Laurence Heifetz, MD founded the Gene Upshaw Memorial Tahoe Forest Cancer Center in the rural town of Truckee, located in the Sierra Nevada mountain range in California. Based in a rural part of California with previously no cancer center, with the use of telehealth technology, commitment, local participation and a partnership with University of California, Davis, the residents of this part of the beautiful and relatively isolated part of California now have access to not only high-quality cancer care but also direct opportunity to participate in global clinical trials with cutting-edge experimental therapies—literally these studies can save lives that a decade ago couldn’t be saved.
Dr. Heifetz and Sarah Murawski, MPAS, an assisting physician at Vanderbilt University Medical Center, presented alongside Dr. Heifetz jointly presented at the Association of Community Cancer Centers (ACCC) 36th National Oncology Conference and contributed to an interview showcasing the power of telehealth to empower rural health systems. Dylann Cohn-Emery with Targeted Oncology recently covered this important story.
Nearly 50 Million Americans Live in Rural Areas
Whether nestled in the Sierra-Nevada mountains like Truckee, Appalachia or in far-flung regions within the Intermountain West (e.g. Montana, Wyoming, Idaho), there are many people residing in America that live very far from an significant major cancer center. In fact, the Pew Research reports that nearly 50 million people live in rural areas.
The Gene Upshaw Memorial Tahoe Forest Cancer Center
As Ms. Cohn-Emery’s piece in Targeted Oncology explained, residents residing in Truckee area within California had few options for cancer care and absolutely did not have any access to advanced clinical research programs.
Heifetz worked to change that after moving from a position at the prestigious Cedars-Sinai in Los Angels for a slower, more peaceful, and higher quality of life in the mountains. Heifetz found that there were no cancer services for a community of 50,000. He was ultimately afforded the opportunity to build a cancer center. Based on a rudimentary program launched in 2006, the community put so much commitment, passion, and hard work that momentum and good decision-making led to the first free-standing cancer center opened in 2012. It has since become a model to showcase the potential of telehealth to support now only high quality cancer care but also to facilitate participation in clinical trials.
Partnership with University of California (UC), Davis Cancer Care Network
In 2008, what was then called the Tahoe Forest Cancer Center affiliated with UC Davis, Cancer Care Network—the group in Truckee became a collaborator in the UC Davis virtual tumor board. The formalized relationship boosted the Truckee group’s initiative, propelling greater community interest, trust, and excitement that they were now part of a clinical research network.
Truckee becomes a Cancer Care and Research Hub Itself
In fact, interest has grown to the extent that now, according to Dr. Heifetz, 62% of their patients come from “outside of our catchment area.” Why? Because what they built in Truckee, integrated, via agreements, relationships and technology to a powerful oncology care and research network, increases access to the best care. In rural areas, where visits to a major health center can be measured in many hours, now with a telehealth-enabled network, residents can access a study team, for example from a local clinic that could be minutes away from their home—or in some cases be seen directly in their home.
To broaden access and extend reach, Tahoe Forest Cancer Center worked with other providers in the Sierra Nevada to create 4 other telehealth clinics—offering access to cancer care in their own communities. The clinics’ network, known as the Rural Oncology Network include communities of Quincy, Portola, Loyalton and South Lake Tahoe. Targeted Oncology reported that some of these clinics were struggling financially.
So, now a resident may be the even more rural Portola, and pay a visit to the Tahoe Forest Cancer Center but then subsequent visits can be at the local clinic that is connected via the network.
“A cycle of benefits” continue to evolve as the Tahoe Forest Cancer Center’s affiliation with UC Davis Cancer Center generated more trust and interest—hence generating more patients which meant more care and economic transactions. The smaller centers, such as Portola, now can develop clinical trials programs themselves which “gives UC Davis Cancer Center a percentage of their accruals—the preferential, advanced cases.” This network has positively impacted UC Davis Cancer Center in the eyes of the National Cancer Institute—according to Dr. Heifetz UC Davis Cancer Center now has greater “effective outreach to community oncologists.”
Heifetz suspects that the telehealth-enabled network has produced greater confidence, brand awareness, and, importantly, patient trust for the Tahoe Forest Cancer Center as the participating physicians are involved in the clinical trials making such investigative program more trustworthy to the rural patient.
Oncology Clinical Trials Program
The Tahoe Forest Cancer Center is presently recruiting patients for about 30 clinical trials including a Phase III Roche-sponsored, multi-center, international study involving 259 sites and 1,155 patients worldwide investigating the combination of ipatasertib with atezolizumab (Tecentriq) and paclitaxel to treat patients with locally advanced metastatic triple-negative breast cancer.
Dr. Heifetz reports that clinical trials are, of course, costly so that the effort must have an economic rational—that more patients are coming in the door meaning greater economic activity; more payer dollars are flowing into potentially life-saving studies. Heifetz noted, “If you see that your combination of clinical trials, your virtual tumor board, and your academic status results in a growth of your program, you known you’re accomplishing something. In a free market where patients can choose to go to center A versus center B, those are differentiators that give the patients a sense of security.”
Call to Action. If this is a topic of interest, we recommend a visit to the source (below) to read in full detail how this program evolved and how it is structured and organized today. Also, we include a link to the cancer center for those interested in connecting as well as link to more information about Dr. Heifetz.