For Jacqueline Hickey, the pain was so severe at times that it interfered with her daily life.
“It just hurt so bad, especially lying down at night. I got so sleep deprived,” she recalls. “During the day, it was hard to even lift a laundry basket or walk for exercise.”
She has been fighting lung cancer for 14 years since being diagnosed at age 40. When the cancer returned three years ago, her personal physician suggested she go to Memorial Sloan Kettering. A combination of chemotherapy and radiation helped, but eventually the cancer spread to her left rib.
By August 2020, Jaqueline was really starting to suffer. But the mother of four was leery of pain medications.
“I want to be able to focus,” she says. “I have one child still at home and my firefighter husband often works 24-hour shifts. I don’t want to be conked out.”
Fortunately, Jacqueline had other options. In 2019, MSK established a dedicated clinic for treating people with metastatic bone cancer. The clinic, led by radiation oncologist Jonathan Yang, interventional radiologist Ernesto Santos, and orthopedic surgeon Max Vaynrub, includes specialists in surgery, radiation oncology, interventional radiology, rehabilitation medicine, and pain management.
“Bone metastases are about 100 times as common as primary bone cancer,” Dr. Vaynrub says. “They often cause acute pain and fractures and can be very frightening and disabling for patients already dealing with their primary cancer. Effective treatment requires expertise from a multidisciplinary team, which is why we launched the clinic.”
The doctors talked through Jacqueline’s case at one of the clinic’s biweekly meetings. The group discussions allow the specialists to make the best decision for a patient.
To help Jacqueline, the clinic team decided to use stereotactic body radiotherapy (SBRT) and cryoablation. SBRT involves targeted, focused external beam radiation to maximize the radiation dose to the tumor, effectively killing the tumor while minimizing damage to the surrounding healthy tissue.
Cryoablation involves inserting small needles into the bone metastases and freezing and killing the bits of tumor. Dr. Santos specializes in this interventional radiology therapy.
“The coordination of the clinic was amazing,” Jacqueline recalls. “I happened to be at Memorial Hospital getting tests, and they said, ‘We’re going to get you in to see Dr. Santos today.’ I didn’t have to go all the way home and come back. They made it so simple.”
At the bone metastases clinic, doctors in five different specialties can all see patients on the same day. This streamlines the care and limits the number of times a patient needs to come in.
Dr. Santos thought cryoablation would work for Jacqueline, but before scheduling the procedure he wanted her to try something else first. On that same day, she visited pain specialist Amitabh Gulati to do a nerve block — an injection of an anesthetic into her back that blocks pain from specific nerves. The procedure eased her pain, which gave Dr. Santos confidence that cryoablation would work well.
Jacqueline returned several weeks later for cryoablation in the David H. Koch Center for Cancer Care at Memorial Sloan Kettering Cancer Center, which opened in 2020. Dr. Santos froze and killed the cancer cells in the rib, along with some nerves surrounding the area. Because the procedure is minimally invasive, “I was in and out the same day,” she says.
Resuming Normal Life
With her pain and left rib bone metastasis now under control, Jacqueline is having a much better life. “I didn’t realize how much I was suffering until they actually gave me treatment,” she says. “It’s unbelievable the difference it has made. Now I’m back to sleeping, and going out walking, and being able to function and run a family.”
Jacqueline just celebrated the marriage of her daughter, Kristen, on June 19, 2021, in Annapolis, Maryland. She continues to get chemotherapy, usually administered at MSK Nassau, an outpatient facility on Long Island that opened in 2019. “I call it my spa day because I get the nice chair, the TV, they bring me tea. It’s a beautiful facility, just like the Koch building. If I wasn’t comfortable as a result of cryoablation, it would be much harder to do these sessions.”
She wants other people with bone metastases to know there are many new options to continue living with cancer if it has spread.
“There’s so many new things coming out and it’s exciting — if one thing doesn’t work, there’s always something else they can try,” says Jacqueline. “The doctors have set me up for success, and even with stage IV lung cancer, I’m never giving up.”
- Cancer that spreads to the bones is painful
- MSK bone metastases clinic offers pain relief
- Team approach coordinates care from many experts
- Doctors use targeted radiation and freezing to shrink or eliminate tumors