Coping With a Secondary Cancer Diagnosis

February 18, 2020
Loriana Hernandez-Aldama

Loriana Hernandez-Aldama is an Emmy Award-winning journalist and former news anchor and medical reporter turned leukemia and breast cancer survivor, advocate, author, and speaker. After being diagnosed with acute myeloid leukemia, she launched ArmorUp for LIFE, a nonprofit organization with the core mission of PREhabilitation, which encourages people to change their lives through diet, exercise, and lifestyle before a life-threatening illness like cancer hits and inspires people to stay healthy during and after treatment.

An hour before boarding my flight to Chicago to speak at a cancer fundraiser, I got the call. It was from a Maryland number, which usually meant it was coming from Johns Hopkins Hospital. My heart started to race, and I answered and listened. Did I hear wrong? Maybe the doctor said, “You don’t have cancer again.” No, no, my husband called back to confirm. I do have cancer again. Yes. This time, it’s breast cancer. The news came just 2 days after my 5-year anniversary party with family and friends to celebrate surviving acute myeloid leukemia (AML) and a bone marrow transplant. We decorated a Christmas tree to celebrate life and, suddenly, I felt like mine was once again in jeopardy.

The third time hearing those words—twice during my leukemia experience and then for breast cancer—made my stomach sink. It triggered my post-traumatic stress disorder (PTSD) and stirred up so many emotions, from fear to frustration and anger. The news put the journalist and medical reporter in me back on assignment for answers just like I did for my AML. What I found reminded me of why I keep advocating. 

At home, as I sat sobbing and holding my son, I asked myself, “Haven’t I paid my dues? Isn’t being separated from my then-2-year-old son for a year while facing a 25% chance of survival enough?” But then I realized that sadly, this is paying my dues. This is likely the trade-off for my survival. It’s the secondary cancer likely caused from the chemotherapy and full-body radiation that was needed to save my life. It was the treatment that I needed if I wanted to go home to my little boy. I wouldn’t be writing this blog without it. Trust me, I’m grateful for it. But I’m also allowed to be angry and want a better quality of life. We, as survivors, are allowed to want more.

The good news is, I don’t have to hand over my son for an entire year and stay in the hospital for my breast cancer treatment. While it was supposed to be only 4 days apart, I now learned post-surgery that it turned into 20 days due to complications from my history, including my compromised immune system. I also know the drill. I already learned to ask for help, quickly assemble caregiver spreadsheets, PREhabilitate, and stay fit. I also learned how to put my head before my heart, focus on the fight, and cry later. I even learned how to expect some friends to show up and others to disappear, which happens with cancer treatment. I’d been there, done that.

I also learned breast cancer involves more waiting and “chasing the scans” to see if the cancer has spread and, if it has, finding out where. When I got my leukemia diagnosis, on the other hand, it meant I was quickly hospitalized and soon had chemotherapy running through my veins. 

When I finally saw the breast cancer surgeon, I was given options, which was something I didn’t often hear when living with leukemia. But then my leukemia oncologist quickly nixed those options since I’d already had a lot of full-body radiation, and a lumpectomy would require 20 days of targeted radiation.

Instead, I would be getting a double mastectomy. There were several factors that added to the decision for a double mastectomy, mostly due to my first experience with cancer. First, I had a year of intensive chemo and a bone marrow transplant, and I don’t have my own DNA. I have my sister’s DNA, which makes accurately determining my genetic markers and risk factors challenging. I also have a compromised immune system, enlarged lymph nodes that are already being monitored on my left side (my breast cancer is on my right), and a low resting heart rate because of the toxicity from the chemotherapy. Finally, my previous cancer treatment resulted in many long-term side effects, including neuropathy, bone pain, eye damage, and more.

Once I have my double mastectomy, there will be more to consider, as certain breast cancer treatments carry a risk of leukemia. The problem is, a different cancer requires a different care team. And my treatment plan, like so many others living with a secondary cancer, requires a team effort from both of my cancer care teams. People with a secondary cancer have overlapping issues from previous cancer treatments that can impact our next course of treatment. We require different considerations than patients who are dealing with their first cancer diagnosis.

That said, my advice to other cancer survivors is, first, be proactive so you don’t find yourself reacting to the situation you are in. Advocate for yourself long before you ever face a secondary cancer. Know what type of treatments you had (chemotherapy, radiation therapy, immunotherapy, targeted therapy, etc.) and each treatment’s risk factors. Find out what screenings you should have and insist on having those screenings. Then, follow up on each and every result.

If you are ever diagnosed with a secondary cancer, don’t operate in one lane. I often complain that the health care industry operates in silos and we need to start talking to each other.  Ask, “How does my treatment for my first cancer impact how we treat the second one?” Ask both of your oncologists to connect and figure out together the most safe and effective way to move forward.

In the meantime, take care of you. Keep your mind and body strong. I advocate to follow the 3 “P’s”: Prepare, Present, Prevail. You must prepare your body for illness, so you can present well to your medical team and position yourself to prevail.

I will prevail. I’m mad. I’m frustrated. Life isn’t fair. No one ever said it was. But I know I have purpose: To watch my little boy grow up and to continue to use my experience to drive my advocacy and bring change to how we treat patients so we don’t just boost patient outcomes but also improve quality of life.

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