Young mother battles cancer, finds hope in Duke's young adult oncology program

It was a feeling Iris Bugbee said she hoped she would never know, but one that always lingered in the back of her mind.

“My mom was 49 when she was diagnosed,” Bugbee shared.

But at 34, that sinking feeling came in the form of a lump in one of Bugbee’s breasts.

“I always knew in the back of my head that there would be a possibility, but I didn’t know that it was going to be this soon,” Bugbee said. “My daughter was only 2 years old. I was not anticipating that.”

The young mom said her treatment for her stage II invasive ductal carcinoma quickly took over her life.

Bugbee said one of the first conversations she had with her oncologist about family planning. Her treatment called for 8-10 years of endocrine treatment, which essentially placed the 34-year-old in medically-induced menopause. She also had six rounds of chemotherapy, a bilateral mastectomy and 17 rounds of radiation.

“My husband, he was taking me to my appointments. We were doing chemo, we were there all day, and then it would take a week or two to get better. It was every three weeks, so that last week I’d start to feel better – and then it was time for another treatment. I was just really going through it,” Bugbee remembered. “The day after my 35th birthday was my surgery.”

She remembered the radiation being even tougher.

“It was going to work, going to treatment, coming back and finishing work – and doing it five days a week for the entire month of January,” said Bugbee.

The mom said she was hit with physical pain from treatment fairly quickly, including what’s called cording syndrome. The condition occurs when fibrous cords develop in the armpit after surgery or radiation for breast cancer, which can cause pain and limited motion of the arm.

The emotional pain came months later.

“The mental health of it all too came way later – maybe even a year after treatment,” said Bugbee. “I feel closer to 60, but I have to perform like a 30-something-year-old. I have my career, I have a young child, I have a husband.”

Bugbee told WRAL along with frustrations and limitations due to physical pain, younger patients must deal with additional emotions tied to their future.

“I got a lot of, ‘But you’re so young. You’re going to get through this.’ I was in that waiting room with 60- and 70-year-old women,” Bugbee recalled. “I know that I am this young, but I sometimes feel like people forget I have much more time left that I have to live through this.”

To help her better navigate the mental and physical burdens of being a young cancer patient, Bugbee started participating in the Duke Teen and Young Adult Oncology Program.

The program was made possible through NIH grants and helps patients cope with the unique challenges of young cancer diagnoses.

“I think if you looked at me at work, you wouldn’t think anything was going on. The mindfulness part of this program helped me see that I went through something, and I’m still going through something,” Bugbee said.

Program coordinator and Duke Health Clinical Psychologist Caroline Dorfman said Bugbee’s experience is more common in younger patients than in older adults.

“One of the things we hear all the time is somebody walks in the doors of the cancer center, they sit down in a waiting room, they look around and everyone around them looks like their parents or grandparents,” Dorfman said.  

The program was specifically designed to help younger patients between 18 and 40 years old better manage symptoms after care.

“One of the things we had seen in both our clinical work and prior research was how impactful cancer can be, specifically for young people,” Dorfman explained. “They’re at a time of their life when they’re trying to build their careers, build their families, and really trying to establish themselves as an independent person from their families.”

She noted a cancer diagnosis often derails a person’s plans and can lead to increased anxiety and depression.

“Anxiety can come up about having your next scan, or depression can come up from having missed out on opportunities because of your cancer or that things aren’t looking how you wanted it to look,” she said. “It may look like trauma-related responses from having this cancer experience.”

One NIH study looking at nearly 40,000 patients, found people diagnosed with cancer between 15-39 years old were 40% more likely to develop depression, and 20% more likely to have anxiety disorders compared to the general population.

Dorfman said finances are likely a contributing factor, with the cost of cancer treatments often exacerbating the mental load on a young patient.

“We also see young people don’t necessarily have the same financial reserves as somebody who is older. That can be a significant source of stress,” she added. “All of a sudden, money that would’ve been diverted to a retirement account is now being used to pay for cancer treatment.”

Bugbee said the program encouraged her to combine physical exercise with mental wellness. She now incorporates yoga and outdoor walks into her daily routine, which has helped her cope with the unknown.

She would tell others, “Take those symptoms and side effects and things that happen to you afterwards, and address them, take care of them, because you do have much more time.

“This happened at you at a young age, so take care of yourself so that you can make it to that 70 age and not feel so run down and terrible.”

Support offered to patients includes skills to navigate conversations with loved ones and coworkers who may not understand the realities of life as a young cancer patient.

“One of the themes we saw throughout all the different patients was how isolating it can be to be a young person with cancer,” said Dorfman. “When their treatments ended, so many people in their life expected them to go back to the way they were or the way life had been before their cancer diagnosis.”

She continued, “When we think of rates of cancer increasing among young people, our treatments are getting better, so we are also seeing more patients surviving their cancer. We want to make sure they’re surviving in a way that we can maintain their quality of life moving forward. That really comes with intervening on some of these psychological symptoms early.”

Dorfman said the program is individualized but offers monthly group meetups, so patients have a chance to meet and share experiences with people in similar situations.

Researchers have the goal of enrolling 260 patients over the next four years of the program. Dorfman said that includes patients beyond Duke Health’s system.

“We are recruiting folks from all across North Carolina, and that will really help us also learn more about the needs of patients from different geographic areas of the state,” she said.

Those interested in joining the program can learn more by emailing TAYO@Duke.edu, or calling 919-668-9752.

WRAL investigated the rise in younger cancer cases in our the documentary Diagnosis: Young, The New Face of Cancer in NC.