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Vital Signs

Cancer Center branches out both south and north

It can take less time than brewing a cup of tea to receive a radiation therapy treatment. But it can take many hours for some cancer patients, especially those in rural areas, to travel to appointments to see specialists or to get treatments such as radiation therapy. Since public transportation is spotty or nonexistent in rural areas, this can be inconvenient, not to mention exhausting and expensive.

Doctors at DHMC's Norris Cotton Cancer Center have long been aware of this problem. Ever since the Cancer Center's establishment in 1972, Dartmouth oncologists have held outreach clinics all over the region. But patients have still had to drive to DHMC to get some treatments or to participate in clinical trials—which can mean a two- to three-hour trip on a weekly or even daily basis.

But now, with one initiative to the south and one to the north, Dartmouth is greatly expanding its commitment to bring the latest cancer therapies to patients throughout the region. In February, Norris Cotton opened a newly renovated 4,000-squarefoot space at the Dartmouth-Hitchcock Clinic in Manchester, N.H. And Norris Cotton Cancer Center-North, a brand new $7.5-million facility under construction in St. Johnsbury, Vt., is projected to open in September 2005.

Both facilities will offer the research-based care that is a hallmark of Norris Cotton—which has been designated since 1990 by the National Cancer Institute as a comprehensive cancer center. Most clinical trials and all but a few very complicated protocols or those requiring hospitalization will be available at the new sites. In both locations, says Dr. Mark Israel, Norris Cotton's director, "we'll save area cancer patients and their families hundreds of hours, thousands of miles, and untold travel expense. More important, cancer patients will no longer be forced to make health-care decisions based on their ability to travel." Some patients in remote towns have felt compelled to set their chemotherapy or radiation schedules—or even decide what kind of treatment to receive—based on travel considerations.

Tailor: Israel emphasizes that "we work collaboratively with area hospitals and health-care providers, to tailor our services and expertise to meet the community's specific needs." Patients may, for example, visit one of the new sites to see a specialist but then receive chemotherapy at a hospital even closer to their home. In fact, eight community hospitals in northern Vermont and New Hampshire collaborated with DHMC in developing the Norris Cotton-North project. Dr. Marc Gautier, the Cancer Center's assistant director for regional affairs, models this philosophy in his own practice. In addition to his administrative responsibilities, Gautier sees patients one day a week in other locations, such as New London and Lancaster, N.H.

It's at academic medical centers like DHMC where researchers develop the latest treatments, Gautier explains. For example, "we're finding the switches that turn cancerous growths off and on." Still newer treatments, he adds, involve the genetic engineering of molecules and proteins tailored to an individual patient's particular cancer—achievements considered impossible just a few years ago. Such breakthroughs can take from two to five years to reach oncologists in community hospitals, however. But now residents of northern New England don't have to wait—or drive—to benefit from such advances.

John Milne

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Dartmouth Medical SchoolDartmouth-Hitchcock Medical CenterWhite River Junction VAMCNorris Cotton Cancer CenterDartmouth College