When age doesn’t matter: New model of care offers women greater expertise for fighting cancer

Brigitte Jenkins has more living to do.

She is 80, has a full and loving family, and aims to reach her U.S. travel goal – she has visited 49 of our 50 states and has yet to see Hawaii.

That’s why when she was diagnosed with ovarian cancer earlier this year, she didn’t pause long when her USF surgeon recommended surgery to remove the cancerous mass before following up with chemotherapy.

“What I have to do, I have to do,” said Jenkins, describing her approach when she was told she needed surgery. It’s the same way she faces many other challenges in her life.

“I take everything I have to do that way, and I pray a lot,” she said.

USF Health physician Dr. Thomas Rutherford meets with his patient Brigitte Jenkins at Tampa General Hospital Cancer Center.

Jenkins is one of the first women to benefit from a new model of cancer care delivery now offered in the Tampa Bay region, a partnership between the USF Health Morsani College of Medicine (MCOM) and Tampa General Hospital. The effort builds on strengths of existing programs to enhance accessible, integrated and high-quality care for patients and their families.

Leading the program is Dr. Thomas Rutherford, a nationally recognized expert for ovarian cancer treatment and research who joined USF in March 2017. He leads the Gynecologic Oncology Division in MCOM’s Department of Obstetrics and Gynecology and directs the medical school’s gynecologic oncology fellowship program, as well as surgical quality at the Tampa General Hospital Cancer Center.

Rutherford performed the life-saving surgery on Jenkins and wants other older women facing cancer to remember that age alone should not preclude surgery as an option.

OVARIAN CANCER IS KNOWN as the silent killer because it is not usually diagnosed until it’s in advanced stages, when prognosis is poor. For women diagnosed when the disease is confined to the ovary, survival rates are much higher. Stage 1 is when cancer is only in the ovary. Stage 2, it has spread to the pelvis. Stage 3, it has spread to the abdomen and lymph glands. And Stage 4 is metastatic – cancer cells have spread to other parts of the body.

“With ovarian cancers that are found late, about 80 percent of the cases are at Stages 3 and 4,” Rutherford said.

It is more likely for women in mid-life and older to have ovarian cancer. In fact, it’s rare for women younger than 40 to have it. Most of these cancers develop after menopause and half of all cases are found in women age 63 or older.

Despite the high prevalence of ovarian cancer in the elderly, treatment of these patients is often less aggressive than that of younger women. As a result, many elderly cancer patients receive inadequate care.

Which is Dr. Rutherford’s point when counseling patients – age alone is not a negative prognostic factor.

“The majority of elderly patients are able to tolerate the standard of care for ovarian cancer,” he said. “There’s a lot to consider, but age by itself should not be a limitation to surgery.”

WHAT MAKES THE NEW USF/TGH INITIATIVE so unique is the concentration of specialists at the ready to treat the comorbidities of even the most complicated cases.

“With patients like Mrs. Jenkins, it must be well orchestrated and with no delays,” Rutherford said.

Jenkins is a kidney transplant recipient, so nephrologists were standing by while Dr. Rutherford performed surgery. Jenkins also has a heart condition, so cardiologists and pulmonologists were on hand, as well. That heart condition is also what made her first surgeon refuse to operate and offer only rounds of chemotherapy to fight the advanced cancer, giving Jenkins, in essence, a terminal prognosis.

“Most patients will respond to chemotherapy, but we know there can be residual cells – there’s no guarantee the chemo will get it all,” Rutherford said. “Chemotherapy alone without surgery makes no sense.”

Another key factor for the USF/TGH program is its use of a standard of care called Enhanced Recovery After Surgery, or ERAS, which follows a protocol that gets the patient in and out of surgery, up and out of bed, and discharged and home as soon as possible for recovery. ERAS limits narcotics, uses short-acting anesthesia, urges patients to eat nearly right after surgery, and has patients walking fairly soon after leaving the operating room. ERAS is helping reduce length of hospital stays by 35 to 40 percent and offering an earlier return to work and productivity. It has also been shown to reduce complications without a rise in re-admissions.

SIX MONTHS LATER – and about to have her last round of chemo – Jenkins said she is a survivor, ready to keep on living.

“Everything went well. I was in the hospital only one day,” she said. “Dr. Rutherford is a real gentleman. Just wonderful. I really like him.”

Jenkins said that Dr. Rutherford gave her the ‘allclear’ news.

“The pathology report came back and said no more cancer!”

Now she can begin thinking about Hawaii.

Photo by Eric Younghans, story by Sarah Worth, USF Communications.