Cindy Koerner survived breast cancer | epirubicin | zoladex | cyclophosphamide | estradiol
- Apr 21
- 11 min read
DESCRIPTION
In 2018, for Cindy Koerner, pain in her right breast led to a diagnosis of Stage 3A breast cancer. She was put on a three-pronged, high-dosage chemotherapy regimen of epirubicin, nab-paclitataxel and cyclophosphamide. The cyclophosphamide compromised her immune system, resulting in fatigue and fever. The chemo regimen shut down her ovaries, but when they became active about a year later, Cindy was told if they remained active, the possibility of a relapse would increase, so she opted to have them removed. These days, Cindy believes her health is at approximately 80 percent of what it was before her diagnosis, but she admits she gets tired easily, which prevents her from doing activities that she thinks would leave her exhausted.
Cindy’s cancer journey began in 2018 when she felt pain behind the nipple in her right breast. The pain would leave, only to return when her menstrual cycle returned. She saw her gynecologist, who called for an ultrasound, which the doctor said did not reveal anything abnormal. When the pain continued to come and go, she went back to the gynecologist. Another ultrasound, the gynecologist said revealed nothing unusual.
However, in 2020, she noticed a change in the shape of her breast and that it included a dimple. Another trip to the doctor and another scan indicated a tumor and a diagnosis of Stage 3A breast cancer. Cindy later learned that such a diagnosis should have provided her with multiple treatment options, but at the time her care team told her she would be going on an aggressive regimen of chemotherapy. Because of the advent of COVID, treatment was made more difficult for Cindy from an emotional perspective because she had to remain in isolation.
The regimen included epirubicin, nab-paclitaxel and cyclophosphamide. She had to come in for a dosage every two weeks. Like many on chemotherapy, Cindy suffered hair loss, but she said the cyclophosphamide was the roughest. It played havoc with her immune system, leading to fatigue, fever and depression. However, this was not the only hurdle in her journey.
Cindy’s tumor was hormone receptor positive, which reacted to the estradiol in her body. This had implications for her ovaries. The chemo had rendered them inactive, but about a year later, they became active again. She was told when the ovaries are active, that increases the possibility of the cancer returning. As a result, with injections of zoladex, a GnRH analogon, she opted to have her ovaries removed.
Cindy Koerner has returned to work as a cancer biologist with the German Cancer Research Center in Heidelberg. She says her health is about 80 percent of what it was before her diagnosis and there are some activities she avoids because she fears they would leave her exhausted.
Cindy is also a cancer patient advocate. Among her messages to patients is to have a heightened awareness of their treatment options, which she admits she didn’t have at the time of her diagnosis.
TRANSCRIPT
Bruce Morton: Greetings. This is the Cancer Interviews podcast, and I am your host, prostate cancer survivor, Bruce Morton. Our guest on this episode not only survived Stage 3A breast cancer, but her journey included an unusual and devastating step. She is Cindy Koerner of Heidelberg, Germany, who is a survivor and a patient advocate. Here she is, and Cindy, guten morgen, willkommen and welcome to Cancer Interviews.
Cindy Koerner: Good morning from my side. Thank you for having me.
BM: It is our custom to get to know our guests before we hear their story, so if you would, tell us a bit about where you are from, what you have done for work and what you do for fun.
CK: I am from Germany, as you said, from the Heidelberg area. I am the mother of three, so I have three kids. The oldest is a teenager now, so when I was diagnosed, the youngest was two years old. I am working as a cancer biologist with the German Cancer Research Center here in Heidelberg. I am trying to figure out molecular mechanisms of breast cancer cells, how they can survive therapy, how they can progress, how they can metastasize. This I was working on long before my diagnosis. And for fun, I spend time with my kids.
BM: For each of us who have survived cancer, there was that point in time in which we experienced something abnormal with our health, which ultimately led to a diagnosis of cancer. In your case, describe that point in time.
CK: It was in 2018 when I first realized I had pain in my right breast, so it came in cycles, usually tied to my menstrual cycle, so a few days within that, I had the pain. Then it went away, only to come back. I scheduled a visit with my gynecologist. She did an ultrasound and did not see anything abnormal. At that time I was 32 years old and she said I was too young for anything bad, so it must be some hormonal disbalance and that everything was fine. I was just lived with the pain for a few months. I returned to the gynecologist. She checked again and saw nothing abnormal. Then in 2020, with the advent of COVID, I noticed that the shape of my breast had changed and saw a dimple. I went to get checked out one more time and this time I learned I had breast cancer.
