Cream Reduces The Pain For Breast-Cancer Patients

9:55 AM, Oct 6, 2009   |    comments
(The Arizona Republic)
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MESA, Arizona (The Arizona Republic) -- Jesse Crowe remembers the woman lying on his imaging table three years ago. She was in her 40s, young for a breast-cancer patient, and she was tense with fear and apprehension.

"She was the type you don't see," Crowe said. "I remember doing the injection and how painful it was for her.

"She was crying. ... She described it as worse than childbirth."

As a nuclear-medicine supervisor at Banner Baywood Medical Center in Mesa, part of Crowe's job is to inject a radioactive tracer dye as part of a procedure called a "sentinel-node biopsy."

He has done hundreds of them over the past 13 years, and even though his sister is a breast-cancer survivor and his grandmother and an aunt died of the disease, there was something about this patient that convinced him he had to do something.

"It wasn't anything about what I had in my life that made me feel more compassionate about this," Crowe said. "It was that I was inflicting pain on another human being. It was, like, what could I do to alleviate the pain?"

It wouldn't be easy.

The radioactive dye is a critical diagnostic tool. It is absorbed by the first lymph node, called the sentinel, beneath the armpit. Under a camera, the dye lights up like stars in the night sky and will track the growth of breast-cancer cells.

The treatment has been a standard diagnostic procedure since the 1990s and almost always is used before a lumpectomy or mastectomy.

The standard way to get the dye into the patient is with four injections into the areola of the breast.

"That's a lot of crying," Crowe said. "I had been trying to find something for years."

He had considered lidocaine, a topical anesthetic, but then discarded the idea because of the possibility of allergic reactions. Others have used local-anesthetic injections, but they're still painful, and some patients say they don't work very well.

Although pain management is becoming an increasingly important priority in health care, Crowe was frustrated by the lack of solutions for his patients.

He started scouring the Web, looking for articles about the procedure. He read journal article after journal article on sentinel-node biopsies. None mentioned anything about using local anesthetics.

Then, a single sentence in a journal caught his attention. It mentioned using a topical cream used in children's procedures.

"I found this obscure article one time from Mount Sinai hospital in New York, and they were describing this technique," he said. "They used EMLA cream, a combination of lidocaine and prilocaine. I didn't know what it was. They used it for little children using IVs. That's what the pharmacy uses today in the medical field. It is for pediatric units to put on the skin of the baby when they put IVs in."

If it worked for children, why not women? he thought.

But in medicine, you can't just start using a new treatment without testing it first.

Crowe began enlisting surgeons and nurses to help him come up with a protocol. One of them was Dr. Katherine McCuaig, a general surgeon, who helped Crowe sift through even more journals in the hopes of finding an effective method for administering the cream. Finally, a little more than a year after that fortysomething patient launched him on his quest, they began testing it on patients in September 2007.

They spent six months experimenting with various doses of the EMLA cream to find out which worked best to numb the areola.

To compare results with those who received the cream, they called previous patients who had the procedure without an anesthetic and asked them to describe their pain to set a baseline.

They finally hit on an effective dose and application, which now is a standard of care at Banner Baywood.

Now, other hospitals are taking notice.

Later this month, their research will be presented online at a national symposium on breast cancer in San Francisco. From there, Crowe and McCuaig expect it will become a standard for sentinel-node biopsies.

"We're seeing considerably less patients feeling significant pain now than before," Crowe said. "We're at the point where 90 percent of our patients are not having pain."

That fact brings a smile to his face.

Recently, under fluorescent lights inside the imaging room, Crowe prepared to do another tracer injection.

Jaci Shaw of Gilbert waited on the scanning table.

"Have any questions for me, young lady?" Crowe asked.

"Nope, just better make sure that cream works," she replied.

Crowe chuckled.

"This is the worst part you're going to feel," he said as he administered the first injection.

Nothing.

"That's what you're going to feel, all right?" Crowe said. "Three more times."

Crowe administered two more injections. A nurse assured Shaw she was doing fine.

One more injection to go, then, "Wow! That's it?" Shaw said. "That's not bad at all."

The only other sound was jazz playing on the examining-room speakers. There was no crying.

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