Care, research attract visitors

By KIMBERLEY MCGEE

VIEW ON HEALTH

For more than 30 years, local engineer Thomas Horen has traveled outside of Las Vegas for his health care needs. From kidney stones to knee surgery, Horen has found that he received better health care and cutting edge, possibly lifesaving, medical procedures at hospitals and clinics in San Diego and Houston. However, he's recently found that the opposite is true when it comes to his beloved hometown.

"It's impressive what is going on right here in our city," Horen said.

Since the mid-1970s, Horen said, he and his extended family felt more comfortable being treated for serious ailments away from the comforts of home.

"Scripps is my go-to hospital if I or anyone in my family for that matter, are seriously ill or need surgery," Horen said. "We just found it was better to be treated outside the city than to take a chance here and (later) have to go to a bigger (hospital)."

Recently, his physician at Scripps in San Diego re-directed him to his hometown for cancer treatment.

"I couldn't believe that this highly respected doctor was telling me to come back to Las Vegas," he said. "We're going to be looking around at what's happening here. We had no idea that people come here from other states now to get (medical care). It's kind of exciting. We love this town."

Las Vegas grew from less than a million residents to more than 2 million in little more than a decade and has since made significant steps in becoming a city worthy of its numbers. Impressive medical facilities conducting cutting edge procedures, surgeries and clinical trials investigating new therapies that can prolong or even save the life of those stricken with cancer have made Las Vegas home in the last decade and are receiving international attention.

One such facility is Comprehensive Cancer Centers of Nevada.

Many of the clinical trials and approved therapies available in Las Vegas can be credited to physicians such as Dr. Nicholas Vogelzang. He has opened five cancer centers and came to Las Vegas from Chicago Jan. 1, 2004 to work as the director of the new Nevada Cancer Institute and is now at Comprehensive Cancer Centers of Nevada and is the current developmental therapeutics medical director for U.S. Oncology.

"I didn't know much about the local environment," Vogelzang said. "I had worked in academic environments my entire life. Most academic institutions create their own environment, create their own weather. You have your full complement of specialists, including pediatricians, internists, surgeons that's what the University of Chicago's environment was like, so I was fairly sheltered I guess."

The Las Vegas valley's community of cancer specialists and general physicians welcomed him, he said, as he began his year-long licensing efforts.

"I didn't have a license for the first year because I spent much of my time administratively," Vogelzang said. "I was intrigued by the process, very meticulous."

The renowned doctor hadn't been re-licensed since 1982, when he moved to Illinois from Minnesota. He had to track down paperwork such as his residency letter from 40 years before and proof of citizenship to work in Las Vegas.

In the meantime, he got to know the valley residents and medical community on a deeper level.

"I fight the perception constantly that Las Vegas does not have adequate health care and I explained it for 99 percent of the patients I see," Vogelzang said. "Las Vegas has completely high quality, available and diverse health care availability."

However there are areas that could use more specialists or concentration.

"The availability that is lacking is some of the very high tech surgical procedures and some of the complicated rare disease management and strategies," he said, "and those are simply rare diseases."

That is not unusual for a city of Las Vegas' size, substantial as it may be.

"What happens is we are a population of 2 million and a population of 2 million, roughly, has a hard time supporting these rarities that a population of 15 million, such as Los Angeles has the means to support," he said.

A city of 2 million should have at least one major cancer center, which is what brought him to Las Vegas to open Las Vegas' first, the Nevada Cancer Institute with Dr. Sunil Sharma, M.D.

"It was that one reason that I was very eager to assist in starting the Nevada Cancer Institute," Vogelzang said. "It was clear the city and the state needed such an institution. In response the local oncology community has also stepped up and created a substantially stronger program here at Comprehensive Cancer Centers."

The addition of specialists such as Vogelzang and his local peers creates a web of knowledge that stretches outside the valley and brings back information and rare procedures through its connections.

"I use the expertise of my colleagues all around the United States," he said. "It's not like I'm the end all and be all for most of the diseases that I see."

