When the poliovirus vaccine put polio specialist Janet Wolter, MD, "out of business" in 1963, she began looking for a new job. She found one--and a new specialty--at Presbyterian-St. Luke's Hospital in Chicago, Illinois, which later became Rush University Medical Center.
Dr. Wolter worked with endocrinologist Samuel G. Taylor III, MD, who was interested in hormonal treatment of breast and prostate cancers. At first she told him, "I would be crazy to go from polio to cancer." After a brief stint at data analysis, however, she was eager to see patients again and began treating and studying people with cancer. Her oncology career lasted until she retired from Rush in fall 2009 as a professor of internal medicine.
Over the course of 5 decades, Dr. Wolter enrolled more than 800 patients in clinical trials that helped define which breast cancer treatments worked, codeveloped the first multidisciplinary comprehensive breast cancer center in the Midwest, and was a pioneer in using nurse specialists to work in tandem with oncologists.
Rather than focusing on her own achievements, she praised Dr. Taylor. "We're lucky that people like Dr. Taylor recognized the potential for hormone therapy," Dr. Wolter said, noting the lives these medications have saved. "A patient of mine with breast cancer was on tamoxifen for 22 years [before] she had a recurrence. Then I put her on an aromatase inhibitor. She's still alive."
In her early days of treating breast cancer, "it was a surgeon's disease, and the internist was not involved," Dr. Wolter recalled. "Now we are giving chemotherapy before surgery, so everything's come around 180 degrees."
Learned as Specialty Developed
As chemotherapy drugs became available and as she tested hormonal treatments, Dr. Wolter said she learned medical oncology "from the ground up." That learning curve included giving high doses of testosterone to women with breast cancer-an unsuccessful strategy that proved to have some undesirable side effects.
Dr. Wolter's work also included many successes. For instance, she began testing tamoxifen in the early 1980s, first for treatment of advanced breast cancer and, when that proved effective, for treating early-stage breast cancer and eventually for prevention.
She conducted those studies through the cooperative work of the National Cancer Institute's National Surgical Adjuvant Breast and Bowel Program (NSABP). Dr. Wolter considers her longtime work with the NSABP her most important contribution to oncology. Besides serving on the NSABP executive committee and board of directors, she was Rush's principal investigator for many of the program's multicenter studies. These studies included finding effective combinations of chemotherapy as well as the landmark clinical trials that led to the establishment of lumpectomy plus radiation therapy as the standard surgical treatment over mastectomy. The latter, she said, was the only time she experienced difficulty recruiting women to participate in clinical trials.
"Patients had to agree that, when they woke up from surgery, they may or may not still have their breast," Dr. Wolter commented.
Team Approach Begins
With the development of more treatment options for breast cancer, Dr. Wolter said it became clear to her and her colleagues that the surgeon, medical oncologist, and radiation oncologist should see the patient together. "Two or three radiation oncologists, a couple of surgeons, and a few of us internists said, 'Let's have a meeting and discuss the patients' cases,'" she said.
That informal collaboration led to the creation in 1985 of what Rush calls "the first comprehensive breast center in the Midwest." In what is now a common model, all cancer specialists see the patient on the same day, meet together to agree on treatment options, and then present the options to the patient.
In the mid-1970s, Dr. Wolter established another multidisciplinary service, the Rush Pigmented Lesion Clinic, reportedly one of only about 15 programs in the United States that offers photodocumentation of dysplastic nevi and diagnosis of skin cancers. The idea came to her, she said, after signing "a lot of death certificates" for patients with melanoma.
"I thought, this is crazy--we ought to be able to save these patients," said Dr. Wolter, who patterned the clinic after one in Philadelphia.
Dr. Wolter also was an early user of advanced practice nurses in oncology, said Rush Director of Hematology-Oncology Philip Bonomi, MD. In the early 1970s, patients needing radiation therapy were admitted to the hospital, creating large inpatient populations. Dr. Wolter and other oncologists trained nurses to go on rounds with them and evaluate some of the patients.
"In a sense, they became nurse practitioners on the job. They couldn't write prescriptions, but they could do patient encounters," Dr. Wolter said. "It was a good system, and pretty soon we all had joint practice nurses."
And for Janet Wolter it was a good career--one that Rush University Medical Center honored with a special celebration on February 27. Dr. Bonomi, who trained with her as an oncology fellow, said, "The things we've learned from her will continue to help us in taking care of patients, doing clinical research, and maintaining the highest standard of integrity."
