Young Mother Facing Cancer While Pregnant Finds Hope Through Coordinated Care at OU Health

When Alana Fernandes discovered she was pregnant in late 2023, she and her husband Bobby were overjoyed. Living in Phoenix at the time, the couple had carefully planned this next chapter of their lives, even taking one last trip to Europe before starting their family.

However, their happiness took an unexpected turn when Alana discovered a concerning lump in her breast during her third trimester.

After initial dismissal of her concerns in Phoenix, where she was told it was likely just a clogged milk duct, Alana made the crucial decision to return to visit family in Oklahoma for a second opinion. Within just one week of visiting the Chickasaw Nation Medical Center in Ada, she had received both a mammogram and biopsy. The diagnosis was devastating — breast cancer.

"That wouldn't happen to me. I'm healthy. I feel great, and I'm pregnant. I can't be sick," Alana said after she received the news over the phone. "Cancer isn't something I thought would happen to me, and it didn't run in my family. It's not genetics."

What followed was a whirlwind of critical medical decisions that most people would have months or years to consider. Alana and Bobby had hours. The complexity of her case was heightened by a particularly aggressive form of hormone-receptor breast cancer that actually fed off her pregnancy hormones, causing it to grow and spread more rapidly with each passing day.

Turning to OU Health for Comprehensive, Coordinated Care

The young family turned to OU Health Stephenson Cancer Center, where Alana did not have to navigate a maze of disconnected medical offices or wait weeks for appointments. Instead, she found herself at the heart of a seamless, coordinated care plan tailored to her need.

Hematologist-oncologist Dr. Wajeeha Razaq,M.D,, associate professor in the Section of Hematology-Oncology at the University of Oklahoma College of Medicine, was a key figure in this coordinated approach.

"Having everybody in one system, it's very easy to get hold of somebody,” Dr. Razaq said.

"It was amazing how everybody just communicated," Alana said. "When my dad had cancer, I remember having to fax documents over, carry documents over and make tons of phone calls because none of the doctors were talking to each other. That never happened to me at OU Health."

At the heart of this coordinated approach was Stephenson Cancer Center’s tumor board, which meets weekly to review and discuss patient cases. This group brought together a diverse team of oncologists, maternal-fetal medicine specialists, surgeons, and other healthcare providers to make unified, well-informed decisions about Alana's care.

"Her case was discussed in the tumor board multiple times, whenever she advanced to another step," Dr. Razaq said. "We all come together and make sure things are moving along well. There are multiple brains working on one patient."

Balancing Multiple Factors in Care

Alana’s care team had to balance multiple critical factors: ensuring the baby's safety, allowing the pregnancy to progress as long as possible, and beginning cancer treatment as soon as feasible. Her maternal-fetal medicine specialists at OU Health were part of the comprehensive approach.

A detailed review of her current pregnancy and health history were performed - as they are for every patient in Maternal-Fetal Medicine - to determine if Alana had any preexisting medical condition that may affect her pregnancy. Conversely, the team looked at her pregnancy to see how it could affect her cancer treatment as well.

Occasionally, the high-risk pregnancy department receives referrals for patients with a new diagnosis of cancer during pregnancy. Because treatment may increase the risk of fetal and/or neonatal complications, collaboration between maternal-fetal medicine and oncology is critical. 

"They already knew my case - knew more than I knew," Alana said.

Crafting a Plan for Delivery and Treatment

Working closely with Dr. Razaq, the care team developed a comprehensive plan to deliver Alana’s baby at 34 weeks, following steroid treatments to promote the baby's lung development. During delivery, the coordinated care approach continued with approximately 10 healthcare team members present, each with specific roles in ensuring both mother and baby's safety,

Alana’s oncologist was confident that starting chemotherapy within this time frame remained within an optimal window for effectively treating her cancer. Babies born at 34 weeks typically have excellent long-term outcomes, and with the support of Oklahoma Children’s Hospital’s Level 4 Neonatal Intensive Care Unit (NICU) - which cares for the most critically ill newborns in the state - the team was well-prepared to manage any complications of prematurity.

The complexity of Alana's cancer treatment was heightened by her hormonal status.

"Her cancer was estrogen, progesterone-positive cancer," Dr. Razaq said.

Hormone-sensitive cancers, such as those that are estrogen- and progesterone-positive, can be more difficult to manage during pregnancy. These cancers rely on hormones like estrogen and progesterone to grow, making it more challenging to find the right balance of treatments while also safeguarding the health of the baby.

Successful Delivery and Postpartum Care

Thanks to careful planning and execution, baby Kamdyn (Kami) was born on March 5, 2024, without requiring NICU care despite being six weeks premature. Her healthy birth is a testament of why having a comprehensive team of specialists from maternal fetal medicine, oncology, and neonatology is invaluable in cases like this. 

The care team formulated a plan that balanced the care of Alana’s pregnancy, her necessary cancer treatment, and the health of her baby. With the support of OU Health’s tertiary care center, doctors were able to seamlessly collaborate with specialists across virtually every medical discipline, ensuring comprehensive care at every step.

"I felt so secure, like I was in such good hands," Alana said. "There were people focusing on making sure the baby is safe, and then there's people focusing on making sure the mom is safe. Being a first-time mother, it was just everything."

Just two weeks after delivery, Alana began an aggressive chemotherapy regimen, which was an even bigger challenge. Dr. Razaq recognized the emotional toll of treatment on her young patient.

To help Alana cope, Dr. Razaq connected her with support care services and therapy.

"It was awful," Alana said. "I'm still recovering from having a baby, and now I need to hobble into getting a port and getting really ugly doses of chemotherapy. But through it all, the medical team remained responsive and supportive. Even at 4 in the morning, I'm messaging 'Doctor Razaq, I don't feel good,' and they would respond right away with reassurance."

Today, Alana is cancer-free and has completed her final rounds of radiation therapy.

"The radiation therapy nurses are absolutely amazing," she shares. "They just make just a crappy time a little bit less crappy. They're always so kind. We've become really close, and I love that."

Destination of Choice for Complex Care

OU Health has become a premier destination for complex medical cases requiring coordinated care. The ability to have all specialists under one roof, communicating regularly and working together, can make a critical difference in outcomes for challenging cases like Alana's.

"If I had stayed in Phoenix and waited for referrals, we wouldn't have this outcome right now," Alana said. "I was so scared, but I just put all of our trust into the team here, because we had to. This is what has to be done."

OU Health continues to lead the way in providing this level of comprehensive, collaborative care for patients throughout the region.

Learn more about breast cancer care at Stephenson Cancer Center and about breast cancer screening and mammography near you or call 1 (800) 422-4626 to make an appointment at any of OU Health’s mammography locations near you.