♪♪

♪♪

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>>> HELLO AND THANKS FOR JOINING

US.

TODAY ON "ARIZONA WEEK" BREAST

CANCER.

FOR WOMEN IT'S ONE OF THE

LEADING CAUSES OF DEATH.

IN ARIZONA, EVERY YEAR MORE THAN

3400 WOMEN ARE DIAGNOSED.

ONE OF THOSE WOMEN IS JACKIE

LAMADRID, A WIFE, A MOM AND NOW

PATIENT RECEIVING CHEMOTHERAPY.

A CAREFUL BALANCING ACT, IT'S

THE FIGHT OF HER LIFE.

>> DID YOU BRUSH YOUR TEETH

ALREADY?

HERE.

WHOOPS, THAT SHIRT IS NOT YOUR

SIZE.

PUT YOUR SHOES ON.

YOU HAVE TO PEE?

>> NO.

I'LL GET YOUR PANTS, SUCK IT IN.

THERE YOU GO.

GET SOME SOCKS.

>> YOU WANT SOME FRESH ORANGE

JUICE?

I'LL MAKE IT.

WITH APPLE?

YOU DON'T KNOW WHAT YOU'RE

MISSING.

>> ALL OF IT.

>> IT'S A LOT OF ORGANIZING

MYSELF AND MY FAMILY.

TO PICK UP TWO FROM HERE, TWO

FROM ELEMENTARY, ONE FROM

PRESCHOOL.

>> GIVE ME A KISS.

THOSE PAPERS ARE SUPPOSED TO

HAVE BEEN TURNED IN THE DAY

BEFORE YESTERDAY.

>> ME AND ROBERTO FLIP HOUSES.

[ SPEAKING SPANISH ]

>> HE NEEDS TO COME AND PAINT

EVERY SINGLE DOOR IN THE HOUSE.

>> IT'S JOTTING DOWN EVERYTHING

THAT WE HAVE TO DO.

WHAT'S MISSING FOR THE DAY.

WERE YOU MISSING A DOORKNOB

HERE.

>> MY NAME IS JACQUELINE

LAMADRID, I'M THE MOTHER OF FOUR

THREE LITTLE BOYS AND ONE LITTLE

GIRL.

MY HUSBAND IS ROBERT LAMADRID.

>> AND I HAVE ROBERTO, HE'S

NINE, AND ROQUE WILL TURN FIVE

ON SUNDAY AND ROMANA TURNED ONE

IN JANUARY.

SO FEBRUARY, I WENT INTO TAKE A

SHOWER IN THE MORNING BEFORE I

GOT THE KIDS READY TO GO TO

SCHOOL, WHEN I WAS TAKING A

SHOWER I FELT A BUMP ON MY RIGHT

BREAST.

TWO WEEKS AFTER THAT, I HAD A

DOCTOR'S APPOINTMENT.

SHE FELT THE LUMP ON MY BREAST.

THEY CALLED ME IN, AND THEY SAID

THE DOCTOR NEEDS TO SEE YOU.

CAN YOU COME INTO THE OFFICE?

AND I SAID CAN YOU JUST TELL ME,

GIVE ME MY RESULTS OVER THE

PHONE?

AND SHE SAID NO, THEY NEED TO

SEE YOU.

AND I WAS LIKE OKAY, I HAVE

BREAST CANCER.

>> WE WALK IN ON FRIDAYS AND SHE

SITS US DOWN AND SHE'S LIKE, YOU

HAVE BREAST CANCER.

THAT'S PRETTY MUCH HOW SHE SAID

IT.

AND I'M LIKE -- I JUST REMEMBER

PUTTING LIKE MY HANDS OVER MY

EYES AND JUST LIKE DROPPING MY

HEAD AND CRYING.

>> AND SO I ASKED HER, HOW MANY

MONTHS DO I HAVE TO LIVE?

AND SHE'S LIKE NO NO NO.

SHE'S LIKE -- YOU, SHE'S LIKE,

IT'S A VERY FAST-SPREADING

CANCER THAT YOU HAVE.

AND I'M LIKE, OH, MY GOSH.

IT'S SPREADING.

OKAY.

IT'S SPREADING.

WHAT DO I DO NOW?

IT'S SPREADING.

I ALWAYS REMEMBER SHE TOLD ME,

YOU GRAB YOUR FAMILY BY ONE HAND

AND YOU GRAB GOD BY THE OTHER

HAND AND YOU WALK DOWN THIS

TUNNEL AND YOU DON'T LOOK BACK.

WELL, OKAY.

I GUESS I'LL JUST WALK THROUGH

THE TUNNEL AND NOT LOOK BACK.

GOT TO THE HOUSE, TALKED TO MY

FAMILY.

CRIED A LITTLE BIT.

AND THE NEXT DAY CRIED A LITTLE

BIT.

KIND OF WAS LIKE, IF YOU'RE IN A

DREAM THE NEXT DAY YOU KNOW KIND

OF WAITING TO JUST WAKE UP, I

GUESS.

AND THEN THE NEXT DAY I WAS LIKE

NO, I'M NOT GOING TO CRY ABOUT

THIS ANY MORE.

