All the physicians at Marin Cancer Care can be found on this peer-to-peer list. Click here to see the list.
Methodology: Marin Magazine conducted a 2017 survey that has resulted in this  Top Doctors list — top physicians practicing in San Francisco and Marin counties who received multiple independent recommendations from their peers. The list was rechecked again this year. The survey process started with a list of more than 3,600 licensed doctors across all specialties in both counties. All doctors on this list were both candidates and eligible voters in the peer-to-peer voting poll. Doctors were allowed to cast an unlimited number of votes across all specialties — they could vote for as many doctors as they wanted regardless of specific area of expertise — but they could only vote for the same doctor once.
Response rate was maximized by the following procedures: (a) a long field period of 12 weeks that was further extended to allow all doctors ample time to log in and vote for peers; (b) multiple channels of solicitations including both individual invitations and organizational outreach to maximize contact with all eligible voters; and (c) repeated invitations and reminders to doctors who did not respond to initial rounds of solicitations. At the close of the voting period, approximately 670 doctors with the highest vote counts were short-listed for the database. Each of these doctors received a statistically significant number of votes from peers based on established principles of sampling probabilities and power analysis. LinChiat Chang, Ph.D.
For many women with breast cancer, one of the most worrisome side effects associated with chemotherapy is hair loss. With cold cap therapy, women receiving chemotherapy treatment at the Smilow Family Breast Health Center at Norwalk Hospital have options that can significantly reduce alopecia or the loss of their hair. For the last 30 years, practitioners and patients have attempted to prevent hair loss during certain chemotherapy regimens. Hair loss occurs because the chemotherapy agents target rapid growing cells in the body. This includes cancer but can also impact normally fast growing cells such as hair and nails. Success rates have improved greatly with recent advancements in cold cap therapy with reports of between 60 to 90 percent effectiveness.
The decision to use cold cap therapy is very personal and can vary between patients. However, there seems to be some shared desires among women including wanting to maintain their privacy, protecting their loved ones, and wanting to get back to “normal” as quickly as possible once treatment is completed.
Shaira Cohen, a chemotherapy nurse, fits Linda Lee’s Dignicap prior to her treatment.
Linda Lee, who is currently going through chemotherapy treatment for breast cancer at Smilow, is a nurse in Labor and Delivery at Norwalk Hospital. She explains that continuing with her normal activities while maintaining her privacy was very important to her. “A few of my colleagues have gone through chemotherapy treatment. I knew that if I had a choice I definitely would not want to lose my hair. I felt like it was an invasion of my privacy. I planned to work, I remember thinking that I don’t want my patients thinking that my nurse is so sick, who wants a sick nurse taking care of you. For me it was a very easy decision.”
Aggie Gussen Mirto shows off her full head of hair following her chemo treatments.
Another patient who has completed her chemotherapy using the DigniCap, Agnes (Aggie) Gussen Mirto, shares how thrilled she is with her decision to use the cold cap therapy. “I am very happy that five weeks post chemo I have an absolutely full head of dark brown hair. Although I did have a little thinning from brushing, you can’t tell that I went through any kind of treatment.”
Similarly to Linda, Aggie is a registered nurse. She is the Director of Nursing at The Carolton Conva-lescent Hospital in Fairfield, CT, and is a mother of an 11-year-old daughter. When she received the diagnosis of breast cancer at 41, picked up on her annual mammogram, she explained that she was in shock. “My diagnosis came completely out of left field. It was not genetic, no one in my family has had breast cancer.” Aggie’s focus quickly shifted to figuring out how to lessen the impact to both her patients and her daughter. “When I received the diagnosis of breast cancer I wanted to make sure that I expressed a heightened awareness of the disease to my staff. But I didn’t want my patients to think that the leader of the organization was sick. It was very important for me to be able to work through my entire treatment without my cancer being obvious.”
Although her patients were an important part of Aggie’s decision, clearly the most heartfelt reason to pursue cold cap therapy was her young daughter. “I have an 11-year-old little girl and I thought keeping my hair, not looking so sick, she might be able to accept my diagnosis a little bit more.”
The Smilow Family Breast Health Center at Norwalk Hospital has more experience than any other Connecticut hospital or medical institution in providing cold cap therapy. Starting in 2012 Smilow implemented a cold cap therapy pilot program for breast cancer patients undergoing taxane-based chemotherapy using Penguin cold caps. In this program, soft, gel-filled caps were chilled to a temperature of between -30°C and -32°C in a special biomedical freezer. The cold caps, which patients wear on their heads on treatment days — before, during, and after chemotherapy infusion — cool the scalp so that hair capillaries become temporarily dormant and do not absorb the chemotherapeutic drugs.
