Jacqueline Hickey (left), with her son, William (center), and husband, (also William) in 2021. MSK’s bone metastasis clinic enabled Jacqueline to get relief without relying on pain medications.
For Jacqueline Hickey, the pain was so severe at times that it interfered with her daily life.
“It just hurt so bad, especially lying down at night. I got so sleep deprived,” she recalls. “During the day, it was hard to even lift a laundry basket or walk for exercise.”
She has been fighting lung cancer for 14 years since being diagnosed at age 40. When the cancer returned three years ago, her personal physician suggested she go to Memorial Sloan Kettering. A combination of chemotherapy and radiation helped, but eventually the cancer spread to her left rib.
By August 2020, Jaqueline was really starting to suffer. But the mother of four was leery of pain medications.
“I want to be able to focus,” she says. “I have one child still at home and my firefighter husband often works 24-hour shifts. I don’t want to be conked out.”
Fortunately, Jacqueline had other options. In 2019, MSK established a dedicated clinic for treating people with metastatic bone cancer. The clinic, led by interventional radiologist Ernesto Santos, MD, and orthopedic surgeon Max Vaynrub, MD, includes specialists in surgery, radiation oncology, interventional radiology, rehabilitation medicine, and pain management.
“Bone metastases are about 100 times as common as primary bone cancer,” Dr. Vaynrub says. “They often cause acute pain and fractures and can be very frightening and disabling for patients already dealing with their primary cancer. Effective treatment requires expertise from a multidisciplinary team, which is why we launched the clinic.”
The doctors talked through Jacqueline’s case at one of the clinic’s biweekly meetings. The group discussions allow the specialists to make the best decision for a patient.
Complementary Treatments
To help Jacqueline, the clinic team decided to use stereotactic body radiotherapy (SBRT) and cryoablation. SBRT involves targeted, focused external beam radiation to maximize the radiation dose to the tumor, effectively killing the tumor while minimizing damage to the surrounding healthy tissue.
Cryoablation involves inserting small needles into the bone metastases and freezing and killing the bits of tumor. Dr. Santos specializes in this interventional radiology therapy.
“The coordination of the clinic was amazing,” Jacqueline recalls. “I happened to be at Memorial Hospital getting tests, and they said, ‘We’re going to get you in to see Dr. Santos today.’ I didn’t have to go all the way home and come back. They made it so simple.”
At the bone metastases clinic, doctors in five different specialties can all see patients on the same day. This streamlines the care and limits the number of times a patient needs to come in.
Dr. Santos thought cryoablation would work for Jacqueline, but before scheduling the procedure he wanted her to try something else first. On that same day, she visited pain specialist Amitabh Gulati, MD, to do a nerve block — an injection of an anesthetic into her back that blocks pain from specific nerves. The procedure eased her pain, which gave Dr. Santos confidence that cryoablation would work well.
Jacqueline returned several weeks later for cryoablation in the David H. Koch Center for Cancer Care at Memorial Sloan Kettering Cancer Center, which opened in 2020. Dr. Santos froze and killed the cancer cells in the rib, along with some nerves surrounding the area. Because the procedure is minimally invasive, “I was in and out the same day,” she says.
Resuming Normal Life
With her pain and left rib bone metastasis now under control, Jacqueline began having a much better life. “I didn’t realize how much I was suffering until they actually gave me treatment,” she says. “It’s unbelievable the difference it made. I was back to sleeping, and going out walking, and being able to function and run a family.”
With her pain alleviated, Jacqueline joyfully celebrated the marriage of her daughter Kristen to Lieutenant Junior Grade Michael Cassano at the Naval Academy in Annapolis, Maryland in 2021.
More than four years later, her pain is still under control. Jacqueline retired from her job as a school nurse and is enjoying her family. Her first grandchild was born in 2022, and another is on the way. Her cancer has remained in remission, and she no longer receives treatment for it — just scans every three to four months.
She wants other people with bone metastases to know there are many new options to continue living with cancer if it has spread.
“There’s so many new things coming out and it’s exciting — if one thing doesn’t work, there’s always something else they can try,” Jacqueline says. “I am here enjoying lots of good things in my life and am forever grateful for the ongoing care that MSK continues to give,” she says.
This story was originally published in 2021 and has been updated.
Key Takeaways
- Cancer that spreads to the bones is painful
- MSK bone metastases clinic offers pain relief
- Team approach coordinates care from many experts
- Doctors use targeted radiation and freezing to shrink or eliminate tumors
