|FEATURES Fall 2000|
Specializing in breast cancer therapy and clinical research, Joanne Mortimer is a physician committed to bringing the highest quality of life to all her patients.
Over and over, the screensaver on Joanne Mortimer's computer flashes the same cheerful reminder: "Ain't it good when things are going your way?" No one is better than Mortimer at valuing the good times. In the life-and-death world that she inhabits, she knows just how bad things can be when they don't go your way at all.
Mortimer, professor of medicine and director of clinical oncology at the School of Medicine, is a specialist in breast cancer therapy and clinical research. Each month, she sees some 300 patientsyoung mothers and retirees, newly diagnosed women and long-term survivorsevaluating each one with a keen eye for her physical symptoms and a warm sensitivity to her emotional needs.
Amid the tears and terror that are an inevitable part of breast cancer, says Mortimer, it is important to remember that 65 percent of women with localized cancer will die of something else. Improved therapies and a national emphasis on early detection have helped to boost these statistics. But that still leaves more than a third of all patients46,000 this year alonewho will die of the disease.
"You watch these women battle from day to day: They do well, then the cancer comes back, and you treat it, and they get better again for a while. For the patient, it's a perpetual roller coaster of emotion. Finally, you see submission on their faces," says Mortimer. "At that point, they know they can't win."
For these patients, she is strongly committed to maintaining the best possible quality of life with the help of powerful new agents, such as long-acting narcotics and morphine preparations. Mortimer serves as co-chair of the Missouri Pain Initiative, a not-for-profit statewide group dedicated to improving the lives of cancer patients through pain management or palliative therapy.
"Some physicians who take care of cancer patients don't make the art of pain management a component of that care, and that is sad," she says. "About 1 in 20 cancer patients will ultimately have intractable pain, but 95 percent should have little or none. If we can't cure a patient, I believe we should at least give that person a comfortable death."
Armed with Courage
Both in living and in dying, Mortimer's patients are an awesome bunch, whose courage always amazes her. "They get their diagnosis and fall apart; then they manage to rally for the battle, still functioning as wives, mothers, workers," she says. "In general, it's the women in a family who keep things togetherand getting cancer doesn't change that for most of them. It's just one more thing to fit into their busy day."
One of these patients is Cheryl Loehr, a physician's assistant from Evansville, Indiana, who travels 360 miles to see Mortimer every few months. She was first diagnosed with breast cancer in 1998, then again in 1999; this past March (2000), she had surgery at Barnes-Jewish Hospital when the cancer had spread to her lungs. Recently, she nominated Mortimer for the Susan G. Komen Award, a national award for clinical and research excellence in this field.
"She is such an outstanding physician, who gives 110 percent to her patients," says Loehr. "With her intensity, her devotion, her knowledge base, I would love to see her get this award while I am still alive. She has a respect for the patient that not every physician has, and she takes more time to listen. She is a great complement to the wonderful doctor I see here in Evansville."
This gesturecoming from a patientmeans a great deal to Mortimer, who has won other honors as well. On August 17, she received the Department of Internal Medicine's Leadership Award in Clinical Care; in the past, she has been named Teacher of the Year by medical school students. She is also listed in the National Register Who's Who and in Best Doctors in America.
"Joanne Mortimer is a nationally recognized authority in breast cancer diagnosis and treatment, who is doing significant clinical and research work to combat this extraordinarily important disease," says William Peck, executive vice chancellor for medical affairs and dean of the School of Medicine.
"As a physician, Joanne Mortimer combines technical knowledge with a human concern for each and every patient. In addition, she is very smart and energetic. We are fortunate that such a special person is part of Washington University," says William H. Danforth, chancellor emeritus.
Mortimer herself is modest about her achievements; breast cancer, she says, is a humbling disease. She would much rather talk about the lessons in resilience that she learns from her patients. "Even when they are cured, they still wonder every time they have an ache or a pain: 'Am I one of those rare people who has her cancer turn up again 20 years later?' So these women live with that over their heads. As time goes on, it's less of a weight, but it never, ever goes away."
Fighting with New Therapies
Mortimer, a Chicago native, came to the School of Medicine in 1989, with an M.D. from Loyola University, internal medicine and oncology training at the Cleveland Clinic, then seven years experience at the Fred Hutchison Cancer Center of the University of Washington. During her first year in St. Louis, she was the only clinical oncologist in her division and saw 1,700 patients; today, she is one of nine oncologists who handle more than 20,000 patient visits annually.
From the start, she has participated in clinical trials of the latest drugs available. Many, like Zofran, have since become standard therapy. In 1995, she began testing Herceptin, an antibody treatment that is now routinely combined with chemotherapy to improve the survival of metastatic breast cancer patients. Right now she is engaged in a nationwide cancer prevention study comparing the effects of two drugstamoxifen and raloxifeneon 20,000 women at high risk for the disease. This protocol was one of hundreds reviewed and approved by medical school faculty associated with the newly created Alvin J. Siteman Cancer Center, now under construction at the Washington University School of Medicine and Barnes-Jewish Hospital.
"In my 20 years in oncology, Herceptin and tamoxifen have been the most important agents developed to treat breast cancer," she says. "Tamoxifen is the most commonly approved cancer agent worldwide, while Herceptin is the first in a series of drugs targeted toward the mechanism that causes cancer. That's clearly where we are heading: to therapies that target how cancer begins and how it spreads." Breast cancer treatment has undergone a dramatic shift, she says, from aggressive and high dose chemotherapy to new hormonal therapies and immunotherapies. Her own research focuses on effects of hormones on breast cancer and normal tissues; during her residency, in fact, a project in which she correlated the effectiveness of chemotherapy with the estrogen-receptor status of a tumor sparked her interest in breast cancer.
She has recently participated in a groundbreaking clinical trial, based at the School of Medicine, in the area of hormonal therapy. In many women with advanced estrogen-receptor positive disease, tamoxifen produces temporary tumor growth before causing the cancer to retreat. Thus, it is hard to tell at first whether a tumor is progressing or actually responding to therapy. Using positron emission tomography (PET), Mortimer and her nuclear medicine colleagues were able to predictvirtually 100 percent of the timewhich patients would benefit from the hormone.
"Joanne has been an essential ingredient in the success of these collaborative studies," says Barry Siegel, professor of radiology and chief of nuclear medicine at the School of Medicine. "Her strongly held conviction that many women with advanced breast cancer should be treated with hormones rather than chemotherapyat lower cost and with greatly improved quality of lifehas energized our project. We all believe that the method we have developed could dramatically impact breast cancer treatment."
Mortimer is continuing to use PET as a tool to study the effects of hormonal therapy on the brain. She is also looking forward to upcoming clinical trials of two exciting new agents: anti-VEGF, which works to prevent cancer cells from obtaining a blood supply; and Theratope, a vaccine that may keep women with stable metastatic breast cancer in remission.
She has things to look forward to in her own life as well. She enjoys early morning roller-blading in Forest Park and entering her smart-but-stubborn terrier, Emma, in obedience trials. This past January, she took her longest vacation ever: an exciting two-week alumni trip to Antarctica.
Asked if some day medical science will beat breast cancer É
"I think so, though I'm not sure it will happen in my lifetime," she says. "But the more we know about the molecular basis of the disease, the better the therapies become. In the meantime, educating women about breast cancer is critically important. If you're going to get itand we can't prevent itlet's find it as early as possible."
"Tamoxifen is the most commonly approved cancer agent worldwide, while Herceptin is the first in a series of drugs targeted toward the mechanism that causes cancer. That's clearly where we are heading É "