Joey Wahler (Host): It's a unique challenge. So, we're discussing cancer care in rural Nevada. Our guests, Kane Deem, he's a cancer care physician assistant, as well as Casey Hirsch, who's a cancer care registered nurse. This is Valley Vitals, the pulse of healthy living in our community, brought to you by Carson Valley Health. We're going beyond the checkup to bring you real conversations with the experts you trust. Thanks so much for joining us. I'm Joey Wahler. Hi there, Kane, Casey. Welcome.

Casey Hirsch, RN: Thank you.

Kane Deem, PA-C: Good morning.

Host: Thank you. Great to have you aboard. So, first, Kane, in a nutshell, can you give us an overview of what cancer care looks like in rural Nevada, specifically at Carson Valley Health?

Kane Deem, PA-C: Certainly, it should look the same. Even though we're a small rural healthcare system, we provide the same excellent up-to-date standard of care that all the cancer centers in the US follow. They are part of the national comprehensive care network that includes 33 of the largest cancer centers in America, including places like Stanford, Mayo Clinic, and MD Anderson. They set up the guidelines that we follow to provide the best access of care, including gold standard treatments.

Host: So that being said, Casey, as we alluded to at the top, there are unique challenges for you and yours in order to make it all look like it does most everywhere else. So, what are a few of those that patients face when receiving cancer treatment in such a rural community?

Casey Hirsch, RN: So if I were a patient in a rural community receiving cancer treatment, I would be worried that I might not be receiving the care that someone with the same diagnosis in a big city would be getting. What Kane mentioned with the NCCN guidelines, it ensures that patients, whether you're rural or in a city you're receiving the same standard of care, regardless of transportation, distance, accessibility to care. We're able to provide that great care, but closer to home for these people, which is great.

Host: And speaking of which, Kane, when we talk about providing care close to home, as the two of you know, as well as anyone, the last thing a cancer patient needs is to be burdened with extra things like getting to and from treatment or to and from a doctor's visit. Oftentimes, that is an issue. So, why is it so important to offer treatment that is up to par, but also that's within reach?

Kane Deem, PA-C: That's a great point. For example, if a patient goes to a big tertiary care center to receive chemotherapy and they have side effects or complications from that treatment and they try to get ahold of their care team, it's exceptionally difficult to navigate leaving messages, email, text, phone calls to actually talk to somebody.

And so, even if they do get through to one of their care team providers, they commonly tell them to go to a local ER, so they end up in one of our ERs here. And then, the hospitalist or the ER physician ends up calling us to help manage their side effects and toxicity for a patient that we don't know, don't know what treatment they had, where they are with their treatment plan.

So if they get their treatment in-house, they have direct access to us 24/7 to talk to a nurse, or even Dr. Freeman or myself directly, to talk about the side effects and complications that we can see the patient even the same-day if they're having side effects, to try to keep them out of the hospital.

Host: And so, Casey, following up on that, we're talking here about a personalized touch, right? Dealing with some of these logistical and other issues aside from just the care itself. So, how does Carson Valley Health approach personalizing its cancer treatment plans for each individual patient?

Casey Hirsch, RN: So, the beauty of our facility is that Dr. Freeman and Kane are right nearby. So if a patient shows up, they have issues, I'm able to just go and grab them, talk to them, they'll come and see the patient right away. They're just wonderful about that, which is unique. Also, it's nice because since we're a smaller facility, we get to know our patients really well.

And I think that that ensures open communication so that they're comfortable speaking to us about everything from family issues, side effects, financial burdens, like anything that might be impacting their treatment, and then eventually their outcomes from the treatment. So, I just love getting to know our patients. Like, they're not a number at our hospital and in our facility. Like, they're actual humans. We know them, we know their families, we know their dogs' names, we know their kids' names, like we know everything about them. And it just ensures the best outcomes, I think, for everybody.

Host: Absolutely. And Kane, when we talk about those relationships that Casey mentioned, I mean, often these people become like family to you and yours. So, who's behind all this great work and personalized touch? Who comprises this cancer care team at Carson Valley Health, and what are the roles essentially that they play?

