LOUISVILLE As a child growing up in Urbana, Illinois, Laila Agrawal, MD, medical oncologist at the Norton Cancer Institute in Louisville, experienced firsthand what a cancer diagnosis means to a family. Her mother was diagnosed with breast cancer at an early age.
“My mother was diagnosed with breast cancer in her 40s. I was a young child, but I still remember that experience, as well as the impact that it had on me and my family growing up,” she says. “Once I started medical school, from the very beginning, I sought out experiences in oncology. I really felt drawn to the relationship that I saw between the oncologist and their patients, and how impactful that relationship could be. I wanted to be able to provide to my patients.”
Agrawal received her medical degree from the Indiana University School of Medicine, then did her internal medicine internship and residency at Washington University in St. Louis at Barnes Jewish Hospital. After completing her residency there, she stayed for a year as a hospitalist, then she moved to Vanderbilt University for a hematology oncology fellowship.
Developing Her Style of Care
Agrawal specializes in breast cancer and works to provide personalized care for her patients. She is part of the cancer care team at the Norton Cancer Institute with practices at both the Brownsboro and downtown Louisville locations.
Through a multidisciplinary clinic, the patient can meet with a medical oncologist like Agrawal, as well as with other specialists—a breast surgeon, a plastic surgeon, a radiation oncologist, and a genetic counselor—all on the same day. The multidisciplinary approach
allows Agrawal to discuss all aspects of the patient’s case with other specialists, she says, to facilitate a very personalized treatment plan.
“We meet together and discuss the imaging with the radiologist. We discuss the pathology with the pathologist, and together, we’re able to design a comprehensive plan for each patient. This really facilitates very individualized care, and it expedites the patient’s care to have those conversations in real time.”
Providing that personalized care is important, she says, because no two cases are exactly alike. “With breast cancer care, there is a lot of research that leads to new treatments, and guidelines exist to establish the standard of care. But oftentimes, the cancer doesn’t read the textbook,’” she says. “It’s important we are able to provide state of the art care and equally important that we’re able to individualize care for each patient.”
The Patient Population
Because she focuses mainly on breast cancer, Agrawal says her practice is primarily women, although she does have some male patients as well. Ranging in age from 20s to 90s, Agrawal says she sees all aspects of cancer care and can help patients in all stages of life—from helping older patients thrive and continue to do the things that are important to them, to helping younger patients who may be facing different challenges and circumstances—including concerns about fertility preservation, raising children, and impact to their careers. Agrawal says that rates of breast cancer are rising in younger women nationally.
“We’re seeing more breast cancer cases in women under age fifty,” she says. “There are likely multiple reasons for this, including lifestyle factors, family history, genetics, reproductive history, and environmental exposures.”
Lifestyle and Cancer
In Kentuckiana, where high rates of diabetes, heart disease, lung cancer and obesity are present, those comorbidities can contribute to the increased risk of breast cancer. They can also contribute to the way patients should be treated for breast cancer.
“We know that many lifestyle factors, including exercise, nutrition, obesity, alcohol intake and other factors are tied to the risk of getting breast cancer,” says Agrawal. “In addition, if a person’s underlying health is compromised, then certain cancer treatments may be harder to tolerate or have greater risks. For example, some chemotherapy agents, immunotherapy, or targeted cancer treatments may have a chance of affecting the heart or the lungs. We factor all of those things in with our patient population here in Kentucky to really be able to pick the best treatment for each individual person.”
Bringing Clinical Trials to the Community
Sometimes the best cancer care for a patient includes a clinical trial. Agrawal is the institutional principal investigator for numerous breast cancer clinical trials at Norton Cancer Institute working with Norton Research Institute. She says research on breast cancer treatments is advancing rapidly. “Being able to offer cutting-edge clinical trials to patients in Kentucky right here in our own community is so important.” She believes that access to innovative clinical trials should reach patients close to home. Some of the trials she has participated in have led to FDA approvals or new indications for cancer treatments. “Seeing the clinical trials we are able to offer to our patients lead to new treatments we can then offer to the next patient is so rewarding.”
Breaking Barriers to Sexual Health Care
Oftentimes, part of that personalized treatment deals with a patient’s sexual health. After cancer treatment, Agrawal says that patients may experience decreased desire, vaginal dryness, dyspareunia, and body image and relationship concerns. As it is often viewed as a taboo topic, Agrawal says patients may have nowhere to turn when dealing with the impact treatments may have on their sexual health. To help patients get care for sexual health symptoms, she founded the Norton Cancer Institute Sexual Health Program.
“I realized there was a huge gap in the standard medical training as it relates to women’s sexual health and what my patients needed. I felt inspired by my patients to learn more and to be able to provide more for their care,” she says.
Agrawal sees women diagnosed with any type of cancer in the Sexual Health Program who are having concerns about sexuality after cancer treatment. After a bio-psychosocial assessment, Agrawal is able to provide patients with treatment recommendations and when needed, referrals to other professionals. The program helps patients deal with the physical, mental, and emotional factors and relationship concerns involved in a person’s experience with their sexuality after a cancer diagnosis.
“I work with other professionals, including mental health professionals such as psychosocial counselors or sex therapists, pelvic floor physical therapists, gynecologists, urogynecologists, urologists, and GYN oncologists for pelvic health concerns as well. Caring for sexual health concerns is also really multidisciplinary as well.”
Lasting Relationships and Patient- Centered Care
“My mother’s experience as a breast cancer survivor has shaped the way I approach my medical practice.” Agrawal strives to provide patient-centered care and build relationships to support patients not only during active cancer treatment, but for their overall well-being.
“One of the reasons I chose to specialize in oncology is that I wanted to really be able to help people in this very difficult. time in their lives,” she says. “I’ve been lucky to have some very long relationships with my patients and through their treatment. I think that’s one of the beautiful things about oncology; that we really have the opportunity to develop these meaningful relationships with our patients.”