SO NOW WE'RE WAITING FOR A WHOLE

WEEK AFTER THAT TO SEE THE

ONCOLOGIST.

SO WHEN WE GET THERE, HE'S LIKE,

IT'S NOT SPREADING.

IT'S STILL THERE.

AND I'M LIKE, OH GOD, THANK YOU.

IT WAS THE LIKE THE BEST NEWS I

THINK I'VE EVER GOT IN MY LIFE.

THE DOCTOR SAID WELL YOU HAVE IT

ON YOUR RIGHT BREAST, YOU DON'T

HAVE ANYTHING ON YOUR LEFT

BREAST.

WHAT DO I NEED ONE BREAST FOR?

I SAID CUT BOTH OF THEM OFF.

>> WHEN IT FIRST HAPPENED, YOU

LOOK DOWN, YOU KNOW YOU GET OUT

OF BEING ALL GROGGY FROM YOUR

ANESTHESIA AND YOUR DRUGS AND

EVERYTHING.

AND I JUST HAD BANDAGES AROUND

ME.

AND WHEN I GOT TO THE HOUSE, I

TOLD ERICA, MY SISTER AND MY

MOM, I TOLD THEM, I DON'T WANT

TO LOOK DOWN.

I STARED AT MYSELF FOR A LITTLE

BIT.

AND -- I THINK I CRIED ONE MORE

DAY AFTER THAT.

AND I HAVEN'T CRIED ABOUT IT

EVER SINCE.

I CAN'T BE SURPRISED THAT I HAVE

CANCER.

I'LL PUT IT THAT WAY.

I CAN'T BE SURPRISED BECAUSE I

SMOKED, BECAUSE I ATE VERY BAD.

I HAVE COMPLETELY CHANGED MY

LIFESTYLE.

I STARTED SMOKING WHEN I WAS 17.

JUST OCCASIONALLY.

AND THEN THAT TURNED INTO LIKE A

HEAVY SMOKER, LIKE A PACK A DAY

KIND OF SMOKER FOR YEARS AND

YEARS.

UNTIL I WOULD GET PREGNANT AND I

WOULD STOP SMOKING, THE SECOND I

FOUND OUT.

UNTIL A FEW MONTHS AFTER I HAD

THEM, STOPPED BREAST FEEDING AND

I WOULD START AGAIN.

IT WAS JUST -- A CYCLE OVER AND

OVER AND OVER.

AND I REALIZED THAT CANCER HAS A

LOT TO DO WITH WHAT WE EAT.

A LOT TO DO WITH WHAT WE EAT.

AND THE ENVIRONMENT OF COURSE.

AND SO I STARTED A THERAPY

THAT'S JUICING, IT'S 90% JUICING

AND IT'S 10% COOKED VEGETABLES.

THEY SAY THAT SUGAR FEEDS CANCER

CELLS.

SO THAT'S THE LAST THING I

WANTED TO DO WAS FEED MY CANCER

CELLS.

>> WE TALKED ABOUT

IMMUNOSUPPRESSION, YOUR IMMUNE

SYSTEM IS COMPROMISED.

>> TRAVELING IS ONE OF THE

HARDEST PARTS OF THIS WHOLE

CANCER JOURNEY.

BECAUSE ALTHOUGH I HAVE GOT SOME

THINGS HERE, MY CHEMOTHERAPY

WILL IN TUCSON.

IT'S A TWO-HOUR DRIVE SO WE GO

120 MILES TO TUCSON EVERY WEEK.

I DECIDED TO GO TO UMC BECAUSE I

FEEL LIKE THAT'S THE BEST PLACE

I COULD GET TREATED AT.

♪♪

♪♪

♪♪

>> THE HARDEST PART OF THIS

WHOLE JOURNEY WOULD PROBABLY BE

NOT BEING ABLE TO PICK UP MY

DAUGHTER.

>> GO, GO, GO, YEAH!

♪♪

>> SO WE KNEW WE HAD TO HAVE A

GAME PLAN FOR THE WHOLE

MASTECTOMY THING.

WHILE MY MOTHER-IN-LAW STAYS AT

HOME.

SHE OFFERED TO YOU KNOW, SHE

SAID THE WHOLE TIME THAT YOU'RE

DOING THIS, SHE'S LIKE, I'LL

TAKE THE BABY.

WE COULD FIGURE OUT A WAY TO

MAKE IT WORK.

SHE'S LIKE YOU GUYS CAN COME

OVER AFTER YOUR WORKDAY IS DONE.

WE CAN MEET EACH OTHER AT THE

GAMES, WE CAN YOU GUYS COME SAY

GOOD NIGHT TO HER, KIND OF

WATCH, PUT HER TO SLEEP AND IN

THE MORNING, SEE HER AGAIN SO

SHE'S YOU GUYS WHEN SHE WAKES

UP.

I KNOW SHE DOESN'T FORGET ME,

BECAUSE SHE CAN'T BECAUSE I SEE

HER EVERY DAY, ALL DAY.

BUT WHAT IF SHE DOESN'T THINK

I'M HER MOM ANY MORE?

I SEE HER SOMETIMES AND SHE LIKE

CLENCHES ON TO MY MOTHER-IN-LAW.

AND IT JUST LIKE KIND OF CRINGE

INSIDE.