Mary Heery, APRN/Breast Health Specialist, working at the Smilow Family Breast Health Center, explains that the cold cap trial went very well. “We started using the Penguin cold caps and have had very good results, with 80 to 100 percent of patients achieving favorable outcomes in hair preservation, with people losing less than 50 percent of their hair.”
In December of 2015, the Food and Drug Administration (FDA) cleared the DigniCap Scalp Cooling System by Dignitana for female breast cancer patients in the United States. It’s the first device that has been granted FDA clearance to reduce the risk of hair loss during chemotherapy.
Mary notes, “We are pleased that Dignitana has received FDA clearance. In addition, the DigniCap technology means less time patients have to spend wearing the cold cap, so we were excited to try it. And we are hopeful that the results will be as successful as with the Penguin cold caps.”
Aggie encourages women to consider cold cap therapy. “This service was offered to me very early on in my treatment. For me, the DigniCap was very easy as it was already at the hospital. I was fitted for the cold cap and it was ready when I got there for my first treatment. I researched the options so I knew what to expect. The hardest part is the initial cold burst until the Ativan, given for discomfort, takes effect. You just have to remain calm and know it’s all for the good cause.”
With cold cap therapy, it is imperative that the cooling caps fit properly on each patient and have complete contact with the scalp. Smilow has arranged to have designated cappers, to work side-by-side with the chemo nurses, to assist patients with the fitting process. This allows the chemo nurses to focus on their patients and the infusions while the cappers administer the cold caps.
The DigniCap Scalp Cooling System consists of a tight-fitting silicone cooling cap connected to a special cooling and control unit. Sensors in the cooling cap ensure that the temperature is automatically regulated during the entire cooling treatment, never dropping below 32°F (0°C). DigniCap Scalp Cooling System is designed to provide continuous cooling with high efficacy, safety, and acceptable patient comfort. To make this process more comfortable, the cooling cap is at room temperature when placed on the head and the lower treatment temperature is gradually achieved over a short period of time.
Melissa Bourestom, Vice President of Marketing at Dignitana, explains, “We know that hair loss is a well-documented and common side effect of chemotherapy, but hair loss is not inevitable. Women now have a choice.” She encourages patients to explore this new option because “it allows people to keep their dignity, to keep their identity, and in many cases, keep their privacy.”
At this point, insurance companies do not cover the cold cap therapy but there are charities that can provide financial assistance for those in need. In April 2016 Norwalk Hospital received a grant from Pink Aid that enables eligible breast cancer patients to receive cold cap therapy not typically covered by insurance. “We are very excited and grateful to receive this Pink Aid grant,” said Zarek Mena, Certified Patient Navigator.
For more information on cold cap therapy contact ??? at XXX-XXX-XXXX .
Leonard L. Berry, PhD, MBA; Katie A. Deming, MD; and Tracey S. Danaher, PhD
Nonclinical and clinical-support personnel serve patients on the front lines of care. Their service interactions have a powerful influence on how patients perceive their entire care experience, including the all-important interactions with clinical staff. Ignoring this reality means squandering opportunities to start patients out on the right foot at each care visit. Medical practices can improve the overall care they provide by focusing on nonclinical and clinical-support services in 5 crucial ways: (1) creating strong first impressions at every care visit by prioritizing superb front-desk service; (2) thoroughly vetting prospective hires to ensure that their values and demeanor align with the organization’s; (3) preparing hired staff to deliver excellent service with a commitment to ongoing training and education at all staff levels; (4) minimizing needless delays in service delivery that can overburden patients and their families in profound ways; and (5) prioritizing the services that patients consider to be most important. We show how cancer care illustrates these principles, which are relevant across medical contexts. Without nonclinical and clinical-support staff who set the right tone for care at every service touchpoint, even the best clinical services cannot be truly optimal.
Marin Cancer Care recently celebrated the work anniversaries of several long-term employees. We are proud that we have staff who have worked here for a very long time and we have little turnover. More than half of the employees have been part of the Marin Cancer Care family for five years or more. This is especially important for developing relationships and connections with cancer patients and their families. The following doctors and employees were honored for their longevity with the practice:
Marin Cancer Care of Greenbrae, CA Achieves AAAHC Accreditation
Greenbrae, California – November 15, 2018– Marin Cancer care has achieved accreditation by the Accreditation Association for Ambulatory Health Care (AAAHC). Accreditation distinguishes this medical group from many other outpatient facilities by providing the highest quality of care to its patients as determined by an independent, external process of evaluation.
