AAPM: Cancer survivor says thanks to medical physicists, oncologists
PHILADELPHIA—Six years ago, Jim Donnelly was told the cancer on his tongue and larynx needed to be surgically removed. Not accepting that opinion, Donnelly, a professor of business at the University of Kentucky, Lexington, decided to go to the Mayo Clinic in Rochester, Minn. As was evident by the standing ovation following his address at the annual meeting of the American Association of Physicists in Medicine (AAPM), Donnelly has not lost his ability to speak, nor his sense of humor.
First and foremost, Donnelly expressed thanks to the oncology therapists, medical oncologists and medical physicists in attendance. Without the dedication to their craft that often goes above and beyond the normal call of duty, he is not sure how he would have handled the difficult ordeal of combined chemo- and radiation therapy five days a week for seven weeks.
One year before the cancer diagnosis, Donnelly was told that the numb feeling in his tongue was due to allergies. When he was finally given the diagnosis of cancer because a lump had formed on his neck, he felt he had two options. "First, to die quickly and painfully from the cancer. Second, to have it surgically removed and live a little longer without a tongue and voice box and then die painfully."
Unbeknownst to him, the doctor had told his wife in 2005 to begin planning for his inevitable death in 2006. But then the Mayo Clinic got involved.
At Mayo, Donnelly's care was overseen by Robert Foote, MD, chair of the radiation oncology department. Foote also spoke at the AAPM meeting. He said that the survival rate for this type of surgery was the same as for combined chemo- and radiation therapy or radiation therapy alone.
"The next question to ask is: Which treatment will give the best quality of life? We want to minimize the losses that might come to speech and eating," Foote said. "We felt the combination of radiation therapy and chemo would be the best."
Foote and colleagues focused much attention on the voice box and whether or not it should be removed. Of course, it's possible for people to talk without a voice box by using a mechanical device placed in a hole in the neck. But they can't smell the food they eat; they can't blow their nose; they continually cough up secretions; intimacy is challenging; and they must give up water-based activities because of the increased risk of drowning.
"For all of these reasons, we decided to use chemo with intensity modulated radiation therapy on the voice box," Foote said.
"It was not an easy ride," Donnelly said of his seven-week treatment regimen. "But I was glad to have my voice box spared. I was a full time professor. I needed my voice for my work."
Regarding patient care, Donnelly said the most important aspects—from the business office to the medical staff—are respect, compassion and responsiveness.
"We all know the experience of the service is greatly influenced by the service," said Donnelly, who has studied business models.
He recounted a story that typified the compassion he felt from the Mayo staff. "After the thirty-third treatment, I got up, wanting to walk on my own power. I was a bit unstable. I said, half under my breath, 'I sure hope these treatments do some good.' I heard a voice say, 'Oh, Mr. Donnelly, we don't hope these treatments do some good, we know they will.' That was exactly what I needed to hear at that point."
"A job is what we do to pay the bills and the work is why we're here and if we get lucky, they sometimes overlap. If we're really, really lucky, they almost seem the same," Donnelly said.
When Foote was asked how he fosters such an atmosphere, he said, "At the Mayo, all staff, no matter what position, learn that the patient always comes first. When we have that aspect of care ingrained, everything flows from there."
Foote recounted that Donnelly's care required "all types of imaging"—CT, MRI, nuclear medicine scans, ultrasound and PET/CT.
"PET/CT showed the hyperemetabiolic activity and no evidence of distant metastases. CT showed pre-epiglottic space invasion and adenopathy in the left side of the neck. MRI showed a large mass over the entire tongue base that was invading the vallecula, the pre-epiglottic space and epiglottis, and it showed bilateral adenopathy in the neck. Ultrasound and biopsy showed metastatic grade 3 keratinizing squamous cell carcinoma."
He told the medical physicists in the audience that having all these imaging tools perform optimally is so vital to the treatment and care of patients such as Donnelly.
"It's so important to administer these tests safely, but also to have the highest quality possible to make the right diagnosis," he said. "You are the unsung heroes working behind the scenes, and we all thank you."
