In early 2018, an X-ray revealed an apple-size tumor growing inside Shinkyong Chang’s chest. The discovery of the growth, which was pressing up against several of the so-called great vessels carrying blood to and from Chang’s heart, led to a diagnosis of thymic carcinoma — a rare type of cancer found on the outside of the thymus gland.
Paul Morris, M.D., the chief of surgery at the Queen’s Medical Center in Honolulu, had performed operations on patients with thymic carcinoma before, but rarely had he seen a tumor this large, and he wasn’t sure if it was too late to perform surgery on the 45-year-old Hawaii resident. So, he reached out to oncologists at MD Anderson for a consultation on the case.
That ability to consult with MD Anderson experts is a valuable advantage for Morris and the doctors at Queen’s Cancer Center and other certified members of MD Anderson Cancer Network®. When the need arises, questions and case details can be shared with MD Anderson cancer experts who review the cases and provide guidance. This is all done electronically through the MD Anderson Physicians Network® — a quality management and best practices organization that delivers cancer management services to Queen’s and 15 other health systems and hospitals that benefit from certified-member status in the network.
“Any patient who comes to the Queen’s Cancer Center and sees a certified physician can gain access to this peer-to-peer collaboration, which is basically a second opinion,” says Morris, a former resident at MD Anderson.
Have skills, will travel
Within days, Morris received a call from MD Anderson thoracic surgeon Reza Mehran, M.D., who believed surgery might be possible after a round of chemotherapy. However, Morris would first have to disconnect Chang’s brachiocephalic vein, which drains blood from the brain, and likely perform a heart bypass surgery.
“I said, ‘Wow, I’ve never done that type of surgery,” Morris recalls. “I was not knowledgeable on how to disconnect that vein and reroute it, so I told Dr. Mehran that I’d need to send Ms. Chang to Houston so he could perform the surgery there.”
That trip to Houston wouldn’t be necessary.
To save the patient from the trouble of traveling, Mehran offered to fly to Honolulu and perform the surgery himself. He still had the Hawaii medical license he earned 15 years ago, around the same time he obtained licenses in Texas, California and Florida.
“For some families it is difficult to come all the way here,” explains Mehran, a professor of Thoracic and Cardiovascular Surgery. “Rather than bring Ms. Chang and her family here, and putting them through that financial burden, I decided I’d just go to them.”
Clinical integration is key to success
Last October, Mehran, Morris and a team of doctors and nurses assembled in an operating room at Queen’s for the 5-hour surgery to remove the tumor.
“It was very tense; very delicate,” Morris says. “All of the great vessels were in danger during the surgery.”
At one point the team had to use a heart bypass machine to avoid fatal blood loss.
“With this kind of surgery, if something goes wrong, the patient can die on the table,” Mehran says.
The surgeons were able to safely cut out the cancerous tissue, leaving only a raisin-size bit of residual tumor on one of Chang’s arteries, which can be controlled with radiation. Within a week, she was back home with her family, and her prognosis is excellent. Morris attributes the outcome to Mehran’s willingness to fly to Hawaii for the surgery.
“If Ms. Chang had to travel to Houston, it would have been a new city, strange faces. It would have been a wonderful surgery, but it would have been difficult for her.”
Peace of mind for patients
Morris also is thankful for the opportunities for collaboration that the cancer network makes possible.
“It really provides physician satisfaction knowing that we can call on the world experts and ask them about the best care for our patients,” he says. “And patients love the fact that they got an opinion from the doctors in Houston.”
For his part, the Canadian-born Mehran enjoyed the opportunity to take his medical expertise on the road, just as he once did as a medical officer in the Canadian Armed Forces.
“I’m an ex-military guy, and this reminded me of the medical missions I’ve done around the world. It was just an extremely rewarding experience.”