IT'S NOT JEALOUSY, OR ANYTHING,

IT'S JUST LIKE THAT SHOULD BE

ME, BUT I CAN'T DO IT.

I DON'T KNOW WHAT I WOULD HAVE

DONE WITHOUT THEM.

WITHOUT MY HUSBAND, WITHOUT MY

MOM AND DAD.

WITHOUT MY MOTHER-IN-LAW

ESPECIALLY WITH HELPING ME WITH

THE BABY.

I TALK TO MY MOM AND DAD EVERY

DAY, TO MY BROTHERS AND SISTERS

EVERY DAY.

TO MY MOTHER-IN-LAW EVERY DAY

BEFORE THIS HAPPENED.

IT WAS LIKE THAT.

>> BYE, BYE!

>> WE'RE VERY CLOSE-KNIT.

AND IT'S ALWAYS BEEN LIKE THAT.

AND I'M VERY LUCKY.

I WANT MY KIDS TO KNOW THAT

NOTHING IS GOING ON.

TIE YOUR SHOE.

JJ IS GOING TO TIE IT FOR YOU.

>> I DO EVERYTHING SO THEY CAN

SEE THAT EVERYTHING IS FINE.

NO, NO, NO, TIE THE SHOE.

THAT A BOY.

>> I'M NOT GOING TO MISS A

BASEBALL GAME.

I DON'T CARE IF IT'S

CHEMOTHERAPY DAY AND I FEEL

HORRIBLE.

I'M GOING TO BE AT THAT THEIR

BASEBALL GAMES, AT THEIR

ASSEMBLIES, I'M GOING TO TAKE

THEM TO SCHOOL.

LIKE IF IT KILLS ME, IF I'M LIKE

AT THE END OF THE DAY,

EXHAUSTED, BUT THEY SAW ME, THE

WHOLE DAY, FINE AND HAPPY AND

EXCITED TO SEE WHAT THEY'RE

GOING TO DO?

THAT'S WHAT I WANT THEM TO KNOW.

IS THAT I DIDN'T STRUGGLE

THROUGH THIS.

THEY CAN KNOW IT WHEN THEY'RE

OLDER.

RIGHT NOW I DON'T THINK THEY

NEED TO KNOW THAT.

>> BREAST CANCER TYPICALLY

AFFECTS OLDER WOMEN.

AT 31, JACKIE'S CASE IS UNIQUE.

DR. PAVANI CHALASANI, AN

ONCOLOGIST AT THE UNIVERSITY OF

ARIZONA CANCER CENTER IS

TREATING JACKIE.

>> TYPICALLY BREAST CANCER IS A

CANCER THAT WE GET AS WOMEN GET

OLDER SO OVER 60, 65, ONE IN

EIGHT WOMEN ARE KNOWN TO HAVE

BREAST CANCER, YOU ABOUT NOT

YOUNG WOMEN.

BUT WE ARE SEEING MORE YOUNG

WOMEN GETTING DIAGNOSED, THERE'S

MORE AWARENESS, THERE'S NO

PARTICULAR, WHEN YOU THINK ABOUT

THE OVERALL STATISTICS, THE

NUMBER IS STILL ON THE LOWER

SIDE.

BUT FOR JACKIE'S YES, IT IS RARE

TO HAVE A YOUNG WOMAN TO HAVE

THAT KIND OF CANCERS.

THERE ARE, YOU HAVE A STRONG

FAMILY HISTORY, LIKE GENETIC

MUTATIONS, THOSE TEND TO

PREDISPOSE, BUT FOR HER, IT WAS

NOT THE CASE.

>> WHY DOES JACKIE HAVE CANCER?

I KNOW THAT'S A TOUGH QUESTION,

BUT WHAT SORTS OF THINGS MAY

HAVE HELPED CAUSE THIS?

>> SO FOR HER IN PARTICULAR, IN

GENERAL FOR WOMEN WE ARE LOOKING

AT THE RICK OF CANCER, WE LOOK

AT THEIR AGE OF FIRST

CHILDBIRTH, WHEN DID THEY

UNDERGOING MENARCHY OR

MENOPAUSE, AGE THAT THEY

BREASTFEED, ANY HORMONE

REPLACEMENT THERAPY.

THINGS LIKE THAT FOR JACKIE,

NONE OF THOSE, SHE, I MEAN THERE

WAS NOTHING.

SHE DID NOT HAVE ANY OF THOSE

RISK FEATURES.

SHE WAS YOUNG, SHE HAD A KID

EARLY ON THERE WAS REALLY NO

RISK FACTORS.

AND THE MAJORITY OF THOSE DO

ALSO GO MORE FOR ESTROGEN

RECEPTOR POSITIVE.

A HORMONE RECEPTOR-POSITIVE THE

MOST COMMON TYPE.

BUT FOR JACKIE, THAT WAS NOT THE

CASE.

>> JACKIE SEEMS TO THINK SHE

SOMEHOW CAUSED THIS, WITH

SMOKING OR DIET.

IS THAT AN OUTRAGEOUS IDEA?

OR DOES THIS MAKE SENSE TO AN

ONCOLOGIST?

