Close to Home

Regional facilities offer patients a direct connection to Dartmouth's world-renowned research and care

The Dartmouth-Hitchcock Norris Cotton Cancer Center hub may be at Dartmouth Medical School and Dartmouth-Hitchcock Medical Center in Lebanon, NH, but the Cancer Center's true home is its broad area of care across multiple states and regionsregions—New Hampshire, Vermont, Maine, northwestern Massachusetts, and parts of western New York state.

Focus article photo

Stefan Balan, MD, Clinical Director of Hematology/Oncology at Norris Cotton Cancer Center Manchester.

To serve these regions and the communities within them, the Cancer Center has built a network of regional facilities and affiliated hospitals that brings Dartmouth home to the diverse populations of northern New England. Just as the Cancer Center's mission covers four crucial elements—patient care, research, education, and community outreach—so its regional locations establish the Cancer Center as a vital patient resource throughout the northern New England area.

"It is the best care you can get, and you don't have to go a long way to get it," comments Stefan Balan, MD, Clinical Director of Hematology/ Oncology at Norris Cotton Cancer Center Manchester. "It's state of the art in every way."

Adds Steve Larmon, MD, Medical Director at Norris Cotton Cancer Center—Kingsbury Pavilion in Keene, NH: "Cancer is a diagnosis that people want to keep local. It involves not just the patient but also their family and loved ones and so their sense of place, of home."

For a patient, this means the Cancer Center's regional centers—in Manchester, Keene, and, soon, Nashua, NH, as well as St. Johnsbury,VT—provide direct access to the expertise and research-based care and technologies of one of the nation's premier National Cancer Institute (NCI) comprehensive cancer centers. Norris Cotton Cancer Center is one of only 40 such centers designated by the NCI for excellence in research, patient care, the development of new cancer therapies, and cancer education and outreach.

Norris Cotton Cancer Center is one of the few rural NCI centers, and caring for patients in communities throughout its region has always been a part of its mission. For more than 35 years, Dartmouth cancer experts have been seeing patients in affiliated hospitals in New Hampshire and Vermont; and today physicians still provide outreach at Valley Regional in Claremont, Weeks Medical Center in Lancaster, Monadnock Community in Peterborough, Speare Memorial in Plymouth, Huggins in Wolfeboro, "What I am striving to do," says Stefan Balan, MD, the Clinical Director of Hematology/Oncology at Norris Cotton Cancer Center Manchester, "is to bring Dartmouth home."

Cottage in Woodsville, and New London, all in New Hampshire; and at Brattleboro Memorial and Springfield Hospitals in Vermont. Four Cancer Center doctors care for patients at Frisbie Memorial Hospital in Rochester, NH, which is also an affiliate, including breast cancer specialist Anjali Sibley, MD, who is joining the Cancer Center staff at Frisbie this fall.

Distance and Cultures

In Manchester, patients are treated for all conditions, and four specialists provide hematology/oncology consultations and individualized chemotherapy at the Notre Dame Pavillion at Catholic Medical Center. Specialists in neuro-oncology, pediatric oncology, breast cancer, head and neck cancers, gynecological cancers, and genetic counseling also see patients in Manchester, both at the Notre Dame Pavilion and at Dartmouth-Hitchcock Manchester. In partnership with the Catholic Medical Center, there is also an on-site nutritionist, social worker, and chaplain, as well as a variety of support groups for cancer patients, families, and caregivers.

Dr. Balan notes the special importance of offering local treatment for pediatric cancer. "This is a huge thing for parents," he says. "We can take care of the family here, close to home, with everything that's available at the Cancer Center in Lebanon."

He also points out that Manchester is one of the most ethnically and culturally diverse cities in New England: by some counts as many as 120 languages are spoken in Manchester. "It is an unusual place in New Hampshire," he says. "All the time, we deal with different cultural attitudes about how diseases are perceived."

Treatment When the Haying's Done

Up in the far north of Vermont, the number of languages heard by the staff at the Cancer Center in St. Johnsbury is considerably fewer: two, English and French. "Rather than a culturally diverse patient base, we deal with a population that's very economically and socially diverse," says Lory Grimes, RN, Practice Manager of the facility. "We often have to work around the schedules of when the cows need to be milked and when the haying needs to be done. Many of our patients go right back out into the fields when they get home from an appointment."

Marge and Alan LeBlanc

Marge, a patient at Norris Cotton Cancer Center North, and her partner Alan.

Marge LeBlanc didn't go haying after she received radiation therapy for breast cancer in St. Johnsbury, but she credits the northern facility with providing exactly the kind of care that made a difference to her emotionally as well as physically. "I felt that the whole person was really taken care of," she says, I really believe my needs were met all around."

The St. Johnsbury facility operates the most advanced radiation technology available for cancer treatment, a fact that caught Marge's attention. "They spent a great deal of time calibrating and making sure everything was lined up just right. Nothing ever felt rushed. My care was exceptional," she comments.

Her partner Alan Astle was treated at the Cancer Center in Lebanon many years earlier. "We are very fortunate to have Norris Cotton Cancer Center in the North Country. The staff is unbelievable—there isn't enough you can say about them. She could not go anywhere and receive better care," he says.

This year the St. Johnsbury clinic celebrates its fifth year. Over that time the Center has grown almost non-stop; last year's addition of a new patient library will be followed next year by a new expansion that will include several examination rooms, expansion of chemotherapy facilities, and additions to the Center's pharmacy to support on-site clinical trials. Recently added services include palliative care, nutrition counseling, genetic counseling, and social work.

"Part of Their Own Medical Center"

The patient base for the Norris Cotton Cancer Center -Kingsbury Pavilion in Keene is a unique blend for northern New England: there is the stalwart rural population typical of New Hampshire and Vermont, but also the faculty and students from Keene State College as well as professionals from the several major corporations with operations in Keene, a city of 23,000.

The facility, founded in 1990, was the first to formally partner with a local hospital. Steve Larmon, MD, calls Kingsbury's partnership with Cheshire Medical Center a critical benefit: "When the community looks at us, they see the Cancer Center as part of their own medical center. We have tremendous interaction and collaboration with Cheshire—in fact, we could not exist without it."

At the same time, the Kingsbury Pavilion maintains an equally interactive and collaborative relationship with the Cancer Center in Lebanon, offering patients access to specialist care and clinical trials. For example, gynecologic oncologist Evelyn Fleming, MD, sees patients several days a week in Keene, and breast cancer specialist, Mary Chamberlin leaves her Keene home base weekly to participate in tumor board and see patients in Lebanon.

Kingsbury Pavilion offers advanced medical and radiation oncology services, including Intensity Modulated Radiation Therapy (IMRT), one of the most precise and sophisticated approaches to 3-D radiation therapy available.

"For a town Keene's size, the depth of care available here at Kingsbury Pavilion is exceptional," comments Dr. Larmon. "With our connection to Norris Cotton Cancer Center, we are unique for the patients in our area."

His words apply to each of the Cancer Center's regional locations—they are unique in their relationship with local patients, yet interconnected with each other and with Lebanon in providing world-class research and expertise. Adds Dr. Stefan Balan: "The patients know. This is the best care you can get anywhere, yet it's so close to home."

October 10, 2010