Lindsay Foster, a Judge in the Federal Court, was treated for a rare type of salivary gland cancer. His story illustrates wide-ranging, comprehensive care by a multidisciplinary team.
Lindsay Foster’s cancer story begins like many others: he noticed a lump. It was on the left side of his neck.
A biopsy and CT scan indicated a type of salivary gland cancer called mucoepidermoid carcinoma. Salivary gland cancers are considered rare. Mucoepidermoid carcinoma is the most common among them.
A head and neck surgeon at another large Sydney hospital quickly scheduled surgery of the neck, however another scan (this time a PET) revealed activity in two other parts of the body. Most concerning of these was under Lindsay’s tongue.
“Every piece of news was getting worse,” said Lindsay. Complex floor-of-mouth surgery appeared likely. The surgeon referred Lindsay to Chris O’Brien Lifehouse, which specialises in treating complex and rare cancers.
At his first consultation, A/Prof Carsten Palme, Director of the Head and Neck Service, explained the multidisciplinary team approach to Lindsay. “He told me that they workshop the cases,” Lindsay said.
“He said ‘there will be a room full of doctors, as well as nurses and allied health. You’ll sit in my room while we discuss your case.’”
The following Monday, that is what happened. Lindsay waited in the head and neck rooms for Carsten to arrive with three colleagues — surgeons Prof Jonathan Clark AM and Dr Anthony Clifford, and Radiation Oncology Director A/Prof Chris Milross.
Each of them examined Lindsay and raised questions. They left and a few moments later, Carsten returned alone and asked Lindsay, “How does Saturday sound?”
He told Lindsay that the operation would require two separate surgical teams. The first, led by himself, would remove the cancer and lymph nodes. The second, led by Jonathan, would manage the floor-of-mouth reconstruction including a free flap reconstruction, which means transferring skin and blood supply from another area of Lindsay’s body such as the forearm or groin.
“It’s a very long operation. We’ve done it before. We feel confident,” Carsten said.
Before surgery, seven different members of a multidisciplinary team contacted Lindsay:
- Two surgeons, leading consecutive surgical teams
- Director radiation oncology
- Nurse practitioner specializing in Head and Neck
- Speech pathologist
The operation lasted 9.5 hours. “I had two specialist teams of surgeons working together, after due consideration in a workshop of eminent doctors … it was complicated, and they needed all their brilliance which they have in spades,” Lindsay said. During surgery, anaesthetist Dr Murray Stokan rang Lindsay’s wife, Anne, twice with updates. He also sent regular text messages. Nurse Practitioner Sarah Davies worked with ward staff to monitor Lindsay’s recovery, particularly the condition of the free flap. In the weeks after surgery, Lindsay underwent concurrent radiotherapy and chemotherapy
During and after this treatment, Lindsay accessed holistic care from a network of integrated services. In addition to those already mentioned, these included:
- Medical oncologists
- Exercise physiologist
- Lymphoedema physiotherapist
Throughout the entire period, Sarah, was always contactable by Lindsay. “I had a nurse practitioner, Sarah, who has looked over me the entire time, in all respects. If I sent her a text, she would come straight back,” Lindsay said.
In late February, as swelling and soreness around Lindsay’s jaw worsened, Lindsay was re-admitted to hospital for an advanced infection.
“As I’ve had these ongoing issues with the infection, I’ve had Carsten, Jonathan and Chris seeing me at regular intervals depending on my needs at the time. Carsten would see me every week. Carsten, Jonathan and Chris talk to each other. It’s very reassuring.”
In the initial stages of treatment planning, Chris Milross referred Lindsay to the RPA Dental Clinic. While Lindsay did not need dental work ahead of surgery, the service was a crucial part of monitoring throughout his treatment.
About six months after surgery, the dental oncology team found a hole in the flap front that exposed bone underneath Lindsay’s molar. Later, a large area of exposed bone towards the back of the left side of his jaw became visible. It was osteoradionecrosis — deadening of the bone caused by radiation therapy and probably the infection.
Through collaboration between the dental clinic at RPA, the head and neck service and the radiation oncology unit, the osteoradionecrosis is being managed cautiously with further surgery a potential outcome.