Tahoe Forest Cancer Center partners with UC Davis Cancer Care Network

Friday, April 20, 2012

Sierra Sun

Cancer treatment: Tahoe Forest Hospital System partners with University of California
Partnership ushers new era of regional cancer treatment for Truckee-Tahoe patients

BY KYLE MAGIN
SIERRA SUN,

To a cancer patient, the time it takes to cover the 114 miles between Truckee and Davis, Calif., means many different things.

It means leaving family for treatments, snaking your way down the Sierra Nevada, weaving in and out of Placer and Nevada Counties as towns like Colfax and Auburn pass by the window.

One hundred fourteen miles means negotiating through the vast, concrete interchanges of Sacramento on Interstate 80’s cramped lanes, all the while wondering how you’re going to pay for the chemotherapy and send your child to college and for an apartment in the city while you receive your treatments.

It means 114 miles worth of time wondering if the tumor inside you, and the lymph nodes it has infected, will take your life.

It’s a long road. Or at least, it was.

Thanks to a partnership between the University of California, Davis, and the Tahoe Forest Hospital System announced in October, cancer patients in the Tahoe/Truckee area won’t have to cover the 114 miles to Davis, Calif., for treatments and second opinions. They won’t need to go to Sacramento or San Francisco. Cancer patients in

this rural part of California and Nevada can now receive top-of-the-line care just a few miles from their home in Truckee.

“We’ve got a partner in UC Davis that is the best you could ever ask for,” said Dr. Larry Heifetz, the Founder at the Tahoe Forest Hospital System’s Cancer Center.

Why UC Davis?
Davis, a National Cancer Institute-rated hospital system — one of only 60-plus in the country — is a name in cancer treatment and research, said Heifetz.

Once a week, each Wednesday, Heifetz and a team of specialists, from radiologists to pathologists to nurses, sit in a darkened room at the Tahoe Forest Medical Services building. Doctors from across the Davis network, across California, watch while Heifetz loads slides of his cancer patient’s particular ailments and offer their opinions on the best way to treat it. The exchange between Heifetz and the doctors is called a virtual tumor board, an improvement on the concept of tumor boards, created in the 1950s. Technology now allows doctors to review cases without leaving their practice, saving time and valuable resources.

“It’s a way for us to facilitate the day to day conversation about a patient’s treatment,” Heifetz said. “If I have a complicated case I know I can present it within a week to a group of experts and talk face-to-face about the best way to treat a patient.”

Specialists in breast, prostate and a wide number of other cancers can offer their input on treatment plans from 114 miles away at Davis, 190 miles away in San Francisco or points further, something that wasn’t available previously.

“Technology has enabled us to do that; it’s more effective than sending a patient away for a second opinion when we can get it instantly,” Heifetz said.

The National Cancer Institute designation for Davis is elite, said Pat Keast, Regional Outreach and Community Network Coordinator at UC Davis.

“There is a very rigorous review process to earn an NCI designation,” Keast said. Only three hospitals is Northern California— Davis, the University of California, San Francisco and Stanford University — have the National Cancer Institute designation, while none in Nevada have it.

Reaching out to rural needs
Bringing better cancer care to rural communities — roughly defined as more than 30 miles outside a metropolitan area — stands at the heart of the partnership.

“We want to advance cancer care throughout the region,” Keast said. “So our patients can stay in their communities.”

The point isn’t lost on Robert Frolich, a 53 year-old Tahoe City man who knows the importance of staying in his community for treatment. Frolich, who suffers from cancer of the appendix, said the stress factors cancer patients have— emotional, physical and concerns about how they’ll pay the hundreds of thousands of dollars for care— would make a commute down the hill unbearable.

“There are enough stress factors involved with cancer without having to worry about fighting a snowstorm over (Donner) Pass to get your treatments,” Frolich said.

The Davis-Tahoe Forest partnership is one of four Davis initiated in October in Northern California, including Fremont-Rideout in Marysville, Valley Care Health in Alameda County and Mercy Hospital in Merced.

