<div><strong>Fundraiser for Hannah:</strong>
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<div>Hannah is a thirty-two-year-old journalist and editor living in Brooklyn, New York. On July 4th, 2020, she discovered a medium-sized lump in her chest. She called her doctor, who told her not to worry--Hannah was young, healthy, and had no family history of breast cancer. The chance of the lump being anything other than benign was a fraction of a fraction of a percent. When she went in for an exam, the gynecologist told her much the same, but put in an order for a sonogram, just to make sure. On August 7, she was diagnosed with Stage IIB breast cancer. She had a 3cm tumor in her right breast, and the cancer had spread to at least one lymph node.
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<div>Throughout chemo, radiation, multiple surgeries, more chemo, and the side effects of her treatment--including heart failure, hypothyroidism, anemia, PTSD, treatment-resistant depression, and the anxiety associated with living with what is really a lifelong disease and disability--Hannah has shown incredible resilience and bravery. She has lived in her apartment in Brooklyn the whole time, acting as her own advocate and organizing her own care. All of this has been made particularly difficult by the pandemic, which has added a new level of fear and danger to the lives of the immunocompromised. COVID restrictions and concerns prevented Hannah from seeing her friends and family at crucial moments in her treatment, increased the cost of transportation, and contributed to her feelings of loneliness throughout a process that is already isolating and incredibly scary. It has also taken away much of the emotional support and daily comforts a cancer patient needs.
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<div>Even with insurance, the out-of-pocket costs associated with cancer treatment, especially during the pandemic, have been astronomical. Hannah has applied for and been approved for New York Presbyterian’s income-based charity care, which discounts her medical bills at the hospital there, and she has received one-off subsidies for certain treatments.* But many of Hannah’s bills are from doctor’s offices that do not offer charity reductions, or for services that aren’t covered by her insurance. She lacks the resources or assistance to pay for the rest. And because she is on short-term disability leave, her salary has been reduced to 60% until she returns to work in January. Your contributions will go towards paying for unpaid medical expenses, a small (but meaningful!) percentage of living costs and transportation for the duration of her medical leave, and additional therapy and rehabilitation programs that will help Hannah rebuild her life.
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<div>Your donation will help cover the costs associated with:
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<li>Chemotherapy, a mastectomy surgery, and radiation
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<li>Transportation to/from chemo and surgery (as covid cases rise, its very important that Hannah can afford taxis to/from her appointments)
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<li>Acupuncture (for post-surgical pain and inflammation)
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<li>Physical therapy
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<li>Lymphatic therapy
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<li>Outpatient mental-health treatment program for survivors
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<li>Out-of-network consultations with experts in breast cancer
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<li>Co-insurance for certain drugs (e.g. self-administered Lupron, which costs $480/kit)
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<div>Anything over this amount will go into a fund for Hannah’s out-of-pocket costs and co-insurance for treatment in the next five years, the bare minimum of which will total $25K. Hannah is so grateful for all the support she has received from friends throughout this incredibly difficult time. Any contribution you can make will be greatly appreciated, and if donating money is difficult and you would still like to find a way to support Hannah please feel free to reach out to the organizers of this campaign. You can find more information about Hannah’s diagnosis, treatment, and recovery below:
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<div><strong>Timeline of Hannah's Treatment:</strong>
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<div>August-December 2020/Diagnosis and Chemo
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<div>After Hannah was diagnosed, her oncologist advised six months of neoadjuvant TCHP chemotherapy followed by surgery and possible radiation. It was important to move fast, given Hannah’s subtype: her cancer was ”triple positive,” meaning that the biopsy sample had tested positive for estrogen hormone receptors, progesterone hormone receptors, and a protein called HER2. Fifteen years ago, the prognosis for HER2+ cancers was grim, almost a death sentence. But in the last decades oncologists have started treating patients with a revolutionary drug, herceptin, that specifically targets HER2 cells. Still, triple-positive breast cancer is a scary thing to have—it means that if Hannah has a recurrence, it is likely to happen within the next few years, and spread through the rest of her body swiftly.*
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<div>Chemo causes all kinds of collateral damage and, especially for younger patients, can severely compromise long-term fertility. The oncologist recommended that Hannah do a two-week egg-retrieval cycle before starting chemo infusions. She started daily hormone shots in late August. The addition of reproductive medicine to the diagnosis period was incredibly overwhelming, making for an extremely compressed timeline. On September 9th, Hannah had the egg-retrieval surgery; on September 10th, she had a surgery to place an IR port in her chest; and on September 11th, she had her first chemo infusion.
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<div>Hannah spent last fall shuttling between her home in Brooklyn and doctor’s appointments on the Upper East Side. Every three weeks, she had a chemo infusion, followed by weeks of extreme exhaustion, debilitating nausea, lack of appetite, brain fog, neuropathy in her hands and feet, and other side effects. Most of the time, she couldn’t even read. After each infusion, a friend had to stay with her for a week to care for basic needs: meals, meds, etc. During the course of treatment, Hannah endured heart failure, anemia, and hypothyroidism as a result of the chemo, adding more doctor and hospital visits and medical expenses to almost daily cancer-related appointments. Hannah worked as best she could through the first ten months of her treatment, taking days off after chemo and a few weeks after surgery. (This was her choice, and her supervisors and colleagues were deeply kind in accommodating temporary disabilities and reduced capacity.)
