{"id":27267,"date":"2019-10-30T14:38:06","date_gmt":"2019-10-30T20:38:06","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=27267"},"modified":"2022-11-15T14:56:24","modified_gmt":"2022-11-15T21:56:24","slug":"fighting-pancreatic-cancer","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/fighting-pancreatic-cancer\/","title":{"rendered":"132 rounds of chemo and still fighting pancreatic cancer"},"content":{"rendered":"
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\"Marybeth
Marybeth Hoffman thought she had just three to six months to live after being diagnosed with pancreatic cancer. But, she’s alive more than 6 years later and will appear on The Price is Right. Photo courtesy of Marybeth Hoffman.<\/figcaption><\/figure>\n

The young woman received an ominous diagnosis back in 2013.<\/p>\n

Marybeth Hoffman had just turned 40. She looked great and felt pretty well too.<\/p>\n

\u201cI had never been sick a day in my life. I\u2019d never spent a night in the hospital since the day I was born,\u201d she said.<\/p>\n

But, some subtle symptoms, powerful intuition and years of work synthesizing and analyzing data led her to believe she had pancreatic cancer. It\u2019s one of the most deadly types since cancerous tumors can lurk undetected for years and grow without obvious symptoms.<\/p>\n

Sadly, Marybeth\u2019s hunch was right.<\/p>\n

A star athlete in high school and college, she looked young enough to be in grad school still when she arrived for surgery at UCHealth University of Colorado Hospital<\/a> on the Anschutz Medical Campus<\/a>.<\/p>\n

Her team hoped to be able to remove her cancerous tumor. But, her surgeon, Dr. Richard Schulick<\/a>, found the cancer already had spread to her liver, meaning it had metastasized. Schulick had to halt the surgery. Cutting out the original tumor wouldn\u2019t do any good since cancer cells already were growing elsewhere in her body. Marybeth now had stage IV cancer and a very poor prognosis.<\/p>\n

\u201cAt that point, the chances of being alive a year later were about 1%. Most people would be dead in three to six months,\u201d Marybeth said. \u201cI knew the odds, but I wasn\u2019t going to let my family down. I was going to fight with all I had.\u201d<\/p>\n

\"Surviving
When Marybeth Hoffman learned she had pancreatic cancer, she fought hard and relished life, getting married to her longtime partner Terry. The two also took great trips, including this one to the United Arab Emirates. Photo courtesy of Marybeth Hoffman.<\/figcaption><\/figure>\n

Remarkably, that was 6 \u00bd years ago.<\/p>\n

Marybeth jokes that she\u2019s a \u201c1 percenter,\u201d alas, not when it comes to riches, but most definitely, when it comes to fighting pancreatic cancer.<\/p>\n

Schulick calls Marybeth a \u201csuper-responder\u201d because she handled her chemotherapy treatments so well.<\/p>\n

In a rare move, Schulick was able to do a second surgery months later and remove Marybeth\u2019s tumor. She credits her Colorado team with saving her life.<\/p>\n

She recently got to share her message of resiliency with the world.<\/p>\n

\"Marybeth
Marybeth Hoffman, right, scored tickets to the Price is Right with her best friend, Vicki. The episode on which she appeared is slated to air Nov. 5. Photo courtesy of Marybeth Hoffman.<\/figcaption><\/figure>\n

During an August trip with her niece and nephew to Los Angeles, Marybeth scored tickets for \u201cThe Price is Right,\u201d the longest-running game show in U.S. history. She wore a T-shirt that said \u201c132 rounds of chemo and still fighting.\u201d Her episode aired on November 5 on CBS stations around the country. Host Drew Carey asked Marybeth about her cancer, she delivered a message of hope.<\/p>\n

\u201cIf you\u2019re diagnosed with stage IV cancer, it doesn\u2019t have to be a death sentence. You can fight,\u201d Marybeth said.<\/p>\n

College athlete, valedictorian and CIA recruit<\/strong><\/h3>\n

If anyone had the determination and detective skills to flag her own cancer, it was Marybeth.<\/p>\n

She was a talented athlete as a kid, who excelled at three sports in high school: softball, basketball and field hockey. She earned both athletic and academic scholarships to college, played D1 softball and graduated as the valedictorian of her class at Quinnipiac University<\/a> in Connecticut. Her academic achievements were all the more remarkable since neither of her parents had gone to college.<\/p>\n

Marybeth went straight into a Ph.D. program in psychology. She taught psychology and continued her research in health and social psychology, authoring her first paper for a scientific journal at just 27.<\/p>\n

\"Marybeth
Marybeth Hoffman worked as an analyst for the Department of Defense and traveled globally for work. Here, she poses at the demilitarized zone or the DMZ between North and South Korea. Photo courtesy of Marybeth Hoffman.<\/figcaption><\/figure>\n

