Walking into the lobby of the Norris Cotton Cancer Center, where patients awaiting treatment flip idly through current issues of "House and Garden" and "Conde Nast Traveler," seemingly ignoring the support group pamphlets that also litter the reception area tables, it might be easy to miss the signs of disease that are ubiquitous here.
Each year, however, the center becomes a "second home" to the 31,000 patients who receive treatment, said Christine Gilbert, who was diagnosed with breast cancer last March.
Norris Cotton, which first opened in 1972, is one of the United States' 40 comprehensive care centers, facilities designated and funded by the National Cancer Institute to engage in patient care, conduct clinical trials and participate in research projects specific to cancer.
The center employs approximately 200 health care providers, who are all officially employed by Dartmouth-Hitchcock Medical Center, according to Dartmouth Medical School professor Mark Israel, the center's director. The center has three regional locations in St. Johnsbury, Vt., Keene and Manchester and also offers patients the option of being treated in 12 local hospitals in their community, Israel said in an interview with The Dartmouth.
"We try our best to give the treatment as close to home as possible," he said. "Cancer is a very devastating experience, for the patient and the family."
The center's extensive clinical trials distinguish it from its peers, Israel said. At any given time, the cancer center is actively conducting approximately 150 different clinical trials, which Israel said he views as an integral part of combating cancer.
"Here's a disease that's, more often than not, lethal," he said. "The treatment for it is ineffective and brutal. Ineffective doesn't mean that it doesn't help patients, but maybe people aren't necessarily cured."
At Norris Cotton Cancer Center, approximately 18 percent of patients participate in clinical trials, Israel said.
In the nation's other 39 comprehensive cancer centers, he said, that number is closer to 10 percent.
Sally Haas, who was diagnosed with high-risk breast cancer in November 2008, was involved in an imaging study designed to evaluate new technology to allow doctors to better monitor a patient's treatment.
"I wanted to give something back and do something to help women in the future," Haas said in an interview.
It was the care she received from her doctor at the center, Haas said, that helped her through the difficulties of chemotherapy, her mastectomy and the three-week period in which she received radiation treatments five days a week.
"I actually have a nephew who is studying cancer at Cold Spring Harbor in New York," Haas said. "Dr. [Peter] Kaufman actually spoke to him on the phone at great lengths. That really impressed me. He always remembered to ask me about my nephew, so it kind of drew me in and made me feel like a part of the family. After spending so much time with these people, you start to feel like you know them."
Rachel Francis, a radiation therapist, told The Dartmouth it is that sort of one-on-one time with a patient that she enjoys most.
"We had a patient who made up limericks for the radiation therapists who treated him," Francis said, laughing. "We had another guy who brought in a whole photo album of bears and deer and fisher cats."
Forging a relationship with sick patients, however, can be bittersweet, Francis said.
"The hardest part is when we find out someone passed away," Francis said. "For me, when they cry, it's like, Oh God, that's hard.'"
To better relate to her patients, Francis tattooed her hand with the same small black dot that patients who receive radiation therapy must get to mark their cancer.
Francis said she and the center's other health care providers try to maintain normal relationships with their patients, free from worry about the disease.
"Most of the time, we don't talk about cancer," Francis said.
In the pediatric infusion suite, where children under 18 receive chemotherapy and biotherapy treatments, the off-white walls are covered with a forest mural.
"We decorated all the rooms, so it seems like a less clinical experience," Heather Harlow, a nurse who works in the pediatric infusion suite, said. "We try to make their experience here even more so about having fun than receiving their medicine."
Michelle Pillsbury, a medical dosimetrist who was trained at M.D. Anderson Cancer Center the largest freestanding cancer hospital in the world said that individualized attention is one factor that sets the Norris Cotton Cancer Center apart from its peers.
"M.D. Anderson is a well-known name," Pillsbury said. "But I feel that everything is comparable. The patient care here is cutting-edge. We are a large facility, but it's not so large that you lose a personal connection and that can happen at Anderson. You feel like a number."
Gilbert said that sort of attitude lends the Norris Center a distinct feel.
"You go to the hospital and you have to give your name and your birth date, but at no point through the experience have I felt like just a number," Gilbert said. "[The doctors and nurses] just go out of their way. It's a huge place, almost like a community in itself. But it never feels like it's too big for you."