Status as an accredited organization means [name of your organization] has met nationally recognized standards for the provision of quality health care set by AAAHC. More than 6,000 ambulatory health care organizations across the United States are accredited by AAAHC. Not all ambulatory health care organizations seek accreditation; not all that undergo the rigorous on-site survey process are granted accreditation.
“We believe our patients deserve the best,” stated Harvey D. Bichkoff, CEO of Marin Cancer Care. “When you see our certificate of accreditation, you will know that AAAHC, an independent, not-for-profit organization, has closely examined our facility and procedures. It means we as an organization care enough about our patients to strive for the highest level of care possible.”
Ambulatory health care organizations seeking accreditation by AAAHC undergo an extensive self-assessment and on-site survey by AAAHC expert surveyors – physicians, nurses, and administrators who are actively involved in ambulatory health care. The survey is consultative and educational, presenting best practices to help an organization improve its care and services.
“Going through the process challenged us to find better ways to serve our patients, and it is a constant reminder that our responsibility is to strive to continuously improve the quality of care we provide,” said Bichkoff.
The Accreditation Association for Ambulatory Health Care, founded in 1979, is the leader in ambulatory health care accreditation with more than 6,000 organizations accredited nationwide. AAAHC accredits a variety of organizations including, ambulatory surgery centers, office-based surgery centers, endoscopy centers, student health centers, military health care clinics, and large medical and dental practices. AAAHC serves as an advocate for the provision of high-quality health care through the development of nationally recognized standards and through its survey and accreditation programs. AAAHC accreditation is recognized as a symbol of quality by third-party payers, medical organizations, liability insurance companies, state and federal agencies and the public.
57-year-old Scott Davis grew up as an Air Force brat. His family moved around a lot, but it was during their time in Phoenix that Scott got the sunburns that would eventually catch up with him, decades later, in the form of an aggressive melanoma.
Scott first came to Marin in 1994 when he and his wife moved to Tiburon. They immediately fell in love with Marin and especially, Mt. Tamalpais. A graduate of the Brooks Institute of Photography, Scott has a life-long passion for taking pictures. He makes his living as a location scout and producer for advertising and loves photographing nature.
In 2001, Scott’s wife thought it would be a good idea for him to get his moles checked and made a dermatology appointment for him. The two were contemplating a move to New York and she decided to take a trip to Chicago to visit family while Scott went out to New York to get the lay of the land. While the couple was apart, tragedy struck. Scott’s wife died suddenly from a congenital heart defect.
When Scott returned, he went to the appointment his late wife had made for him – an appointment that likely saved his life. The dermatologist found a melanoma on his back. The doctor removed the growth, which did not appear to have spread, and Scott went through with the planned move to New York.
Scott lived in New York for a year, where he met his current girlfriend. In 2002, the two moved to Los Angeles. Scott was ready for a new beginning, but melanoma was not finished with him. In 2003 he was getting really bad headaches and found himself suddenly losing his peripheral vision. He started bumping into walls and couldn’t keep his signature on the line when he was signing traveler’s checks. An MRI revealed a brain tumor.
Within days of his diagnosis, Scott had emergency brain surgery followed by CyberKnife radiosurgery 2 months later. Although the tumor was successfully destroyed, Scott’s oncologist was not enthusiastic about his prognosis. Sure enough, a year later, follow up scans revealed two more brain tumors. This time, Scott had Gamma Knife® radiosurgery to destroy the tumors. In addition, two lymph nodes under his right arm showed involvement by melanoma.
For a decade, Scott went about his life with no sign of a recurrence. In 2014, his girlfriend was hired by Levi’s in San Francisco, and the couple moved from Los Angeles to Marin. Scott was delighted to be back in Northern California and felt perfectly healthy. However, his girlfriend and his sister, who is an oncology nurse, kept nagging him to get a checkup.
One person whose nudging made quite an impact was Scott’s long-time friend, Dr. Peter Eisenberg, a medical oncologist at Marin Cancer Care and member of Marin General Hospital’s Cancer Institute. “Peter,” Scott points out, “is the kind of guy who won’t take no for an answer.” Together, they decided Scott, who was officially “disease free” and hadn’t seen a doctor for years, should have a PET scan. That’s when Scott learned his cancer was actually back and had spread to his lungs, lymph nodes, intestines, and liver.
