August 11, 2022 by Muriel Sommers
Miami Cancer Institute and an ‘Overwhelmingly Positive Attitude’ Help Lymphoma Patient Survive Fight of Her Life
To her family, friends and clients, Kristine Flook is one of the strongest, most courageous and most relentlessly positive women they know. And it’s precisely because of those qualities that she’s alive today – with a big assist from Miami Cancer Institute, where the Jacksonville, Fla. native was treated several years ago for aggressive, late-stage lymphoma.
Ms. Flook, 51, a commercial real estate specialist who moved to Miami in 1999 and now resides in the city’s Belle Meade neighborhood with her partner in life and business, Janet Crucet, was about as sick as one can be from cancer. Problem was, she didn’t even know she had it, despite feeling miserable for months and having her general practitioner suggest the possibility.
Ms. Flook’s health odyssey began in January 2019 when she was at a real estate appointment with one of her Urbanize Properties clients and could barely make it up the stairs. “I thought I might have the flu because all of Janet’s family had had it and we spent some time with them over the holidays,” she says. Ms. Flook had other symptoms, too – a persistent cough, clogged ears and nose, poor sleep and just feeling miserable. “I had just seen my GP in December and everything was fine then, but I was feeling really sick at this point so I went back to see him.”
Apparently, her symptoms weren’t checking all the boxes for flu, and Ms. Flook’s doctor suggested she consider seeing an oncologist. “That word startled me,” she says. “‘What do you mean?’ I asked him. I was in disbelief.” Perhaps she was in denial, too, but the busy real estate executive continued to soldier on as usual with life and work.
Eventually, Ms. Flook saw an allergist in Aventura but he saw nothing unusual. “He suggested I see an ear-nose-throat specialist in the same building,” she recalls. “The ENT probed my nose and detected something way in the back, but he wasn’t sure what it was.” She was prescribed an antibiotic and prednisone, a corticosteroid used to treat inflammation and a wide variety of other conditions.
Little changed after she had completed her medications, however, and by now Ms. Flook had suffered with her flu-like symptoms for three months. Then, she says, the lymph node under her left ear started to swell. “I began to think that maybe my general practitioner had been right when he suggested I see an oncologist.”
Seeing the specialists at Miami Cancer Institute
A friend of Ms. Flook’s works at Miami Cancer Institute, which is part of Baptist Health. She offered to reach out to her colleagues and was able to get Ms. Flook an appointment in April with the doctors who would oversee her care, Peter Lee Citron, M.D., a medical oncologist specializing in hematologic malignancies like lymphoma, and Lyle Craig Feinstein, M.D., a medical oncologist who also specializes in blood cancers.
The doctors learned that Ms. Flook’s medical history includes chronic illness – Crohn’s Disease – and that she had been undergoing immunosuppressant therapy for this, a regimen that can render some patients more vulnerable to lymphoma. Indeed, Ms. Flook that day was diagnosed by Dr. Feinstein with stage 4 diffuse large B cell lymphoma, a type of non-Hodgkin lymphoma that develops when the body makes abnormal B lymphocytes, the white blood cells that normally help fight off infection.
Dr. Feinstein told Ms. Flook she would need a bone marrow biopsy that day and would have to be admitted immediately for 30 days of chemotherapy. She was in shock when she heard this. “I said to him, ‘What? I’ve got work to do! I have to keep on living!’ I didn’t even have time to make arrangements at home or at work,” she says.
Dr. Citron remembers the condition Ms. Flook was in when her treatment began. “She had multi-focal sites of disease, including lung, nose, larynx, trachea,” he says. “Her spinal fluid tested positive for cancer but her bone marrow test was negative.” Further tests revealed the extensive nature of her disease, with multi-organ involvement and multiple bone lesions, he notes.
“With these aggressive lymphomas, we can get complete remission in about 70 percent of patients but sustaining that remission can be a challenge,” Dr. Citron explains. “Roughly half of those patients may relapse – most of them within the first two years.”
