Oncology Nurse Shares Insights From Her Stage 4 Breast Cancer Journey

As an oncology nurse at Tanner Medical Center in Carrollton, Georgia, April Fowler, RN, spent 16 years as a Licensed Practical Nurse (LPN) providing bedside care to patients with cancer. Her clinical perspective transformed when she transitioned from provider to patient. Today, Fowler is managing Stage 4 metastatic breast cancer while continuing to work on her unit and advocating for patients, colleagues, and family members.

Initial Diagnosis and Concurrent Pregnancy

Fowler's cancer journey began in February 2019 at age 33, when she reported underarm pain during a routine checkup. Despite no palpable masses, her maternal history of breast cancer prompted a mammogram and biopsy. On Valentine's Day, she received confirmation of HER2-positive breast cancer.

Recalling the diagnostic call during an interview with Oncology Nursing News, Fowler noted her initial stance: "You know what? It's Stage 1. I got this. It's going to be OK." She shared that emotional gravity materialized when telling her mother, calling it "the first time I actually got upset over my diagnosis."

Following a bilateral mastectomy in March 2019, routine screening prior to her chemotherapy port placement revealed an unexpected pregnancy. Her oncologist, Minesh Patel, MD, advised that systemic therapy could not be safely delayed. Fowler recalled asking her oncologist, "Can I wait until baby is born until I take any chemo?" but was advised that delaying treatment posed severe maternal risks.

Initiating chemotherapy at 16 weeks’ gestation, Fowler minimized ancillary medications to protect fetal health. "I didn't take anything for my heartburn. I didn't take anything for my nausea and vomiting. I just I dealt with it ... I was trying my best to protect her," Fowler explained.

Mid-gestation ultrasound evaluations identified hypoplastic left heart syndrome (HLHS) in her unborn daughter, Ivy. As detailed in a local news report in The Newnan Times-Herald, Ivy was born on November 11, 2019, and underwent open-heart surgery two days later at Children's Healthcare of Atlanta, eventually completing three cardiac reconstructions.

Metastatic Recurrence and RN Milestone

After a period of remission, Fowler experienced a recurrence. Biopsy confirmed Stage 4 disease with bone involvement.

Despite undergoing demanding systemic therapy, Fowler completed an academic bridge program to earn her Registered Nurse degree, graduating on August 6. She recounted maintaining academic standards despite acute side effects: "I would be sitting in class and sometimes in tests and have an emesis bag right next to me and I would have to show it to the teacher like, 'Look, I don't have anything written on it. It's just a plain old emesis bag.'"

During night shifts, when wearing a protective mask and toboggan, a patient likened her to a martial artist. "I like that better. That's what I'm going with. I'm a ninja," Fowler joked.

Patient Advocacy, Empathy, and Burnout Prevention

Fowler's dual status as clinician and patient informs her approach to symptom management and patient advocacy. She counsels patients to report subtle physiological shifts: "You need to advocate for yourself,” she urged. “Nobody knows how you feel. So, you need to tell — even if you think it's small and insignificant, you tell that doctor.”

She emphasized vigilance, warning that "some cancers are very aggressive and just missing one little thing can be detrimental to some people.”

Furthermore, her experience with cancer pain heightened her commitment to empathetic care. Recalling an emotionally distressed inpatient whose spouse had departed, Fowler spent an hour listening. "Sometimes that's what these people need. It's not medicine, they just need somebody to listen to them," she emphasized.

To address professional burnout among oncology nurses, Fowler underscored honoring patient autonomy regarding goals of care. "I tell my patients, ‘This is your body. If you are done, then you are done. And it is OK to be done. It is OK to fight, it is OK to be done,'" she reflected.

Addressing pain management for advanced bone metastases, she urged nurses: "Give these people all the medicine you can to keep them comfortable. Do unto others as you would have them do unto you." She advised less experienced nurses: "Just pretend like that's your mama and you don't want them to hurt.”

Familial Risk and Preventive Health

Addressing multi-generational cancer risk, Fowler, a mother of 3 girls, advised individuals with a strong familial pattern to undergo early risk assessment. "If it's that prominent in your family, do the genetic testing, get your mammograms," she recommended, advising early screening and routine self-breast examinations for younger relatives.

References

1. A Mom-umental task. The Newnan Times-Herald. May 8, 2020. Accessed September 23, 2026. https://www.times-herald.com/news/local/a-mom-umental-task/article_51cb7608-a12d-5a6c-8f9f-3debf909741a.html