Champion of the Patient With Cancer's Voice

Written by Ginny Kirklin, M.P.H., on behalf of the Advanced Breast Cancer (ABC) Program steering committee, advocates and patients at The University of Texas MD Anderson Cancer Center, Houston, Texas

On behalf of patients with metastatic breast cancer (MBC), advocates and members of the Advanced Breast Cancer (ABC) Program at The University of Texas MD Anderson Cancer Center (MDACC), we are thrilled to nominate the ABC Program’s nurse practitioner navigator, Abbey Kaler, M.S., APRN, FNP-C, CMSRN.

Abbey is so many things to each of us personally and is a beloved and treasured friend. She has been instrumental in the fight against MBC within MDACC and beyond. Her contributions and impact are far-reaching in helping create and implement many important supportive programs to assist patients with MBC, caregivers and health care providers alike. This is largely because she has an ear attuned to listening that helps her represent the patient’s voice.

READ MORE: Abbey Kaler, M.S., APRN, FNP-C, CMSRN, Wins CURE®’s 2023 Extraordinary Healer® Award

Abbey’s immersion into the medical world began at a very young age. When she was 9 years old, Abbey received a diagnosis of juvenile pilocytic astrocytoma, a rare benign brain tumor. Two brain surgeries later, doctors successfully removed the entire mass and, fortunately, it has not reappeared.

Abbey has shared that she remembers how she and her family felt vulnerable and helpless during this time. Questions of her mortality surfaced during her health scare at that tender age. She recalls how grateful she was for the supportive nurses and doctors during those frightening times.

In addition, it ignited Abbey’s desire to pursue a medical career in hopes of caring for and supporting patients. In 2011, Abbey received her Bachelor of Science in nursing at Baptist Health Sciences University in Memphis, Tennessee. Thankfully, in a different capacity, she returned to MDACC, not as a patient this time but as a bedside registered nurse working in the targeted therapy clinical center with patients participating in phase 1 clinical trials. With her past experiences, memories and natural empathy, she could share her experiences and educate the patients to empower them.

Moreover, in 2019, MDACC published an article about Abbey. She was quoted as saying, “So if I, as a nurse, could use any of my knowledge to help them have a bit more control over the situation and feel a little less scared, that was the biggest gift I could give.”

Abbey continued her postgraduate education to become a family nurse practitioner in 2017. She daily follows the motto “Love, Listen and Heal.” She was hired as a nurse practitioner navigator for the ABC program in the department of breast medical oncology (BMO) at MDACC in 2018 and has been essential in the initiation and implementation of many patient support programs.

Additionally, she is enrolled as a Ph.D. nursing student at the UTHealth Houston Cizik School of Nursing, where she was awarded a Jane and Robert Cizik Scholarship. Her research focuses on incorporating the patient’s voice in their care planning to improve the overall experience of individuals with metastatic cancer.

Abbey had an article published in the journal Nursing Forum in 2022 as part of her doctoral work: “Patient Voice in Metastatic Cancer: A Conceptual Analysis.” Indeed, this is one of the extraordinary qualities of Abbey that sets her apart: Abbey closely works with each patient and uses the patient’s voice to positively influence their quantity and quality of life. Patient education and empowerment utilizing the patient’s voice are two of Abbey’s true loves and life pursuits.

She is an accomplished researcher and presented several posters at the San Antonio Breast Cancer Symposium in December 2022. All presentations focused on supporting patients with MBC. She also was a finalist for the 2022 Brown Foundation Award for Excellence in Oncology Nursing. This is one of MDACC’s highest nursing honors and recognizes excellence in all aspects of oncology nursing, including patient care and adherence to standards in clinical treatment.

Our ABC Program is unique in that grassroot efforts of a small support group of patients with MBC, caretakers and advocates made its creation a reality. They quickly gained sup- port of faculty and staff at MDACC, and together they collaborated to brainstorm and plan. Meeting once a month on site, this fledgling group formed to expand their idea of building a new program that met the distinctive needs of patients with MBC, to support them and their families through the emotional and physical roller coaster of MBC treatments.

With institutional support and huge fundraising efforts by patients with MBC, caretakers and advocates, the ABC program has quickly grown into a wonderfully diverse and cohesive group of research and practicing physicians and faculty, nurses, patients with MBC and advocates. Its overriding goal is to improve the quality and quantity of life of patients with MBC.

Abbey has been instrumental in the growth of the program and its many initiatives. She has been involved with collaborative grant writing, program implementation and communications among all its working parts.

In addition to her professional contributions, Abbey and her family have participated annually as part of the wildly successful MBC fundraising team, Stomp Out Stage 4 Breast Cancer, at MDACC’s annual institutional Boot Walk to End Cancer fundraiser. The money raised has helped support the ABC program and, ironically, provided the essential “seed money” to hire our dedicated nurse navigator, Abbey Kaler, in 2018.

Abbey’s telehealth appointments with patients with MBC have steadily grown to assist more than 300 patients each year. Abbey also moderates the weekly virtual MBC support group. By its virtual nature, the hourlong meetings have reached patients across the country and average 20 attendees weekly. Abbey skillfully manages the meetings to allow all who are connected to participate; ask questions related to symptoms, treatments and side effects; and communicate with other patients with MBC. Abbey’s medical knowledge and compassion always help make it rewarding, and a close camaraderie has developed among its members.

Abbey also organizes and moderates a popular weekly virtual webinar, “The ABCs of Healthy Living in Challenging Times.” She has invited guest speakers, faculty and staff to educate the broader community. More than 130 webinars have been presented so far, with topics including medicine and research, participatory self-expression (art, dance and writing) and end-of-life discussions. Importantly, these have helped to educate and empower patients with MBC and are an important component of her nurse navigator toolbox.

Voices of patients with MBC have been able to initiate and shape many new grant initiatives. Abbey was instrumental in starting a medical partnership with general internal medicine at MDACC. This unique partnership is named the LIMBS clinic (Linking Internal Medicine and Metastatic Breast Cancer for Success clinic) and was specifically created for patients with MBC lacking an outside primary care physician who was comfortable treating patients with this disease. This addressed a need vocalized by many patients with MBC who required specialized medical care complicated by their ongoing metastatic cancer.

Abbey has collaborated on grant writing with BMO research faculty on several grant initiatives that greatly benefited the MBC community. Again, this was often driven by listening to patient voices. For instance, an implemented Pfizer grant enables patients on oral oncolytic treatments to have bloodwork done at local laboratories outside of MDACC and follow up with their oncologist via a video visit. The lab results can now be forwarded to the doctor via email rather than by faxing, which further increases efficiency. This has also helped to minimize the number of trips to MDACC by patients who live a distance away.

The post-mortem tissue collection subcommittee was formed to restart the collection and analysis of tissues donated by patients with MBC after their death. The COVID-19 pandemic temporarily suspended this important research work, but with collaboration from Abbey, patient advocates and researchers, it has reopened again for enrollment. This novel approach will enhance ongoing investigations into further characterizing MBC pathology, which may help lead to new therapeutic strategies and therapies. And what a beautiful gift for a patient to give at the end of their life! Again, we have Abbey to thank for helping to connect the ABC program with other MDACC departments to advance research and clinical initiatives.

Abbey has been deeply involved in a multitude of ways in increasing both the quality and length of lives of patients with MBC. She is our ABC program champion. She listens and acts on what she learns from the patient’s voice. On top of all Abbey’s accomplishments within the ABC program at MDACC, she is also a loving wife and mother of two young girls. Abbey has dedicated her life to fighting metastatic breast cancer in countless ways and is truly worthy of the Extraordinary Healer Award for Oncology Nursing.

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