothing lucky about any of this, but I am glad that I was at least diagnosed in a time of rapidly expanding medical options and treatment that is individually determined.
What is life like for you now?
I am currently doing well. I have a PET scan done every three months to check on my status and so far, there has been no progression. The large tumor shrank by half and is currently inactive. The malignant effusion and pleural metastases resolved and my involved lymph nodes decreased to normal size. I receive Keytruda as an injection every three weeks. In my house, this is referred to as my “spa day.” I actually don’t mind going!
I was diagnosed with cancer at age 61. I made the decision to retire a year ago, although my initial plan was to work for another 5-10 years. Of course, now with the COVID-19 pandemic, I feel this was definitely the appropriate decision for me. I am thankful for each and every day. I wish I could get out and do more and be more productive, but the risk is too great. I stay busy with a wonderful husband and family and hobbies and have been so fortunate to have been blessed with my first two grandchildren since I was diagnosed with lung cancer.
I do hear of people that have been diagnosed with cancer and make the decision to not undergo any treatment! No, No, No! Life is precious and every day is worth fighting for, so never give up!