At Penn Medicine’s Jordan Center for Gynecologic Cancers, radiation oncologist Neil Taunk, MD, cultivates a professional but friendly relationship with his patients. He prefers they call him by his first name and always makes sure to leave plenty of time to talk about the non-cancer stuff, jotting down notes in the electronic medical record about upcoming vacations, marriages, and expected grandchildren to follow up on at the next visit. In turn, Taunk happily trades stories about his own family, travels, and love of snow sports.
Amid the hustle of the Abramson Cancer Center, Taunk, the director of Brachytherapy and Procedural Radiation and Radiation Oncology’s director of Imaging Sciences, wants patients to feel that they’re really seen, as humans, by the health care providers who will be treating them for years through initial treatment and follow-up visits. All of which is to say, while Taunk is serious about treating gynecologic cancers, the professional tone he sets in the clinic is also a bit fun and a bit casual at times, too.
But when Dalia Jakas, a retired research chemist in her 80s, arrived in Taunk’s office in 2017 seeking treatment for a rare recurrence of uterine cancer, the physician sat up a little straighter. He sensed more formality was in order.
“She’s very put together: Her posture is better than mine, her clothes are perfect, and she’s taking notes,” Taunk said, remembering their first meeting. “I’m thinking, ‘I really need to be on my A game.’ I felt like I had valuable treatment options to offer her, and I needed to see if she'd trust me with them.”
A Rare Case
The patient’s case was unique in that her uterine cancer had returned 26 years later in a single, but different spot from the initial cancer. That rarely happens — to have a single recurrence this far removed from an initial diagnosis and in the location of her recurrence, Taunk said.
Jakas made clear she was seeking treatment that would not compromise her quality of life. She had withstood three rounds of chemotherapy at another cancer center, which left her, previously an active volunteer, church-goer, traveler, and grandmother, completely debilitated after treatment. The soles of her feet burned and she was no longer able to drive, or walk without assistance. She left there and came to Penn seeking another option.
“She wanted to live, but she would not accept something that would affect what was important to her,” Taunk said. “Dalia very much values her quality of life. She's very active in her community, she travels frequently, she’s a leader in her Lithuanian church, and she goes out probably more than I do at this point.”
Taunk explained to Jakas how targeted proton radiation could be useful in her case. Proton therapy delivers a beam of proton particles that targets the tumor and minimizes the exposure of nearby organs to unintended lower-dose radiation. It’s typically used as the primary therapy for an initial diagnosis — not as frequently for recurrences of gynecologic cancer — but he believed it could work as a noninvasive treatment to maximize her quality of life goals and treat her recurrence.
He gave her his email address, and Jakas, who retired from GlaxoSmithKline's discovery department in 2001, followed up with some more questions until she had the information she needed to begin treatment.
Three weeks of daily proton radiation killed Jakas’ tumor without any noticeable side effects, an outcome Taunk never promises patients. Her particular cancer expressed the estrogen receptor — that is, it relied on estrogen to develop and grow — so she continues to take an oral estrogen blocker that has prevented her tumor from recurring or any new cancers from growing.
“I am eternally grateful to Dr. Taunk and his competent team for saving my life,” Jakas said.
A Grateful Patient Pays It Forward
In appreciation for his team, Jakas established a fund to empower Taunk’s research into how treatment can be improved for uterine cancers like the one she experienced. Her support will allow Taunk to pursue clinical research on the use of positron-emission tomography (PET) scans to calculate estrogen-receptor levels in uterine tumors, building on estrogen PET research by Penn’s David A. Mankoff, MD, PhD.
Having such a diagnostic tool would help clinicians predict which patients are most likely to respond to the estrogen blockers like the ones Jakas now takes, Taunk said. Using estrogen PET is well established for breast cancer, but uterine cancers are less well seen or understood at this level.
“Using anti-estrogen medication is a common regimen in patients with recurrent or metastatic uterine cancer, but there's going to be a proportion of patients that will never benefit from it,” he said. “We don't want to expose patients to a futile therapy, nor delay them from getting to a more appropriate therapy.”
Taunk is excited about this work — and about his relationship with Jakas growing through her role as a philanthropist, and not just as a patient — because of all that it represents at the forefront of advanced care for the specific needs of any patient’s gynecologic cancer.
“We can do the standard things in a very high quality, but we also have the interest, innovation, and skill to do the outside-of-the-box things really well at Penn Medicine,” Taunk said. “We have proton therapy; we can use new PET tracers to image cancers in an innovative way; and there are meaningful research contributions that philanthropy can execute. If this study, and those that will follow, works as we expect it to ... it can absolutely change the way women with metastatic and recurrent uterine cancer are treated.”
For her part, Jakas feels “very honored to be part of this important research.”
These days, their conversations are much less formal than that first meeting in 2017. In their most recent conversation, Jakas recalled, they discussed both her 2022 trip to Switzerland and the need (or not) for further appointments. By this point, Taunk and Jakas have built a comfortable rapport over e-mail, telemedicine, and phone calls, strengthened by their mutual intellectual curiosity about science and the world.
“She's constantly learning. She does her own research and will say, ‘What do you think about this?’ or ‘I found this study saying that this might be a possible treatment for women in the future. What do you think?’” Taunk said. “It's a really fun type of patient to work with, when they come to you with this kind of curiosity and then you get to talk about it together. I’ve really enjoyed our relationship.”
This story was originally published by Penn Medicine on February 2, 2023.