Fifteen minutes before the lecture, over a hundred students are already seated on the red chairs of Lecture Hall 1. “Patient demonstrations are always packed”, says a student in the second row. “Everyone finds them super interesting, and today’s guest is very special.”

The student is referring to Eva Hermans-Kroot, a terminal lung cancer patient at Erasmus MC. She sits in the middle of the room beside the lecturers: lung specialist Robin Cornelissen, molecular biologist Erik Jan Dubbink and lung pathologist Jan von der Thüsen.

Von der Thüsen kicks off the lecture by explaining the different types of lung cancer. In the second part, Eva talks about her disease progression.

The Oncology block of the Molecular Diagnostics of Lung Cancer course offers regular patient demonstration sessions. The sessions are designed to teach students about the medical and social aspects of a disease. Lecturers explain the medical part while patients share their personal experience of the disease and treatment. It helps students learn how best to approach treatment and patient contact as doctors.

Incurably ill

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From left to right: Jan von der Thüsen, Robin Cornelissen, Eva Hermans-Kroot, and Erik Jan Dubbink. Image credit: Daan Stam

“Shit”, Eva replies to the first question from the lecturer and her attending physician Robin Cornelissen, when asked about her reaction when she first heard the diagnosis.

In 2021, Eva discovered a lump in her neck. Her GP referred her to a specialist in internal medicine. Two weeks later, she was told she had lung cancer. “And a week after the diagnosis, the specialist told it was incurable”, says Eva. “My whole life collapsed. It was like the ground crumbled under my feet.”

“I don’t have any family members with cancer, so I had no idea how you were supposed to deal with it, or how big an impact cancer has on your life and the lives of your loved ones”, Eva continues. Her husband Matthijs, sitting in the audience, nods in agreement.

The specialist at Elisabeth-TweeSteden Hospital in Tilburg informed Eva’s parents and in-laws about her diagnosis. “I really appreciated that, it was a huge weight off my shoulders. Because how do you tell your family that you’re dying?”

Disease progression

Eva was quickly referred to Erasmus MC. Based on the CT scan and biopsy, the doctors drew up a treatment plan. They opted for a combination of chemotherapy and immunotherapy. “The chemo really sucked. I couldn’t cope”, says Eva, who at the time was a communications student at Fontys University of Applied Sciences in Tilburg. “I tried to continue my routine as a student, but at a certain point I couldn’t do it anymore because I got sick from the chemo.”

After the chemotherapy, her condition was stable for six months. Then the doctors noticed that the tumour cells were growing again. This time, Eva was given an afatinib pill. The drug worked great, she says. “I was able to live a fairly normal life. All I had to do was take the medicine and come to Erasmus MC every eight weeks for a check-up. That was chill, and very different from during chemo. With chemotherapy, you can’t really plan ahead because the side effects are intense.”

Unfortunately, after six months the afatinib stopped having the desired effect. “The cells became resistant and the mutation made the drug less effective”, Dubbink explains.

What followed was a series of new examinations and treatments. Eva was given a new drug, osimertinib, which worked and was ‘even more chill’. But the doctors discovered metastases in the meninges in October 2022. Multiple courses of radiotherapy and chemotherapy proved futile, so the doctors finally decided to call it quits. Since then, Eva has only been taking osimertinib. “I’m lucky that my body is responding well to the drug. The tumour isn’t growing as fast now as it would be without the osimertnib, but of course no one knows how long that will last.”

Honest and positive

“But despite your illness, you kept busy and did a lot of things”, says Cornelissen. Eva participated in the TV programme Over mijn lijk (Over my dead body), got married and graduated cum laude, and in December she will publish her book Longeneeslijk. “Something always seems to turn up. I like that, because you can work towards something and have something to look forward to. Of course, I only have short-term goals, but that helps me keep going.”

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Over a hundred students are attending the class. Image credit: Daan Stam

Eva recounts her experience honestly and with humour. “When you’re sick for so long, there’s no point feeling sorry for yourself. Of course, I occasionally play the ‘cancer card’ – it’s handy if I need a quick taxi or something”, she laughs. “But I don’t want to abuse my situation.”

Eva is glad she ended up at Erasmus MC. “Sharing my experience is a way of giving something back to the Erasmus community. If I hadn’t been treated here, I wouldn’t be here today”, she says. Then, half joking: “Well, soon I won’t be here anyway, but you get what I mean.”

Impressive

After the lecture, a few students come and ask Eva questions. “I’m sure you have times when you feel down. How do you keep yourself going at times like that?”, one student asks.

“I just let myself be carried along by the emotion, because when things are shitty, it’s okay to just feel like shit for a while. But I don’t dwell on it for too long. I talk to Matthijs about it. There’s no point in wasting days on it. Then I just occupy myself with my hobbies: making pottery and playing sport.”

Another student approaches Eva. “I don’t have a question, I just want to thank you for this impressive lecture.” He chokes up and wipes away a tear. “I find it so inspiring how strong you are and how positive you are about life.”

“Oh, I wish I could’ve given him a hug”, says Eva after the student leaves the room. “I understand that people feel sympathy for me.  I think it’s incredibly sweet, but you really don’t have to feel sorry for me. It’s okay.”

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