The cutting edge of cancer treatment
Another facet of the partnership which may yield even greater results involves the ability for Heifetz to treat patients with experimental cures. Previously patients would have needed to travel to Reno, possibly as far as the Bay Area, to receive experimental drugs and treatments doctors call clinical trials.

“The only way to get access to investigational agents is through the clinical trial situation,” Heifetz said. Clinical trials require a team of doctors and specialists to have their eyes on a patient. “Every ‘I’ must be dotted, every ‘T’ crossed,” Heifetz said.

But, with the partnership, that group of researchers and specialists can treat a patient hundreds of miles away as if they were in the same room.

The partnership also allows those researchers to connect with front-line doctors like Heifetz.

“It let’s the Ivory tower guys, the academics, to learn from the guys on the front-lines, and allows us to learn from them,” Heifetz said.

A partnership is formed
That connection appeals to at least one person connected with both Davis and Tahoe Forest — Tom Hobday.

A former assistant dean of the Davis medical school and current senior advisor to the Tahoe Forest Health System, Hobday credits Heifetz’s enthusiasm with establishing the partnership.

“Dr. Heifetz really put it together from the first day he was here( in 2006),” Hobday said. “He had extensive meetings with Dr. (Ralph) De Vere White, (head of the Davis Cancer Center) and helped to get this off the ground with his background and enthusiasm.”

Two factors drove the need for the partnership, Hobday said.

“The National Health Institute was concerned that cancer funding was going into major medical centers and not rural areas,” Hobday said. “And, rural residents couldn’t participate in clinics.”

Connecting the expertise of big-city hospitals with rural community practices was a big deal, Hobday said, as is developing models to provide top-flight cancer care to rural areas.

“I wouldn’t be surprised to see more people staying here than getting out of dodge to get their treatments,” Hobday said.

The model is attracting attention, Keast said. Davis has received inquiries on the program’s mechanics and ways to join it from a number of hospitals in California and nationally. Davis plans to add more hospitals to the network in future years, Keast said.

The partnership will also bring medical students, at least two third-year medical students by July, Keast said, to the Tahoe Forest Hospital System. Heifetz said having medical students at the hospital is a positive step because doctors must become teachers and stay very current on medical advances.

Cancer treatment part 2: Two cases of never giving up

Two patients share their stories about doing everything it takes to get their health back

BY KYLE MAGIN

SIERRA SUN,

One day, we will all confront age and ailments.

Even in Tahoe, where youthful experiences are exalted, where hikes, climbing, skiing and wakeboarding are more passion than pastimes, invincibility one day ends.

Robert “Fro” Frohlich knows it as well as anyone. Frohlich, 53, has spent the better part of the last 30 years cataloging the exploits most Tahoans enjoy. The Tahoe City resident, magazine writer and adventurer has covered local icons like skier Shane McConkey, been to his share of sailing regattas and just this summer began training for the expedition of a lifetime: A ski trip to Antarctica.

Tom Selfridge of Truckee also enjoys what the area offers, whether that means cross country skiing or kayaking. An avid hiker and climber, Selfridge, 58, appears as healthy as anyone you’ll see taking coffee at Wild Cherries.

Both have something in common, though. Cancer.

Diagnosed
Doctors diagnosed Frohlich this year with cancer of the appendix, an extremely deadly form of the disease.

Selfridge is now freed of colon cancer after months of battling with the disease and its treatments in 2006.

Each sought treatment from Dr. Larry Heifetz at the Tahoe Forest Hospital system, where they are among scores of regional patients. A new partnership between Tahoe Forest and the University of California in Davis is providing state-of-the art services for cancer patients, a rarity in rural hospitals.

“In January 2006 I went in for a colonoscopy, you know, just one of those things you should do,” Selfridge said. “The doctor said I had a mass about the size of a fist wrapped around my large intestine.”

He balls his fist slightly as he pauses to remember the moment, then moves on.

Selfridge said he felt fine before the test and had no indications cancer was attacking his system.

For Frohlich, the discovery came this summer while he was training for the trip to Antarctica. After months of working out with a trainer, he wasn’t losing weight. He said his stomach was notably distended.

