【The story of coordinator】Treatment of malignant melanoma (melanoma) with proton beam.　Speedy response less than 3 weeks from inquiry to first consultation

The patient wished to undergo irradiation to prevent postoperative recurrence in Japan, not in other countries.

The doctor opined that irradiation should be performed as soon as possible.

A type of skin cancer, malignant melanoma (melanoma) is said to be particularly common in white races. The disease progresses extremely quickly, and even after surgery, it often recurs or metastasizes at an early stage. This patient, from the European region, had a melanoma on the mucosa of his left nose. The tumor was removed by incisional surgery on the nose, but recurred. He underwent another successful surgery, but was advised to have proton irradiation to prevent recurrence as early as possible in his home country. The surgery was performed at the end of November, but the patient contacted our company in mid-December. As this type of cancer progresses very quickly, a speedy response is required. The patient had already received opinions from Germany and Israel that treatment was possible, but he insisted on treatment in Japan, where there is a wealth of experience in proton beam treatment.

Contact multiple medical institutions for the fastest possible treatment

I immediately asked the patient to send his medical information including pre- and post-operative images. In this case, I inquired at two proton therapy facilities because the applicability of the treatment has been confirmed in other countries. Both facilities responded that they could accept the patient as soon as possible after the new year. One facility stated that it would be possible to accept the patient immediately after the new year, as it should be better to start a therapy as soon as possible. but the other facility said that they would have to postpone to accept the patient until February at the earliest, so if the patient has a chance to undergo therapy earlier elsewhere, that would be better. I reported the patient on the availability of therapy and was able to schedule the first appointment on January 4 after coordinating with the medical institution in the fastest possible time. As a side note, I heard that the patient himself also sent the images to another Japanese university hospital to inquire. But the patient failed to send the images in a condition so that the hospital can open the data file, so the date of therapy in the fastest possible time that I arranged was determined while the communication with another hospital was taking time. EAJ coordinates in advance with each medical institution on the conditions under which test images should be sent, so that information can be shared smoothly with medical institutions even in urgent situations.

Coordination of special visa issuance for year-end and New Year’s holidays

I received a response from the medical institution that they could accept the patient in about three days, but the patient only has a little more than two weeks, including the year-end and New Year holidays, before the patient arrives in Japan. I consulted with the Japanese consulate in the country region where the patient is residing and coordinated with the consulate regarding the issuance of a special visa for the year-end and New Year holidays. The patient hurriedly sent the estimated treatment cost by bank transfer before our company provides guarantee to the patient, and upon confirmation, I sent the original identity document to the local consulate by the fastest delivery method. Since the patient was staying far from the consulate, I contacted a company specializing in visa processing to coordinate the proxy application and pickup. However, the original documents did not arrive at the consulate on the scheduled date, as it was rare for the international mail to arrive on time in the area. Therefore, I contacted the consulate and negotiated with them to issue the visa on the promise that our company would bring in the original documents immediately upon our receipt. Due to humanitarian considerations, a special visa was issued on the morning of January 2, the day of departure, and our company was able to hand over the visa to the patient by the proxy applicant at the airport in the capital city of the country where the patient was about to leave for Japan. I, who was in charge of this case as coordinator at the time, also do not remember taking a good rest during the New Year’s holiday that year.

Careful examination of irradiation of the head and neck area, which is prone to side effects

15 proton irradiations focusing on the spots where excisions of cancers are insufficient

While waiting for visa-related procedures, I was in a great hurry to arrange a serviced apartment and a car to pick up and drop off the patient. It was a big task because all the arrangements had to be completed before the end of the year vacation. This patient was the first patient at this medical center in this year. Initial consultation on January 4. PET scan to confirm metastasis, MRI/CT imaging, blood tests, etc. are then performed, followed by 10 days to 2 weeks of preparation time for fixture preparation and treatment planning. The results of the examination showed no metastasis to the lymph glands or brain, but there was a clear shadow on the left half of the face, indicating that the surgery may have left some parts undone, and it was decided to irradiate those areas. Irradiation was to be done 3 times a week for a total of 15 sessions. After irradiation, scabs form inside the nostrils and side effects such as nasal congestion and nosebleeds occur, so there are twice-weekly visits to clinic to check on these side effects. Since head and neck cancers are more prone to side effects than other types of cancers, the patient will have to stay in Japan for two weeks after the irradiation to check for side effects, so the patient will probably be able to return to his home country in March. As the treatment plan is clarified, the contract period of serviced apartments and other facilities will be extended accordingly. The patient came to Japan with an open airline ticket without setting return date, but he needs to inform the airline of his return date and time by about a month and a half after his arrival. I explained the airline the situation that the patient might not be able to decide on a return date by that time and negotiated with the airline to set a special return date after that date with a letter from the medical facility.

Post-treatment follow-up

After treatment, a discharge summary was prepared by the Japanese doctor in charge to the local doctor who recommended proton beam. Our company translated the discharge summary into the language of the country and I requested the patient to bring to his home country, and to send the images of MRI and PET scan taken locally three months later after his return. The patient said that he might go back to a nearby foreign country for testing because PET testing is not available in the area where the patient is already living.

As the scheduled return date approached, a medical examination confirmed that the mucous membrane was recovering well. The patient needs to submit a certificate of leave of absence to the local government office, so I prepared so that the patient can return to his home country by having a letter from the medical institution translated with a translation certificate at the embassy in Japan and obtaining an apostille at the ward office. A month and a half after the patient returned to his home country, Japanese doctor contacted me to obtain an MRI image from the patient, and three months later, I received a reminder to obtain a PET scan. He also advised me on the details of the MRI imaging, and informed me as follows. “The results of the MRI taken at the site showed that the tumor is shrinking. In the course of treatment for malignant melanoma, the tumor shrinks slowly from 3 to 6 months, so the response is within the normal range.” and he instructed me to request the patient to send MRI images for follow-up in another 3 months.
When the PET images arrived, the patient consulted the doctor about periodic pain on the left side of the upper jaw and left eye, as well as residual swelling and redness on the left cheek, but the doctor advised the patient not to worry too much compared to the pre-treatment images. The patient received several more follow-up checks from the doctor every 3 or 4 months after treatment.