Photo by Michael J. GallegosTribune

Tribune

Cancer patient Cathy Williams (left) listens to oncologist Melanie Royce as they discuss Williams' upcoming first chemotherapy treatment. Royce saw 17 patients that same day, without a lunch break. Her patients say Royce spends extra time with them to ensure they get the best possible treatment.

Photo by Michael J. GallegosTribune

Tribune

With her daughter Anjelica Jurado (left) at her side, cancer patient Nora Trujillo (center) laughs as oncologist Melanie Royce peeks under her scarf at her bald head. Trujillo, who is undergoing chemotherapy, said she cut off her hair so it wouldn't fall out in clumps later.

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It is morning, and oncologist Melanie Royce is seeing her first patient of the day, Paula Corder, who was told in September she had breast cancer.

After several months of chemotherapy, Corder's tumor has shrunk from 1 inch to nearly nothing.

Corder, 51, asks Royce the big question, the scariest one, the one on the mind of any cancer patient: "Am I cured?"

Royce, 46, director of the Multidisciplinary Breast Cancer clinical working group at University of New Mexico Cancer Center, gives a gentle smile and pauses for a moment, because even in the world of extensive research on breast cancer - even when she herself is responsible for some of the best of that research - nothing is certain.

"The term cured is relative," she says. "The term we use is in remission, which means there's no evidence of disease. Live your life with your goals and your dreams, and if it (cancer) doesn't come back, thank God."

Royce is leading one of seven research groups at UNM Cancer Center, which is among the leading research facilities in the United States. Ultimately, their goal is to provide New Mexicans with world-class cancer care and advance understanding of the disease.

Royce's research takes a multidisciplinary approach - a combination of surgery, radiation, chemotherapy and hormonal therapy - to treat cancer.

The approach "gets into what is the biology of the tumor," she said.

Royce is part of a team researching neoadjuvent chemotherapy - treatment to reduce a tumor's size before surgery.

Reducing a tumor's size before surgery helps show whether a particular chemotherapy works, Royce said. Removing a tumor eliminates the opportunity for researching the particular chemotherapy.

Royce and other researchers are experimenting with the drug Tykerb, anti-estrogen therapies and a combination of chemotherapies to treat breast cancer.

In Royce's everyday life, she tries to put herself in her patients' shoes, she said, not only through research but by being honest and positive.

She advises Corder and other patients to take baby steps and set realistic goals for the near term.

In Corder's case, her immediate goal was to eat a big salad and fresh vegetables. She couldn't during chemotherapy because of potentially deadly bacteria in the vegetables.

During chemotherapy, a person's white-blood-cell count is so low that it can't fight off the typical bacteria in vegetables, Royce said.

But at Corder's appointment, after chemotherapy and her latest lab work, Royce held out hope for Corder.

"If your blood count numbers are good, you can have a salad," she told her patient.

Royce said later that although she cannot predict how long patients will live, she can provide them with treatment options that might help them set goals - like living to see their children graduate from high school.

"Some patients come to you and ask you to extend their life, and you can't do it," she said. "You can offer them treatment and all the comfort measures, but all the life-prolonging measures you can't."

Royce came to UNM in 2004 from the famed M.D. Anderson Cancer Center in Houston. She had met Cheryl Willman, director and CEO of the UNM center, during a lecture series in Albuquerque on breast cancer.

"I wasn't looking to move here," Royce said. "Willman said, `You're really needed here,' and laid out a vision on what she wanted to do. Willman wanted to see a program that is truly multidisciplinary to a specific disease, which in my case is breast cancer."

Jeffrey Griffith, co-director of the women's cancer and hormone-responsive cancer research program, has been involved in breast-cancer research with Royce.

"Her background and experience into research comes from her clinical experience" working with patients, he said. "She's the kind of person that will take on any assignment with great humor and great enthusiasm. This kind of positive, can-do enthusiasm probably shines through with her patients and makes their situation better."

Corder said in her case, that was definitely true.

"She is always smiling and in a great mood," Corder said.

The patient and doctor agreed that Royce spends extra time with her patients, making sure she addresses their concerns.

At her appointment this spring, Corder had pages of questions for Royce after finishing chemotherapy: Will my hair grow back after chemo? Should my daughter start having mammograms now? Can I use the hot tub before or after radiation?

Royce had good news for Corder. After looking at her patient's blood count, she said Corder could have that salad.

Corder smiled about the simple goal she had accomplished.

"I'm relieved now. The worst part (chemotherapy) is behind me," she said.

And then she added, as almost every cancer patient does: "I'm a little apprehensive, because I'm afraid it will come back."

But even with all the research conducted at UNM and elsewhere, all that is known about cancer and with all the technology available, Royce said she could make no promises.