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First Came Breast Cancer, Then COVID-19

Surviving the Diseases Simultaneously Became the Challenge of a Lifetime for Cedars-Sinai Patient

Natalie Coehlo wasn’t concerned at first about the sudden rash on her left breast last December. Six months later, though, when the rash had morphed into sores, she visited her primary care physician in Tulare, California.

“My doctor said I had either a bacterial infection called cellulitis, or cancer,” Coehlo, 49, said. “Cellulitis would require a three-day IV treatment. If it were cancer …”

The diagnosis turned out to be HER2-positive inflammatory breast cancer. Inflammatory breast cancer is rare and aggressive, accounting for up to only 5% of all breast cancers. Patients often do not detect it by feeling a breast lump, but rather when one breast becomes swollen, red and tender. HER2-positive refers to patients who have elevated levels of a protein called human epidermal growth factor receptor 2, which promotes the growth of cancer cells, said Reva Basho, MD, a medical breast oncologist at Cedars-Sinai, and Coehlo’s physician.

“Because of the redness and inflammation of inflammatory breast cancer, it’s hard to know by feeling the breast where the tumor is, so patients may not know they have one,” Basho said. “When the cancer is diagnosed, we take an aggressive approach to treating it.”

In June, Coehlo began a pre-surgery treatment regimen of the anti-HER2 drug Herceptin, which targets HER2 receptors to fight tumor cell growth and “tells” the body's immune system to destroy cancer cells, plus chemotherapy to shrink the tumors. She determined to fight the illness head-on and focused on getting through each treatment session and recovery. Little did she know that another menace was lurking nearby.

About one month after Coelho’s treatments began, her husband tested positive for COVID-19. His symptoms were mild. Coelho developed mild symptoms of the virus about a week later. Although manageable at first, her condition rapidly deteriorated.

“I couldn’t breathe, I was winded and fatigued,” Coehlo recalls. “I quickly got myself to Cedars-Sinai – I wanted to get treated for both illnesses in one place – and was admitted to the hospital. I almost ended up in the intensive care unit. It was very scary."

During her hospital stay, Coehlo, a bookkeeper, lost her senses of smell and taste and endured crippling panic attacks.

“I suddenly couldn’t get air, I was so panicked,” Coehlo recalls. “The nurses assured me that all of my vitals were fine and that my oxygen intake was fine. They really helped me get through those attacks.” She also was comforted by frequent FaceTime calls from Basho, who answered her questions and provided reassurance, she said.

“Dr. Basho was my guardian angel,” Coelho said. “Her calls meant so much to me.”

Like other cancer patients undergoing immune-suppressing chemotherapy treatments who also are stricken with COVID-19, Coelho was worried when Basho recommended Coelho pause those treatments for a few weeks so her immune system could better fight the novel coronavirus.

Basho made the recommendation based on American Society of Clinical Oncology guidelines and current scientific studies that have shown that ceasing cancer treatments in the short term – to prevent further immune-system suppression – would allow her body to fight the virus and probably would not negatively affect her cancer outcome. Coelho agreed to that plan and tests showed that her cancer did not grow during the break.

 “Fortunately, it remained the same," Basho said. "She now has only a couple months of therapy left.”

To avoid facing difficult decisions about conflicting cancer and COVID-19 treatments, Basho strongly recommends that cancer patients undergoing chemotherapy – especially those with leukemia and cancers that have spread, putting them at higher risk for worse COVID-19 outcomes – “be extra vigilant about wearing a mask, washing their hands and distancing themselves from others, particularly during a community outbreak.”

Today, with COVID-19 behind her, Coelho says she is focused on completing her cancer treatment and resuming her normal life with her husband and children.

“When I got my cancer diagnosis, I thought at first that I couldn’t handle it,” Coelho said. “But then I determined I was going to fight this, and I am. I have tremendous support: my sisters, friends, husband and kids. I stay away from people whose attitudes are negative and reach out to those who know what it’s like to walk in my shoes. It’s made all the difference.”

Read more on the Cedars-Sinai Blog: Cancer/COVID-19 Update: Don’t Delay Screenings, Urges Oncologist