Amy Scolieri on the boardwalk at Jones Beach, near her home in Seaford, New York. Scolieri says that thanks to the Symptom Management Program, her cancer treatment side effects have “stopped disrupting my life.”
CRedit: Jonathan Kozowyk
In 2010, when Amy Scolieri was diagnosed with breast cancer for the first time, she was 34 and the mother of three young children. Although the tumor was small and localized, the special education teacher from Seaford, New York, opted for a double mastectomy, largely because her mother, grandmother, and great-grandmother had all endured similar cancers.
Over the next 13 years, Scolieri divorced, remarried, and expanded her brood by two (including a stepchild). Then, in November 2023, she found a lump in her reconstructed right breast. “Mentally, it hit me like a ton of bricks,” she recalls. “I couldn’t believe this was happening again.” This time, she was referred to NYU Langone Hospital—Long Island, where she underwent an extensive course of treatment. After breast cancer surgeon Soojin Ahn, MD, removed the tumor, medical oncologist Douglas K. Marks, MD, oversaw several rounds of chemotherapy, and radiation oncologist Amy N. Solan, MD, administered external-beam radiotherapy. Dr. Marks also put Scolieri on anastrozole, a class of drug called an aromatase inhibitor, which hinders the growth of estrogen-driven cancers by blocking production of the hormone. Later, he enrolled her in a clinical trial for a targeted therapy already approved for certain high-risk breast cancers that has shown promise in preventing recurrences like the one he suspected Scolieri was experiencing.
The cancer treatments triggered sudden menopause, along with other common side effects, including nausea and fatigue. The most troublesome symptom, however, appeared in August 2024, soon after Scolieri completed her last radiation treatment: severe itching. It began on her chest and soon spread almost everywhere. “The itch felt like it was coming from deep within my body, and it never stopped,” she says. She often scratched herself until she bled. At night, she wore socks on her hands to prevent lacerations while she slept.
Uncertain of the cause, Dr. Solan sent Scolieri to Mario Lacouture, MD, a leading expert on the management of skin-, hair-, and nail-related side effects of cancer treatments. Dr. Lacouture, chief of dermatology at NYU Langone Hospital—Long Island, is also the medical director of the Symptom Management Program at NYU Langone’s Perlmutter Cancer Center. This multidisciplinary initiative, the first of its kind in New York State, is dedicated to easing the torments of patients like Scolieri.
“Up to 75 percent of cancer patients suffer from adverse effects associated with their therapies, ranging from hair loss to allergic reactions to serious heart or kidney conditions,” Dr. Lacouture explains. “Being able to effectively address the side effects of treatment can often make the difference as to whether patients are able to continue potentially lifesaving treatments or have to compromise their cancer care.”
The Symptom Management Program is designed to prevent that scenario. Dr. Lacouture launched the initiative soon after he arrived at NYU Langone in 2023 from Memorial Sloan Kettering Cancer Center. His first step was to survey oncologists at Perlmutter Cancer Center, ranked among the top 20 cancer centers in the nation by U.S. News & World Report, on the barriers they faced in managing treatment-related symptoms. The biggest obstacle, he found, was difficulty in arranging referrals to qualified specialists.
Dr. Lacouture assembled a team of clinical collaborators from across the health system, representing cardiology, pulmonology, nephrology, neuro-oncology, gastroenterology, rheumatology, endocrinology, dermatology, hepatology, allergy and immunology, ophthalmology, and physical medicine and rehabilitation. The program enables oncologists to order rapid referrals to these specialists through Epic, NYU Langone’s electronic medical record system, and to arrange real-time “e-consults” with them during patient visits.
In its first year, the Symptom Management Program reduced wait times for referral appointments by 82 percent and doubled the number of specialist visits among Long Island patients being treated for cancer. Buoyed by these outcomes, the program will expand to NYU Langone’s Manhattan and Brooklyn hospitals this fall. “We’re providing seamless access to expert care for treatment-related symptoms of all kinds,” Dr. Lacouture says.
Scolieri has benefited in ways that are beyond skin-deep. Because her itching was so variable—sometimes accompanied by redness or hives, sometimes not—identifying the source and finding a solution was a challenge. After ruling out radiation injury and various environmental irritants, Dr. Lacouture wondered if Scolieri might be having a reaction to anastrozole, the drug she’d begun taking shortly before the symptoms began.
Dr. Lacouture prescribed topical creams, steroid medications, and anti-inflammatory drugs. None worked. Then he turned to an injectable asthma medication known as Xolair. After Scolieri’s fourth monthly shot, the incessant itching began to subside. Meanwhile, after consulting with Dr. Lacouture, Dr. Marks switched her to a different aromatase inhibitor, which she will continue taking long-term.
“The symptoms didn’t vanish entirely, but they’ve stopped disrupting my life,” Scolieri says. “I’m about 80 percent resolved.”
Recently, Dr. Lacouture enlisted Stephanie L. Mawhirt, DO, the program’s allergy and immunology specialist, to help with the remaining 20 percent. When Scolieri’s blood work revealed an elevated immune marker, Dr. Mawhirt referred Scolieri to rheumatologist Julie Nusbaum, MD. “We keep each other informed as we learn more about her case,” says Dr. Mawhirt.
That level of coordination is central to Dr. Lacouture’s vision. “I came to NYU Langone because this is an extraordinarily well-integrated organization, blending the skills of clinicians from every discipline and delivering high-quality care to patients wherever they live,” he says. “Few other institutions have the resources or the sense of mission to support this kind of project.”
For Scolieri, now 49, the program’s carefully choreographed expertise has eased the physical and emotional burdens of her illness. “It’s such a safe, good feeling,” she says, “to have these experts working together to heal me.”