After the 9\/11 tragedy, she wanted to use her analytical skills to serve her country and applied to work for the CIA. Recruiters from the clandestine service wanted to hire her to work as a covert agent.<\/p>\n

\"Marybeth
Marybeth Hoffman tapped her background and experience as an analyst to figure out she had pancreatic cancer. Photo courtesy of Marybeth Hoffman.<\/figcaption><\/figure>\n

While Marybeth was excited about the challenging work, which also appealed to her sense of adventure, she decided she did not want to keep her life a secret from her large, extended family and many close friends. Ultimately, she accepted a job as an analyst with the Department of Defense in Colorado.<\/p>\n

\u201cI really enjoyed my work. I traveled all over the world \u2014 Korea, Japan, Europe, and even had deployments to the Middle East,\u201d Marybeth said.<\/p>\n

She got to solve challenging problems, gathering information, analyzing data, diagnosing root causes and working with teams on solutions.<\/p>\n

She also found love. She and her girlfriend, Terry, met on Veterans Day in 2003. For Marybeth, it was love at first sight. They had been together for 10 years and had bought their dream home in Denver when the cancer diagnosis hit.<\/p>\n

\u201cI felt like I had made it. I had traveled the world and I had been to every state. We had everything we needed. We loved our family, friends and amazing pets. We loved our house,\u201d said Marybeth, who had grown up in an economically depressed, working class area of Long Island.<\/p>\n

Following the clues to a tough diagnosis<\/strong><\/h3>\n

Marybeth\u2019s background analyzing complex situations came in handy when she noticed some strange physical symptoms. Since age 25, Marybeth had dealt with what appeared to be minor digestive issues like constipation. Then, in 2012, she\u2019d noticed some black, tar-like stools, which could indicate an ulcer. Like many athletes, she had some aches and pains from many years of sports, and took a lot of ibuprofen, so it made sense that she might have an ulcer.<\/p>\n

She also had torn a tendon in her elbow and had surgery to repair it in January of 2013. Prohibited from even light activity, Marybeth noticed her body seemed to be having trouble processing sugar. In the past, when she had felt a \u201crush of sugar in her bloodstream,\u201d she would jump on an elliptical or go for a run.<\/p>\n

\u201cWhen I couldn\u2019t exercise, this sugar problem hit me like a ton of bricks,\u201d she said.<\/p>\n

Type 2 diabetes runs on her dad\u2019s side of the family. So, Marybeth visited her primary care doctor, who ran some tests. The only result that was out of range was a slightly elevated level for blood glucose. Her doctor thought it was a fluke, but Marybeth wasn\u2019t convinced. She asked for more tests, including an A1c, which measures average fasting glucose levels over time. Again, all tests came back normal, except the A1c; it was slightly elevated. Her doctor referred her to specialists, who conducted more tests. Marybeth also started monitoring her own blood sugar levels with a $10 glucose meter.<\/p>\n

\"Marybeth
Marybeth looked healthy even while fighting pancreatic cancer. Her surgeon couldn’t remove her tumor at first, but she handled high doses of chemotherapy so well that she was able to get a rare second surgery. Photo courtesy of Marybeth Hoffman.<\/figcaption><\/figure>\n

She tested her blood sugar in the morning and randomly during the day. She observed that she would wake up with elevated blood sugar, then her levels would dip low during the day.<\/p>\n

Marybeth was used to sifting through data and studies at work and pondered what her own results were telling her.<\/p>\n

\u201cI started to read some medical research and observed an inexplicable relationship between otherwise normal lab tests,\u201d she said.<\/p>\n

Insulin and glucagon are hormones that the pancreas produces. They play a critical role in keeping blood glucose levels within a healthy range.<\/p>\n

When the body does not convert enough glucose, blood sugar levels remain high. Insulin helps the cells absorb glucose, reducing blood sugar and providing the cells with glucose for energy.\u00a0 When blood sugar levels are too low, the pancreas releases glucagon. Glucagon instructs the liver to release stored glucose, which causes blood sugar to rise.<\/p>\n

\u201cIt then occurred to me that when you go to bed at night, the liver takes over and releases glucose into the bloodstream. It takes its cue on how much to release from the pancreas,\u201d Marybeth said.<\/p>\n

She started to wonder if she could have a tumor in her pancreas.<\/p>\n

Since she looked so healthy, her doctors doubted anything serious was wrong.<\/p>\n

Marybeth later realized that her appearance might have deceived them.<\/p>\n

\u201cThere\u2019s a bias in health care. When you look healthy, people don\u2019t believe you can be sick. My rosy cheeks could have cost me my life.\u201d<\/p>\n

