Delaying her annual mammogram because of COVID-19 could have meant fewer cancer treatment options for Nicole Cavaliere.
Back in the spring, with the country facing its worst health crisis in over 100 years, Nicole Cavaliere learned that she would have to simultaneously overcome her own health scare.
A nurse practitioner in Jefferson Health’s Cardiovascular Intensive Care Unit (CVICU) since 2017, Cavaliere was on the front lines of the nation’s COVID-19 response, treating the “sickest of the sick” COVID patients, many requiring Extracorporeal Membrane Oxygenation (ECMO), a lifesaving treatment option for patients with acute respiratory distress syndrome or cardiogenic shock. Against this backdrop, she received the initial results of a routine mammogram she had done in March. There was something in the imaging her doctor didn’t like that would require another round of tests.
“It did cross my mind, like ‘oh God, I’m actually going to have to fight cancer during a pandemic,’” Cavaliere, 44, recalls thinking at the time. “I guess I had that fear in my head that I was going to be immunocompromised during all of this.”
One thing she was certain of was her decision to go through with her annual scheduled mammogram, just as the pandemic was descending on the U.S. She hopes that sharing her experience will encourage people who are scared to go into the doctor’s office right now for fear of being exposed to the virus, to not ignore or delay their healthcare needs.
According to the American Cancer Society, at the onset of the COVID-19 pandemic, elective medical procedures, including cancer screening, were largely put on hold to prioritize urgent needs and reduce the risk of the spread of COVID-19 in healthcare settings. One consequence of this has been a substantial decline in cancer screenings.
As states and other authorities re-open businesses and ease restrictions, many healthcare facilities are again offering elective procedures, including cancer screenings.
“I could have postponed it,” Cavaliere says, “because I’m young and I didn’t have any signs or symptoms. It would have been very easy to wait until next year. The year before, my mammogram was clean.”
After a series of appointments for additional imaging and biopsies, she was diagnosed with breast cancer in May. With surgery scheduled for late June, she continued working in the CVICU for another two weeks. “It was those weeks that were probably the most trying, when I hadn’t had surgery or started any kind of treatment,” Cavaliere says. “It was the knowing that I was going to have to go in to have surgery during the pandemic and the treatment that was coming—that was the more trying time for me.”
She was also understandably concerned about maintaining an extraordinarily busy schedule. Besides her work in the CVICU, Cavaliere is a full-time faculty member at the Jefferson College of Nursing, as well as a student working toward a Doctor in Nursing Practice (DNP) degree. “I tried not to think about it too much,” she recalls. “I was just matter of fact: I have a job to do, so I’m going to do my job.”
Her surgery–segmental mastectomy, an operation to remove the cancer and some normal tissue around it, but not the breast itself, and bilateral breast reduction—went well, so well that she was discharged and able to return home that night. Five weeks of radiation treatments began a little over a month after the surgery. Throughout her journey, a road that’s included numerous appointments spanning at least six Jefferson facilities—from Center City to Jefferson Methodist Hospital and back—Cavaliere says she felt completely safe from the coronavirus.
“I feel like it was safer than going to the grocery store,” Cavaliere says. “Because everybody is doing what they’re supposed to do. They were taking everyone’s temperature, asking the questions, everybody was wearing a mask, washing their hands and social distancing–everything even smelled clean. It didn’t just look clean, it smelled clean.”
A Montgomery County native, Cavaliere’s experience as a Jefferson patient brought her back to where it all began. She was born at Jefferson in 1976, grew up in Abington and left the Delaware Valley after high school to study dance at NYU. She spent 12 years working in the arts in New York before deciding to return to Philadelphia to become a nurse. “After some soul searching, I felt that there was something different that I wanted to do with the rest of my life, decided on the nursing profession and came to Jefferson for school. It just kind of started from there.”
As she recovers from surgery, Cavaliere has been able to work from home in her role as a faculty member with the College of Nursing. She’s looking forward to returning to her unit in the CVICU, although that won’t be until later in the fall. Seeing things from a patient perspective, she says, reinforced her pride in working at Jefferson as a nurse practitioner surrounded by so many talented and caring colleagues.
“My care team was incredible,” she says, adding “shout outs” to nurse practitioner Janice Carsello; her breast surgeon, Dr. Melissa Lazar; reconstructive plastic surgeon Dr. Matthew Jenkins; medical oncologist Dr. Allison Zibelli; and radiation oncologist Dr. Rani P. Anne.
“They obviously know each other well and work well together in caring for patients,” Cavaliere says. “With my case, there were options and it was always ‘what’s the best option for Nicole?’ Even beyond the surgery, I can’t tell you the countless MRIs and ultrasounds and mammograms and doctor’s visits and bloodwork and COVID testing I’ve had. I was at Jefferson almost more than when I was working there,” she laughs.
The fact that she had those options, Cavaliere says, goes back to following through with her annual mammogram appointment in March. Had she put it off, things could have been very different.
She speaks of a 46-year-old friend—who had never had a mammogram. She was inspired by Cavaliere’s story and finally got checked.
“Had I waited, my journey would have been a lot different and 2021 would be looking a lot bleaker for me,” Cavaliere says. “I would have been sicker, my treatment would have been a lot longer and I most likely would not have had the surgical options that I had in an earlier stage.”