>> SMOKING AND CERTAIN DIETS DO

LEAD TO RISKS OF CANCER, BUT NOT

THE ONE THAT JACKIE HAS.

IT'S HARD BECAUSE WE ALWAYS TEND

TO BE HARD ON OURSELVES, I TRY

TO TELL JACKIE, I DON'T THINK

SHE COULD HAVE DONE ANYTHING OR

NOT DONE ANYTHING TO HAVE

PREVENTED THIS.

I MEAN SHE'S NOT SUPPOSED TO

HAVE CANCER AT THIS AGE AND SHE

DID.

AND SMOKING IS KNOWN TO BE

ASSOCIATED, LUNG CANCERS, YOU

KNOW.

BREAST CANCER, BUT STILL SMOKING

IS NOT GOOD FOR YOU.

BUT AT THE SAME TIME SMOKING, WE

TALK ABOUT HOW MANY YEARS OF

SMOKING AND HOW MUCH ARE YOU

SMOKING.

AGAIN, JACKIE IS NOT EVEN OLD

ENOUGH TO HAVE HAD EXPOSURE TO

THOSE NOT SO GOOD SIDE, NOT SO

GOOD HABITS THAT SHE KEEPS ON

THINKING.

EVEN FOR LONG-TERM.

>> JACKIE IS CANCER-FREE, BUT

SHE DOES HAVE TO UNDERGO

CHEMOTHERAPY.

WHY?

>> BECAUSE THE ODDS ARE FROM

SELF-LEAKING, BEFORE THE CANCER

WAS REMOVED FROM HER BODY WERE

PRETTY HIGH, DEPENDING ON THE

SIZE OF THE TUMOR AND THE

BIOLOGY OF THE TUMOR.

BECAUSE OF THE SIZE OF JACKIE'S

TOMBER AND THE BIOLOGY AND HER

AGE, CHEMOTHERAPY HAS BEEN SHOWN

TO DECREASE THE INCIDENCE OF

THIS CANCER COMING BACK.

NOT FOR NEW CANCER, BUT THAT

CANCER COMING BACK.

ARE GOING TO REDUCE WITH THE

CHEMOTHERAPY.

BECAUSE NO MATTER WHERE IN YOUR

BODY, IT'S THE SAME KIND OF CELL

WITH THE SAME BIOLOGY.

WE'RE TRYING TO ATTACK THEM.

>> CAN YOU DESCRIBE

CHEMOTHERAPY?

WHAT THE PROCESS IS, WHAT IT

DOES TO THESE CELLS?

>> CHEMOTHERAPY, THE REASON IT'S

STILL AROUND NOW, IN THE AGE OF

ALL THE TARGETED THERAPIES IS

BECAUSE IT'S EFFECTIVE.

CHEMOTHERAPY, MOST MAJORITY OF

THEM ARE DESIGNED TO KILL CELLS

WHICH DIVIDE FAST.

BUT CHEMOTHERAPY IS NOT A VERY

SMART CELL THAT WAY.

SO IT DIVIDES, IT KIND OF OF

KILLS CELLS, ALL WHICH ARE

DIVIDING FAST.

IT DOESN'T DIFFERENTIATE BETWEEN

A NORMAL CELL OR A CANCER CELL.

ANY CELL WHICH IS GROWING FAST.

SO SELECTIVELY, THE CANCERS ARE

DYING, BUT AT THE SAME TIME, WE

LOSE HAIR BECAUSE OUR HAIR IS

CONSTANTLY GROWING.

BUT OUR MAIN AREA WITH

CHEMOTHERAPY IS IMMUNE

SUPPRESSION, BECAUSE THE BONE

MARROW IS CONSTANTLY MAKING OUR

WHITE BLOOD CELLS AND OUR RED

BLOOD CELLS AND OUR PLATELETS.

OUR BONE MARROW IS HEALTHY, IT

WILL RECOVER.

THE CHEMOTHERAPY MAJORITY IS

GIVEN IN AN IV.

THEY GO IN AND OUT OF YOUR BODY

FOR 24 HOURS.

IT'S NOT GOING TO BE IN YOUR

BODY FOR THE WHOLE THREE WEEKS.

BUT THE CHEMOTHERAPY REGIMENS

ARE GIVEN EVERY TWO WEEKS, EVERY

WEEK OR EVERY THREE WEEKS.

THE REASON WE GIVE THE BREAK IS

DEPENDING ON YOUR REGIMEN, WE

WANT YOUR BODY GOING TO RECOVER.

THE CHEMOTHERAPY IS NOT GOING TO

BE IN THERE FOR THREE WEEKS.

IT GOES IN, DOES ITS

CELL-KILLING AND GOES OUT.

>> SHE DECIDED TO HAVE A DOUBLE

MASTECTOMY.

IS THAT THE BEST DECISION?

>> FOR JACKIE, I THINK FOR HER

IT WAS REALLY A VERY EMOTIONAL

DECISION.

WHEN SHE WAS DIAGNOSED WITH

THAT.

SHE REALLY WANTED TO.

BUT WE DID TALK ABOUT THAT IT

WAS NOT INDICATED FOR HER.