BM: For all of us diagnosed with cancer, it is always a horrific day when we receive the diagnosis. But each diagnosis is different and each person and their makeup is different. For you, when you received this news, how did you handle it?
CK: As I said, it was during the pandemic, so I had to go in all alone. It was really devastating, so I had the feeling that something within me had shut down; so, even though I am in the health care field, I knew all the words she was talking about, but I still could not understand I had been diagnosed. It took me some time to realize she was talking about cancer. I kept on thinking she must be wrong, it cannot be the case.
BM: With different types of cancer, there is only one treatment while with others, there are multiple available approaches. In your case, did you have options?
CK: I would say yes, there were treatment options, but the way the communications went, especially in the beginning, I did not feel as though I could choose. I was told I would have to go on chemotherapy. It was only after quite a few steps that I felt I could make any choices. Until then, I just followed what I was told.
BM: So, the next step for you was a chemo regimen, and if you would, do you recall the medications used as part of that regimen?
CK: I was on a high-dosage regimen, which I had to undergo every two weeks. There were three. They were epirubicin, nab-paclitaxel and cyclophosphamide. The cyclophosphamide gave me a fever, so my immune system was kind of gone, so I spent a week in the hospital, because they were afraid I would catch any germs, which was not so pleasant.
BM: By the way, we hope you will find time to like and subscribe. And if you click on the bell icon, you will be notified anytime we post an interview. We also want to remind you that we are not distributors of medical advice. If you seek medical advice, please contact a licensed healthcare professional.
So, Cindy, I am guessing that what you were going through was doubly difficult because not only were you going through chemo, not only was it a heavy dosage, but because of COVID, you could not be visited by your husband or other family and friends. How tough was that?
CK: On the one hand, I always like to look at the positive aspect of everything, so I think what was positive is that in Germany we had very strict lockdown for quite some time. The kids would not go to school, they would not be allowed to see friends, which was really devastating on the one hand, but on the other, I was safe from not catching any infection from anyone. So, that was kind of positive, I think. On the other side, it was super hard to be alone in the hospital, even the conversations with the medical staff, that was tough.
BM: Now, when one thinks of chemotherapy, one thinks of fatigue, of hair loss, or food tasting like metal. For you, what was the toughest part of your chemo regimen?
CK: I am a scientist, so with the three different drugs, one after the other, I kind of felt the difference between the different drugs, which was really interesting for me. So, with the first one, with the epirubicin, I felt a lot of nausea. I didn’t want to eat and got very weak. Then with the second one, the nab-paclitaxel, I didn’t feel anything. The side effects were managed well. The worst part was hair loss. But with the third one, the cyclophosphamide, I had these very bad drops in my immune system. It made me feel very bad, so that was the worst of the three.
BM: At the very beginning, we mentioned an unusual step that was part of your journey, one we don’t normally associate with a breast cancer journey, but as your treatment progressed, you learned that you were going to have to have your ovaries removed. What necessitated that, Cindy?
CK: So, my tumor was hormone receptor positive, which reacted to the estradiol in my body. Because of that, I was told I should become post-menopausal, so I should not have active ovaries anymore to make sure that my estradiol levels would stay low. That was the case directly after chemotherapy, so the chemotherapy kind of shut down my ovaries and everything was fine; but about a year later, my ovaries started working again, then I would have high estradiol levels again, which can lead to the tumor coming back because it was already quite locally advanced, so the prognosis was not awesome, I would say, so to reduce the risk, we needed to shut down the ovaries again. To do that, we tried injections with a GnRH analogon with Zoladex. That was effective in that my ovaries didn’t work anymore, but at the same time I developed a really bad depression over the few months that I took it. Then I had a decision to make. Either I stop the treatment and the risk of the cancer returning increases or I have my ovaries removed, and that’s what I chose. I have to say for me it was the right decision. The depression was gone after that.
BM: Cindy, I have to ask. You were diagnosed with breast cancer, you suffered a bout of depression and you had your ovaries removed. Where did you find the strength to deal with this?
CK: In this situation, you have this feeling that you have to keep on going on, like there is no alternative option. Also, as I said, I have kids, so I didn’t have the option to say I give up because you know you have to be there for them. I also have my job, so it also gave me strength, the will to proceed. But I also had panic attacks, so I feel I didn’t always cope in a positive way. I had a psychologist and she really helped me.
BM: At some point here, you started to advance toward survivorship. You must have noticed that things were getting better. What was that like?
