The Beam: Proton therapy for rare cancers, an in-depth look at our team coordinators’ role and meet new medical assistant

Proton therapy can play a role in treating gastrointestinal, testicular and skin cancers

Proton therapy is often a preferred form of radiation for cancers such as head and neck, brain, eye and lung. But other less common cancers may also benefit from this therapy. These can include cancers of the pancreas, adrenal gland, skin and testes. Fred Hutch Cancer Center radiation oncologists decide on a case-by-case basis if proton therapy can be helpful for patients with these cancers.

“Even though the standard of care for, say, adrenal gland cancers is surgery, radiation is sometimes needed after surgery if there are positive margins or other high-risk features,” said Smith Apisarnthanarax, MD, Fred Hutch radiation oncologist. “In these cases, because the radiation area is often extensive and occurs next to organs such as the liver, stomach or kidneys, protons can be used to better avoid these healthy tissues during treatment.”

Similarly, protons may be most useful when radiation oncologists have to irradiate the region of the pancreas after surgical resection. Because this area can be relatively large and will include gastrointestinal organs like the stomach and bowel, protons have the potential to reduce gastrointestinal toxicities.

Emily Weg, MD, considers proton therapy when she has cases of seminoma, a type of testicular cancer that tends to occur in patients who are very young — often in their 20s and 30s.

Proton therapy is a technique that minimizes how much of their healthy tissue gets exposed to radiation. Several recent studies suggest that proton therapy may reduce the risk of long-term adverse effects and secondary cancer risk compared to conventional photon radiation in these cases.

Protons can also be effective in treating advanced-stage skin cancers, especially if they are in the head and neck region. For example, those cancers requiring irradiation to cranial nerve pathways into the skull base, lymph nodes in the neck, or other complex geometric and anatomical considerations such as large irregular scalp defects, proton therapy may have an advantage over IMRT/VMAT in minimizing brain radiation.

“Proton therapy is a sophisticated tool that provides an elegant treatment solution in the right clinical scenario,” said Weg. “We are very fortunate to have access to it at Fred Hutch — in fact, we’re the only treatment facility in 900 miles to offer it — and our team of physicians are experts who know when and how best to use it.”

Fred Hutch radiation oncologists are available to consult on all cancer types. For a second opinion or to schedule a consult, please visit us here.

What is a team coordinator’s role?

When patients receive proton therapy, they can have many appointments in addition to their treatments, including meetings with their radiation oncologist and visits with the registered dietician, social worker or child life specialist.

There are also collaborations with other health care facilities such as UW Medicine, Seattle Children’s, the VA Puget Sound Healthcare System and nursing facilities. Fred Hutch proton therapy facility therefore has a dedicated scheduling team, also known as team coordinators, led by support staff supervisor, Dana DeMarco, CRCR. 

“Creating a schedule that works for the patient can be challenging,” she said. “There are instances where we may work on a complex schedule adjustment for a patient that can take a lot of time, discussion and critical thinking. But the feeling of finding a solution and being able to create a schedule that is more manageable for the patient makes all the time and effort worth it.”

Team coordinators must take into consideration many factors and meeting each patient’s unique scheduling needs is one of their biggest challenges. Anesthesia patients can only be treated when an anesthesiologist is on site and need to be done early in the day, for example. Some patients need to start treatment within just one to two days of meeting with their physician. And some equipment is shared between rooms; the team must ensure that it will be available for the radiation therapists when needed.

“When we have a full schedule, we treat from 7:30 a.m. until sometimes as late as 11 p.m. and that can be a challenge when we have to relay late treatment times to the patient,” said team coordinator lead Tina McCoy. “We feel grateful when we can help patients optimally navigate their treatment and support them while they receive proton therapy.”

Sometimes may be unforeseen circumstances that affect a patient’s schedule; the team coordinators also need to handle that.  

“Machine downtime can be extremely stressful when it is for an undetermined or extended amount of time,” said Jenny Dang. “When downtime occurs, we keep patients informed on the treatment room status, reschedule treatments and other appointments and update patient charts.”

When a team coordinator first starts at Fred Hutch, they are trained in-person for the first month. They meet with the different teams at the proton therapy facility such as nursing, medical physics and radiation therapy to get a deeper understanding of the many roles and how a team coordinator collaborates with them. They receive in-depth training on health care software such as EPIC, Mosaiq and Vantage. The team coordinators take turns working on different treatment plans, including complex ones, to stay well-versed on scheduling of all types of plans.

“This position challenges us to always continue learning and growing,” said DeMarco. “We are collectively discovering more efficient ways to improve our workflow as well as developing resources that will help future treatment coordinators be successful in this role. The nature of scheduling is often more efficient when we strategize together on best practices in scheduling.”

To keep her team happy in a mostly work-from-home environment, DeMarco gets creative with finding ways to spend time together and bond outside of work. The team has quarterly employee events like BBQs and bowling, and the team makes coffee runs to cafes together. Sharing shout outs at bi-weekly team meetings to recognize each other’s hard work also helps the team stay motivated.

“And of course, helping to navigate this journey alongside our patients and their families is so rewarding and is a daily reminder of why we do what we do,” said DeMarco.

Meet new medical assistant Jade Duke

Jade Duke joined the proton therapy team earlier this year as a medical assistant (MA). 

Her uncle received proton therapy at Fred Hutch and spoke highly of the staff and the care he received there. Duke was so inspired by his experience that when she saw an open position, she decided to apply.

She also wanted a role where she could contribute more of what she wants to see in the world: compassion, love and integrity, delivered wholeheartedly with the same level of care she would provide her own family.

“I love learning, connecting and building relationships with others,” Duke said. “At the proton therapy facility, I'm grateful for the chance to do both of these things. I appreciate working in an environment where everyone strives for excellence.”

As a medical assistant, she performs many duties, including recording vital signs, prepping patients for their exams and consults and making sure the oncologist has everything they need for the patient’s appointment.

Outside of work, Duke loves being creative. She’s been a dancer for the past 13 years, studying hip-hop variations, silk fans, heels, waacking and jazz funk, among other styles. She has performed both on camera and for live audiences. Duke also enjoys other forms of artistic expression such as painting, doing make-up, clothes styling, cooking, writing and interior decorating. 

Please say “hi” to Duke when you see her next.

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