Julie Freeland was just 38 when she was diagnosed with breast cancer. She’s a family nurse practitioner at Atrium Health Primary Care Ardsley Internal Medicine, but then, she became an Atrium Health patient, too. She sought care at Atrium Health Levine Cancer Institute-Cabarrus. Freeland was happy when Atrium Health combined with Atrium Health Wake Forest Baptist, so she could easily access resources from Atrium Health Wake Forest Baptist’s NCI-designated Comprehensive Cancer Center as well.
Freeland’s breast cancer was estrogen receptor-positive/HER2-negative, a type of cancer that feeds on estrogen. The number of people who have this kind of cancer has increased over the past twenty years – as have their survival rates. Freeland’s care team created an approach to fight the cancer and heal the patient. To fight the cancer, Freeland underwent a surgery to remove her fallopian tubes and ovaries, a double mastectomy and a therapy that “zaps” the estrogen out of her body to starve the cancer. To alleviate her side effects, Integrative Oncology at Levine Cancer Institute’s Supportive Oncology Clinic offered her acupuncture and massage therapy to alleviate her night sweats, insomnia and joint pain.
Now, Freeland’s cancer is under control and she’s back to work – but her relationship with her care team continues. Because estrogen-depleting therapies increase risk of heart disease, her care team, including Dr. Alexandra Thomas, professor of hematology and oncology at Wake Forest University School of Medicine, invited Freeland to join a pilot study into the heart health of breast cancer survivors like her. Freeland immediately agreed.
“I wanted to be part of the research and help. In the beginning, I spent so much time just fighting and trying to just stay alive. Once I got through that, I could shift my attention and was open to the possibility of helping others,” Freeland says. “Plus, from my experience in the medical field, I know that joining this research will allow me to help other people and give back.”
Now, that research will go even further. National Institutes of Health (NIH) awarded a five-year, $3.1 million grant to that study, Cardiac Outcomes With Near Complete Estrogen Deprivation (CROWN). The CROWN study is a collaboration between Atrium Health Wake Forest Baptist’s NCI-designated Comprehensive Cancer Center, Virginia Commonwealth University Massey Cancer Center and Duke Cancer Institute. Thomas is a co-principal investigator of this study.
“Our collaboration is a great demonstration of team science that integrates the unique expertise of multiple investigators to address a major unanswered question in cardio-oncology. It has been very exciting to build this team across our institutions, each of which has top-rated cancer centers in addition to cardiovascular imaging centers of excellence,” says Jennifer Jordan, PhD., assistant professor in the Virginia Commonwealth University Department of Biomedical Engineering and Pauley Heart Center.
Supporting Cancer Survivors, Long After Treatment Ends
We have more cancer survivors than ever, due to increasingly effective treatments, earlier screenings and greater cancer awareness. That means that more people live for decades after their cancer treatments end. Sometimes, the therapies that treat cancer can increase long-term health risks later, such as the risk for heart disease, joint pain or digestion problems. That’s why Atrium Health maintains relationships with survivors: to manage these risks and help them live healthy and full lives, post-cancer.
CROWN is part of this mission. It’s a first-of-its-kind study to learn more about cardiovascular risk to young, pre-menopausal, breast cancer survivors. For five years, the study will perform sophisticated imaging tests to monitor cardiovascular health of women who underwent estrogen-depleting therapies. The researchers will compare these tests to those of survivors with hormone receptor-negative breast cancer who didn’t need estrogen-depleting therapies. This will show the extent of heart risk to breast cancer survivors and to treat heart disease that emerges as early as possible.
“These patients have decades of life ahead of them, and we hope that by identifying early changes in coronary arteries, we may find ways to lower their risk of irreversible heart disease,” Thomas says.
The study will also prioritize a diverse pool of participants that represent the diversity of breast cancer survivors. This is crucial: Black patients have historically been underrepresented in medical studies. Because Black women have higher rates of breast cancer and heart disease, CROWN aims to include strong Black representation in this study.
Back to Living a Life of Fulfilled Dreams
Freeland feels grateful to a doctor like Thomas, who specializes in breast cancer in young women and prioritizes their long-term health.
“Dr. Thomas is incredible! She’s amazing. She is supportive, understanding, empathetic,” Freeland says. “She is up-to-date with research and recommendations, and she’s everything you would want in a doctor.”
Now, Freeland’s focus is on living her fullest life. She’s taken dream vacations with her family, including an African safari and an Alaskan cruise. She and her husband have also fulfilled a long-time dream to become foster parents. In addition to raising their two daughters, they’re now the proud foster parents of two girls.
“I am so grateful, I’m trying to live each day to the fullest, and I try to stay positive as much as I can,” Freeland says.
This is the outcome that the CROWN study will work to achieve: giving more breast cancer survivors like Freeland the opportunity to live long, full lives, with many healthy years to fulfill their dreams.