SO, BUT SO A DOUBLE MASTECTOMY

IS INDICATED FOR CERTAIN WOMEN,

FOR CERTAIN CANCER TYPES WHEN

THERE'S A GENETIC MUTATION, A

VERY STRONG FAMILY HISTORY.

PERSONALLY WHEN THEY'RE HAVING

MULTIPLE CANCERS OR IF

LUMPECTOMY IS NOT AN OPTION.

BUT FOR JACKIE, IT WAS JUST

REALLY HARD FOR HER.

I THINK SHE CHOSE TO DO THE

BILATERAL MASTECTOMY.

BUT FOR TRIPLE NEGATIVE CANCERS,

IF THERE'S NO OTHERWISE

INDICATION, GETTING LUMPECTOMY

WITH RADIATION IS A VERY GOOD

OPTION.

>> THE CHANCES OF MOM, SISTER OR

EVEN DAUGHTER HAVING BREAST

CANCER ARE SLIM AT THIS POINT?

>> SO THE MAIN THING IS, EVEN

THOUGH THE MUTATION IS NEGATIVE,

IT COULD MEAN TWO THINGS.

A, IT'S COMPLETELY SPORADIC, IT

WAS JUST THE LUCK OF THE LAW AND

IT WAS JUST JACKIE.

IT ALSO MEANS IT COULD BE A

MUTATION THAT WE DO NOT KNOW

RIGHT NOW.

WE HAVEN'T FIGURED IT OUT.

HOWEVER, THE OTHER MAIN THING WE

NEED TO REMEMBER IS THE FAMILY

HISTORY.

SO HER DAUGHTER, IF HER MOTHER

GETS DIAGNOSED AT 30, HAVING

IMMEDIATE RELATIVE WITH BREAST

CANCER AT A YOUNG AGE DOES PUT

YOU AT A HIGHER CHANCE OF

DEVELOPING BREAST CANCER.

IT'S IMPORTANT TO BE AWARE.

SAME THING FOR HER SISTER AND

HER MOM.

HAVING AN IMMEDIATE FIRST

RELATIVE BEING DIAGNOSED WITH

BREAST CANCER, INCREASES YOUR

RISK OF BREAST CANCER.

>> JACKIE APPEARS TO BE QUITE

PROACTIVE.

WHAT'S THE PROGNOSIS FOR HER

OVER THE NEXT FEW MONTHS?

>> IT'S PRETTY GOOD.

I JUST TALKED TO HER OVER THE

PHONE.

AND THE FIRST FEW DAYS AFTER

CHEMOTHERAPY, SHE SAID SHE WAS

TIRED.

WHICH IS EXPECTED.

BUT TODAY SHE FEELS LIKE IT'S

NOTHING HAS EVER HAPPENED.

SHE DIDN'T GO THROUGH

CHEMOTHERAPY.

NOT EVERYONE IS GOING TO HAVE

SUCH A BREEZE LIKE JACKIE MIGHT

HAVE.

EVEN SHE IS GOING TO HAVE SOME

TOUGH DAYS WITH THINGS, BUT THE

GOAL IS TO REMEMBER IS, WHAT ARE

THE SIDE EFFECTS AND TALKING TO

YOUR ONCOLOGIST SO THEY CAN

ADJUST IT.

WE START OFF WITH THESE DOSES

AND MAKE SURE, BUT WE CAN TAILOR

IT TO WHAT'S RIGHT FOR THE

PATIENT.

WE MONITOR THEM VERY, VERY

CLOSELY WITH THEIR CHEMOTHERAPY.

BECAUSE IT'S A BIG THING FOR

THEM.

SO WE HAVE TO MAKE SURE WE

ADJUST THE DOSES.

WE ADJUST THE MEDICATIONS.

OR OTHER TREATMENTS IF WE NEED

TO.

SO THAT IT'S, IT BECOMES EASY

FOR HER.

>> OFTENTIMES WE HEAR THE WORD

"CURE" AND AS PATIENTS WE THINK

WE'RE IN THE CLEAR AND FOR

DOCTORS IT MEANS SOMETHING

DIFFERENT.

>> FOR ME IT'S IF THE CANCER

DOESN'T COME BACK AND WHAT ARE

THE ODDS?

>> I WANT TO USE THE WORD CURE,

TOO.

BUT I ALSO WANT TO BE CAUTIOUS.

YOU KNOW, WHEN I'M TRYING TO

GIVE IT.

BECAUSE THERE'S A LOT MORE

EMPHASIS PUT ON THE WORD THAN

ACTUALLY WHAT IT MEANS.

AND WHAT I'M TRYING TO EXPLAIN.

SO I USE THE WORD THE LAST.

NOT THAT I DON'T WANT TO GIVE

THEM HOPE, BUT IT'S JUST THAT

YOU HAVE TO EXPLAIN TO THEM WHAT

IT IS.

SO LIKE I SAID, YES, AS FAR AS I

KNOW, IF SOMEONE, IF JACKIE ASKS

ME, AM I CURED?

WELL I CANNOT SEE ANY CANCERS,

BUT NONE OF US CAN SEE THOSE

CELLS.

>> JACKIE LIFRS IN DOUGLAS, A

TWO-HOUR DRIVE TO BANNER

UNIVERSITY MEDICAL CENTER IN

TUCSON WHERE SHE'S BEING

TREATED.

