Denise Spector, PhD, MPH, ARNP, is a nurse practitioner and integrative medicine clinician at UNC Lineberger and the North Carolina Basnight Cancer Hospital.
As a high school senior, she worked 25 hours a week as a proofreader of government patents for a computer company to help pay for her college. Her passion to help others led her to pursue a medical career supporting cancer patients.
Here’s a few minutes with Denise Spector.
Tell us about your journey to this point in your career
I was destined to become a nurse and particularly an oncology nurse. My family has a photo of me at the age of four or five wearing a nurse’s cap with a red cross symbol on it. For as long as I can remember I have always been sensitive and tuned into the emotional and physical needs of others, including non-human beings.
In high school I had the opportunity to attend half a day at my regular public school and the other half at an area vocational technical high school. I entered a medical office assistant program, which was the closest program to pre-nursing as it included clinical skill development. My clinical instructor was an RN and a significant role model. I admired her teaching skills but also her compassion and kindness when she talked about patients she cared for. She encouraged me to consider obtaining a BSN after high school.
For a clinical experience, I spent time working with some of the most challenging hospitalized patients at the Delaware Psychiatric Center. Following high school, I enrolled in the University of Delaware’s School of Nursing program.
Since my start in oncology nursing in the mid-‘80s, I have worked in various settings within several NCI-designated cancer centers. In the early ‘90s I began sub-specializing in pain and symptom management (before it became known as Palliative Care) at the Dana-Farber Cancer Institute in Boston.
In addition to pharmacological management of symptoms/side effects, I focused on complementary therapies such as guided imagery and other mindfulness activities for pain and anxiety. I knew there had to be more than prescribing yet another medication and started exploring more about complementary strategies. Through the years this interest grew and expanded to disease risk-reduction and health promotion strategies, such as nutrition, exercise, etc.
I was extremely fortunate to complete a two-year interdisciplinary clinical training in integrative medicine through the Academy of Integrative Health & Medicine in 2018. This training was a general integrative medicine program, which was a great foundation. Subsequently, I learned of an opportunity to apply for an NIH-funded T32 training grant specifically for integrative oncology through the University of Michigan.
Over the course of four years, the program accepted one hundred interdisciplinary oncology clinicians across North America. I was delighted for the acceptance into the integrative oncology scholars training program, which I completed in 2022. Both programs provided me with a wealth of knowledge and experience in the field of integrative medicine and lifestyle medicine.
Why did you decide to pursue a career in cancer, in particular integrative medicine?
While in nursing school, I did not yet have any friends or family who had been diagnosed with cancer, although I had developed a deep interest and curiosity about cancer. It was not at all like other diseases, since it really is not just one disease, and I wanted to learn more about the complex nature of cancers and how best to care for those affected.
Growing up in Delaware, I was aware that our state had a higher-than-average incidence of cancer (perhaps in part due to many chemical plants, such as Dupont). Later in my 20s, I not only had close family members diagnosed with cancer, but one of my best friends was diagnosed with a high-grade astrocytoma. It was devastating to watch her decline and, despite treatments, she eventually succumbed to the disease. By this point I had already chosen the path of oncology nursing, but it led to a deeper passion for the specialty.
My pursuit for navigating towards a sub-specialty in integrative and lifestyle medicine in cancer care grew out of my frustration from the lack of attention to disease risk-reduction and health promotion strategies at many cancer centers, as well as the lack of use for complementary therapies to help mitigate symptoms and treatment-related side effects. Through the years there has been mounting evidence for complementary and lifestyle medicine modalities to enhance the quality of life for cancer patients.
On a very personal note, my beloved departed husband Dr. Neil Spector lived for many years with life-threatening heart failure due to undiagnosed/misdiagnosed Lyme disease, which eventually led to a heart transplant. Through his long ordeal with a chronic illness, we kept him as healthy as possible for 24 years with both conventional medical care along with integrative and lifestyle practices.
Sadly, he developed post-transplant lymphoproliferative disorder in the height of the COVID pandemic. The disease behaved like an aggressive Burkitt lymphoma. Despite attempts with chemotherapy/immunotherapy, he lost his life to this horrible disease in 2020.
Neil was a medical oncologist and cancer researcher who for many years counseled his patients about the benefits of complementary practices in oncology care. Neil was also a UNC-Chapel Hill undergraduate who played soccer and lacrosse for the school he loved so well. He was true Tar Heel, despite working for the darker shade of blue.
Why is serving this patient population important to you?
There is always more that we can do as oncology providers to improve the lives of our patients and their families, especially with many survivors living longer with newer therapies. While the advances in oncology have been tremendous and have led to improved survival, many of our patients are at higher-than-average risk for other chronic diseases and have lingering late effects from treatments.
While not a panacea, integrative and lifestyle medicine helps to address many chronic illnesses and persistent effects from prior treatments.
While I questioned whether I could continue in oncology after my husband’s death, as well as the death of my mom from metastatic renal cell carcinoma in 2021, I realized it was important to stay involved in cancer care. I feel that I am honoring both of them in some way by supporting others affected by cancer.
What is your most memorable moment with a patient?
While I have countless memories of patients through the years, the most memorable patient in relation to my current role as an integrative medicine clinician is a middle-aged woman diagnosed with an early-stage breast cancer who underwent breast conserving surgery, adjuvant radiation and targeted therapy for HER2+ disease. She truly took the diagnosis as a “teachable moment” and felt empowered to begin making lifestyle changes with diet, exercise, stress management, improved sleep, etc.
After our initial visit she started implementing healthier dietary changes and began enjoying cooking again. She enrolled in UNC Lineberger’s Get REAL & HEEL exercise program as well as our yoga program. She began meditating more using a meditation app to help manage the stress of the diagnosis/treatment and life in general. She reported feeling better physically and emotionally following the implementation of these strategies. It is always so wonderful to have patients who are highly motivated and then to learn that they actually take our advice.
What advice do you have for someone entering this line of work?
If an oncology provider is extremely interested in empowering their patients towards taking some personal control over their cancer experience through healthy lifestyle behavior changes, mind-body approaches, and other non-pharmacologic strategies, this sub-specialty would be a great path. Discussions about evidence-based integrative/complementary practices can be incorporated into regular oncology practice visits or if a clinician is interested in moving solely into this field, I would suggest training through an integrative oncology program.
What was your very first job?
My very first paying job started in my senior year of high school and it was not in health care.
I worked 25 hours a week as a proofreader of government patents for a computer company. It paid quite well and allowed me to save for college since my parents were unable to cover the cost of a four-year degree program. While it was not the most exciting job, it led to my having a keener eye for typographical errors. Unfortunately, I think that has waned to some degree over the years. Thank goodness for spell check!
In nursing school, I worked as a nursing assistant in a local nursing home, which was both rewarding and sad at times.
Anything else you want the audience to know about you?
I am so grateful to Dr. Gary Asher, medical director for the Integrative Medicine Program at the cancer center, for bringing me along on the journey for the clinical expansion of the IM consult service.
My gratitude extends to Dr. Shelley Earp and Dr. Don Rosenstein for their administrative support of the program, along with all my amazing and talented colleagues within the Comprehensive Cancer Support Program. Thank you all for allowing me to be in a role I feel so passionate about, that helps enhance the health and wellness of individuals affected by cancer.