USF graduate nursing students gain insight from an innovative program promoting earlier diagnosis

L to R: Ovarian cancer survivors Kris Walker, Carole Martinez and Joel Valdes spoke candidly about the challenges of interacting with health care practitioners during diagnosis and treatment.

Their stories were all different, but they shared a common thread. At different times during their journeys through the health care system, the three woman – all ovarian cancer survivors – experienced symptoms that were unrecognized or dismissed by health care professionals.

The women – Kris Walker, Carole Martinez and Joel Valdes – brought the innovative Survivors Teaching Students (STS): Saving Women’s Lives program to Tampa for the first time May 13 when they spoke to nearly 100 graduate nursing students taking Advanced Health Assessment in the USF College of Nursing. Carla Jimenez substituted for Martinez during the afternoon sessions.

Among gynecological cancers, ovarian is the deadliest – one of the five leading causes of cancer death among U.S. women. Early symptoms are frequently ill-defined and may mimic other conditions, so by the time most cases are detected the cancer is advanced and often incurable.

Kris Walker

Walker, diagnosed with ovarian cancer in 1999 following several misdiagnoses, said the key message the STS team wanted to convey to students is the importance of checking out even vague symptoms like bloating and back pain.

“It’s so important to listen to the patient,” she said. “Yes, the symptoms could be anything, but remember that they might also be ovarian cancer. Health practitioners need to keep it mind and rule it out.”

The STS program, started by the survivor-led organization Ovarian Cancer National Alliance (Alliance), has been conducted in more than 50 medical schools across the United States. Recently expanded to nursing schools, the program aims to promote the earlier diagnosis of ovarian cancer by increasing the number of health care professionals who recognize its symptoms and risk factors.

This year, the Florida Department of Health Comprehensive Cancer Control Program, in partnership with the Alliance, received a grant from the Centers for Disease Control and Prevention to begin offering the program to medical and nursing schools in three regions – Tampa, Tallahassee and South Florida.

The nursing school at USF is the third in Florida to host the STS team, said Mary Shafer, a health educator for the state’s Comprehensive Cancer Control Program. The state also hopes to bring the presentation to USF medical students in the third-year women’s health rotation during fall semester, Shafer said. “The student feedback has indicated this is a valuable way to help put a face and voice to ovarian cancer.”

During the recent morning session in their Advanced Health Assessment class, the graduate nursing students listened attentively as the panel of survivors shared the stories of their experiences with the disease, including the risk factors, symptoms and how physicians and nurses communicated (or failed to communicate) with them throughout their diagnosis and treatment. The women demonstrated their resilience – while undergoing chemotherapy one continued to care for an ailing mother-in-law while another lost her father.

The survivors touched on the ever-present concern that their cancer could recur and what the diagnosis means for their children. They stressed the importance of health professionals providing a sense of hope to patients facing a daunting disease.

Carole Martinez, a retired school media specialist, said that a work accident, which she initially thought was the cause of severe back pain, led to a series of doctors’ visits ultimately culminating in a diagnosis of ovarian cancer in February 2003. “The accident actually proved to be a blessing in disguise that resulted in my ovarian cancer being diagnosed early,” said Martinez. “If the disease is found at an early stage, the prognosis is much better.”

Even before the accident, Martinez had visited a primary care physician complaining of unusual weight gain, pelvic pain and fatigue. “She told me it was my age, my diet, stress,” she said. “She failed to do a manual palpation of the abdomen.”

Carole Martinez

Because of changes in insurance or disease recurrences, the women often ended up seeing several physicians during the course of their treatments, which often included more than one surgery and several rounds of chemotherapy. Walker recalled one gynecological oncologist “who proved to be the bane of my travels through this journey with ovarian cancer.”

"He was very crass and didn’t have time to talk with you about anything,” Walker said. “It was pretty much ‘Here’s the types of chemo you can have – pick one.’ I said, ‘Hey, wait a minute. I need a little more input from you regarding what direction I should take, considering what I’ve already been through.’”

Following their presentations, the survivors – all members of the ovarian cancer support and advocacy group Ovacome – invited the students to ask questions and complete evaluations of the program.

USF graduate nursing students listened intently to the survivors' stories.

Student Maria Gallo, an oncology nurse at Fawcett Memorial Hospital in Port Charlotte, said it made an impression on her when Martinez said her blood test for the tumor marker CA125 came back normal before she was diagnosed, despite other symptoms associated with ovarian cancer.

“It just reinforces that you can’t rely on one lab value,” Gallo said. “You need to evaluate lab reports and test results in light of the patient’s comprehensive history.”

Student Lori King, a maternal child health nurse at St. Joseph’s Hospital in Tampa, said the presentations offered insight into how each woman reacted differently to the same disease and its treatment. For instance, Martinez described the hair loss associated with chemotherapy as “very disturbing” and disliked the hot, scratchy feel of wigs. But, fellow survivor Valdes, called the hair loss her “Mrs. Potatohead” stage and joked with co-workers who critiqued the different styles and colors of wigs she wore.

“It really emphasizes the importance of treating each patient as an individual, with individual concerns and different ways of coping, instead of as a disease state,” King said.

Nadine Connor, MSN, ARNP-BC, USF nursing instructor for the Advanced Health Assessment class, said patient presentations such as STS are an important adjunct to students’ academic studies on cancer and other chronic diseases. “If you truly believe patients are partners in their care, then it’s important to hear their stories, to understand their perspectives of care,” said Connor, a family nurse practitioner. “These women have been through a devastating diagnosis... We need to learn from their experiences what we can do to better help our patients live with an acute or chronic illness.”

Ovarian cancer resources for health care professionals are available at the National Cancer Institute’s website, www.cancer.gov/cancertopics/types/ovarian.

- Story by Anne DeLotto Baier/USF Health Communications
- Photos by Eric Younghans/USF Health Media Center