LAST SUMMER, DOUGLAS' ONLY

HOSPITAL CLOSED, HERE'S DR.

DANIEL DERKSEN FOR THE ARIZONA

CENTER FOR RURAL HEALTH.

>> THE CHALLENGES FOR ARIZONA

RURAL IS THAT THERE'S FEWER

HEALTH PROFESSIONALS PRACTICING

IN RURAL AREAS.

WE HAVE ABOUT 85% OF OUR

POPULATION THAT LIVES IN THE

LARGE METROPOLITAN AREAS OF

PHOENIX AND TUCSON.

PIMA COUNTY AND MARICOPA COUNTY.

AND ABOUT 90% OF THE HEALTH

PROFESSIONALS PRACTICE IN THOSE

TWO AREAS.

SO THE REMAINDER OF THE

POPULATION LIVES IN SMALLER

COMMUNITIES IN ARIZONA.

YET HAS FEWER HEALTH PROVIDERS.

SO THAT'S PROBABLY THE MAIN

ISSUE IS TRYING TO ACCESS

HIGH-QUALITY CARE IN RURAL

AREAS.

THERE'S OTHER CHALLENGES THAT WE

HAVE IN RURAL AREAS.

THERE'S A HIGHER PERCENTAGE OF

UNINSURED.

THE PER CAPITA INCOME IS ABOUT

$7,000 LESS PER PERSON IN RURAL

AREAS.

WE HAVE A HIGHER PERCENTAGE OF

THE POPULATION IN RURAL AREAS,

THAT'S ELDERLY.

SO WE HAVE SOME OF THOSE

CHALLENGES.

AND THEN THERE'S NOT AS MANY

HOSPITALS WITHIN THE GEOGRAPHIC

AREA.

THERE'S NOT AS MANY CLINICS.

SO WHEN A COMMUNITY LIKE DOUGLAS

LOSES A HOSPITAL AND 60 JOBS GO

AWAY, IT NOT ONLY AFFECTS THOSE

JOBS IN THE HEALTH AREA, BUT

ALSO THE COMMUNITY'S JOBS AND

THINGS LIKE THE PHARMACY AND THE

NURSING HOME AND THE OTHER

THINGS THAT RELATE TO THE HEALTH

INFRASTRUCTURE.

>> WHY IS IT SO HARD TO RECRUIT

PHYSICIANS OR OTHER MEDICAL

STAFF TO A SMALL TOWN?

>> THERE'S A NUMBER OF VARIABLES

THAT AFFECT THE LIKELIHOOD THAT

A HEALTH PROFESSION'S GRADUATE

WILL GO INTO A RURAL AREA.

AND WHAT WE TRY TO DO IN THE

ADMISSIONS PROCESS IS ACCOUNT

FOR SOME OF THOSE.

THAT WE WOULD LIKE TO SEE OUR

HEALTH PROFESSION'S GRADUATES GO

INTO AREAS OF NEED AND GO INTO

THE HIGH-NEED SPECIALTIES.

THOSE MORE LIKELY TO GO INTO

RURAL AREAS AND PRACTICE WHETHER

THEY'RE NURSES OR PHYSICIANS OR

DENTISTS, ARE INDIVIDUALS THAT

HAVE GROWN UP IN A RURAL AREA OR

HAVE A SPOUSE THAT GREW UP IN A

RURAL AREA.

THE OTHER PART THAT WE CAN

INFLUENCE IN OUR HEALTH

PROFESSION'S TRAINING PROGRAMS

IS PROVIDING EXPERIENCES, SO

THAT PEOPLE DO ROTATIONS IN

RURAL AREAS.

PERHAPS DURING RESIDENCY

TRAINING, THEY HAVE A CONTINUITY

CLINIC WHERE THEY'RE ACTUALLY

SEEING PATIENTS ON A REGULAR

BASIS IN A RURAL COMMUNITY.

THE HEALTH PROFESSION'S TRAINING

PROGRAMS THAT HAVE DONE THE BEST

AS FAR AS RECRUITING AND

RETAINING INDIVIDUALS AFTER

GRADUATION TO RURAL AREAS ARE

THOSE THAT OFFER SIGNIFICANT

PORTION OF THE TRAINING

EXPERIENCE IN THOSE TYPES OF

COMMUNITIES.

>> WHAT SORTS OF THINGS HAVE

HAPPENED TO HEALTH CARE IN THE

LAST FEW YEARS THAT HAVE SORT OF

PERPETUATED THIS PROBLEM OR

MAYBE CREATED IT?

>> WELL THERE'S A PERFECT STORM

OF THINGS THAT HAVE CHALLENGED

THE FISCAL VIABILITY OF RURAL

HOSPITALS.

I WAS JUST LOOKING AT THE DATA

THIS MORNING AND 72 RURAL

HOSPITALS HAVE CLOSED SINCE

2010.

SO JUST IN SIX YEARS WE'VE HAD

72 RURAL HOSPITALS CLOSE.

OVER THE LAST 25 YEARS, WE'VE

HAD ALMOST 500 RURAL HOSPITALS

CLOSE.

