Living fiercely: MUSC program helps gynecologic cancer patients to regain quality of life from side effects of treatment

Candy Stalteri was cancer-free.

Life should have been good. Not only had she survived surgery and three rounds of chemo but also the long COVID and autoimmune hepatitis that had consumed the two years prior to her ovarian cancer diagnosis.

She was now a full 12 months post-chemo. And yet – she was struggling.

“It seemed like it was taking forever to feel better, and I wasn't really feeling better. And we were doing as much as we could.”

She went into a follow-up appointment with MUSC Hollings Cancer Center gynecologic oncologist Justin Harold, M.D., feeling hopeless.

“I saw him the first of the year, and I said, ‘I'm very depressed,’” she said.

And that’s when he introduced her to women’s health nurse practitioner Montana Woods, who works exclusively with gynecologic cancer patients at Hollings.

Woods told her about a new program being offered at the MUSC Wellness Center in partnership with Hollings.

 

Dubbed Fierce Foundations, the 10-week program gathers up to 12 gynecologic cancer survivors for a structured program of exercise, introduction to physical therapy and occupational therapy, education in nutrition and breathwork and more, all tailored to the unique needs of people who’ve gone through gynecologic cancer and the accompanying treatments.

It’s the third such program at the Wellness Center, following in the footsteps of Fit Club, designed for breast cancer survivors, and Strength Camp, designed for prostate cancer survivors.

Developed by clinical exercise specialists, each program works on problems common among all cancer survivors, like fatigue and cognitive troubles, while also zeroing in on physical symptoms specific to that type of cancer. For example, breast cancer survivors often have trouble lifting their arms because of surgery or radiation to the chest.

For the gynecologic cancer survivors, the exercises focus on strengthening the deep core and pelvic floor muscles as well as improving balance and cardiovascular conditioning, said Cindi Day, clinical exercise program coordinator.

It was just what Stalteri needed.

“I'd probably be very delayed in my recovery if I hadn't done the program,” she said.

A common bond

Each of the women who participated in the inaugural Fierce Foundations session was at a different point in her journey. Three shared their stories here.

Stalteri’s oncologist told her that her primary care doctor’s diligence in investigating her symptoms saved her life.

Caroline Dabney had survived an ovarian germ cell tumor as a 14-year-old in Baltimore and thought she had put the experience behind her.

Jeri Lawing thought she was having heart problems when scans revealed a mass in her lungs. It was a rare form of smooth muscle cancer, leiomyosarcoma, that had metastasized from her uterus to her lungs.

 

Stalteri and Lawing were struggling with common side effects like fatigue, balance issues and cognitive problems – often called “chemo brain.” Dabney, on the other hand, was years past her cancer and worried about taking a spot from a more recent survivor, but she was persuaded to join by a friend who works at the Wellness Center.

She was not prepared for how deeply the program would resonate with her.

“It's been amazing. I think I underestimated what it would be like, what it would mean,” she said. “You just see the care team pouring support and resources into this group of women, myself included, and it's so intentional. It was really, really profound, and it made me realize that I had been shelving my own health.”

The women not only benefited from the professionals working with them but also from each other.

“The camaraderie with the women – we're all so different, but we all have this weird one thing in common,” Dabney said.

“It's not really a club you want to be in, but us ladies who are survivors have formed a good bond, good friendships,” Lawing added.

The women compared notes and talked about the things that other people just wouldn’t get.

“The fact that everybody, with their medication and everything, is constipated – I mean, things that you don't normally talk about. And you think you're alone and you're the only one, but no,” Stalteri said.

Dealing with cancer side effects

The cognitive dysfunction – chemo brain – is real, Lawing said.

“The biggest thing that I have a problem with – and OT said this was, hands down, what everyone complains about – is searching for words,” she said. “Just this morning I was talking to my husband, and I said, ‘Yeah, we need to go exercising. No – walking. No – hiking.’ Hiking was the word I wanted. It’s just that grasping for words.”

 

Chemo brain can make working more difficult, but after working for the MUSC Department of Surgery for almost 24 years, Lawing’s job is second nature.

Her job also means she’s surrounded by surgeons who were anxious to ensure that “Mama Lawing” got the best possible care for a cancer that is already rare but even more unusual in that symptoms showed up years after she had a hysterectomy.

“One of the surgeons said, ‘Oh, I can get you with MD Anderson.’ And somebody else was like, ‘I can get you into Sloan Kettering.’ But I said, ‘You know, I live here. I work here. I'm going to have my treatment here.’ And I swear, I tell everybody, nobody could have taken better care of me,” she said.

Because of the unusual way her cancer showed up, thoracic surgeon Barry Gibney, D.O., was the one who operated, but gynecologic oncologist Brian Orr, M.D., handled her overall care.

“I feel like I'm cured,” she said. “Dr. Orr said we don't use that word. I just feel like, between God looking out for me and these great surgeons, it's just been wonderful.”

She credited Montana Woods with getting her to try Fierce Foundations, which has pushed her to work on her health.

“I never was one to exercise or take care of myself. But this was like a wake-up call,” she said. “I think I'm getting the most benefit from the exercise because, for years, my only exercise was walking from the garage.”

 

Now, she said, she has strength she can feel.

“You can't tell it to look at me, but I feel like my muscles have gotten better. Chemo kind of kills muscle mass, so I feel like I've gotten more muscle,” she said. “I can feel my core, and I can definitely feel it when I’m working out.”

Holistic wellness – preparing cancer survivors for a well-balanced life

Just as important as the directed physical exercise, Day pointed out, are the wellness components like nutritional counseling and therapeutic gardening.

Lawing, for example, found the yogic breathing helpful.

 

Stalteri learned a lot from the information provided by the dietitian.

“The nutritionist came out and created a chart for us: the eight colors you should eat every day, what they were, and what they would help us with. Just that kind of thing, which gave us more knowledge,” she said. “Frankly, that's not what an oncologist would do. And that's not what your primary physician would do.”

And Stalteri especially appreciated that the providers from different disciplines didn’t view their jobs as simply to impart information; instead, they all wanted to hear what the survivors needed.

“No two people are the same. What they need is different. And these specialists do an excellent job of evaluating to say, ‘No, it's not this. It’s not this. It’s not this. Here's what it is,’” she said. “The questions we asked were not silly. There was just no place to ask them before. And we gave knowledge to the professionals who were trying to modify things and see what questions people had.”

Dabney, who had cancer as a young teenager, found herself reconsidering the experience.

“It's always a question for me, when I hear these other women speaking about some of their side effects – I wonder what things I experienced that I just didn't have the wherewithal or the maturity or even just the desire to share,” she said. “I would see a social worker or a therapist, and they'd want to talk about everything I was feeling. And I remember just wanting to talk about what was happening at school with my girlfriends and the drama of being a teenager.”

"Where else does this exist, where, for free, you are receiving this intense amount of almost one-on-one care? It's a huge benefit to having your treatment here in Charleston. It feels like a luxury to have this programming available at no cost to the patient.”

Caroline Dabney
cancer survivor

She encourages women who are undergoing treatment to make a note of the program. They may not feel up to the idea of exercise and socializing now, but it’s something they should try once treatment is finished, she said.

Finding the time is probably the biggest challenge – some of the women had trouble with work schedules, and she sometimes had scheduling problems when childcare fell through. But the program should be a priority, just like treatment, she said.

“Where else does this exist, where, for free, you are receiving this intense amount of almost one-on-one care? It's a huge benefit to having your treatment here in Charleston,” she said. “It feels like a luxury to have this programming available at no cost to the patient.”

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