CK: I hadn’t mentioned some various steps in my breast cancer journey. I had a mastectomy, then I had implants which had an infection, so I had to get them removed. This covered like two years, so I did not get out of this process of being in the hospital all the time and medical appointments all the time and once that was over, I had panic attacks. Once I was over these panic attacks, I felt like I was at a point in which I could call myself a survivor and I wanted to take something positive out of it.
BM: When your care team told you that you had reached survivorship, how exciting was that?
CK: In Germany, they never say you have reached survivorship because in the end, you don’t know if you are really cancer-free. There is always this uncertainty that is attached to it. Also, for me, one day I will say I am a survivor, but at another time, I will still feel that I am a patient. It is not like I feel that I am cancer-free and that I am over it because I know that the relapse risk is there for like twenty years or so, the type of tumor that I had.
BM: Cindy, if you could look back to the days before your diagnosis, and we could call your health at that time, 100 percent, these days, how close are you to 100 percent? These days, what can you not do?
CK: I would say I am maybe 75 or 80 percent because I still have fatigue. I am not sleeping very well. I used to be very energetic, but sometimes I don’t want to do certain activities because it would drain so much energy. Things that I used to enjoy, I don’t do because I know they will be exhausting.
BM: We mentioned at the very beginning that you are an advocate for cancer patients. Can you tell us about that?
CK: I am mostly engaged with the Center for Tumor Diseases here in Heidelberg. I am with the Patient Advisory Board, trying to bring the patient perspective into patient care. When I was diagnosed I didn’t feel as though I had choices, even though I later learned I had many choices at my disposal. I try to advocate for wiser patient decision making and for better dialog between patients and their care team. On the other hand, I engage in cancer research, mostly in clinical research, which can lead to clinical trials.
BM: Cindy, we are going to wrap up, and we usually conclude with the following question. If you encountered someone who had just been diagnosed with breast cancer, that person will likely have lots of questions for you and you might have lots of answers; but if there is one point you really hope this person would remember as you two parted ways, what would it be?
CK: Don’t put pressure on yourself to become the ‘old’ one, for your health to be the same as it was before the diagnosis. One of my doctors said I would eventually become the “old” one, like when everything is over, I will be the same as I was, pre-diagnosis. That put me under pressure for quiet some time until I realized I don’t have to achieve that goal.
BM: Excellent. Cindy Koerner, Heidelberg, Germany, thank you very much for sharing your story. You have overcome so much, and that all by itself should be a major source of inspiration for anyone on a cancer journey. Cindy, thanks so much for being with us on Cancer Interviews.
CK: Thank you for having me.
BM: And we want to remind you as we always do when we bring an episode to a close, that if you or a loved one are on a cancer journey, you are not alone. There are individuals out there like Cindy Koerner who can inform and inspire and make that cancer journey a little bit easier. So, until next time, we’ll see you on down the road.
SHOW NOTES
TITLE: Cindy Koerner, Stage 3A Breast Cancer Survivor – Heidelberg, Germany
In 2018, for Cindy Koerner, pain in her right breast led to a diagnosis of Stage 3A breast cancer. She was put on a three-pronged, high-dosage chemotherapy regimen of epirubicin, nab-paclitxel and cyclophosphamide. The cyclophosphamide compromised her immune system, resulting in fatigue and fever. The chemo regimen shut down her ovaries, but when they became active about a year later, Cindy was told if they remained active, the possibility of a relapse would increase, so she opted to have them removed. These days, Cindy believes her health is at approximately 80 percent of what it was before her diagnosis, but she admits she gets tired easily, which prevents from doing activities that she thinks would leave her exhausted.
Time Stamps:
01:38 In 2018, Cindy noticed pain in her right breast.
02:45 In 2020, she saw the shape of her breast had changed, sought medical attention and learned she had breast cancer.
03:16 Recalls her reaction to the diagnosis.
04:19 Said she was given but one treatment option.
05:12 Was put on an aggressive, high-dosage chemotherapy regimen.
06:49 Cindy said because of COVID in 2020, she had to be isolated during treatment.
07:55 Recalls the roughest part of her chemo regimen.
09:19 Explains why she chose to have her ovaries removed.
10:45 Said her chemo regimen led to depression.
11:32 Cindy names her source of strength during an arduous cancer journey.
12:49 Recalls when her condition began to improve.
13:57 Said she was never told she had reached survivorship.
14:54 Is asked what physically she can and cannot do, post-treatment.
17:21 Her advice to others diagnosed with cancer.
KEYWORDS (tags):
stage 3a breast cancer
epirubicin
zoladex
nab-paclitaxel
cyclophosphamide
mastectomy
estradiol
gnph analogon
estradiol levels
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