Beth Henderson considers that Edward Levine, MD, has saved her life not once but twice.
The first involved the “mother of all surgeries,” as she calls it, to address her appendix cancer. The second was a life-threatening blood clot in her lung.
The surgery was HIPEC, or Hyperthermic Intraperitoneal Chemotherapy, a method used to treat cancers that have spread to the lining of the abdominal cavity. It delivers highly concentrated, heated chemotherapy directly to any residual cancer cells at the time of surgery.
Nearly 14 years after the surgery, Henderson is cancer-free. She beat the odds to join the 30+ percent of people diagnosed with her type of cancer who do not have a recurrence.
The turning point, she believes, was the day before Thanksgiving 2004, her first appointment with Levine, who is, head of Surgical Oncology and professor at Wake Forest Baptist Medical Center’s Comprehensive Cancer Center
“That’s the day I met my hero,” she says.
First Appendicitis, Then Cancer
“It was 2004, and we were at the beach,” Henderson recalls. “I woke up in the middle of the night in a lot of pain.”
The resident of King insisted on returning home to see a doctor to find out what was causing the pain. Once home, she learned that her appendix, which she had been told had been removed years earlier during another surgery, was still in place and was rupturing.
Surgery took care of the appendix but revealed that, at age 45, she had cancer. Her doctor had studied under Levine as a resident at Wake Forest Baptist and made an immediate referral.
“I had gone through a lot,” she said, “and they told me I had to go to Wake Forest Baptist to see Dr. Levine and go through a lot more.”
Rare Cancer, Rare Surgery
Henderson’s cancer was rare, with fewer than 2,500 cases diagnosed each year. The median range for survival is five years, depending on the exact type and stage of cancer.
“Dr. Levine explained to me and Ronnie (her husband) what I had, and what HIPEC was, and everything that this surgery involved,” Henderson says. “Then he said, “We will take care of you.’”
HIPEC is an aggressive procedure, but for many, it is the best option for saving or prolonging their life.
“If you were in the military, you’d call it a search and destroy mission,” Levine says.
Surgeons clear as much diseased tumor tissue as they can find inside the abdomen. Knowing some cancer cells likely remain unseen, chemotherapy is then applied throughout the abdominal cavity, usually at an elevated temperature to make the chemo more effective.
Levine has been performing the surgery for more than 20 years and is one of its leading practitioners in the world. Wake Forest Baptist was among the first to offer HIPEC (in 1991), and more than 1,500 HIPEC surgeries have been performed at the Medical Center.
“This is a truly a world-class center for this type of surgery,” Levine says.
Henderson’s surgery in February 2005 went well, lasting about eight hours. The recovery was difficult at times, and it took months before she regained her full strength. The experience, though, made her a believer.
“I would not be here today if I had not had it,” she says. “Systemic chemo doesn’t get to the peritoneal cavity. It goes to the organs in the lymph system. It doesn’t get inside that cavity where your cancer is.”
Beyond Levine, Henderson found a team on hand to help.
“When people come here to be evaluated for the surgery, not only the surgeon but the nurse navigator and the clinic staff take the approach that this is a team,” says Joyce Fenstermaker, RN, an oncology nurse navigator who has worked with all of Wake Forest Baptist’s HIPEC patients, including Henderson, for more than 15 years.
The team helps navigate the process, from evaluation and pre-operative visits to a care pathway program that starts once the patient is admitted for surgery. After surgery, a care coordinator helps ensure that needs are met following discharge and beyond. The process comes full circle when the patient returns to the doctor for post-operative visits and follow-up care.
“Nutrition, financial health, social counseling, how to cope with surgery and unexpected complications—all of those things can weigh heavily on a person,” Fenstermaker says. “Part of the value of the team is that emotional stability.”
A Second Save
Eighteen months after her HIPEC surgery, Henderson was enrolled in a cancer drug clinical trial. During a routine follow-up scan, Levine spotted a blood clot in Henderson’s lung. She dropped out of the trial, but the drug involved was later approved for use with certain types of late-stage cancers “so I still helped somebody,” she says.
As a cancer survivor, Henderson continues to help people, serving as an informal counselor to patients and their families, at the Cancer Center and through social media patient support groups.
“It’s great to see somebody doing so well, so long after the surgery, free of disease and giving so much back to the community,” Levine says of Henderson. “This is not just survivorship. This is survivorship plus, taking her difficult experience and turning it into a big positive for her and for other patients as well.”
Says Henderson, “It’s really good to go over there and encourage people and tell them ‘Yeah, this is really big. But you’re bigger. Don’t ever give up. You’re in the best hands you can be in.’
“I have no regrets and I encourage people to meet Dr. Levine. I will always return to him. Always.”