Oncologist aims to help patients thrive throughout ‘hills and valleys’ of cancer treatment
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Along with her research and clinical work on breast cancer, Lori Alfonse, DO, has made development of multidisciplinary teams and community engagement for cancer care a forefront focus of her work.
Alfonse, deputy physician in chief at the Lehigh Valley Topper Cancer Institute, spoke to Healio about her personal connection with cancer and her first-generation steps into college and eventually the medical field, which led her to treating patients with cancer.
She also spoke about how important it is to make sure those patients are taken care of from every aspect necessary, from diagnosis through survivorship.
“When you hear people say that medicine is a calling for them, it really was a calling for me,” she said.
Humble beginnings
Alfonse said she grew up a “Pennsylvania girl” in a blue-collar family, attending the public school system before heading to Penn State University and eventually Philadelphia College of Osteopathic Medicine, or PCOM, for medical school. She later became a breast fellow at Bryn Mawr College, and is the only fellowship-trained breast surgeon in the Lehigh Valley Health Network.
“I’m the first person in my family to go to college, and I don’t know what drove me to do that, but I felt like there was something more out there for me,” she said.
Her drive to medicine became personal, as she witnessed her mother’s breast cancer diagnosis and treatment and eventual passing away from lung cancer. Several other family members also have been diagnosed with breast cancer, with members on her father’s side also facing oncologic conditions.
Alfonse said that this left her, the younger of two siblings, spending time in the hospital watching how her family members were being cared for.
“Medicine always seemed to me like something of an investigation, and cancer care is a team sport,” she said. “It wasn’t one doctor making all the decisions, but rather it was a team of people. Even back then before I knew what I know now, I thought that team care would provide the best outcome for whoever we were caring for.”
After attending PCOM, Alfonse went on to start a breast cancer program from the ground up at Mercy Women’s Health Care in Blue Bell, Pennsylvania, before “returning home” when the opportunity arose for a fellowship-trained breast surgeon position at Lehigh Valley Health Network, where she has worked for more than 11 years.
Multidisciplinary teams
Many oncologists have faced the same couple of questions, including “why cancer care?” and “why this cancer specialty?” Alfonse was asked the same about her choice in breast cancer care.
“Breast cancer care is something that I’m never going to know everything about. I’m never going to come home at night and think I learned all there is to know about this field. I’m also not in it by myself,” she said.
She continued that she gets to work with the smartest people in medicine, from medical oncologists and radiation oncologists to nutritionists, nurse navigators “who are holding the patient’s hand every step of the way” and geneticists who are “finding out why these things are happening” in the first place.
She said that the multidisciplinary clinics at Lehigh Valley Topper Cancer Institute offer a way to show patients that coordination of their care is a priority.
“It’s rare that a patient who comes to me for cancer only needs surgery,” Alfonse said. “Cancer care especially needs to include a whole team approach.”
She continued that, during multidisciplinary conferences, not only is the treating team there, but also the patient and their family so that, as a group effort, the team can create an opportunity to relay the treatment plan and allow the patient and their support network to ask any questions.
“When we first started having these conferences, I thought that they might be overwhelming for a newly diagnosed cancer patient,” Alfonse said.
However, she found that patients have “far and away” walked out of conferences saying that they felt they had a better idea of what comes next than they did before meeting the team.
“If that’s the case, then we’ve done our job,” she said.
Surrounding support
As important as the multidisciplinary team is to guide a patient through treatment and survivorship, the very beginning of the cancer journey also requires a balance of support and understanding.
“The great part about Lehigh Valley Topper Cancer Institute is that we make it so easy for the patient because we recognize that a cancer diagnosis can be very overwhelming, and the last thing we want a patient to have to worry about is who they need to see for an appointment and when — that’s why this is all built in at the institute for each patient,” Alfonse said.
She continued that, between the nurse navigators and other team practitioners, all the visits are set up for the patients, so that the institute can ease the burden of the primary care or referring provider.
“Likewise, our network is big, but it is still personal,” she said. “When we see a new patient, their family doctor has likely been taking care of them for 25 years, and now all of a sudden there is required coordination among departments and physicians. As part of our approach, the Lehigh Valley Health Network uses interdepartmental communication tools to communicate with one another, which also reassures the primary care providers that their patients are receiving the best care and treatment.”
Regarding continued health care support, most institutions and networks have information on their websites. However, between the disruptions from COVID-19 and patients who “feel fine,” there can be a struggle to make sure there is adequate follow-up. Alfonse noted that she requires 5 years of follow-up to make sure the patient is not hitting any “bumps in the road.”
This includes making sure they are keeping up with yearly screenings, checking how they are coping in general and even how they are handling things financially.
“Just coming out of cancer treatment, it’s one thing to foot the bill for everything you have during cancer treatment, but sometimes that involves catch-up afterward,” she said. “So, we actually have a designated Survivor Place where we refer patients who may need continued help.”
Early-career advice
Finally, Alfonse shared one of her key goals as a treating oncologist.
“What I would urge anybody in oncology care to focus on is ‘thrivership,’ not survivorship,” she said. “There are plenty of patients who go through their treatment, and they might have hills and valleys. Some of them go through it seamlessly, some of them have a difficult time with treatment, but they’re all warriors.”
She added that, particularly with her patients, she believes that patients are stronger after treatment, having dealt with a serious illness and the mental fatigue that comes with it. She admits that treatment and the diagnosis can be traumatic, and many have a hard time facing what they went through, but she encourages them to embrace their ordeal and realize how strong they were to make it through.
“I tell them, ‘You never thought you’d have to do it and we hope you never have to go through it again, but you did it. That makes you so strong, it makes you level out all the things in your life that didn’t matter and you didn’t know it,’” she said.
Alfonse concluded with two messages she would encourage anyone heading into oncology care to realize. Firstly, and unfortunately, you cannot prevent an established diagnosis. So secondly, it’s important to celebrate success.
“No matter what, I am with each of my patients through their entire journey, ensuring they feel safe, understand that their diagnosis and next steps, and that they feel comfortable and cared for,” she said. “The reality is that sometimes you can’t do anything about that diagnosis, but you sure can do something about the experience that patients have going through it — and knowing that somebody is going to be honest and available when they have questions or their family is concerned is the most important aspect of the process.”
For more information:
Lori A. Alfonse, DO, can be reached at 888-402-LVHN (888-402-5846).
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