The Paid Leave Podcast

Our CEO's Personal Struggle with Cervical Cancer

• The Connecticut Paid Leave Authority • Season 3 • Episode 12

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January is National Cervical Health Awareness Month. The American Cancer Society says about 13,820 new cases of invasive cervical cancer will be diagnosed this year and about 4,360 women will die from cervical cancer.  CT paid Leave can help women going through any stage of this disease with income replacement benefits, and flexibility with different types of leave options. You can get up to 12 weeks of income replacement to take care of your own serious health condition or that of a loved one. 

 Dr. Jennifer Jorgensen is an OB-GYN at UConn Health Center and Assistant Professor of Obstetrics and Gynecology at the UConn School of Medicine. She is a Gynecological Oncologist and treats cervical cancer. She says it's important to do all your screenings to catch anything in the early stages. She also thinks CT Paid Leave is really important for patients to be able to take time off for radiation or chemotherapy treatments. She also thinks allowing caregivers time off to help the patients is vital to improving the outcome of treatment.

 Erin Choquette is the CEO of CT Paid Leave and is a survivor of cervical cancer. Erin tells her personal story and how she found out she had cervical cancer at a follow-up medical appointment after the birth of her daughter.  She said cervical cancer screenings are important, but knowing and trusting when something just isn't right with your body is vital for an early diagnosis. Erin says she had a great support system and that helped her to get through the treatments and allowed her to focus on her healing. Erin says CT Paid Leave is so important for women going through a cervical cancer diagnosis to be able to take time off from work for treatment and recovery.
 
For information about Cervical Cancer at UConn Health  go to: Cervical Cancer | Carole and Ray Neag Comprehensive Cancer Center (uconn.edu)

For Cervical Cancer prevention go to: Cervical Cancer is Preventable - UConn Today

For information about CT Paid Leave and to apply for benefits go to: CT Paid Leave




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Nancy Barrow:

Hello, Connecticut and welcome to The Paid Leave Podcast. The title basically says it all. I'm Nancy Barrow and I will be delving into this new state program and how it can help you and your family. This podcast will give you information you should know about Connecticut Paid Leave, and maybe just a little bit more. Connecticut Paid Leave brings peace of mind to your home, family and workplace. Welcome to the paid leave Podcast. Today we're talking about cervical cancer and January is Cervical Cancer Awareness Month. Here is what the American Cancer Society says about cervical cancer. About 13,820 new cases of invasive cervical cancer will be diagnosed and 4360 women will die from cervical cancer. Cervical cancer is most frequently diagnosed in women between the ages of 35 and 45. And Connecticut paid leave can help women going through any stage of this disease with income replacement benefits. You can get up to 12 weeks of income replacement to take care of your own serious health condition. Or of course, that of a loved one and caregivers are so critical to help with treatment and recovery. Joining me to talk about the clinical aspect of cervical cancer is Dr. Jennifer Jorgensen, an OB GYN at UConn health and Assistant Professor of Obstetrics and Gynecology at the UConn School of Medicine and she's also a gynecological oncologist and treats cervical cancer. Welcome. And thank you so much for being on the podcast.

Doctor Jennifer Jorgensen:

Thank you so much for having me. It's a pleasure to be here.

Nancy Barrow:

And of course another guest no stranger to Connecticut Paid Leave. It's the CEO of Connecticut Paid Leave, Erin Choquette is a survivor of cervical cancer and is brave and courageous. And stepping forward to talk about her story and hopefully helping someone else who might be going through this. Thank you so much for being on the podcast once again, Erin,

Erin Choquette:

Thank you so much, Nancy.

Nancy Barrow:

So Dr. Jorgenson, can you tell me what Cervical cancer is?

Doctor Jennifer Jorgensen:

Yes, cervical cancer is a type of cancer that arises from the cervix, which is actually connected to the uterus or the womb where a baby would grow. And the cervix is the part that opens and connects this uterus womb to the vaginal canal, the birthing canal. It's what the baby passes through to be delivered in and so when women develop cervical cancer, it usually actually starts as abnormal cells that we actually are called dysplastic cells. But we typically say they're abnormal, precancerous cells, and then they can develop into a cancer.