Kane Deem, PA-C: Yeah. It's just Dr. Freeman and myself, we rotate through all the patients, so we know the patients quite well. And then, we have MAs, nurses, pharmacists who help deliver this high level of care.

Host: Casey, how about the way in which technology is enhancing cancer treatment and the coordination of care in a rural setting? Obviously, things are changing and improving all the time in the medical world. What are the biggest one or two things happening along those lines now that help you and yours do your job better considering the challenges you are up against?

Casey Hirsch, RN: So, Kane talked about the NCCN guidelines earlier. We've had so many new outcomes with clinical trials, drug advancements, side effect management. And even though we are not one of those bigger facilities, one of those 33 top ones that he discussed, that, you know, sets those guidelines, we still follow those guidelines.

So, their advancements in technology, they just directly impacted us and the ability that we're able to take care of our patients. And that's all technology-driven with immunotherapies, genetic testing, biomarkers, all that cool stuff, which has been amazing. Carson Valley Health, we don't do PET scans, but I will say what we lack in technology we make up in just TLC for our patients. It's a great facility. It's the best. And we just provide a personalized care to all of our patients, which makes a huge difference, I think.

Host: And Kane, continuing along those lines, how about maybe an example of something that you provide in terms of a service that people might be surprised to hear they can get at Carson Valley in a rural setting?

Kane Deem, PA-C: What I think is important is most people are concerned with if they're getting cutting-edge treatment. Now through the Pennington Cancer Institute at Renown Health, under the director of Dr. Max Coppes, we do have access to clinical trials, not only for treatment, but also for diagnosis and screening. And through the Healthy Nevada project, we also have genetic healthcare risk assessments that can be done even through primary care. So, patients who want to be involved in clinical trials, they can come to us now. And we can help enroll them in clinical trials, which is amazing for patients living in rural Nevada.

Host: And so, Casey, what's some of the feedback, generally speaking, that you're getting from patients that shows that you really are making a difference in the community when you're providing this kind of a personal touch that we've discussed, what does it mean to them?

Casey Hirsch, RN: It is tremendous. It's amazing. You know, the first thing we're normally met with is patients always say, "We didn't know you were here." They had no idea that we're able to provide these services to them. And often patients start out getting treated elsewhere in Reno or Utah or Texas, wherever, and then they live in Gardnerville, transfer care to us. And that's always the first thing they say is they had no idea they were there. They say they love getting to know us.

I get told all the time that we make chemotherapy and cancer treatment actually enjoyable, and that they actually look forward to coming and seeing us, which is amazing. And that, you know, like you already mentioned, they become family almost.

And I mean, I have had patients over the years that I have spent holidays with. I mean, it's amazing the relationships we make and I've worked at bigger facilities. And I always establish great relationships with my patients, but it's just on a much more personal deep level at Carson Valley Health. And that's what the patients say too. It's the best.

Host: So, how rewarding, in summary here, Kane, is that when you go home from work at the end of a long day to know that you're making this kind of a difference?

Kane Deem, PA-C: Well, that's the nice thing about living and working in a small community. Every day, I'm at a ball field or the local grocery store. And I see patients and they come up to me and express their gratitude for making a difference. So, you see this whenever you live in such a small community, how much of a difference you can make in someone's life.

Host: And that's important, right, Casey? Because if you're shopping at the supermarket and you see someone that's been under your care, you better have had your ducks in a row, right?

Casey Hirsch, RN: I know. It's true. And I love running into patients. It's the best. I mean, they know my daughter, they know my family. I mean, and it goes both ways. It's the best. I love seeing them out in the real-world and healthy and living their lives. It's the best.

Host: That's really what community means in this instance, right?

Casey Hirsch, RN: Absolutely.

Host: Well, folks, we trust you are now more familiar with cancer care in rural Nevada. It's not all that different from cancer care most other places, as we've just learned. Kane, Casey, sounds great. Keep up all your great work, and thanks so much again.

Casey Hirsch, RN: Thank you.

Kane Deem, PA-C: Thanks for the invite.

Host: Absolutely. And for more information, please visit carsonvalleyhealth.org. Also, please make sure to subscribe to our podcast, share and connect with us on social media and stay tuned for more engaging discussions. I'm Joey Wahler. Thanks so much again for being part of Valley Vitals.