A web of care, close to home: Support on the cancer journey
Jamie Dollahite is used to looking after other people’s health. A nutritional sciences professor at Cornell University, she also directs a community program that increases low-income families’ access to options for healthful food and physical activity.
Then came the day Dr. Dollahite was too exhausted to finish writing an email.
She had decided to work from her home in Ithaca, New York, due to fatigue that had built up over months. “I didn’t really feel sick. I just felt so tired all the time,” she says.
But that afternoon, she told her husband, Chris Syphers, that she felt unwell and would lie down after writing one more email. “After a minute, I said, ‘I can’t finish the email.’ I thought I might be having a heart attack,” she says. “I didn’t have chest pain, but I know women at my gym have had heart attacks without that symptom.”
Dr. Dollahite, who was then 68, and her husband went to the convenient care clinic at Cayuga Medical Center, a community health care provider in Ithaca. A chest X-ray there subsequently led to a startling diagnosis: lung cancer.
“It felt like getting kicked in the chest,” Mr. Syphers says. “I used to smoke, but she never did. If anybody was supposed to get lung cancer, it was me.”
Dr. Dollahite received world-class cancer treatment from a web of health care organizations, including Mayo Clinic in Rochester, Minnesota. Yet she never left New York; most of her treatment occurred in Ithaca. What made that possible was Cayuga Medical Center’s collaborative relationship with Mayo Clinic. Genetic testing at Mayo Clinic Laboratories provided important information about Dr. Dollahite’s cancer.
“There is a network of people, from Ithaca to New York City to Rochester, Minnesota, who have taken care of me,” Dr. Dollahite says. “I’ve never even seen a lot of those people. But their work benefits me and my family. I could not have gotten this care without this geographically diverse web of people.”
At the heart of Dr. Dollahite’s care network is Adam Law, M.D., her primary physician for more than 20 years. Dr. Law is an endocrinologist, the type of specialist who treats diabetes. Dr. Dollahite has had type 1 or insulin-dependent diabetes since childhood. People with type 1 diabetes must carefully control their blood sugar levels to avoid disabling or even life-threatening complications.
“Jamie has been meticulous about managing this complex medical problem and so has had remarkably few complications,” Dr. Law says. “She has never let diabetes get in the way of living a normal life. Her very functional relationship with a chronic condition probably helped her deal with this new health challenge.”
Before her cancer diagnosis, Dr. Dollahite routinely started her day at 5 a.m. At Cornell, she supervised graduate students, lectured, and conducted research, in addition to directing the community health program. She often walked to and from work, in addition to hiking with her husband and their dogs in the gorges near Ithaca.
At the convenient care clinic, the radiologist who evaluated Dr. Dollahite’s chest X-ray detected something in the upper lobe of her left lung, and recommended further testing. “It was a very good call by the radiologist,” Dr. Law says. “When Jamie and I looked at the X-ray in my office the next day, there were just a few extra markings—nothing very impressive.”
Nevertheless, Dr. Law and Dr. Dollahite agreed that they should follow the radiologist’s advice and obtain a chest CT. “When she and I looked at the scan in my office, we could both see a lump in the left upper lobe,” Dr. Law says. “The mass was spiculated—it had spikes on the surface. A spiculated mass looks like a crab, which is where the word ‘cancer’ comes from.”
“I knew it was cancer,” Dr. Dollahite says. She recalls Dr. Law telling her, “I’m always here for you. I will know everything that’s happening with your treatment because I will manage your overall care.”
The next step in that care was getting a definitive diagnosis. Determining whether a tumor is cancerous requires laboratory analysis of tumor cells. To obtain tumor cells, Dr. Dollahite had a fine-needle biopsy, the least invasive approach. Fine-needle biopsy uses CT imaging to guide a thin, hollow needle that draws cells from the body.
At Cayuga Medical Center, a pathologist routinely works alongside the interventional radiologist performing the biopsy, to quickly analyze the tissue. That collaboration played a crucial role in Dr. Dollahite’s case.