Global experts around the corner<\/strong><\/h3>\n

Marybeth celebrated her 40th<\/sup> birthday on April 20 with Terry on a camping trip. Normally, she avoided eating a lot of fatty foods. But, she indulged in rich meals on the trip. When she returned, she noticed what appeared to be fat in her stools. That\u2019s a condition known as steatorrhea.<\/p>\n

Marybeth called her gastrointestinal doctor and arranged for an endoscopy. Everything looked OK, but lab work later showed a severe insufficiency of fecal elastase, an enzyme that the pancreas is supposed to produce. A normal level for an adult would be greater than 200 and sometimes 500 or more. Marybeth\u2019s results came back at 76.<\/p>\n

She honed in on a very scary diagnosis.<\/p>\n

\u201cI was convinced I had pancreatic cancer and I don\u2019t know how to get anyone to believe me,\u201d she said.<\/p>\n

Finally, on Mother\u2019s Day in 2013, Marybeth went to an ER near her home. She knew a CT scan would show a tumor if she had one. Doctors there tried to reassure her that she was fine, but when the scans came back, they revealed a mass in Marybeth\u2019s pancreas.<\/p>\n

\u201cAnd with that, my life changed in a second.\u201d<\/p>\n

The next day, not sure what to do, she went in to see her regular doctors. They were crestfallen that they had missed her cancer.<\/p>\n

Marybeth\u2019s friends jumped into action to help her. A friend, who is a doctor, consulted with a colleague at Stanford University about the best specialists on pancreatic cancer in the country. She told Marybeth that a world-renowned team worked at the University of Colorado Hospital, just four miles from Marybeth\u2019s home. Dr. Schulick had come to Colorado only a year earlier from Johns Hopkins in Maryland and an interdisciplinary team of pros had come with him.<\/p>\n

\"Dr.
Department of Surgery chairman Richard Schulick, MD, sees the site as an opportunity for the School of Medicine and UCHealth to build referrals and stronger relationships with community providers.<\/figcaption><\/figure>\n

Marybeth called and the team squeezed her in for a biopsy the next day. At the time, she was one of the youngest pancreatic cancer patients the team had ever seen. She saw the entire team later in May, and Schulick agreed to do surgery on May 31.<\/p>\n

Marybeth had high hopes. But, when her anesthesia wore off and she learned Schulick had had to cut the surgery short because the cancer had already spread, she worried about Terry and her mom.<\/p>\n

\u201cYou don\u2019t think about yourself. You think about your family,\u201d she said.<\/p>\n

While not offering false hope, Schulick explained that the team was going to start Marybeth immediately on intensive chemotherapy to see if the medication would attack her cancer.<\/p>\n

\u201cWe\u2019re going to see you back here in six months,\u201d he said.<\/p>\n

In early June, Marybeth learned she was dealing with multiple areas of cancer, including spots on her liver and her lymph nodes. That meant her cancer was even worse \u2013 stage IVB \u2013 and the possibility that Schulick ever could cut out her original tumor grew even more remote.<\/p>\n

Still, the fight was on.<\/p>\n

And so began Marybeth\u2019s 132 rounds of chemo.<\/p>\n

Fighting pancreatic cancer: A \u2018super-responder\u2019<\/strong><\/h3>\n

Pancreatic cancer is especially challenging and deadly because there\u2019s no screening test for it.<\/p>\n

\u201cFor breast cancer, we\u2019ve got mammograms. For colon cancer, we\u2019ve got colonoscopies. For melanoma, we can do skin checks,\u201d Schulick said.<\/p>\n

\"Marybeth
Marybeth Hoffman’s team said her fitness and her attitude helped her endure extremely tough chemotherapy treatments. So far, she has received 132 rounds of chemotherapy and her doctors call her a “super-responder.” Photo courtesy of Marybeth Hoffman.<\/figcaption><\/figure>\n

\u201cBut there\u2019s no way to find pancreatic cancer until you find it. And by then, it\u2019s often too late. Pancreatic is the No. 3 cancer killer in the U.S. behind lung cancer and colorectal cancer.\u201d<\/p>\n

\u201cThere are risk factors for pancreatic cancer like smoking and obesity. Age is a risk factor, as well, along with having a family member with pancreatic cancer,\u201d Schulick said.<\/p>\n

\"Marybeth
Marybeth Hoffman during a trip to Thailand. Photo courtesy of Marybeth Hoffman.<\/figcaption><\/figure>\n

Marybeth didn\u2019t fit into any of those categories. She had grown up near Brookhaven National Lab in New York. The lab was one of the places in the country where nuclear scientists did research following World War II. Some chemicals used at the lab are now labeled carcinogens and Marybeth wonders if water she drank as a kid might have been contaminated and increased her cancer risk.<\/p>\n

Her athleticism, on the other hand, was a big help.<\/p>\n

\u201cWhenever someone goes into treatment healthy, we can treat them with a tougher and more effective regimen,\u201d Schulick said. \u201cIt\u2019s always better to go in in good shape. If you\u2019re frail, you can\u2019t get much chemo.\u201d<\/p>\n

