All-Star Team
Inova Loudoun Hospital’s Breast Care Institute Practices Coordinated Approach

Shannon Lehr, MD, and Madelyn Hetherington worked together to figure out the best approach to treating Hetherington's breast cancer.

This past April, Madelyn Hetherington was diagnosed with breast cancer. “Once I knew I had this, I wanted the operation and I wanted it out of me,” says Hetherington, 44.

Less than three weeks later, doctors at Inova Loudoun Hospital coordinated to perform the mastectomy. “It’s pretty much unheard of to have the operation so soon after the diagnosis,” she says, “but they put me first.”

That inter-physician communication is no accident, explains Shannon Lehr, MD, who was named Medical Director of Inova Loudoun’s Breast Care Institute in January 2010. “The program we’ve designed here is all-inclusive. We develop an all-encompassing, comprehensive yet individualized treatment plan for each patient prior to the initiation of any therapy,” Dr. Lehr says.

Group Effort

As part of this program, each patient has the opportunity to consult with, be evaluated by and receive guidance from each physician team member, including the breast surgeon, medical oncologist, radiation oncologist, reconstructive surgeon and often the genetic counselor. These team members plus the pathologist, breast radiologist, breast care navigator and ancillary support staff meet bi-weekly to “discuss each newly diagnosed breast cancer patient from nuts to bolts,” Dr. Lehr says. This way, patients receive information that reflects the whole team’s opinion.

The strategy was “a bit of a sell,” Dr. Lehr says, because it contradicts the thought that newly diagnosed women should immediately undergo surgery. “Women faced with a breast cancer diagnosis very often have many choices to make, and I want to be sure each woman has the opportunity to get educated and make well-informed treatment decisions that she will be happy with for years to come,” she says.

Most importantly, the approach works. “It’s been shown to not only improve survival rates … but also improve the seamlessness and timeliness of care and [the likelihood of] actually completing treatment,” Dr. Lehr says.

The method starts on day one. Hetherington says when she was first diagnosed, Dr. Lehr gave her a binder containing the business card of every doctor she could work with. “She said, ‘It’s kind of like football — you’ve got to put your team together. I’m your quarterback,’” Hetherington says.

One key member of that team is Barb McDonnell, RN, Inova Loudoun’s breast care navigator. She helps patients through the cancer journey, offering support and advice — something she finds rewarding as a breast cancer survivor herself. “I frequently share [that I’m a survivor] with patients because I think it helps them to know,” McDonnell says. “I’m alive and well and thriving, and they’re going to be too.”

Hetherington says working with McDonnell was especially helpful when her diagnosis took an unexpected turn. After Hetherington’s ultrasound, Dr. Lehr told her that her lymph nodes looked clear, but that the mastectomy would ultimately expose their status. The operation revealed cancer in the lymph nodes, moving Hetherington’s cancer from stage 1 to stage 3.

“Thinking I’m stage 1 and going to stage 3 was kind of hard to swallow,” but McDonnell’s care helped, Hetherington says. “When you are talking to somebody who’s actually gone through it, you go from thinking that your goose is cooked to, ‘Oh my God, I’m going to be OK.’”

A Laughing Matter

Hetherington began chemotherapy treatment in the summer. The night before her first session, she went to see the movie Magic Mike. In the waiting room the next day, Hetherington started talking to the 80-year-old patient next to her, who said she wanted see that “crazy movie,” she says. “Never in my wildest imagination did I think I’d be laughing in the infusion room, and that is just a testament to the doctors and nurses who’ve let it play out that way.”

While Hetherington had her choice of hospitals — including Memorial Sloan-Kettering Cancer Center in her home state of New York — she’s confident in her decision to choose Inova Loudoun Hospital. “My ultimate choice was my best choice and I’ve never looked back. It’s like the Nordstrom of hospitals,” she says. “I’ve always been confident that everything I’ve needed has been right at Inova Loudoun Hospital.”