There was no question in Scott’s mind as to where to get his treatment. “Staying in Marin became a kind of a no-brainer, because I needed to keep living my life. I needed to keep working. When you get a diagnosis like this, you choose a horse and you ride him. Dr. Eisenberg was the horse I chose, and I was counting on his expertise.”
Dr. Eisenberg immediately went in to high gear. He recommended immunotherapy. “There’s no other treatment that had the potential to be successful,” he explained. As Scott points out, “Peter’s been great about networking and meeting with experts.” Dr. Eisenberg started by consulting with the melanoma specialist who had treated Scott in LA. He also corresponded with the author of the groundbreaking immunotherapy study reported in the New England Journal of Medicine. All agreed that immunotherapy was the right course of action.
Like chemotherapy, immunotherapy is given orally or intravenously but the way the drugs work is very different. In the case of melanoma and certain other cancers, tumors secrete substances that mask the cancer cells, effectively “hiding” the tumor from the patient’s immune system. Immunotherapy disables the cancer’s masking abilities and allows the patient’s immune system to work as it should.
Once he had his port put in at Marin General Hospital, Scott was able to have his immunotherapy treatments at the doctor’s office with Dr. Eisenberg and his colleague, Dr. Barbara Galligan, monitoring his progress. Treatment began with two drugs, given every three weeks over a 12-week period. Then, treatment continued with one of the drugs, given every two weeks to complete a year of treatment.
Throughout his treatments, Scott felt totally supported by his doctors and by Marin General Hospital. He worked with a nutritionist at the hospital’s Center for Integrative Health & Wellness to ensure that he maintained a healthy diet. When Scott developed rheumatoid arthritis in his knee as a side effect of treatment, Dr. Eisenberg tracked down a UCSF rheumatologist who was participating in a Johns Hopkins study on the side effects of immunotherapy. But the main effect far outweighed the side effects: Scott’s most recent PET scans show no signs of the tumors! “It’s mind blowing,” Scott marvels. “It’s like magic.”
Nowadays, Scott sees Dr. Eisenberg every six weeks and has scans every six months. He feels great and spends a lot of time at his beloved Mount Tamalpais, taking photos. As Scott says, “It allows me to let go of even thinking about the disease and the kind of the journey that I’ve been on, and just puts me in the moment for being right there and appreciating what I’m seeing and where I’m at.”
Listen to Bill Klaproth discuss Immunotherapy with Dr. Barbara Galligan
One of the most promising tools in an oncologist’s toolbox is immunotherapy. This treatment boosts the body’s own immune system so it can effectively destroy cancer cells. Immunotherapy has proven very effective in certain cancers, such as some melanomas and lung tumors. While immunotherapy is still unavailable at many community hospitals, it has been prescribed at Marin General Hospital for several years, with encouraging results.
Learn more as Dr. Barbara Galligan explains immunotherapy and how it works. Topics covered include how the treatment is administered, who is a good candidate, and potential side effects.
Advances in immunotherapy have had a continual impact on how physicians help patients with cancer, bringing a complex mix of challenges and successes, says Barbara Galligan, M.D., an oncologist at Marin Cancer Center.
“Immunotherapy means a lot of different things,” she says. For example, the Food and Drug Administration (FDA) has approved immunotherapy for use on only some cancers, including metastatic melanoma, lung cancers, bladder cancer and others. “These are new, expensive, drugs that are promoted with direct-to-consumer advertising campaigns resulting in patients coming in to their doctors asking for immunotherapy.”
“Immunotherapy doesn’t work on every cancer, says Galligan. “Or, it may not be the right time for immunotherapy. There are times over the course of someone’s treatment where immunotherapy may or may not be useful.” She explains some of the complex conditions behind the miraculous-appearing results portrayed on ads.
“The thing about immunotherapy is that if you have a great response, it looks like a true miracle drug,” says Galligan. For example, there are people whose cancers such as a deadly metastasized melanoma, have disappeared for years after treatment with immunotherapy. “But the flip side is that there are patients who won’t respond,” she adds. Current statistics place the responders (those who show lasting improvement) in the neighborhood of 20 to 30 percent. This means there are a great many for whom the drug, no matter how seemingly miraculous for others, does not work.