Nancy Barrow:

How do you find out that someone has this?

Doctor Jennifer Jorgensen:

Yeah, so typically, we can find out in a couple of ways, the most common way here in the United States is with annual physical exams with their obstetrics and gynecologist but even more so is with the Pap smear screening or the cervical cancer screening that we perform. And that is usually a test that we do on the cervix itself when we collect cervical cells, and then we test those for two different things HPV virus itself, and then we also look at the cells and see how abnormal they are. And that can be done on a basis of either every three years or five years depending on a woman's histo ry and her specific risk factors.

Nancy Barrow:

And once you do a baseline for pap smears, just out of curiosity,

Doctor Jennifer Jorgensen:

USPS TF. So the United States Preventive its preventive Task Force who helps us make all these guidelines and when we should start cancer screening recommends beginning pap smears at age 21.

Nancy Barrow:

So Young

Doctor Jennifer Jorgensen:

Yes.

Nancy Barrow:

And what is the age bracket that like you know, I said it a lot of women get it but 35 to 44 Is that the average age?

Doctor Jennifer Jorgensen:

that is the average age, but women basically from their 20s on are at risk. That level of risk varies depending on where you are in in your lifetime. And like I was saying, it also depends on a woman's risk. So if she's had HPV infection, that risk might be higher and or abnormal cells before are their symptoms. Most commonly in the United States. Women don't actually have symptoms because we do this screening. If a woman is getting their screening done most commonly they don't have symptoms, but there are symptoms that folks can look out for such as bleeding between periods if the woman is still menstruating bleeding before or after vaginal intercourse. If they're postmenopausal any bleeding after menopause is concerning and it could signify either cervical cancer or something else. And then also lower back pain can be a symptom and the last one would be abnormal discharge from the vagina.

Nancy Barrow:

Wow, back pain. That seems like it could be anything.

Doctor Jennifer Jorgensen:

Exactly, It could be anything. But unfortunately, when the cancer is a little bit more advanced it can cause that back pain. And they're they're stages right of cervical cancer. Yes, there's different stages of cervical cancer and it's based on how far the cancer has spread itself. Typically, the first stage of cancer is of cervical cancer, I should say is kind of confined to the cervix itself, and then increases by based on how far it's spread if it's gone to the regional lymph nodes, meaning that lymph nodes in the pelvis or beyond to other areas of the body.

Nancy Barrow:

And when you're at a stage four, is there still treatment that you can get?

Doctor Jennifer Jorgensen:

Yes, there is there still treatment that typically is chemotherapy. And it's a lot of chemotherapy, it's four different drugs, usually these days that we give all at once.

Nancy Barrow:

Wow, and so time off would be essential when you're going through this.

Doctor Jennifer Jorgensen:

Yes, time off is very important to be able to get to the chemo appointments themselves. But in addition, we have to have our patients get lab work, but in between chemo visits, not to mention there's many side effects from chemotherapy. So time off is really key.

Nancy Barrow:

I know you're being so brave to come on here and talk about your own personal story. Why don't you tell us how you found out you had cervical cancer.

Erin Choquette:

Sure, thank you. So when my younger daughter was six months old, I went in for your traditional six month post childbirth appointment and said, I'm having bleeding, you know, a nursing. I'm not sure why I'm still bleeding. And the doctor said, Whoa, check that out. And then I still remember, change your plans, we're gonna do a quick biopsy, which is not the thing you want to hear a few days later. Got a call. Second worst thing, well, not worst. Second difficult thing to hear when you get a call from a doctor is, is there anybody home with you other than the babies? Maybe you want to get your husband on the call. And so that's what I learned to hit cancer. I'm fine, by the way, and I don't know why I'm so emotional about this. I'm fine. It's been a long time. But I had a six month old and a two and a half year old. And that was scary. The original plan was that we would just do surgery. And at the time, it seemed like because I hadn't gotten pap smears and I had been falling out then I just had a baby that's only been looking at my interiors for quite a while. There is an option to do sort of a to sort of scrape the cervix or kind of go in and do kind of a more complete just to be careful. And so he said, Okay, we're gonna go in, do the hysterectomy. Partial hysterectomy says hoping I could still nurse my daughter. What we learned after the surgery, though, was that the cancer was much more progressed than we'd had to spit it across really quickly. Over 80% of my cervix was compromised. And so I had to do chemo and radiation. So that went the nursing. But so I had six to eight weeks of recovery for the surgery, because that was a pretty significant surgery when you have to open up the abdominal wall, but it takes a while to recover. And then it was daily radiation and weekly chemotherapy, or over two months. So it was definitely a lot. I did go back to work while I was going through radiation and chemotherapy. But yeah, it's it's a lot. And so I would take a couple of hours, every day off to go to radiation. Chemo days, I was off for the day. And then as it progressed, I was more and more likely to take the day after chemo off because,

Nancy Barrow:

yeah, it wipes you out.

Erin Choquette:

You don't feel good.

Nancy Barrow:

Yeah.

Unknown:

By the end my I was I was pretty, pretty sick. So you know, in the beginning, I was like, Okay, going through this is great. And then by the end, it's like, okay, I need some time. So it definitely took time.

Nancy Barrow:

DoctorJorgensen is, is this common that women who have a baby get cervical cancer? Is this kind of unusual with Erin's case?

Doctor Jennifer Jorgensen:

Yeah, it's not as common, but it can surface during pregnancy. Or more commonly, what happens is that a lot of women don't have health insurance until they become pregnant. And that's when they enter the healthcare system and we're able to do all the screening that they should have had and and that's sometimes when we pick up the cervical cancer, so cervical cancer affects about maybe just less than one to one and a half births per 10,000 births. Okay, women with for per 10,000 births. So it's not that common, but it is a chance for us to be able to pick it up in those who have never had screening before. Yeah, I know, in Erin's case, it was a little different cuz she was screened before. So her situation is not that common, actually kind of rare. But like she said, she had that, that bleeding that just didn't seem right. And so she did the right thing. She went to the doctor and said, Hey, I have this bleeding. I don't know why it doesn't make sense to me. And, you know, I think that's a really important point of her story to for others to pick up on if something doesn't feel right. Be persistent, go to the doctor and get checked out.

Nancy Barrow:

And how important was it Erin, for you to have a support group at home, and I know that you had caregivers helping you, how important was that for your recovery?

Erin Choquette:

Oh, it was priceless. Between my husband, my parents and brother, my sisters in law, even the daycare providers or my daughters were going to daycare I mean, friends, everybody rallied round to help with taking care of the girls to help with making sure that we had food. My best friend arranged for a house cleaner to come for me, so that, you know, I was it was the best part of chemo day was I would come home to a house that had been professionally cleaned. It was lovely. One of the the most generous things that happened, though, is the people I was working with, because I had, I had had my daughter and I had gone, I had only been with the state for a little over a year when she was born. And so I had sort of saved up all my paid time off. And we had kind of planned for being home after she was born. And I had just recently gone back to work, and I just sort of started to rebuild my PTO bank when all this happened. So I had no time. And and that's, you know, bills don't stop, and daycare didn't stop. And everything else didn't stop while I was going through this. And so my coworkers at the state were incredibly generous and donated time to me. So that even though I had no sick time available, they donated time so that all that time that I was taking off, I could still receive a paycheck, which was amazing. And it's been a long time. But I still have a list of all the people who did that for me. And I think them every day. This was long before Paid Leave came around. And so I had to rely on the generosity of my co workers to kind of be able to get through that piece of it.

Nancy Barrow:

Now that you're CEO of Connecticut Paid Leave, do you feel a sense of I don't want to say responsibility, because that's a big word to use. But that you're paying it forward in a way that you're helping other women that are going through cervical cancer, you've been there, you've been a patient.