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<div>January-April 2021/Surgery, Radiation, More Chemo
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<div>On February 1st, Hannah underwent a bilateral mastectomy. She had anticipated her treatment would largely be over after this--she and her doctors had hoped that the chemo would kill all the cancer cells--that the pathology of the excised breast tissue and lymph nodes would show that she’d had what’s called a pathologically complete response (PCR). Unfortunately, two weeks after the mastectomy, the pathology report came back showing residual cancer cells. Because of this report, her doctors advised her to undergo both radiation and another, longer cycle of chemo with a new drug, TDM1, that has been shown to decrease rates of recurrence in cases like Hannah’s. Fourteen more rounds, once every three weeks: ten more months of chemo.
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<div>Hannah got her first TDM1 infusion in late March. A few days later, she started radiation, which required her to make the 1.5-hour subway trek to the Upper East Side every weekday for five weeks.** The side effects were brutal. By the time Hannah completed radiation, two days before her thirty-second birthday, the cumulative effects of treatment--chemo, surgery, radiation, more chemo, along with the psychological wear of living as an immunocompromised person in New York in the midst of the pandemic--had inhibited her functioning to the point where a medical leave from work was necessary.
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<div>May 2020-Present/Medical Leave and More Surgery
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<div>The leave has been going well, even given the fatigue, nausea, brain fog, and other side effects that come with her TDM1 chemo infusions. She is still recovering the full use of her body after radiation and surgery, but she has come a long way. Over the summer, after a year trapped in her apartment and with the increased security of the COVID vaccine, she was able to leave New York on multiple trips to visit friends and family. She says that she’s been enjoying hiking, recently -- her oncologist encouraged her to pursue vigorous exercise to lower the chances of recurrence, and on trips she tried to find places to go backpacking whenever she could. To pay for these visits, she sublet her apartment in New York and relied on the generosity of friends and strangers.
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<div>Hannah is now back in her apartment in Brooklyn, where she is currently finishing up the last six rounds of chemo and beginning an intensive recovery and rehabilitation process. She also has one more major surgery on the horizon. During the initial diagnosis period, her PET scan showed hypermetabolic activity around one of her ovaries, and imaging showed medium-sized masses. There was a worry of the possibility of ovarian cancer. Her onco-gynocologist suspects that the masses are endometrioma, but to rule out ovarian cancer altogether, she has to operate. It’s difficult for the doctor to predict what exactly she’ll find and how invasive the surgery will be. The endometriosis might have destroyed just a fallopian tube, but it might have destroyed both ovaries, likely resulting in a total hysterectomy. The surgery is scheduled to take place right after Hannah’s final TDM1 infusion, in late January.
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<div>Future/Recovery and Rehabilitation
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<div>To mitigate the risk of recurrence of breast cancer, Hannah will require ongoing treatments and medication for five to ten years. This includes monthly Lupron shots, which suppress ovarian function, and a daily aromatase inhibitor pill. These medications cut down on estrogen and progesterone production in her body, hormones that her specific type of cancer feeds on. Both of these treatments put her into a sort of medically-induced menopause, which comes with its own side effects and late effects, and require her to get twice-yearly shots to support her bone density (a lack of estrogen is associated with conditions like osteoporosis later in life).
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<div>As Hannah completes her second cycle of chemo, prepares for her fourth surgery, and anticipates the side effects of these ongoing medications, she is beginning a series of programs and treatments to help her heal and prevent a recurrence of cancer. Hannah has received miraculous cancer-fighting medications and treatments. But the struggles of a survivor aren’t over when treatment ends--the long-term physical and psychological side effects endure, and without proper therapy, can become debilitating to people’s lives even if they never suffer a relapse.
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<div>If we are able to raise sufficient funds, the treatments and therapies that could vastly help improve Hannah’s outcome going forward include physical therapy, lymphatic therapy, acupuncture for pain relief and inflammation reduction, various forms of trauma therapy, and survivor support groups.
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<div>Recovery requires setting up a new life in which cancer survivors are supported in pursuing the things about their body and mind that they can control, while learning strategies for dealing with the uncertainty of all the things they can’t. This is why this period of treatment and recovery is crucial, and why, given the abysmal state of American healthcare, Hannah needs our help.
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<div>Thank you so much for reading and for your love and support for Hannah &lt;3
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<div>*At other hospitals, like NYU Langone, where her surgery took place, she was told that, even though she was eligible for charity care discounts, she would have had to apply *before* her surgery took place, which no one had told her.
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<div>**When Hannah got a second consultation about her options for radiation treatment, she learned that she was eligible to participate in a clinical trial of proton radiation, a cutting-edge radiation therapy that many doctors think will eliminate the rare but devastating late effects associated with X-ray radiation, including secondary cancers, lung deterioration, and heart damage. As someone who had gotten breast cancer at such a young age, she was a particularly good candidate for this. But because she didn’t learn about it until a month after her surgery, and because her insurance would have required a weekslong process to approve her, she had to go with the typical course of x-ray radiation. X-ray radiation is sophisticated, and the risks are still very low, but still, the fact that she couldn’t participate because of insurance bureaucracy was a big blow to her morale.<br /><br />*** David Solomon is a friend of Hannah's. They met in college, 13 years ago. All funds will be withdrawn by Hannah and used to cover out-of-pocket medical expenses for her breast cancer treatment and recovery treatments. 
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