If a physician can't help a cancer patient or a patient not reacting positively to treatment, or at all, they can find someone who can, if the patient is willing to travel.

Vogelzang continually receives patients from around the country that have been referred to him. Of his 356 patients, a substantial number were referred from colleagues in the valley as well as referrals from Utah, Illinois, Arizona and Miami. Recently, a Lake Havasu man with cancer who was not responding to treatment was referred to Vogelzang, but the ill gentleman did not want to make the trip to Las Vegas. Instead, the man's doctor and Vogelzang chose a new plan of treatment for the patient based on Vogelzang's extensive background and work with rare treatments.

Still there are certain immutable principals that not all disease is curable and not all disease is understandable, he said.

"The key is knowing what you don't know, or at least recognizing that you don't know, and then asking for help, and that's where my roll comes in here in the southwest," Vogelzang said.

The companies and institutions that develop new drugs bring those new drugs here earlier than they would to other cities due to the caliber of physicians in the valley, particularly Vogelzang, "so I've had the opportunity to participate in, oh, 100 of new drug developments," he said.

The Comprehensive Cancer Centers have 50 to 60 clinical trials open currently and he is responsible for a large chunk of them, he said.

Patients in trials have access to new drugs, surgeries and procedures that are generally not available outside of a clinical trial. Medicare and other federal insurances may cover some or all of a trials costs to the patient. In Nevada, private insurers and managed care providers are required to pay for clinical trial costs to the patient, according to the National Cancer Institute.

Most clinical research trials are broken down into three phases so that researchers can receive reliable information about the drug being tested on patients. Phase I trials are the first time a drug is studied on people and involves a small number of patients. Phase II trials continue the test and focuses on how well the new drug works on patients of a particular type of cancer. Phase III trials concentrate on the new drug or a combination of drugs or a new surgical procedure and compare it to the standard treatments. This trial usually enrolls a large number of people around the country. A Phase IV trail evaluates the side effects, risks and benefits of the drug with a larger number of people and over a longer period of time.

There are also trials for preventing cancer, which are listed at www.cancer.gov. If you are considering on being in a trial after a referral from your physician, consider how the side effects would affect your life.

Vogelzang is part of TOPS, translational oncology programs, an elite group of institutions in US oncology. He is on the executive research committee of the 90-100 medical oncology practices in the United States, compromising of 1,400 oncologists, and it is growing constantly.

Of those medical oncology practices, 12 of those practices perform phase 1 trials, the earliest clinical trials performed on people.

"We are one of those groups, so as part of that I have access to very interesting and exciting new molecules for the patients whose cancers do not respond to the normal treatments," he said. "A group of 22 medical oncologist know I do that so they, from around the city, refer their patients who normal therapy who is no longer affective refer to me and they are most of the time interested in trying these new drugs."

Previously they would have to leave the city for this.

Since doctors such as Vogelzang and Sunil Sharma, M.D., Chief of the Sections of Phase I and Gastrointestinal Oncology at Nevada Cancer Institute, have come to Las Vegas, you no longer have to leave the city for inclusion in these trials.

"It's a new story and Nevada Cancer Institute is continuing the tradition," Vogelzang, a former NCI physician, said. "And now we have one here and it's been open here at Comprehensive Cancer Centers for three years. It really has stepped up the quality of care in the valley, at least as far as cancer is concerned."

Scripps is considering a satellite facility in Las Vegas due to the significant number of patients that travel from this city to Southern California in pursuit of better health care, although no plans have been announced as of yet.

Good physicians and strong programs will attract patients from the region as well. Due to the city's growth and subsequent addition of physicians to accommodate that growth, you no longer have to leave the city for many invasive diseases or ailments, Vogelzang said.

"I think that's very true," he said, adding it will only get better. "With the Cleveland Clinic presence at the (Lou) Ruvo Center, that certainly is a realistic future. I think that every time you look at big metro centers, there are several cancer centers and a population as big as Las Vegas would support several cancer centers as well as several sub specialties such as gastro, cardio, pulmonary and such."