by Vicki Hildner
When Mara was diagnosed with lung cancer, she and her husband, Marc, sought advice from the best-known lung cancer experts in the country, traveling from the West Coast to the East Coast and many points in between.
What they found, said Marc, a lawyer from Altadena, Calif., was a standard of care he labels “narrow-minded,” “conventional” and “average.” To his way of thinking, average was not good enough. “You never have the average patient when you are married to her,” he said.
Mara, a 47-year-old artist and mother of three, underwent chemotherapy, surgery, another round of chemotherapy and radiation. Still, the cancer kept growing, and her husband redoubled his efforts to find a treatment that would prove effective.
“I needed to have an intelligent conversation with an expert,” said Marc, “not just another visit to the doctor.”
An intelligent conversation with an expert—that is exactly what this couple found when they went to the Internet, came across the name “Dr. Ross Camidge
” and picked up the phone.
“It was the right thing to do.”
“Many of our doctors have national and international reputations,” said Camidge. “When a great breakthrough happens, publicity drives patients to contact us for medical advice.”
Camidge knows that to be true from personal experience. He pioneered research into the development and use of the drug crizotinib
as a successful treatment for lung cancer patients who have an abnormality in their cancer called an “ALK fusion gene.” When the U.S. Food and Drug Administration (FDA) announced its approval for crizotinib—the first new drug for lung cancer approved in more than six years—the story broke in the media, locally, nationally and then internationally.
“I would get waves of emails and phone calls, based on where the story was being reported,” said Camidge. “Within hours, I heard from people locally. When the story went viral within a few weeks, I was hearing from people as far away as Israel, Australia and China. I was getting up to 10 different people a day contacting me to ask my advice.”
During his evenings and on weekends, Camidge set up a “virtual clinic,” contacting every one of the patients seeking a second opinion from him. After a long day doing research and seeing patients, the extra work was intense and demanding, but he did it because “it was the right thing to do.”
The experience made clear to Camidge that, in the 21st century, the number of people seeking medical advice from the Internet is enormous. “There was a clear unmet need not to drag a patient half-way across the country or the world just to sit in the same room as a physician,” he said.
With that realization, a formal pilot program to offer remote second opinions at CU Anschutz was born.
“Ross didn’t know me from Adam.”
Marc's exhaustive research into lung cancer led him to Camidge on the Internet. What he read convinced him that Camidge, with his passion for both research and patients, could help his wife.
“He was researching the range of treatments that were relevant to us,” said Marc. “Many of the clinical oncologists we had seen were willing to try only what they knew, even if they knew it would be ineffective. [Camidge] seemed willing to think creatively, to think outside the box.”
For his part, Marc brought Camidge exactly what the physician needed to consult on the case. He had amassed a small library comprising his wife’s medical history, including genetic analyses, treatment details and tissue reports. He had become a self-taught medical expert, a super-specialist in the case of Mara.
“I could give Ross everything he needed,” said Marc. “My records are good enough that I could answer any question he asked. That’s the ideal situation for a remote second opinion.”
In their phone conversation—with the couple sitting comfortably in California and Camidge in Denver—Camidge confirmed that Mara's cancer had a genetic mutation, which suggested it might respond to treatment with erlotinib, a tablet in the same family as crizotinib. He gave the Marc and Mara direction for future care, and he gave them hope.
“Ross didn’t know me from Adam,” said Marc, “but he talked to us for an hour on the phone and took an active interest [in Mara’s case]. That’s a big deal when you are reaching out to someone from Internet research.”
“A job well done.”
Remote second opinions, as envisioned by Camidge, take people who are world leaders in treatment and make them available to the world. Few of these programs are currently in place, which makes CU Anschutz a leader in the direction Camidge believes the field is going.
“We try and give our opinion over the phone first, getting to know the patient as a person. Then we summarize it all and send it to them as a letter,” said Camidge. His written response captures all the patient’s details in case Camidge needs them in the future, but it does not replace the phone call. “That phone call is really important,” said Camidge.” If someone sends you their case notes, and you just send a written reply, it could be written by a robot. That’s not what we’re offering here.”
In less than one year, with no advertising, Camidge’s pilot program has offered 15 remote second opinions to patients from New Mexico, Oregon, Virginia, Missouri, the United Kingdom and Israel. Four of those patients have subsequently decided to come to the University of Colorado Anschutz Medical Campus for treatment.
“If someone emails me today and says ‘I want to pick your brain’ and it’s a one-sentence answer, I still reply as quickly as I can,” said Camidge. “But if it’s more than that, and especially if I am worried the case needs real thinking time, then I feel much better asking them to consider scheduling a remote second opinion.”
Insurers are not yet covering remote second opinions, so a patient is billed directly on a credit card. The pilot program currently exists only in gastrointestinal oncology and thoracic oncology. The results of the pilot are being reviewed by the University of Colorado Hospital, however, to assess its potential as a model that could be rolled out to multiple other medical specialties.
For Camidge, this program simply does more of what he lives to do.
“In the thoracic oncology
program, what makes us get up in the morning is to try to change the world for people with lung cancer,” he said. “If going ‘virtual’ means we can help even more people, then that is a job well done.”