Marybeth tolerated very high doses of chemotherapy and by the end of 2013, scans showed that the tumor in her pancreas had shrunk in half.<\/p>\n

\"Marybeth
At the Great Wall in China. Photo courtesy of Marybeth Hoffman.<\/figcaption><\/figure>\n

Schulick, who describes himself as conservative when it comes to using surgery with metastatic pancreatic cancer, made the rare decision to do a second surgery.<\/p>\n

\u201cIn the proper situation, I\u2019m willing to be very aggressive. I typically will vet my decision with the 30 pancreas experts who work with me in our multidisciplinary group. It\u2019s not something I do very often. You treat everyone and you follow them and see who responds. There are super-responders. That\u2019s what I would call Marybeth,\u201d he said.<\/p>\n

Schulick said it\u2019s incredibly helpful that 30 experts, who are part of the multidisciplinary team, meet and make decisions together.<\/p>\n

\u201cIt\u2019s surgeons, medical oncologists, pathologists, interventional radiologists, pain specialists, gastroenterologists all reviewing the scans and deciding, \u2018Should we re-explore? Should we take a look?\u2019\u201d Schulick said.<\/p>\n

In Marybeth\u2019s case, the answer was yes, and in early January of 2014, Schulick did a second surgery. This time, he saw no sign of the cancer metastases, so he removed Marybeth\u2019s original tumor.<\/p>\n

\u2018Extremely unusual\u2019 to get 132 rounds of chemo<\/strong><\/h3>\n

\u201cShe\u2019s done extremely well,\u201d Schulick said. \u201cMarybeth is one of those rare patients \u2013 who are getting more common \u2013 who have a great response to chemotherapy.\u201d<\/p>\n

Even, so, it\u2019s extremely unusual for any patient to get 132 rounds of chemo, said Cheryl Meguid, a nurse practitioner who runs the pancreatic cancer clinic and moved with Schulick and the team from Johns Hopkins to Colorado.<\/p>\n

\"\"
Marybeth Hoffman’s family rallied to support her. Marybeth, upper left, poses with her mom, her brother, Rob, and his wife, Julia, at the top of Loveland Pass soon after her pancreatic cancer diagnosis. Photo courtesy of Marybeth Hoffman.<\/figcaption><\/figure>\n

\u201cThat\u2019s the most I\u2019ve ever heard of. This is a very aggressive type of chemo. It\u2019s very hard to tolerate. It\u2019s incredible. She\u2019s a miracle,\u201d Meguid said.<\/p>\n

Both Meguid and Schulick said Marybeth\u2019s excellent response paved a path for other patients. Chemotherapy medications continue to improve, along with the understanding of how best to use them. Pancreatic cancer remains quite deadly, but some other patients, like Marybeth, are beating the odds.<\/p>\n

\u201cI\u2019ve been doing this for three decades, and in the last 10 years, I\u2019ve seen more people completely respond. It\u2019s a game changer,\u201d Schulick said.<\/p>\n

The blessings of being alive<\/strong><\/h3>\n

After her diagnosis, Marybeth was showered with love. There were so many bouquets that the house sometimes looked like a florist\u2019s shop and countless heartfelt messages strengthened her and boosted her will to fight. Old friends and teachers unexpectedly reached out to tell her what she had meant to them.<\/p>\n

\u201cIt\u2019s like being at your own funeral, except I\u2019m still alive to enjoy it,\u201d she joked. \u201cA terminal illness has shown me it\u2019s better to have lived for your eulogy than your resume.\u201d<\/p>\n

When Marybeth\u2019s mother, Virginia, learned how seriously ill her daughter was, she immediately put her life in Connecticut on hold and moved to Denver, time that Marybeth treasured.<\/p>\n

\"Marybeth
Marybeth Hoffman with her mother, who moved to Denver to support her daughter through intensive chemotherapy treatments. Photo courtesy of Marybeth Hoffman.<\/figcaption><\/figure>\n

\u201cShe was a great companion. She has a tremendous sense of humor and brought me much laughter during the hardest days of my treatment and recovery,\u201d Marybeth said. \u201cI never would have gotten to know my mother again in this way had I not been diagnosed with this cancer.\u201d<\/p>\n

Marybeth and Terry also raced to get married. They had just won the right to marry in June of 2013 after the U.S. Supreme Court invalidated the Defense of Marriage Act. But, Colorado hadn\u2019t yet legalized same-sex marriage, so later in the summer, Marybeth\u2019s mom drove with the couple to the closest state where they could marry, Iowa, and they exchanged vows in a simple courthouse wedding. Both women were in tears as they pledged to love each other “in sickness and in health.”<\/p>\n