Ali Spain

Some might say she was at the peak of health and fitness. The prior summer, Ali Spain completed the TransRockies Run, a six-day ultra trail race that covered 120 miles at elevation in the Rocky Mountains. Then at the age of 47, her breast cancer diagnosis changed everything.

Ali Spain
Ali Spain

Some might say she was at the peak of health and fitness. The prior summer, Ali Spain completed the TransRockies Run, a six-day ultra trail race that covered 120 miles at elevation in the Rocky Mountains.

Then at the age of 47, her breast cancer diagnosis changed everything. “I was shocked,” Ali says. “At the time I was very healthy and fit. I was a runner, and had no family history of cancer. But that was the reality.”

Diagnosis

The first sign was a small lump under her armpit that she noticed in June 2013. It wasn’t painful so Ali didn’t think anything of it, but by August it had grown significantly. She went to her primary care physician at the UW Neighborhood Clinic in Woodinville, who quickly referred her to Seattle Cancer Care Alliance.

Ali was diagnosed in September with triple negative breast cancer, an aggressive cancer that makes up about 12 percent of all breast cancer cases.

Coordinated Care

Because of the aggressive nature of her cancer, Ali’s care team decided on a multi-step, coordinated approach to treatment

In total, Ali received five months of chemotherapy, followed by a mastectomy, six weeks of radiation and reconstructive surgery. Her team included VK Gadi, MD, medical oncologistJanice Kim, MD, radiation oncologist, and David Byrd, MD, surgical oncologist. “You’re part of the team with your care providers,” Ali says.

In addition, Dr. Gadi suggested that Ali participate in a clinical trial of an oral chemotherapy treatment, something she would have never considered. “I had always thought that trials were for patients on their final treatment option,” she says. “I was happy to find [and] provide some benefit for the bigger cause in going through my treatment … If I could help advance the cause and contribute to a cure someday, I was happy to do so. I was also happy to attack my cancer with all the ‘tools in the toolbox.’”

“I think I had a misconception that clinical trials were for patients who were on their third of fourth treatment option. But they’re not, so I took advantage of that.
Not only because it made me feel like I was using all the tools in the shed, but I felt like I was giving back.”

The trial lasted three months and Ali took a pill weekly on her infusion day. The commitment was minimal since it didn’t require an additional procedure or special trip to the clinic. Ali also participated in an imaging research study during her treatment. The study involved six additional PET and MRI scans as well as a core biopsy midway through her five months of chemotherapy. This required extra time and commitment on her part, but Ali says she didn’t mind since she knew she was contributing to research.  

“It also gave my care team more insight into the shrinkage of the tumors, which gave me peace of mind knowing the chemo was working,” she says. “If I was not on the [imaging] research study I would not have gotten that information until the end of the chemo scan.” 

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Infusion An injection of medications or fluids into a vein over a period of time. Medical oncologist A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A medical oncologist is often the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists. Magnetic resonance imaging A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or X-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints and the inside of bones. Oncologist A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment, such as treating cancer with radiation. A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. Sign In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. Some examples of signs are fever, swelling, skin rash, high blood pressure and high blood glucose.
Ali and team
Ali Spain and her care team

Side Effects

Ali experienced common side effects from chemo and radiation. She had hair loss as well as fatigue and loss of appetite. She also experienced neuropathy (numbness caused by chemotherapy) in her hands and feet, which meant no running.

“I continued to work, but because I worked for myself at the time, I could manage a very flexible schedule,” she says. “I took a couple days off after each chemo day, which I think were about 16 to 18 infusions over five months. I also worked from home much of the five months.”

Ali’s care team encouraged her to keep active even during treatment. Shortly after her mastectomy, she began running again and continued doing so during radiation. “Running is my ultimate freedom,” she says.

Running On

Ali continues to see both Dr. Gadi and Dr. Kim every six months for check-ups — something she’ll continue to do until she’s five years out from treatment.

She is also now in the process of selling her business and plans to take some months off and decide what’s next. “I’m not sure where I’ll land, but I do know my next chapter will involve more creativity and balance – two things that were missing in my pre-cancer life.”

For now, she is cherishing time with family and friends. She says cancer brought her closer to her family. Ali is looking forward to being active with her now 12-year-old daughter and while she is no longer running long distances, it continues to be a big part of her life. She is set to do a three-day run in California with some girlfriends in May.

“Our bags are transported for us and we run from one inn to the next on trails along California’s coastal hills,” she says. “A bit of a luxury trek … this is just my speed now.”

 “I still have a hard time even aligning myself with cancer, even when going through treatment I felt like I really didn’t belong in this category,” Ali says. “So I guess I do feel cured, as I know I’m going to die someday at a ripe old age, but it won’t be of cancer, ever.”

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Infusion An injection of medications or fluids into a vein over a period of time. Neuropathy A numbness, tingling or pain from nerve damage caused by a tumor or by treatment. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.