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Just because you don’t have cancer doesn’t mean you’re not living with it.

Nearly everyone knows and cares about someone who has been diagnosed with cancer, but most of us still feel powerless to talk about it. It is a word that is loaded with fear, anxiety, and ignorance. We need a place where we can set those things aside, learn, and better understand what it means to live with cancer.

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The Gift of Friendship During Breast Cancer Treatment

It's easier to fight with cancer with family's helpThis is the first in a series on the Gift of Friendship during cancer treatment.

When a loved one receives a breast cancer diagnosis, it can be difficult to know how to help. Rev. Laurel Buwalda, Chaplain at Avera Cancer Institute shares insight about how to support a friend during cancer treatment.

“Offering friendship to someone going through cancer treatment is so important because we can’t do cancer alone,” says Buwalda. “My mother used to tell me that I didn’t need a lot of friends. But if I have a couple of good friends, then I’m rich. That’s especially true when going through something difficult like cancer treatment.”


The first step to being a good friend is to simply listen. “Listen to what’s on your friend’s heart. Always be sensitive to her wants and needs, which may change throughout her treatment and even day to day.”

Buwalda adds that it’s helpful to resist the urge to offer advice (unless asked for) or fill the silence. “You’ll never know what your friend wants to talk about until you give her the space to talk. If you fill the space with your own nervous chatter, you may miss the opportunity to hear what she wants to share. As a chaplain, people often ask me how I know what to say. The truth is, I don’t always know – I simply show up and listen well.”

Some days – especially throughout treatment – your friend may not have the energy or desire to talk. “A good friend is sensitive to that too. If that happens, simply reassure her that you’re there for her.”

In the age of social media, Buwalda says it’s also important to ask your friend whether or not she wants her story shared online before posting anything about her. One woman may prefer privacy, while another feels encouraged when you share positive comments about her on social media. “Every woman has her own story, and it’s hers to tell in whatever manner she feels the most comfortable with,” she says.


“We’re always looking for reasons to celebrate because cancer is tough – to say the least,” says Buwalda. “Take time to notice, acknowledge and be thankful for the special moments and good things in her life.”

First, find out what’s meaningful to her. Then, celebrate in a way that’s appropriate for her. You can celebrate anything from positive results and her final treatment to how amazing she looks in her new wig or scarf. Milestones such as a child’s wedding, an anniversary, birth or graduation in her family are great reasons to celebrate too.

“Celebration is tied very closely with hope,” adds Buwalda. “When we celebrate, it gives her a renewed sense of hope. Friends can play such a big role in offering that encouragement and hope.”


“There’s no greater gift that you can give a friend than to come alongside her and pray,” says Buwalda. If you pray for your friend, encourage her by letting her know how you’re praying for her. And if you’re both open to it, offer to pray for her out loud and in person. “There’s something about praying with a friend that takes your relationship to a deeper level,” she adds.

To discover fun gift ideas for a friend undergoing breast cancer treatment, stay tuned for part two of this series.

Have cancer-related questions or concerns? Call the Avera Cancer Institute Navigation Center at 888-422-1410 to talk with a cancer expert 24/7. It’s free for all Avera patients, along with their family members and friends.

The Latest Science to Help Patients Stay Cancer Free

DNA sequenceWomen want to not only survive breast cancer, but thrive. That means years of cancer-free living, rather than years spent in treatment for future bouts of disease.

That’s what the genomic medicine team at the Avera Cancer Institute Center for Precision Oncology hopes to deliver, as they treat more breast cancer patients earlier in the course of their disease.

“One woman might have surgery for early stage breast cancer and remain cancer free. A second woman with a similar diagnosis might have a mastectomy, but then end up with another bout of cancer years later,” explained Casey Williams, PharmD, Director of the Avera Center for Precision Oncology. “On paper, the second woman has a very good chance of doing well without future cancer. But it still happens.”

Providing genomic sequencing that guides chemotherapy or other treatments before surgery is called neoadjuvant therapy.

When women are sequenced before surgery, the genomic team knows exactly what they’re dealing with, and whether or not a woman needs to have aggressive treatment up front to fight her particular type of cancer and prevent future recurrences.