“I basically had no alarms,” Frohlich said. “But I was completely mystified as to why I was getting rounder instead of leaner. My stomach had become bloated where the tumor was.”

So Frohlich went to get himself checked out, and the doctor came back with bad news. Fluid from the tumor in his stomach was causing the distention. It was a cancer of the appendix, extremely rare and extremely deadly.

Going under the knife
From those initial diagnoses, each took different routes to Heifetz. After an initial meeting with the doctor, Selfridge went in for surgery on March 1, 2006. He’d never gone under the knife before that date.

“I couldn’t even believe what was happening,” Selfridge said. The surgery removed the tumor, but bad news awaited Selfridge when he awoke. The doctor informed him the cancer had spread into his lymph nodes, which makes it easier for cancer to spread throughout the body. “The highway to hell,” Selfridge calls it.

Despite the cancer’s spread, the surgery went well, though, leaving Selfridge ready to return to his job as the general manager at the Truckee Sanitation District within a week and a half.

In contrast, Frohlich’s Sept. 13 surgery didn’t get him back into the sports he loves quickly.

Doctors performed extensive exploratory surgery, worked for six-plus hours on his insides to remove an orange sized tumor, and cracked open the area from his sternum to his stomach to remove 95 percent of his cancer.

“Pre-op, I was about 250 pounds, post-op I was 210,” Frohlich said. “I stayed in the hospital for two and a half weeks before I convalesced at home.”

It took months for Frohlich’s body to heal from such a massive, arduous operation, he said.

Chemo
Chemotherapy treatments, which Selfridge explained as “the best treatment they have” awaited both men next.

Selfridge started treatments in April 2006, and had a port placed in his chest for the easy distribution of drugs.

An intense feeling of cold-sensitivity — a common chemo side-effect — hit him hard.

“The first time I got home from a treatment I shot down some pills with a glass of water,” Selfridge said. “Then I felt like I was choking. My throat contracted when I took the pills with the cold water. After that I always had warm water.”

Monday treatments left him fatigued on Tuesday and Wednesday each week, but couldn’t keep him from the outdoor activities he enjoys. Throughout the summer Selfridge continued to hike and climb, taking on Mount Tallac, Mount Rose and Castle Peak.

“It’s easy to say ‘Mind over body,’ but harder to do it,” Selfridge said. “If things are going good, it’s easy to have that mindset. During one cycle I remember that I got really depressed, and it would be difficult to get yourself out of that.”

Frohlich has recently started his chemo, but like Selfridge, isn’t letting his life go by the wayside. After the first storm of the season Frohlich took his ski gear out to Blackwood Canyon on Lake Tahoe’s West Shore to find fresh snow. He plans on attending the February World Alpine Championships in Val D’isere, France.

He said support from the friends he’s made over the years— skiers like Daron Rahlves and Hermann Maier— has helped tremendously.

“I have in my corner a lot of famous friends who are great, and a lot of great friends who aren’t famous,” Frohlich said. For all of the silly things in Tahoe people like to pursue, Frohlich said, they know how to support a friend who’s hurting. “There are a lot of world class people here, and when things go South they’ll step up to the plate.”

The help is needed. Selfridge’s daughter helped to drive him to and from his treatments, especially when the dark days of radiation started in November 2006.

“The range of side-effects can be broad and severe with radiation,” Selfridge said. “I had 28 treatments, I went five days a week. It was by far the worst part.”

Selfridge said the radiation left him feeling brutalized.

“The thing you have to realize is that you’re not out of the tunnel yet with that last treatment. The side effects stay around for awhile,” Selfridge said.

Frohlich, who is being treated with chemo, said there are also days he struggles with the treatments.

“Cancer is (expletive) terrifying,” Frohlich said. “You go in for a treatment sometimes and you see hollow faces, sunken eyes, bald heads, it’s scary.”

A positive environment
Both said the atmosphere at the Tahoe Forest cancer center kept them positive.

“The people there make all the difference,” Selfridge said. “Having Larry there is huge, not just for local availability but because he has such great connections. He has pipelines to Stanford and the (University of California, San Francisco) hospitals.”

