More care close to home – Middlesex Health

EConsult invokes multiple disciplines, changes cancer diagnosis and outcome

A Middlesex Health caregiver with a patient.

Member: Middlesex Health, Middletown, Connecticut

As part of Middlesex Health's general community oncology practice team since 2003, Michael P. Farrell, M.D., Ph.D., routinely requests eConsults from Mayo Clinic cancer specialists.

"I offer them to every patient as a way to give them extra information," he says. "eConsults are an opportunity for my patients to receive world-class care locally. They don't have to travel or spend a dime for a phenomenal second opinion. They love it."

Dr. Farrell says the Mayo Clinic Care Network has yielded multiple benefits, including the ability to be at the forefront of medical innovation. "Anyone can read guidelines, but folks at Mayo learn about things often before others in the field. I have one Mayo colleague who works in the prostate cancer practice who clued me in on new standards of care before they were even published. My patient benefited from that. To have that kind of access to cutting-edge knowledge is phenomenal, and the teamwork across the clinical practice is incredible."

'This was a massive game changer'

Dr. Farrell recalls another specific case that brought together multiple disciplines from Mayo Clinic, Middlesex Health and other local health care providers, significantly impacting his patient's life. A young male who had a cancerous lung tumor removed was referred to Dr. Farrell. When another lung nodule appeared, he requested an eConsult. It was deemed an aggressive form of lung cancer.

"In the meantime, pathologists from Middlesex were reviewing his medical history and saw that a couple of years prior he had also had a type of skin cancer removed that, upon their review, resembled pathology from the new lung lesion," Dr. Farrell recounts. "At that time, the original pathology was done by a renowned East Coast pathologist, who could not say definitively what it was. It didn't seem relevant, but it was cancer." With this new information, Dr. Farrell asked Mayo Clinic to review the case again. This new information also caught the attention of the Mayo specialist, who saw similarities in the lung tumor and skin lesion pathologies.

"The lung cancer specialist at Mayo Clinic got their dermatology practice involved," Dr. Farrell says. "After more tests and discussions, ultimately, the primary diagnosis was deemed metastasized squamous skin cancer that had moved to the lungs. This was a massive game changer."

A team approach makes the difference

Dr. Farrell changed the patient's treatment plan, employing a regimen of immunotherapy, drugs that stimulate a body's immune system to fight cancer.

"If we'd not worked together to figure this out, this patient would have received chemotherapy, which would likely have made him pretty miserable," he says. "We treated him and restaged him. The fluid on his lungs? Gone, and the lung expanded. The nodules? Gone. Those horrible skin lesions? Resolved, which also surprised the dermatologist."

"The patient is now enjoying life, big time," Dr. Farrell say. "Thankfully, with the huge amount of collaboration among several disciplines, lots of conversations and dozens of emails, we found a better path forward. The patient is really happy now. Actually, he's thriving."

What made the difference? "Team medicine is a great way to characterize our relationship with Mayo Clinic," he says. "It brings our collective expertise together, which benefits patients. In my opinion, the decision for Middlesex Health to join the Mayo Clinic Care Network is one of the best decisions we ever made."