Erin Choquette:

I really do feel that responsibility. I was very fortunate I am a lawyer, I worked for a great company, or the great agency, I knew what my rights were under FMLA. I had wonderful people who were helping. So we were able to get through this. And I was able to focus on recovery and taking care of my family. A lot of people don't have those benefits. And so it's really important to me is one of the reasons that I'm so happy to be working with the authority is to make sure that people know what their rights are. Make sure that people know that there are resources available, they don't have to go through this alone, they can get the help they need. They can make sure that they can still put food on the table and get gas in the car so they can get to their appointments, while they're going through all of this.

Nancy Barrow:

And the caregivers can also take the time off to help them which is I think so essential too because that's the way that you get through your treatments and recovery. How important is that? Doctor? How important is that for recovery?

Doctor Jennifer Jorgensen:

Oh, it's so important. Our patients, a lot of the time they can't drive home after a whole day of chemo, partly because we give medication that makes them sleepy so that they don't necessarily react to the chemo. And then they've been there for six to eight hours sometimes depending on or if it's they'll get chemo and then like Aaron was saying then you go down and you get radiation the same day. And so it's a very long day. And it's really important for our patients to be able to have someone who can sit with them and be there with them. And just, you know, kind of maybe distract them a tiny bit from what's going on, and then give them their ride home. and helped make sure they have a dinner. And it really is key to success. In those patients who don't have that support, it's very difficult for them we try, we try our hardest to support them. But there's only so much we can do while they're here.

Nancy Barrow:

Yeah. Do you also encourage people to find other support whether behavioral health or mental health?

Doctor Jennifer Jorgensen:

Absolutely. We have here at UConn health. In our cancer center, we have nurse navigators who are assigned to each patient. And they have a abundance of resources, different support groups, depending on you know, young patients with cervical cancer, older patients with cervical cancer, not even necessarily, it doesn't even have to be cervical cancer, it could just be female genital certain cancers. They support each other, there's groups that have, you know, young women who have children and cancer, sometimes that's what they need. We also have a great psychologist here who's dedicated to our cancer center and our patients with cancer who are having difficulty to deal with their diagnosis. And everything else going on. Rates of depression and anxiety at baseline in this country are pretty high. And so that can be exacerbated by a cancer diagnosis. And in dealing with all of how am I going to pay my bills? How am I going to do all of this and get treatment? And so that is really a key resource. And I would say that most cancer centers have those same similar resources, it's really important.

Nancy Barrow:

What are your chances of getting cervical cancer again, once you've had it.

Doctor Jennifer Jorgensen:

It depends on the stage of cancer that you had at diagnosis. So an early stage cancer has a very low risk risk of the cancer coming back once it's fully treated. As stage three cancer, which means it's more locally advanced, does have a pretty significant chance that the cancer could come back. Sometimes we tell patients about 20 to 30%. But it really honestly depends on how much cancer there was at the time of diagnosis. A stage four cancer, unfortunately, which is means it's spread beyond the pelvis and those lymph nodes that line our major vessels in the belly is actually something that is not fully curable, we can often get patients to the point where they might be in remission for a while, but it will come back at some point.

Nancy Barrow:

Erin, like what was your diagnosis after everything was done? Do you still go back to see your doctor or were you cleared after a certain amount of time.

Erin Choquette:

So I continue to see the gynecological oncologist for five years to make sure that everything stayed clear and that there were no other issues. As it turned out, I was diagnosed with colorectal cancer and four years after all of this had happened. I was tested you there are certain diseases where you have a high likelihood of receipt of getting different types of cancer. I was tested and I did not show the genetic markers for that. However, it seems likely that there's something going on that made me have this sort of proclivity toward cancers. So thankfully, I don't have any more issues with the gynecological cancers, I continue to get pap smears on a regular basis now, but not a heightened basis. But the focus is now switched over to the colorectal side. So I am a frequent flyer on a colonoscopy, I get those, I graduated though I don't have to do them every year anymore. I can do them every other year, which is, which is lovely. But it's better to be tested and have things caught, particularly on the colorectal side because you can get those quite quick, quickly and get them resolved. To the ability to have people paying attention and seeing what's happening in your body is actually a huge gift. It's so much better than just having it be opaque and just wondering. So I just try and follow up with all those recommended tests as much as I can.