Frohlich said that while the nurses at Tahoe Forest are matter-of-fact, it is an overwhelmingly positive atmosphere, from Heifetz’s dog, Theo, to the other patients.

“I believe in the care that I’m getting there,” Frohlich said. “I’m getting a high level of energy from everyone you meet there, and also a high level of friendship. These people are into what I’m into, they talk about skiing, hiking, mountain biking, they make you feel very positive. When people suggested I should get to a ‘real hospital,’ I asked if they were kidding.”

The outlook for both men looks starkly different. Selfridge is free of the disease, but knows he’s always one bad test away.

“You have to look at it like you’re just along for the ride, but you learn to take nothing for granted, even your next day. I try to live right, stay active and involved, and keep a positive attitude,” Selfridge said.

Frohlich knows he has a big challenge ahead of him, and making it through the next year will be a feat.

“If I can make it this year, maybe I can make it two years, if I can make it two years, maybe I can make it five,” Frohlich said. “Cancer or no cancer, I intend on following my life’s passion. Cancer doesn’t play favorites, I have no idea how I got it. But, I say bring it on, man. I’ve never backed away from anything and I’m not going to start now.”

More online resources

Read more about the Tahoe Cancer Center at https://tahoecancercenter.com.

Cancer treatment part 3: Will there ever be a cure?

Exporting big-city treatments to rural areas may be future for cancer patients

BY KYLE MAGIN
SIERRA SUN

Cancer isn’t a shrinking problem. One look at the cabinet where patient’s files are kept at the Tahoe Forest Hospital System’s cancer center proves that.

Hundreds of files appear when Cancer Center Director and Registered Nurse Eileen Knudson opens the door of a green cabinet, and the list, sadly, is growing every day.

Cancer is the second-leading cause of death in the U.S. after heart disease, according to a 2005 report by the American Cancer Society, the most recent figures available.

In 2005, a total of 559,312 people in the U.S. died of cancer. That’s 5,424 more people than in 2004, according to the American Cancer Society.

According to a 2007 study published in the Journal of Oncology Practice, the number of Americans who are diagnosed with cancer — both those in treatment and those who have finished therapy — will grow to 18.2 million by 2020, up from 11.7 million in 2005. Today, about 1 in 26 Americans have had cancer. By 2020, roughly 1 in 19 will have been diagnosed with the disease, the report said.

Worldwide, the numbers aren’t any better. A 2008 World Health Organization World Cancer Report, released in December, predicted cancer will overtake heart disease as the world’s top killer by 2010, and that global cancer cases and deaths will more than double by 2030.

The October introduction of Tahoe Forest’s partnership with the University of California, Davis’ cancer center may signal a way to treat a growing number of cases nation- and worldwide.

Technology couples a number of medical resources— doctors who specialize in nearly every facet of cancer treatment— to allow patients in Truckee or Tahoe to receive the same level of care and attention available to patients in San Francisco or Davis as a result of the partnership.

The partnership is considered revolutionary by cancer experts because it brings treatments only available at large medical centers to rural hospitals.

“Our intent (with this partnership) has been to build a model that is replicable,” said Dr. Scott Christensen, an oncologist and assistant professor of internal medicine at UC Davis. “We wanted to prove to others that this is possible.”

Christensen sees the idea, which includes virtual tumor boards video- conferencing doctors from every corner of California to view cancer cases from Truckee, working nationwide. Cancer patients wouldn’t need to leave their rural communities in areas like Northern Maine, West Texas, along the sparsely populated stretches of Easter

Washington and Oregon and every out-of-the-way locale in between.

Dr. Larry Heifetz, the Founder at the Tahoe Forest Hospital System’s cancer center, sees even farther ranging possibilities.

“What Davis is working on is useful, you can put this partnership out to the rest of the country if you can get it to work here, and if you can get it to work anywhere,” Heifetz said. “You could be in Ethiopia and get this kind of treatment as long as you have the technology.”

The technology needed includes video-conferencing equipment, diagnostic equipment, chemotherapy drugs and access to radiation.

Pat Keast, Regional Outreach and Community Network Coordinator at UC Davis, said the cancer center has already received inquiries into the partnership.