THE ESTIMATE IS THAT THERE'S

ANOTHER 500 TO 700 HOSPITALS

THAT ARE VULNERABLE TO CLOSURE.

AND PART OF THE CHALLENGE FOR

RURAL HOSPITALS IS THAT IF YOU

DON'T HAVE A POSITIVE FISCAL

MARGIN, IF YOU'RE RUNNING A

DEFICIT, YOU CAN'T KEEP YOUR

DOORS OPEN.

SO THEY ALWAYS SAY, YOU KNOW, NO

MARGIN, NO MISSION.

AND SOME OF THE CHALLENGES FOR

THE RURAL HOSPITALS HAVE BEEN

THE CHANGE IN THE WAY THAT

MEDICARE PAYS FOR CARE.

IN THE PAST THERE'S BEEN A

SLIGHT DIFFERENTIAL.

SO THAT RURAL HOSPITALS GOT PAID

A LITTLE BIT MORE BY ONE OF THE

LARGEST PUBLIC INSURERS,

MEDICARE.

AND THOSE HAVE BEEN RATCHETED

DOWN.

AND IT'S VERY HARD FOR RURAL

HOSPITALS, BECAUSE THEY HAVE TO

KEEP THEIR DOORS OPEN.

EVEN THOUGH THEY HAVE SMALL

VOLUME.

AND SO THOSE CHANGES IN PAYMENT

BY MEDICARE, STATE'S MEDICAID

PROGRAM MAY CHANGE PAYMENT.

AND EVEN A SLIGHT DECREASE, 1 OR

2% DECREASE IN PAYMENT CAN

INFLUENCE WHETHER OR NOT YOUR

NUMBERS ARE IN RED OR IN GREEN.

YOU KNOW THAT YOU'RE DOING WELL

OR THAT YOU'RE REALLY

CHALLENGED.

>> CANCER IMPACTS NEARLY EVERY

PART OF A PERSON'S LIFE.

AT THE ARIZONA CANCER CENTER IN

TUCSON, FINANCIAL COUNSELORS

HELP PATIENTS NAVIGATE THEIR

TREATMENT PLANS.

WENDY ANDREWS LOST HER OWN

MOTHER TO BREAST CANCER AND

DEVELOPED A GRID TO GUIDE

PATIENTS THROUGH THE PROCESS OF

MANAGING THEIR HEALTH CARE.

>> ONE OF THE MOST IMPORTANT

THINGS FOR ME, HAVING A MOTHER

WHO PASSED AWAY FROM BREAST

CANCER, WAS MAKING SURE PATIENTS

HAD ACCESS.

BECAUSE IT WAS REAL INTERESTING,

SITTING WITH HER ONE EVENING,

AND SAYING, YOU KNOW, AS A

CANCER PATIENT, I DON'T KNOW HOW

PATIENTS DO THIS AND NAVIGATE

THROUGH THE SYSTEM.

AND I'M SO FORTUNATE TO HAVE YOU

AS MY DAUGHTER, TO BE ABLE TO

HELP WITH THIS.

AND IT REALLY KIND OF RESONATED

WITH ME AS TO HOW REAL THAT WAS.

AND HAVING YOU KNOW, A MOM THAT

HAD REALLY GOOD ACCESS TO

SOMEBODY THAT COULD HELP WITH

NAVIGATING THAT.

WITH ON A FINANCIAL STRAIN FOR

PEOPLE IS THAT WE NEED TO DO A

BETTER JOB AT MAKING SURE THAT

PATIENTS KNOW AND FACILITIES

KNOW WHAT HELP IS OUT THERE.

>> IF SOMEONE IS DIAGNOSED WITH

CANCER HERE AT BANNER UNIVERSITY

MEDICAL CENTER, AND RIGHT AWAY

THEY'RE THINKING ABOUT THE

COSTS, THERE ARE OPTIONS FOR

THEM.

>> YES.

YEAH, AGAIN WE HAVE FINANCIAL

COUNSELORS THAT MEET WITH THEM

TO REALLY DISCUSS ALL OF THE

AVAILABLE OPTIONS THAT WE HAVE.

IN WORKING WITH THEM TO MAKE

SURE THAT NUMBER ONE, THEY GET

THE TREATMENT THAT REALLY IS FOR

THEM.

AND THAT, THAT FIRST AND

FOREMOST.

IT'S THE BEST THAT THE PROVIDER

FEELS THAT IS GOING TO WORK FOR

THEM.

AND THEN WE WORK ON WHAT OTHER

MEASURES WE HAVE TO HELP THEM

MAKE SURE THAT EVERYTHING THAT

IS BEING ASKED FOR THE PATIENT

TO RECEIVE, WE CAN HELP THEM.

AND EVEN IF THE INSURANCE

COMPANY IS DENYING THAT THERAPY,

WHICH WILL ASK FOR AN

AUTHORIZATION UP FRONT, OR

WHAT'S CALLED A

PREDETERMINATION, IF THEY DON'T

AUTHORIZE, WE WILL GO TO THE

MANUFACTURER AND CAN WORK ON

ACTUALLY GETTING FREE DRUGS FOR

THE PATIENT.

IF THE THERAPY IS EVEN CURRENTLY

IN A CLINICAL TRIAL, THAT ISN'T

AVAILABLE TO US.