Cutting-edge cancer care involves determining whether cancer cells have certain genetic mutations—information that can lead to targeted treatment. Fine-needle biopsy often doesn’t provide enough material for genetic testing. But a pathologist can determine if cancer is present and ask the interventional radiologist for a second draw to enable genetic testing.
“We discovered at the bedside that Jamie had malignant cells in her sample,” says Elizabeth Plocharczyk, M.D., a clinical pathologist at Cayuga Medical Center. “By learning this at the site, we were able to go back and get additional material for testing for targeted mutations that could direct Jamie’s care.”
The initial diagnosis was adenocarcinoma, a type of lung cancer more common in women than men. “Adenocarcinomas can have various types of genetic mutations,” says Timothy Bael, M.D., the Cayuga Medical Center oncologist who treated Dr. Dollahite. “We want to make sure we have full molecular studies done on adenocarcinomas because the specific type of genetic mutation can guide therapy.”
Only a few specialized laboratories perform the sophisticated genetic testing that can identify mutations in the minute amount of tissue obtained by fine-needle biopsy. Cayuga Medical Center partners with Mayo Clinic Laboratories for this testing, known as next-generation sequencing. Mayo has developed a method to prepare and ship tumor cells for next-generation sequencing.
“Mayo’s method was a revolution,” says Daniel Sudilovsky, M.D., chairman of pathology at Cayuga Medical Center. “In Jamie’s case, it allowed us to prepare and send material to Mayo Clinic for the gene-sequencing studies.”
The testing revealed a mutation called EGFR, which can be targeted by a specific chemotherapy. But before starting chemotherapy, Dr. Dollahite needed surgery to remove the upper lobe of her left lung. After investigating options in New York state, she and her husband chose Memorial Sloan Kettering Cancer Center in New York City, where their son lives. The mass was successfully removed; a biopsy of lymph nodes showed a few cancer cells.
Once Dr. Dollahite recovered from surgery, she and Dr. Bael discussed chemotherapy options. After much reflection, she opted for conventional chemotherapy. “Dr. Bael tells me that if the cancer should come back, there’s an oral drug that would target the EGFR marker. It sounds like a good backup plan if needed,” she says.
Dr. Dollahite finished four rounds of chemotherapy just before Christmas 2018. The regime was grueling. “But I feel good now,” she says. “I have probably 75% or 80% of my energy back. I’m walking more and more—probably two miles a day.”
A CT six months after treatment showed no recurrence. Dr. Dollahite will continue to have follow-up physical exams, blood tests and CT every six months for 18 months. “I think the prognosis is favorable,” Dr. Bael says.
Dr. Law notes that “cancer” is always an arresting word. “But many cancers are being successfully managed now as chronic diseases,” he says. “Here in Ithaca, we have a regional hospital with excellent pathology, radiology, pulmonology, and oncology. We also have a wonderful tertiary care center at Mayo Clinic that can do the right tests. With that backing, people can feel confident they’re going to get the best disease management.
“We work with a patient-centered team, both right here and at a distance, communicating with each other all the time,” he adds. “That allowed Jamie to get her treatment done as much as possible locally, close to her family and community, rather than having to spend long periods of time away from home.”
Now age 70, Dr. Dollahite plans to retire and travel with her husband, who recently retired from his job as a drug and alcohol counselor. “I’m one of those people who just takes life as it comes,” she says. “I’m grateful. I frankly couldn’t be happier with my medical care.”
Guided by a patient-centric philosophy, Mayo Clinic Laboratories has a unique internal structure of quality specialists, coordinators, and engineers who constantly evaluate and improve laboratory operations. This structure supports a host of quality assurance activities.
Each day, some 40 to 45 thousand specimens are shipped to Mayo Clinic Laboratories in Rochester, Minnesota, from hospitals and other health care organizations around the world. And for every sample, there’s a patient to whom it belongs, someone on the other end hoping for answers to a challenging, perhaps even life-threatening, condition.