Traveling 1,550 Miles for World-class Cancer Care
Mass General Brigham patient José Moreno with his wife.
When José Moreno was diagnosed with oral cavity cancer at age 64, his doctor didn't just recommend treatment. He recommended a journey to Mass General Brigham, 1,550 miles away from José's home in Puerto Plata, Dominican Republic.
Why travel so far for care?
"My maxillofacial surgeon recommended the Mass General Cancer Center team for their expertise and extensive experience in head and neck cancer," José said. "He also highlighted that very few hospitals in the United States have this expertise—and one is Massachusetts General Hospital."
Mass General is a founding member of the Mass General Brigham health care system.
Biopsy leads to diagnosis of squamous cell carcinoma
José developed a sore in his right cheek and was seen by a maxillofacial surgeon in the Dominican Republic. The doctor took a biopsy, which came back negative.
With the sore lingering several months later, José went to a different maxillofacial specialist. Following a biopsy, this doctor made a diagnosis of lichen planus, a chronic inflammatory disease. The doctor prescribed medication to José, who assumed the condition would improve.
After a few months, the sore was still there. José sought out yet another maxillofacial specialist. This time, a more thorough biopsy led to a diagnosis of squamous cell carcinoma, the most common type of oral cavity cancer, in the cells lining his cheek. If left untreated, the tumor can spread to other areas of the body.
"I was shocked to find out my condition," José said. "'Cancer' is a scary word."
Finding the right doctor for José
A family friend recommended that José call International Patient Services at Mass General Brigham. International patient liaison Marvin Gonzalez-Romero was his point of contact.
Marvin helps patients from the Dominican Republic with their care journey at Mass General Brigham. This includes guiding each new patient to the right doctor. In José's case, one name stood out: Wais Rahmati, MD, MPH, FACS. He is an otolaryngologist and head and neck surgeon at Mass Eye and Ear, a Mass General Brigham member institution.
Dr. Rahmati would soon assemble a cancer care team that included doctors from Mass General. But for now, his top priority was getting José into his office for an exam.
"I see patients quickly if they have an irregularity in their mouth, throat, or neck that may be malignant," Dr. Rahmati said. "We know that with cancer, time to treatment has a major impact on outcome. That's why we want to start the workup and treatment as quickly as possible."
Learn about Mass General Brigham International Patient Care
A team effort to determine the treatment plan
José's wife, daughter, and sister came with him to Boston. A new biopsy at Mass Eye and Ear confirmed the diagnosis of squamous cell carcinoma.
"Tumors in this location are generally treated with surgery first," Dr. Rahmati said. "But the procedure can leave a major deformity that requires significant reconstruction. There can be loss of function as well. Plus, the cheek is a thin area. The tumor can expand in any number of directions, which can make a complete removal of the tumor challenging."
Dr. Rahmati set out to create José's cancer care team, which included:
- Daniel G. Deschler, MD, FACS, an oncologic and reconstructive surgeon at Mass Eye and Ear
- Manisha Jayandra Patel, MD, a medical oncologist at Mass General
- Annie Waifong Chan, MD, a radiation oncologist at Mass General
Dr. Patel and Dr. Chan next met José at their weekly multidisciplinary clinic. After that, the Mass General/Mass Eye and Ear tumor board reviewed his case. The tumor board consists of surgeons, radiation oncologists, medical oncologists, radiologists, pathologists, and other health care professionals who focus on head and neck cancer care. Together, they discuss each case and decide on the best treatment plan for the patient.
The tumor board agreed on a plan for José. It included surgery with removal of the tumor and reconstruction at the same time, followed by radiation therapy and possibly chemotherapy.
"When cancer reaches an advanced stage, most patients need what we call 'multimodality therapy.' This includes some combination of surgery, radiation therapy, chemotherapy, and immunotherapy," Dr. Rahmati said. "While surgery addresses the visible tumor at the primary site and affected lymph nodes in the neck, the patient may need radiation and chemotherapy to address microscopic disease. The final pathology findings help in the decision-making process."
Complicated surgery to remove tumor
José's six-hour surgery took place at Mass Eye and Ear a week after he arrived in Boston.
Dr. Rahmati removed the tumor in the mouth. He also took out an enlarged lymph node and nearby lymph nodes. These latter nodes were at the highest risk for cancer spread.
Dr. Deschler then reconstructed the affected area inside the cheek. He took tissue from under José's chin and rotated it into the mouth to fill in the gap that had been left behind.
José was walking the next day and discharged after a five-day recovery.
Dr. Patel and Dr. Chan collaborated in designing and scheduling the next phase of José's treatment plan. It called for six-and-a-half weeks of radiation (Monday through Friday) along with chemotherapy once a week.
"Chemotherapy works as a radiosensitizer," Dr. Patel said. "It helps make the cancer cells more vulnerable to the radiation, enhancing its effects."
During this period, Dr. Patel and Dr. Chan watched José's health closely. They also monitored how well his body handled the radiation and chemotherapy. Other vital members of the team—including speech and swallow specialists, nurses, and therapists—tracked José's progress closely during his chemoradiation treatment.
After completing his treatment, José was able to go back to the Dominican. Two months later, scans showed no signs of cancer.
Making for a positive patient experience
Beyond his core doctors, José had an expansive care team spanning a wide range of disciplines. Speech language pathologists, nutritionists, dietitians, social workers, and integrative therapists all played key roles.
"There are many important people on the cancer care team who help patients with their recovery after treatment," Dr. Rahmati said. "Helping to improve mouth opening, chewing, and swallowing after oral cavity cancer treatment all enhance the patient's quality of life."
Another key factor in José's outcome is Mass General Brigham's strong experience in treating patients with head and neck cancer. As Dr. Rahmati said, high-volume expertise results in better surgical and treatment outcomes, fewer complications, and higher survival rates.
"Treatment delays can have a negative outcome, so effective communication and coordination of care are also a critical part of successful treatment," added Dr. Rahmati, noting another benefit of high-volume expertise.
As a patient, José could sense his care team was a smooth-running machine. "It felt like a seamless transition between Mass Eye and Ear and Mass General," he said.