AT OUR INSTITUTION, WE CAN WORK

WITH THE MANUFACTURERS ON

GETTING THE DRUG AVAILABLE FOR

THE PATIENT.

>> AFTER A PATIENT IS DIAGNOSED

WITH CANCER, WHAT DOES HE OR SHE

NEED TO KNOW?

>> I THINK THE BIGGEST THING FOR

PATIENTS IS, IF THEY AREN'T

BEING INFORMED, ESPECIALLY ABOUT

THE FINANCIAL, IS TO ASK.

I KNOW WE TRY TO DO OUR BEST IN

MAKING SURE THAT WE IDENTIFY ALL

THE DIFFERENT SERVICES THAT A

CANCER PATIENT IS GOING TO HAVE

TO MAKE SURE THAT THEY

UNDERSTAND.

EVEN WHAT NEEDS AUTHORIZED AND

WHAT DOESN'T.

I MEAN THOSE CAN DIFFER FROM ONE

INSURANCE COMPANY TO ANOTHER.

AND IT'S REALLY IMPORTANT FOR

THEM TO UNDERSTAND WHAT THAT IS.

AND I THINK THE OTHER THING IS,

IF THEY DON'T UNDERSTAND THEIR

BENEFITS, YOU KNOW, TO COME IN

AND ASK.

WE LOOK AT THEIR BENEFITS, AND

WE TRY TO HELP THEM UNDERSTAND

WHAT THOSE BENEFITS ARE.

AND WHAT THAT MEANS TO THEM.

BECAUSE CAN YOU HAVE AN

INSURANCE FOR TEN YEARS AND

DON'T REALIZE EACH YEAR YOUR

DEDUCTIBLE CAN BE CHANGING, YOUR

CO-INSURANCE CAN BE CHANGING.

EVEN THE BENEFITS CAN CHANGE.

AND YOU DON'T REALIZE THAT.

SO I THINK THAT'S REALLY

IMPORTANT FOR PATIENTS TO KNOW

THAT THEY NEED TO BE ABLE TO

UNDERSTAND WHAT THEIR BENEFITS

COVER.

>> JACKIE IS RECEIVING

CHEMOTHERAPY FOR THE NEXT THREE

MONTHS.

IN JULY SHE EXPECTS TO BE WELL

ON THE ROAD TO RECOVERY.

AND SHE'S TAKING EVERY DAY IN

STRIDE.

>> I DON'T KNOW WHAT THE

SYMPTOMS ARE FOR BRAIN CANCER OR

FOR LUNG CANCER OR FOR COLON

CANCER.

I DON'T KNOW ABOUT THAT.

ALL I CAN SAY IS FROM MY

EXPERIENCE, I FOUND A LUMP IN MY

RIGHT BREAST.

AND I THANK GOD EVERY DAY THAT

HE PUT THAT BUMP WHERE HE PUT

IT.

BECAUSE I FELT IT.

OTHER PEOPLE CAN'T FEEL IT I

NEVER WOULD HAVE FELT THAT IF I

DIDN'T LITERALLY RUN INTO IT OR

BRUSH IT WITH MY HAND.

IF YOU FEEL ONE LITTLE BUMP, GO

TO THE DOCTOR.

YOU MIGHT BE IN STAGE 1.

YOU MIGHT BE IN STAGE 2.

YOU MIGHT BE, IT MIGHT BE

BENIGN.

IT MIGHT NOT BE ANYTHING.

BUT IF IT IS AND YOU CATCH IT

EARLY, YOU CAN HAVE THE SAME

OPPORTUNITY I HAD.

TO GET IT CUT OFF.

AND TO START CHEMOTHERAPY.

AND TO WATCH YOUR KIDS GROW UP.

>> I KNOW.

>> SOME PEOPLE AREN'T THAT

FORTUNATE.

SOME PEOPLE DON'T FEEL IT.

SOME PEOPLE START FEELING SICK.

TO THE POINT WHERE THEY GO,

THEY'RE AT STAGE 4 ALREADY AND

THERE'S NOTHING THEY CAN DO.

I AM VERY BLESSED.

I DON'T LOOK THIS AS A BURDEN.

I DON'T LOOK AT THIS AS A CURSE

ON MYSELF.

I LOOK AT THIS AS A SECOND

OPPORTUNITY TO DO MY LIFE

COMPLETELY DIFFERENT AND TO LET

ALL NEGATIVITY GO.

AND TO NOT HOLD ON TO GRUDGES.

AND TO START A DIFFERENT

LIFESTYLE.

AND TO BE THANKFUL FOR

EVERYTHING YOU'RE BLESSED FOR.

>> AND THAT'S OUR PROGRAM.

WE HOPE TO TELL YOU MORE ABOUT

JACKIE'S PROGRESS IN THE COMING

MONTHS.

IF YOU'D LIKE TO LEARN MORE

ABOUT THE FINANCIAL COUNSELING

SERVICES AVAILABLE AT THE

ARIZONA CANCER CENTER, WE'VE

POSTED A LINK ON OUR WEBSITE.

FOR ALL OF US AT ARIZONA PUBLIC

MEDIA, I'M LORRAINE REGETTA.