Stage IV Cancer: Judy LaRose Is on a Path to Good Health Again

Yale Medicine doctors combined advanced technology with comprehensive cancer care to put one patient back on the path to good health.

Healthy again

Judy LaRose's family helped her in her long battle with lung cancer.

Credit: Robert A. Lisak

Christmastime 2013 did not hold much cheer for Judy LaRose. Her husband, Michael, had been diagnosed in 2009 with an inoperable brain aneurysm at the base of his cerebellum, a condition that had become increasingly debilitating. LaRose was caring for him at their home in Uncasville, while working in the Montville Planning Department.

Then, a visit to the doctor’s office for a lingering cough forced LaRose into an even tougher spot: She was diagnosed with Stage IV lung cancer in her right lung.

The most advanced form of lung cancer, Stage IV is cancer that has begun in the lung and metastasized, or spread to other parts of the body. In LaRose’s case, her cancer had metastasized to her liver. Although the cancer was advanced, her only symptom was that cough, which she attributed to having caught a virus around Thanksgiving. When her husband became ill and needed round-the-clock care, LaRose’s son, daughter-in-law and grandchildren moved in with them. “I never thought they’d be taking care of me,” she says. “But now they are.”

Her daughter-in-law, who has nurse’s training, provided invaluable help. That allowed LaRose to focus at least some of her attention on her treatment while enjoying time with her family.

“I think it’s therapeutic—especially my grandchildren, having them here with us,” she says. “They make me smile. They bring me joy every day. So it’s not me sitting here at home saying, ‘Oh, poor me.’”

‘Treat, treat, treat’

Judy began her treatment close to home at Lawrence + Memorial (L + M) Cancer Center in Waterford—which is now affiliated with Yale Medicine and the Smilow Cancer Hospital at Yale New Haven.

Because the tumor in LaRose’s right lung was wrapped around her aorta (the body’s largest artery, which runs from the heart through the chest and down to the abdomen), surgery to remove it was not an option.

“So it’s always been treat, treat, treat, and let’s do the best we can,” she says. The first treatment was several courses of chemotherapy, which began in January 2014.

“I had horrendous side effects,” LaRose says of the chemo. “I mean, it was doing its job, but I had every side effect on the list other than nausea and vomiting, and it was really beating me up. It would take me time to heal, and I would come back from it, but it wasn’t so great.”

When she started her chemotherapy, her doctor told her that she would have to quit working, but LaRose was adamant about trying to soldier through.

“My doctor said, ‘Judy, you’re not going to be able to work,’” she said.

“And I said, ‘Well, I have to. I need the insurance. I need this. I need that.’ So then, after the second week in, I said, ‘Yep, you’re right.’”

She applied for Social Security Disability and began receiving benefits. Eventually, she had to resign from her position in the planning department.

As she neared the end of her chemotherapy, Michael died, and LaRose relied on her family ever more to help her through. “We had a long five years,” she says.

Taking the next step

After finishing her last round of chemotherapy in March 2015 and taking a short break to recover, the next step for LaRose was radiation to treat her lung tumor. In June, Yale Medicine radiation oncologist James Hansen, MD, began treating LaRose.

LaRose’s daughter-in-law and other family members drove her to appointments after she stopped driving because of chemotherapy-induced peripheral neuropathy (CIPN) in her hands and feet. This is a common side effect in which nerves outside the brain and spinal cord are damaged by chemotherapy drugs, resulting in symptoms such as pain, tingling and loss of feeling.

“I made the decision myself that I didn’t feel comfortable with my not being able to react quickly,” she says. 

From the start, LaRose says, she was “really pleased” with Dr. Hansen and the Yale Medicine staff. The radiation team prepared her well for possible side effects. “The explanations were very good, very thorough,” she says. “I never felt the need to call them, even though they made it clear that I could call 24-7.” Her treatment consisted of 30 sessions from June to mid-August 2015.

LaRose was lucky that her skin did not have many side effects at the spot where the radiation was aimed. (It is common for radiation treatment to cause skin irritation and redness, which can be similar to a severe sunburn.) But, she did suffer fatigue, which has lingered.

“The fatigue affects you in such a way that when I say I have to lie down, it’s not for a 10-minute power nap,” she says. “It’s going to be three hours because I’m just flat-out exhausted and my body can’t take it anymore.” 

Targeted treatment

After taking the early part of fall 2015 to regain her strength, LaRose had a positron emission tomography (PET) scan and a magnetic resonance imaging (MRI) scan in November, to assess how the lung tumor had responded to radiation and the status of the metastases. The results were good, but Dr. Hansen and LaRose’s medical team wanted to go after one spot in her liver.

Dr. Hansen referred LaRose to Kimberly Johung, MD, PhD, a Yale Medicine radiation oncologist for the Yale Cancer Center who practices at Smilow. She is a leader in using stereotactic body radiation therapy (SBRT), which is a special form of radiation used to treat specific cancers in the liver.

The technology is newer than other forms of radiation, but there is a growing body of medical evidence to support the use of SBRT, and Dr. Johung says the technique has become more accepted as a treatment option. For certain tumors, it has advantages over other approaches to radiation therapy.

“Treatment with SBRT is essentially very well tolerated, with minimal side effects,” Dr. Johung says. “And it can be given in three to five treatments, rather than with typical radiation, where you’re coming every day for six or seven weeks sometimes.”

This shorter course of radiation is usually a welcome convenience for patients. And recent research shows that SBRT has a strong success rate in treating some kinds of tumors, especially smaller ones.

Always watching out for her

LaRose started SBRT in January 2016. She had to travel to Smilow Cancer Hospital at Yale New Haven for her sessions because the specialized machines needed for SBRT aren’t widely available. Yale Medicine is one of only a few institutions in and around Connecticut to offer it. She had five sessions total of SBRT, and Dr. Johung aimed for a couple of days in between them so LaRose could have some time to heal.

LaRose’s side effects were minimal, just as Dr. Johung had described. “Going through it, I actually felt pretty decent,” LaRose says. “I felt better than I had when I had received the lung cancer radiation treatment.”

Although they didn’t see each other for every treatment, LaRose says she felt like Dr. Johung was always watching out for her. Cancer treatment can be impersonal at times, LaRose says, but Dr. Johung and the Yale Medicine team made it much less so.

“Dr. Johung would come see me as they were either setting me up for my treatment or while something else was going on,” LaRose says. Dr. Johung also called her at home to check up on her after some treatment sessions. “So I did have interaction with her a lot,” LaRose says. “Which made my comfort level great.”

LaRose finished SBRT at the end of February 2016. She then met with Dr. Johung and the rest of her medical team in May 2016 to see how well it worked. At that point, the good news was that it did work on the spot that was concentrated on, but others had shown up. A new treatment plan would be needed.  But just because her trips to Yale Medicine are over for now, that doesn’t mean the doctors there have forgotten about her.

“Dr. Johung has phoned me to see how I’m doing,” LaRose says. “Which is also great, because I think that it really gives you a good feeling to know that somebody cares.”

LaRose conferred with her oncologist Dr. Benjamin Newton at L + M, and it was determined that she would begin immunotherapy treatment. She has been receiving treatments every two weeks since June 2016, and so far it has been keeping the cancer at bay. Her fight continues.

To learn more about how Yale Cancer Center treats lung cancer, click here.