Doctor Jennifer Jorgensen:

As Erin was saying, as oncologists, we also make sure that our patients are getting their colonoscopies, their mammograms. You know, as much as we like to think we know a lot about cancer, which we do. Unfortunately, we don't know everything. And as Erin alluded to, there probably is something genetic. Let's linking her to this propensity to develop a second cancer, which is we don't know what that is yet. And so we're doing the best we have we can with what we have, which is the passenger screening the colonoscopies and mammograms.

Nancy Barrow:

What about clinical trials?

Doctor Jennifer Jorgensen:

There's certainly several clinical trials available for cervical cancer typically, it's You get more advanced cervical cancers, with adding immunotherapy to chemotherapy and seeing if that makes a difference. We actually, so in medicine, anything new is within the last five to 10 years. So we newly have a trial that shows adding immunotherapy to chemotherapy for those patients with the advanced stage four disease really does make a difference. And so that was really exciting to see that. And we have seen our patients here in Connecticut really benefit from that four dose drug chemotherapy regimen that I was speaking about, we also have this special drug that helps to fight the growth of new blood vessels. And so that has also made a change in cervical cancer treatment. And so we have these things that we can work on with and put them all together to help treat that more advanced disease or if the cancer comes back, we would use that same regimen.

Nancy Barrow:

Erin because it's Cervical Cancer Awareness Month, what does that mean to you? What do you hope happens during this

Erin Choquette:

Well, two things. One, I hope people do month? get the regular doctor's appointments, get their pap smears, we're all really busy, it's really easy to just quit off some of those things that just seem routine. I've got a great OBGYN, but nobody really loves going to those appointments. It's important to do. And I think it's important to make the time. And I think it is very easy if you're busy, and if you're trying to deal with all sorts of other obligations in your life to put yourself last. And this is an area where you really need to put yourself first and get those appointments in go to them get screened. So I think just that reminder that this is really an important thing to do. And secondly, there, HPV is an is a high there's a high correlation between cancer and HPV. There is a vaccine that you can give to your teenagers, boys and girls. And I think it's it's something that parents and their teens should really seriously consider doing, again, boys and girls. Because if you can prevent or avoid or minimize, you know, bad things getting a hold in your body. It's just so much better than dealing with it after the fact. So those are the two things I would encourage people to think about.

Nancy Barrow:

Yeah, Dr. Jorgenson, I was gonna ask you about prevention?

Doctor Jennifer Jorgensen:

Yes. So I think Erin hit it spot on the HPV vaccine is very effective in preventing those precancerous cells that I was speaking about from developing. And so I highly recommend that all parents consider vaccinating their boys and girls at an early age, we recommend starting at 10 to 11. You really want to get the vaccine in before the the individual could be exposed to the HPV virus. And it's important to understand that the HPV virus can be transmitted just from skin to skin contact. And it's not necessarily we traditional sex that we all think of that can result in the the infection. And so if we can get the vaccine in before any of that exposure occurs, the chances of the vaccine working is higher. Now, that doesn't mean someone who's 16 or 17 or 18 shouldn't get vaccinated if they haven't been they should definitely get vaccinated. And actually, we just change recommendations for women in women up to age 45 If they haven't been vaccinated previously, even if they have HPV. There's many different types of HPV and the vaccine forgive, excuse me protects against nine different viruses now, and so we can still give the vaccine because it's unlikely that she has been she has all nine versions of that HPV.

Nancy Barrow:

Yeah, really interesting. How important do you feel the services are at Connecticut Paid Leave in the treatment and recovery of your patients? The ability to have the time off and paid time off?