Michele Reiman of Sioux Falls was such a case. In May 2015 she was diagnosed with stage I breast cancer, yet it was triple negative, a particularly aggressive type of breast cancer with a higher recurrence rate. Growth of triple negative cancer is not supported by hormones, so hormonal therapies are not effective against it. Her Avera medical oncologist, Amy Krie, MD, recommended that she have genomic sequencing.

“We wanted to make sure we were fighting it from every direction,” Michele said.

Michele had standard of care chemotherapy plus an oral medication as recommended by the genomic medicine team. At the time of surgery (a double mastectomy) Michelle was found to have had a pathologic complete response to the treatment with no detectable disease remaining. “After my surgery, I was 100 percent cancer free. I will never really know what killed the cancer; all I know is that it worked.”

The 10-year survival rate of breast cancer is higher than it’s ever been, at 83 percent. When caught in early stages, five-year survival is as high as 99 percent, according to the American Cancer Society.

“The vast majority of women live for many years after a breast cancer diagnosis, but those years may include treatment for relapses,” said Brian Leyland-Jones, MB BS, PhD, Vice President of the Avera Center for Precision Oncology.

“We want to do a better job of predicting the possibility of recurrence up front. Because if cancer comes back, it often comes back with a vengeance,” Leyland-Jones said.

Patients treated through the Avera Center for Precision Oncology receive standard of care protocols, plus care guided by sequencing. “We maintain the best conventional care, but at the same time we’re pushing the leading edge to improve outcomes,” Williams said.

Avera is seeing patients from Canada, California, Florida, New York, and as far away as the United Kingdom and Australia. “Patients are starting to understand what genomics has to offer, not just locally, but regionally and even internationally,” Leyland-Jones said.

If you are interested in genomic medicine, ask your oncologist about a referral to the Avera Cancer Institute Center for Precision Oncology or self-refer by calling 605-322-HOPE (605-322-4673).


I Have Breast Cancer… Now What? Five Things to Expect After Diagnosis

Bald woman cancer patient in the hospital“You have breast cancer…”

Sitting together in her office, your physician just said the ‘C’ word — at least you think she did.


“You have breast cancer.”

Just let that sink in. It feels like the wind has been knocked out of you, your mind both racing and wiped blank, and emotions of fear, stress and anger wash over you. Now what?

Nancy Terveen, BC, FNP, Breast Health Navigator at Avera Cancer Institute, reassures that her team has the expertise, technology and resources to guide you through your breast cancer journey.

  1. You will meet with a surgeon first. The surgeon will discuss your diagnosis and order more continued work-up for your breast cancer. A multidisciplinary team will then work together with the surgeon to present at the breast tumor conference.
  2. Your case will be reviewed by an entire team of experts. Every week, 15 to 20 Avera Cancer Institute breast cancer specialists — surgeons, oncologists, geneticists, pathologists, etc. — meet to analyze the cases of Avera breast cancer patients. They put their heads together to direct the most appropriate treatment options. There’s also the possibility of Avera’s Breast Cancer Consult Clinic, which offers patients who are newly diagnosed and desiring a second opinion an opportunity to meet with a medical oncologist, radiation oncologist and breast surgeon in one visit.
  3. Genetic counseling/testing may be ordered. If breast cancer has been found on your family tree, genetic testing may take place before surgery. “Genetic testing helps us determine if there’s been a gene mutation within the family lineage,” explained Terveen. About five to 10 percent of breast cancers are found to have a hereditary mutation.
  4. A breast patient navigator will be there to guide you through treatment. Two breast-specific nurse practitioner navigators work together with your multidisciplinary team to address any of your questions or concerns during your care. Also, they help with the education and understanding of breast cancer and treatment. And because your questions don’t end at 5 p.m., you can call the Avera Cancer Institute Navigation Center at 888-422-1410. They are available after hours and at night.
  5. “Avera’s philosophy involves caring for the mind, body and spirit,” said Terveen. A chaplain is available to support spiritual needs, social workers help with emotional concerns, dietitians propose food plans to soothe nausea or boost suppressed appetites, patient advocates address for billing or financial concerns, and integrative medicine eases symptoms. “We can recommend local support groups or websites where you can find accurate information about your breast cancer diagnosis or talk to someone who has gone through breast cancer treatment.”

“Treating breast cancer is complex, a step-by-step process,” said Terveen. “We’re humbled that our patients put their complete trust in us, and we work diligently to deliver not only great care, but hope as well.”


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