Three months after he finished treatment, Donnelly received a call from an old friend in his native Brooklyn, N.Y. The friend told Donnelly to come to the city to take a "farewell" tour.
"I will be soon celebrating my fifth farewell tour," he concluded with a laugh.
First and foremost, Donnelly expressed thanks to the oncology therapists, medical oncologists and medical physicists in attendance. Without the dedication to their craft that often goes above and beyond the normal call of duty, he is not sure how he would have handled the difficult ordeal of combined chemo- and radiation therapy five days a week for seven weeks.
One year before the cancer diagnosis, Donnelly was told that the numb feeling in his tongue was due to allergies. When he was finally given the diagnosis of cancer because a lump had formed on his neck, he felt he had two options. "First, to die quickly and painfully from the cancer. Second, to have it surgically removed and live a little longer without a tongue and voice box and then die painfully."
Unbeknownst to him, the doctor had told his wife in 2005 to begin planning for his inevitable death in 2006. But then the Mayo Clinic got involved.
At Mayo, Donnelly's care was overseen by Robert Foote, MD, chair of the radiation oncology department. Foote also spoke at the AAPM meeting. He said that the survival rate for this type of surgery was the same as for combined chemo- and radiation therapy or radiation therapy alone.
"The next question to ask is: Which treatment will give the best quality of life? We want to minimize the losses that might come to speech and eating," Foote said. "We felt the combination of radiation therapy and chemo would be the best."
Foote and colleagues focused much attention on the voice box and whether or not it should be removed. Of course, it's possible for people to talk without a voice box by using a mechanical device placed in a hole in the neck. But they can't smell the food they eat; they can't blow their nose; they continually cough up secretions; intimacy is challenging; and they must give up water-based activities because of the increased risk of drowning.
"For all of these reasons, we decided to use chemo with intensity modulated radiation therapy on the voice box," Foote said.
"It was not an easy ride," Donnelly said of his seven-week treatment regimen. "But I was glad to have my voice box spared. I was a full time professor. I needed my voice for my work."
Regarding patient care, Donnelly said the most important aspects—from the business office to the medical staff—are respect, compassion and responsiveness.
"We all know the experience of the service is greatly influenced by the service," said Donnelly, who has studied business models.
He recounted a story that typified the compassion he felt from the Mayo staff. "After the thirty-third treatment, I got up, wanting to walk on my own power. I was a bit unstable. I said, half under my breath, 'I sure hope these treatments do some good.' I heard a voice say, 'Oh, Mr. Donnelly, we don't hope these treatments do some good, we know they will.' That was exactly what I needed to hear at that point."
"A job is what we do to pay the bills and the work is why we're here and if we get lucky, they sometimes overlap. If we're really, really lucky, they almost seem the same," Donnelly said.
When Foote was asked how he fosters such an atmosphere, he said, "At the Mayo, all staff, no matter what position, learn that the patient always comes first. When we have that aspect of care ingrained, everything flows from there."
Foote recounted that Donnelly's care required "all types of imaging"—CT, MRI, nuclear medicine scans, ultrasound and PET/CT.
"PET/CT showed the hyperemetabiolic activity and no evidence of distant metastases. CT showed pre-epiglottic space invasion and adenopathy in the left side of the neck. MRI showed a large mass over the entire tongue base that was invading the vallecula, the pre-epiglottic space and epiglottis, and it showed bilateral adenopathy in the neck. Ultrasound and biopsy showed metastatic grade 3 keratinizing squamous cell carcinoma."
He told the medical physicists in the audience that having all these imaging tools perform optimally is so vital to the treatment and care of patients such as Donnelly.
"It's so important to administer these tests safely, but also to have the highest quality possible to make the right diagnosis," he said. "You are the unsung heroes working behind the scenes, and we all thank you."
Three months after he finished treatment, Donnelly received a call from an old friend in his native Brooklyn, N.Y. The friend told Donnelly to come to the city to take a "farewell" tour.
"I will be soon celebrating my fifth farewell tour," he concluded with a laugh.