Leaning on chemotherapy, faith and family
Ms. Flook recalls feeling terrified and overwhelmed but even so, she was already preparing herself for the fight of – and for – her life. “I was so ill but, in my mind, I wasn’t going to be defeated,” she says. She became very connected to her church during her ordeal. “I was leaning on God so much and praying the Rosary several times a day. At the same time, I was being ‘swarmed’ by prayer warriors in my family.” She says she also was anointed by her priest with the oil of the sick, a special sacrament performed in the Catholic Church for the severely ill.
Ms. Flook was immediately started on an aggressive chemotherapy regimen, R-EPOCH, used to treat certain types of non-Hodgkin lymphoma, according to Dr. Citron. This chemical “cocktail” contains a variety of drugs, including rituximab, etoposide phosphate, prednisone, vincristine sulfate (Oncovin), cyclophosphamide and doxorubicin hydrochloride (hydroxydaunorubicin). It is typically administered via infusion over five days.
Next, Ms. Flook received five cycles of R-CHOP, a different type of chemotherapy regimen, followed by three high doses of methotrexate, says Dr. Citron. These were administered via an Omaya port, a temporary port implanted in Ms. Flook’s brain that allowed doctors to deliver chemotherapy agents directly into her spinal fluid. “Standard intravenous chemotherapy drugs don’t pass through the blood-brain barrier, so you need to take a different approach,” Dr. Citron notes.
“I felt like I just kicked cancer’s ass”
Ms. Flook’s final treatment was in October 2019; a PET scan confirmed she had what Dr. Citron terms a complete response. “It took her many months to recover her voice and breathing, but she’s been in remission now for nearly three years,” he says. “She’s now seen every three months but I would say that the odds are in her favor.”
To mark the completion of her treatment, Ms. Flook rang the ceremonial bell at Miami Cancer Institute on Nov. 15th. “For my bell-ringing ceremony, I made a playlist, I bought three bottles of prosecco and I created my own little party at Miami Cancer Institute with 15 family members and friends,” Ms. Flook says. “I felt like a courageous undefeated warrior who had just kicked cancer’s ass. And I felt blessed that the child of God had carried me through all of this.”
Filled with gratitude, Ms. Flook says her partner, Janet, kept their business running while also doubling as her patient advocate. “Janet was so important throughout this whole ordeal,” says Ms. Flook. “She took care of the business, she communicated with my family and my doctors, she cooked and brought me meals in the hospital, she bathed me and helped me walk,” Ms. Flook says. “I couldn’t have gone through this without her.”
At the same time, Ms. Flook credits her care team at Miami Cancer Institute with saving her life. “The staff, the technology, the facility – it all projects ‘science’ and that there are experts here who are going to fight for you. And that’s exactly what they did,” she says.
Throughout her cancer journey, Ms. Flook says she never once had a bad experience at Miami Cancer Institute. “There is so much care and love shared there,” Ms. Flook says. “Every single person – even the valet attendant – was always so accommodating and generous with their time and attention. And I developed such a close bond with my nurses and doctors. I still keep in touch with them.”
A culture of compassionate care is what makes Miami Cancer Institute different from any other cancer center in the country, says Dr. Citron, and is a major reason why it’s one of the busiest cancer centers in Florida. “Every member of our staff is on the same page,” says Dr. Citron. “They’re supportive, welcoming, helpful and friendly, and they’re extraordinarily responsive and great at communicating with patients and caregivers.”
Pushing through your fear
Dr. Citron describes Ms. Flook as a special patient because she had “such extensive, horrendous disease” and has done “so remarkably well.” He says the two bonded during her long hospital admission when Ms. Flook underwent chemotherapy, and that their friendship has continued over the past few years. “She’s such an engaging personality,” remarks Dr. Citron. “To say she has a positive attitude is an understatement. She’s overwhelmingly positive, and very intelligent.”
As for Ms. Flook, she says fighting cancer is all about pushing through your fear, which she learned can be “super energizing,” and that she was able to take a terrible situation and turn it into a positive. “I never once asked, ‘Why me, God?’” she says. “And now I know what my role is – to help others with cancer get through their journey. When I run into people who have cancer, I always reach out and offer them hope and encouragement. I’ve been there. I know what they’re going through.”