Why don't all patients respond? “We’re learning that cancer is not just one disease,” says Galligan. “It’s many diseases. And even within one cancer type (lung cancer, for example), there are many different types.” According to Galligan, it’s important to take a sample of a patient’s tumor to take a closer look at the biology. “If you take a sample and study it, you can see the differences,” she says. “The closer you look at the biology, [you note] there’s a lot of variability.” One patient’s lung cancer may not be the same as another patient’s lung cancer. “That’s what predicts [a patient’s] response to immunotherapy.”
Another complication is that the cancer’s “disguise” can be outsmarted by the immunotherapy drug, but the cancer may mutate and outsmart it back. As a result, says Galligan, you may need to change treatment to select for new mutants that are not going to go away with prior treatments.
Currently, medical science is working to find ways to predict whether cancer patients will respond to immunotherapy. “That’s a nascent field and I hope it gets better every year,” says Galligan. Some patients are set on immunotherapy, and are frustrated when they hear that it might not be the right treatment for them at the time, she adds. When preparing for treatment, she says, the best approach is to find a doctor who will support you. “It’s important to find an open-minded, enthusiastic oncologist and to establish a good doctor-patient relationship, one with communication and trust, because the field is complex, and [immunotherapy] is not one-size-fits all,” she says.
A little over two years ago, the American Society of Clinical Oncology (ASCO) in its annual report, named cancer immunotherapy the clinical cancer advance of the year.
“No recent advance has been more transformative than the rise of immunotherapy” said ASCO President Julie Vose. “These new therapies are not only transforming patient lives, they are also opening intriguing avenues for further research.”
ASCO recognized advancements in immunotherapy again in 2017 and in 2018, with the expansion of adoptive cell therapy. This recognition has driven a lot of research and development within the field of immunotherapy, with some projecting that the global immunotherapy market, valued at $60 Billion in 2016, will grow to $120 Billion by 2021.
The excitement over these treatments stems from the fact that immunotherapy can get dramatic, durable results in cancers that are difficult to treat. But the story behind immunotherapy is not simple.
Immunotherapy encompasses many different types of treatments both old and new including vaccines, antibodies, and the newer checkpoint modulators and adoptive cell therapies. What these treatments have in common is that they all harness the body’s own immune system to fight cancer.
But ramping up the body’s immune system can cause serious side effects including fatigue, pain, autoimmune diseases and organ damage. Patients undergoing immunotherapy must be monitored carefully for such side effects with regular physical exams, blood work, and scans.
Another limitation to immunotherapy is that it is not always effective. Even in best cases scenarios, only about 20% - 30% of patients receiving immunotherapy respond to treatment. That is why immunotherapy is not as widely used as radiation therapy, chemotherapy or surgery, and the Food and Drug Administration (FDA) has only approved immunotherapy for certain types of cancer.
Doctors cannot yet predict if an individual cancer patient will respond to immunotherapy because cancer is a complex set of diseases and individuals have their own unique response profiles. It can be confusing for patients when direct-to-consumer advertising campaigns for immunotherapy portray results as miraculous without discussing side effects or the chances that the treatment will not work.
For cancer patients navigating the field of immunotherapy it’s especially important to have a good relationship with an oncologist. When discussing immunotherapy with an oncologist, start by asking if the type and stage of the cancer make it eligible for treatment with immunotherapy. Ask if the goal of treatment is to eliminate the cancer, or to slow it down so that it does not spread. It’s also good to know if immunotherapy will be combined with other cancer treatments and how often treatments are given.
No treatments are without side effects, so asking about short term as well as long term side effects is important. The cost of treatment and insurance coverage are also important to consider. A frank conversation with an oncologist can help set expectations and develop the best treatment plan for the patient including monitoring for side effects and checking to see if the cancer is responding to treatment.
The field of immunotherapy is complex and, like all aspects of cancer care, there is no one-size-fits-all approach. Patients in Marin interested in discussing immunotherapy as a possible cancer treatment can find it right here in the community because together, Marin Cancer Care and Marin General Hospital offer immunotherapy as well as clinical trials in immunotherapy. When deciding if these treatments are appropriate, it is important to have a good relationship with an oncologist who can help explain the many new treatments now available to cancer patients.
Developing good communication and trust with a doctor can help patients navigate the path between older cancer therapies and newer treatments such as immunotherapy and personalized medicine. No new treatment can ever replace the healing that happens when a doctor cares for a patient as a unique individual with distinct personal characteristics, goals and plans.