Gilbert said that the staff was especially helpful when she first received her prognosis. Social worker Margie Cole broke the news to Gilbert's husband because she "just couldn't do it [her]self," Gilbert said.
"Welcome to the club that nobody wants to be a part of," Gilbert said.
Gilbert said her interactions with her physicians and nurses have given her the confidence to fight her disease. Her last treatment is scheduled for Dec. 2.
"I plan to go on with the rest of my life," Gilbert said. "I have a son, and I'm going to be a grandmother. I need to be here, and I need to keep on going."
Despite efforts to increase patients' comfort, however, the treatments that patients receive are still difficult for both patients and staff.
"It's just awful being a patient," Gibb Cornwell, who previously served as the center's director of hematology and oncology and was diagnosed with lymphoma two weeks ago, said. "It's not because people aren't being nice to you, but you have no control over your life. You don't want the food, and you don't want all those pills and you want to sit on the edge of the bed without the alarm going off. Those things seem little, but they add up to a lot."
In the infusion suite, where chemotherapy and biotherapy are administered, 1,000 combinations of drugs are mixed and delivered to patients each month, said Dorothy Dulko, the center's nursing director of hematology and oncology. The 30 nurses who work in the infusion suite are registered nurses, which is "very unique," Dulko said.
"It has to do with not only adhering to professional standards, but going above and beyond to make sure understanding is reinforced," Dulko said.
The center is among 365 health care organizations with Magnet status, an award given by the American Nurses' Credentialing Center to hospitals with high professional standards, according to Dulko.
Norris Cotton Cancer Center's radiation department sees approximately 1,000 patients and administers over 20,000 treatments a year, Linda Metcalf, director of radiation oncology, said.
Radiation is one of the center's most advanced departments, she said.
In a collaborative effort with Dartmouth-Hitchcock Medical Center's neurosurgery department, physicians perform stereotactic radiology surgeries, which allow physicians to perform just one half-day, outpatient procedure as treatment. In hospitals without similar technologies, patients must typically undergo 35 treatments, Metcalf said.
The stereotactic radiology surgery uses a computer-based simulation of the patient's tumor to pinpoint where to give the proper dosage of radiation to spare as much healthy tissue as possible, Metcalf said.
Marc Bellerive, associate director of physics and dosimetry in the radiation oncology department, was among the three individuals at Harvard Medical School who helped modify and apply this new innovation.
"We are state-of-the-art in the sense that we use the most advanced technology," Bellerive said. "The neurosurgery team and radiation are always pushing the envelope. We take a quantum leap almost every 10 years. Before, you drew [the tumor] on a piece of paper. Now, it's a support-based image."
Norris Cotton Cancer Center has more than 200 research projects currently being worked on in "at least a dozen labs," according to Matt Havrda, who works in Israel's lab, which focuses on brain cancer research. Havrda cited the center's many academic departments as important assets.
"It's a unique opportunity to be able to interact with the clinical trials or go to Grand Rounds, [a lecture series], and find out what patients need for research," Havrda said. "It's a really neat environment because you have all phases of cancer care and research working together."
The center's small size, however, does inhibit some research efforts, Pillsbury said.
"You can do research more readily at M.D. Anderson because you have a larger patient base, so it provides you with a larger sample size," she said.
The cancer center receives approximately $72 million dollars a year from the National Institutes of Health, its largest funder, Israel said. Over the past few years, however, money allocated to cancer research has decreased by approximately 20 percent due in part to the economic crisis, he said.
The economic downturn has also forced the center to reduce its workforce by approximately six people, Israel said.
Through the economic stimulus plan, however, individual health care providers were able to apply for grants from the federal government. Faculty members at Norris Cotton Cancer Center were awarded 38 of these grants, Israel said.
Friends of Norris Cotton Cancer Center, a volunteer group that seeks to raise money for and awareness of the center, meanwhile, has increased its efforts as the budget of the center has decreased, Jean Brown, director of Friends of Norris Cotton Cancer Center, said.
"We raise discretionary money, so when someone has a good idea we can give them money to start their research," Brown said. "It's very important we fund patient services like massages and support groups, because insurance groups aren't going to fund that."
Norris Cotton is named in honor of former U.S. Sen. Norris Cotton, R-N.H., who secured a $3 million grant in 1970 to support the construction of rural New England's first regional cancer center.
