Pursuing her dream after breast cancer

Janita Green has been passionate about health and fitness her whole life, even competing as a novice bodybuilder in her late 30s. But a series of breast cancer diagnoses when she was in her 40s forced her to postpone her dream of winning a fitness competition.

“I saw it as God tapping me on the shoulder saying, ‘I want your attention; you’re not listening,’” said Green, a certified public accountant who traveled to work sites throughout Atlanta and Chicago as an internal audit and health care consultant. “‘You need to change your hectic lifestyle.’”

That opportunity came when she was offered a position as a finance director at Kaiser Permanente in Georgia. Along with a great culture and reduced travel, the job came with another important benefit: Kaiser Permanente health care.

Comprehensive care for breast cancer survivors

Still recovering from a double mastectomy, Green was referred to the Multidisciplinary Breast Cancer Survivorship Program, which offers comprehensive care for women who have finished active treatment but still need monitoring for possible recurrences or secondary cancers. Survivors may also have physical problems such as numbness, fatigue, and lymphedema and mental health issues such as depression and struggles with body image.

“When women complete treatment for breast cancer, they have a lot of questions: ‘What do I do now? Where do I go? Who do I see?’ Prior to the creation of survivorship programs like ours, there wasn’t a good answer,” said Peter Burns, MD, physician lead for the Kaiser Permanente of Georgia Breast Care Center, who helped launch the survivorship program in 2012.

Appointment overload was another challenge. “Women had as many as 12 separate follow-up appointments a year,” said Dr. Burns. “They’d see their surgeon, their medical oncologist, their radiation oncologist … There was a lot of redundancy.”

The survivorship program consolidates those appointments into 2 comprehensive visits a year for the 5 years following the conclusion of treatment, when recurrences are most likely to occur.

“I make sure they’re up to date on their recommended screenings and diagnostic tests, go over their medications, and ask about problems and side effects,” said physician assistant April Liverman. “I also do a physical exam and screen them for psychosocial factors such as anxiety, financial strain, and work challenges. If patients have concerns that I can’t resolve, I refer them to a specialist. That might include a plastic surgeon, behavioral health specialist, oncologist, breast surgeon, or ob-gyn.”

In Green’s case, numbness and pain in her shoulders was an ongoing challenge. “That’s a common complaint after a bilateral mastectomy because women tend to build up a lot of scar tissue, so I referred her for physical therapy,” said Liverman.