Pat McGrath’s home is less than 40 miles from Iowa City but the Cedar Rapids man travelled across the country on his cancer journey before family members directed him to the Holden Comprehensive Cancer Center at the University of Iowa.
“The most eye-opening thing for me was that I just wasn’t aware of what was available here at the Holden,” he says. “I was relying on my physician to direct me where I needed to go and he was sending me elsewhere,” says McGrath, 56.
Despite the cross-country route, McGrath says he’s glad he was finally directed to Mohammed Milhem, MD, deputy director for clinical cancer services at the Holden.
Milhem says a team approach that incorporates a commitment to high-level cancer research enables the University of Iowa to offer the highest quality patient care.
“When the team gets together to discuss a case, what happens is you dismiss the possibility of any errors that may occur with just one person looking at it,” he says. “We get the radiologist, medical oncologist, surgical oncologist, everyone is involved in each case to make a decision on treatment. Then that decision gets refined, cleaned up.
“We have overturned many decisions, and we have helped surgeons do better surgery,” Milhem says. “You get to see all the points and possibilities.” McGrath and Milhem first crossed paths in 2009, two years after McGrath’s first cancer diagnosis and two months after the cancer returned and surgeons in Cedar Rapids removed another tumor.
How The Journey Began
McGrath was first diagnosed with Stage II melanoma in November 2007 when doctors in Cedar Rapids removed two tumors from his small intestine. The removal of a lump on his shoulder just a few days later – which he’d earlier been told was a cyst–led to the diagnosis of Stage IV melanoma.
The diagnosis was surprising for McGrath, who had first complained of stomach pain that May and again in September. A routine blood test in September showed his hemoglobin at 5.9 grams per deciliter – well below the average 14 to 18 grams per deciliter found in a healthy adult male. Doctors at the time said he was anemic.
It wasn’t until a cardiologist friend encouraged him to see an oncologist that McGrath got the correct diagnosis.
“I went in on Nov. 19 (2007) and on the 21st I was getting two tumors removed from my small intestine,” he says.
He started discussing follow-up treatment options with the oncologist, who suggested interferon but wanted McGrath to get a second opinion. The doctor sent him to the Mayo Clinic, where doctors suggested a different kind of treatment.
“I was really confused by that point,” McGrath says. He says Mayo’s doctors asked if he wanted to get yet another opinion – and sent him to an oncologist in Pittsburgh who specialized in melanoma. That doctor agreed with McGrath’s original oncologist’s recommendation of interferon.
McGrath was on interferon for a year. Then in June 2009, the cancer returned to his small intestine.
Birth of a Strong Melanoma Program
At about the same time that McGrath was learning he had cancer, Milhem joined Holden Comprehensive Cancer Center and began working to establish a strong melanoma program.
“I came here in 2007, my first role was to get more people involved in the study and treatment of melanoma,” Milhem says.
He led the effort to create a melanoma multi-disciplinary team, which was developed and in place by 2008, and a donor registry and tissue bank was built that same year. The team’s first clinical trials started in 2009.
“Our program has grown consistently since then,” Milhem says.
In 2012, Milhem was instrumental in establishing the Midwest Melanoma Partnership, a collaboration of 15 cancer centers mostly located in the Midwest. Together, these centers serve more than 4,000 advanced melanoma patients, engaging the resources and expertise of all participating institutions.
The partnership’s goal is to improve the diagnosis, treatment and long-term care of patients with malignant melanoma.
Although he spent his first few years building the melanoma program at Holden, by early 2009 Milhem was ready for word of the program to spread. Referrals began to come in as UI Hospitals and Clinics and the Holden became recognized leaders in melanoma research and patient care.
The Cancer Returns
When McGrath’s cancer came back in his small intestine doctors found evidence of the cancer in some of his lymph nodes, as well. After surgery to remove the tumors, his oncologist looked to a new and more aggressive form of treatment and recommended McGrath go to the John Wayne Cancer Institute in Santa Monica, Calif.
“I went out for an initial consultation and they wanted to do the treatment there, so I went out twice more for treatment,” he says.
A New Door Opens
Shortly after returning to Iowa, he says, a cousin of his wife, Mary Kay, called to talk about McGrath’s cancer. The cousin had been a nurse in oncology until a few years prior to the call; she told McGrath and his wife about Milhem and his work with melanoma and he needed to see him.
“Then my sister called and said, ‘There’s this specialist you need to see at UI,’” he says. “That’s how I ended up in Iowa City. I talked to my oncologist and asked him to get me in to see Dr. Milhem for a consultation.”
The changes in his treatment and followup care were almost immediate, McGrath says. One of the most drastic changes he noticed were in his quarterly positron emission tomography (P.E.T.) scans.
“I’ve had a lot of P.E.T. scans, every three months since 2007,” he says.
In his earlier scans, McGrath says, he and his wife were shown to a room and he received his injection. There were no blood draws, no one checked sugar levels, he says, and he was generally told to read or put his ear buds in to listen to music for the 45-minute wait before the scan.
“The first time we came to Holden, Mary Kay couldn’t come into the room, they didn’t want me to talk or read, they played very, very light music and the lights were really dim,” he says. He learned from his UI doctors that research had shown that keeping brain activity to a minimum prior to the P.E.T. scans provided more accurate results.
Additionally, staff tested his blood and blood sugar and told him if the sugars reached a certain level they would postpone the scan. Rather than a 45-minute wait, McGrath was given 80 minutes for his body to absorb the injection.
“The staff at Holden told me they wanted my mind to rest, that if there’s any brain activity it will show up in the scan and they wanted to be able to see just the glucose level,” McGrath says.
“It’s a whole different level of care,” he says.
Milhem credits that higher level of care to the quality of the teams that come together to work each case. Researchers, doctors, surgeons, and specialists discuss each patient’s situation and are apprised of treatments and procedures throughout the patient’s care.
“When I meet a patient whose surgery is done, I already know about the person, about the case and about the history,” he says. “That adds a level of confidence. The patient wants a plan and he wants to know someone knows what they’re doing, they know about his particular case. They want to know someone has been thinking about this.”
That team approach and the importance placed on continued research with other institutions were important to McGrath. He was given the opportunity in 2012 to sit in on a melanoma symposium at UI Hospitals and Clinics attended by researchers from across the country.
“It’s great knowing that not only is my oncologist involved in this but he’s leading it,” McGrath says. “Anything that is hitting the medical field, my oncologist is going to be on top of it.”
For more information, call 319-356-4200 or 800-777-8442, or visit the UI Melanoma Clinic