Joan Calkin (a pseudonym) had ten good years. Diagnosed with breast cancer in 1983, she was treated with breast conserving surgery. No radiation. And the cancer was kept at bay through the turn of the century. In the summer of 2004, however, Calkin developed a cough. Her doctors discovered multiple small lung nodules: malignant cells consistent with breast cancer. The cancer was back.
Calkin experienced frightening symptoms: a ten-pound weight loss, pain in the chest, and voice loss, apparently due to vocal chord paralysis. She was already taking tamoxifen, a drug that is sometimes capable of slowing or preventing the recurrence of breast cancer. But her doctors were talking about more serious alternatives. Chemotherapy. Calkin had chemotherapy after her first bout with cancer. The treatment had been discontinued at that time. The drug combination she had been taking was too toxic. Now Calkin wondered if she would have to go through all that again. She needed a second opinion. Like millions of people with health problems, she went online. There, she discovered the second-opinion experts: Cleveland Clinic MyConsult.
The MyConsult® Online Medical Second Opinion program is a sophisticated, Web-based extension of Cleveland Clinics 90-plus-year role as one of Americas most respected referral institutions. The secure, online program provides second opinions from Cleveland Clinic specialists for more than 1,200 life-threatening and life-changing diagnoses.
Once registered, Calkin only needed to answer two online questionnaires and then forward her medical records and test results to Cleveland Clinic for review by the expert oncologists at Cleveland Clinic. These oncologists were part of Cleveland Clinic Taussig Cancer Center, Ohio's largest cancer practice, and - according to U.S. News & World Report -- one of the nation's best.
The Cleveland Clinic oncologist thoroughly reviewed Calkin's records and sent her a detailed analysis. His second opinion agreed with the diagnosis and the treatment she was currently receiving, based on her response. He noted that metastatic breast cancer is usually treated as a chronic condition calling for ongoing treatment, and that life expectancy for women with this condition is in the range of three or four years. The good news was that Calkin appeared to have several good prognostic features, including the long interval between her first diagnosis of cancer and the recurrence. He expressed the opinion that she might very well do better than the average. Further recommendations included diagnostic evaluations to better understand the possible causes of Calkin's vocal loss, chest pains and weight loss.
The good news for Calkin was that her MyConsult second opinion oncologist did not recommend extensive chemotherapy. He did recommend that she continue with tamoxifen and have her response closely monitored. Hormonal treatment for her condition might be necessary later, depending on the durability of her response to tamoxifen. Only if tamoxifen ceased to work, and hormonal therapy failed, should chemotherapy be considered. The oncologist went on to name the chemotherapeutic agents he believed would be most effective, noting that the decision of which to use would depend largely on the side-effect profiles and her overall health condition.
Calkin lived a great distance from Cleveland Clinic. But she didn't have to travel to get this expert advice. It came to her right in her study, over her computer. Now, she could proceed with confidence to the next stage of treatment with her local doctors, knowing that - for now at least - extensive chemotherapy was not a necessary option.