Doctor Jennifer Jorgensen:

Yeah, yes, exactly. I think it's extremely important. I am so grateful that it exists, and that our social workers here at UConn know about this, and then there's so much easy information for us to give our patients and I think it kind of can be very difficult for patients to understand what their rights are. It's hard sometimes when you're reading if you go to the you know, a certain website, you'll see the some of this ct.gov stuff is a little bit complex. But the infographics make it so much easier to understand. And we're so grateful that that exists and then patients can understand what's going on. And I think even more so is the, as we alluded to the ability for the caregivers to be able to take time off and but also be paid for their time off. Several of my patients are able to utilize both resources. And it just makes the world of a difference. I think having that support also helps them to heal and make it through the chemo, or the radiation or just recover from surgery. Surgery, as Erin was saying is not a small feat, especially for cervical cancer. It is an open surgery, even these days, we when in the days of minimally invasive surgery, we know that open surgery is the better route for cervical cancer. And so it's still a big incision, it takes six to eight weeks, sometimes even 12 weeks to recover. So having that ability to take that time off from work, get paid still, you know, be able to pay your bills is really crucial.

Nancy Barrow:

Yeah, I think the flexibility to of doing it in a block, like you said, if they really need it after surgery, or if they want to do it intermittently. Or if they need to reduce schedule, and they still need to work like Erin, who was still working. You know, it's nice that that we have that flexibility.

Doctor Jennifer Jorgensen:

Absolutely. And I think a lot of my patients have a similar experience, they try to work through radiation, and chemo and the radiation itself also, you know, has side effects of fatigue and sometimes nausea, and they can't eat that well. And so then that leads to, you know, being also tired, and they start off and they can work. But then it gets to the point where they need that flexibility that they you know, I just need to take a few more days than I did before. And it's great that we have that ability.

Nancy Barrow:

Yeah, I think Erin, we know how important it is. And we've seen people who used it. And it's it's really satisfying.

Erin Choquette:

I think it's one of those things where it's it's sort of that ounce of prevention. If you can take the time, you need to get the recovery that you need to, to you know, even in my situation, I was told after the first six weeks, we really think you should do this additional therapy, which is going to need another month of radiation, another month of chemotherapy. I had the ability to do that. I had the ability to take the time I had it didn't have the money worries because of the generosity of my co workers. And I was like yeah, okay, it was not fun. March was not fun, but I did it. But I can also see someone who says, I can't take another month off of work. I'll go with just what you said, but I'm not going to do the extra. And I'll basically risk because that was what was presented to me. If you do this, your chances of recurrence are likely to be less. That's a terrible decision to have to make. And if it can only CT Paid Leave program can help people make the decision in favor of their health make the decision in favor of their families. That is priceless.

Doctor Jennifer Jorgensen:

It's beautifully good.

Nancy Barrow:

Yeah, that's just amazing. And Doctor, what do you hope for this month of cervical cancer awareness,

Doctor Jennifer Jorgensen:

I hope that women go to their gynecologist get their pap smear screening on time, and on a regular schedule. And as Erin was saying, also vaccinate your kids. If we can prevent this from happening, it is so much easier than having to deal with a cancer diagnosis. And on the same allude, if we can pick up the cancer, the precancerous cells, I mean,

Erin Choquette:

and for people who are looking for information. We have a lot of information on our website at ctpaidleave.org about the paid leave program that had to apply about understanding what conditions are covered. And we also have information about FMLA. Because while we provide the money, it's important to also have your job waiting for you when you come back. And so that's important. You know, there's two parts to that process. And we can give you information about FMLA and connect you to the Department of Labor. So please check out ctpaidleave.org if you are friends or family members are dealing with health, healthcare crises or other conditions.

Nancy Barrow:

Thank you so much, both of you for being on the podcast. I think it was a really important podcast. I appreciate you Erin and I appreciate you Dr. Jorgenson, thank you so much. For more information you can go to ctpaidleave.org. This has been another edition of The Paid Leave Podcast. Please like and subscribe so you'll be notified about new podcasts that become available. Connecticut Paid Leave is a public act with a personal purpose. I'm Nancy Barrow and thanks for listening!

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