After Chico resident Debbie Pease was diagnosed with breast cancer, she learned that she qualified for a clinical trial through UC Davis Comprehensive Cancer Center. It was designed to test the effectiveness of low-dose tamoxifen in treating women with early-stage breast cancer.

Pease, a patient at the Enloe Health Regional Cancer Center, signed up for the LoTam trial knowing she wouldn’t have to travel far from home.

That’s because Enloe is a UC Davis Cancer Care Network (CCN) affiliate — one of four sites in Northern California where patients benefit from the services of a major academic medical center. Not having to drive to Sacramento for the study was important to Pease. When her husband, John, underwent a heart procedure a few years ago, they had to go to Marysville, 50 miles away. “It was a miserably long day,” she recalled. “Enloe’s a mile from my house. I’m so grateful my travel time is zip.”

The CCN is a national model for integrated, collaborative cancer care between community cancer centers and an academic medical center such as UC Davis Health. In addition to Enloe Health’s cancer center, the other affiliates in Northern California include: Gene Upshaw Memorial Tahoe Forest Cancer Center in Truckee, Adventist Health and Rideout Cancer Care Center in Marysville and Marshall Cancer Center in Cameron Park.

A key benefit of being an affiliate is access to clinical trials. 

Pease’s oncologist, Nicole Whitlatch, is lead investigator for the LoTam trial at the Enloe site. The study aims to determine if a low dose of tamoxifen can effectively prevent disease recurrence as usual hormonal therapy, including aromatase inhibitors, in patients with stage 1 breast cancer. If successful, low-risk patients like Pease may be able to avoid the unpleasant side effects — hot flashes, mood swings, night sweats and joint pain — that often accompany traditional hormonal therapy.

From routine screening to stage 1 diagnosis

Pease, 68, had been getting yearly mammograms and occasional biopsies since 2017 when she was diagnosed with atypical lobular hyperplasia. So, she was not overly concerned this past summer when, after her annual scan, she was called back for additional imaging and a biopsy.

Until now, she received the results — always negative — by mail. This time was different. Her doctor’s office phoned and asked her to come in on a Friday afternoon. “I knew this wasn’t a social call,” she said, half joking.

She was diagnosed with stage 1 invasive ductal carcinoma and, on July 23, underwent a lumpectomy, then five radiation treatments at Enloe over the course of a week. Whitlatch, her oncologist, mentioned the clinical trial.

“She’s generally quite healthy, had very early-stage breast cancer and fit all the criteria,” Whitlatch said.

Making the decision

Pease consulted with a friend who was treated for breast cancer 15 years prior. Her friend found the treatment side effects intolerable and encouraged her to join the study. Pease thought about the women who had gone before her, participating in research that resulted in the lumpectomy that she now benefited from. “Let’s do it,” she said.

Whitlatch explained that she would be randomly placed into one of two study arms, receiving either low-dose tamoxifen (the investigational arm), or the standard or higher dose of tamoxifen versus an aromatase inhibitor (standard of care arm).

Because the study isn’t blind, Pease was placed on the standard of care arm, and she elected to take an aromatase inhibitor, letrozole.

“Great. I get to have hot flashes, mood swings and weight gain again,” she recently groused good-naturedly. “I was hoping to get the lesser arm. But it is not that bad. Not a lot keeps me down.”

Clinical research that comes to patients

Married for 40 years and retired from her job as an office manager for a local orthodontist, Pease has two grown sons, two young granddaughters and another on the way. She spends much of her time reading, crocheting, “putzing” around the house and walking at a nearby park or at the mall with her husband. Being in the study, she said, hasn’t cramped her style in the least. “I’ve had no bad experiences,” she said. “It hasn’t stopped me from doing anything I’d normally do.” As a benefit, she will be observed by the study’s researchers for 10 years, which gives her an extra sense of security about her health.

Whitlatch has proven especially adept at signing up participants for the LoTam trial. Enloe is consistently in the top three highest-accruing sites among nearly 650 study locations. The Mayo Clinic and Washington University School of Medicine are the other two. She heads up three other breast cancer clinical trials, and Enloe clinicians are involved in 11 additional cancer-related clinical trials, all through Enloe’s status as a CCN affiliate. According to Yulia Thorpe, director of the UC Davis Cancer Care Network, more trials will roll out soon.

“Our research involvement with UC Davis has been incredible,” said Whitlatch, who has been at Enloe since 2010. “It’s the most robust research program I’ve been involved with since coming to Enloe.”

She noted that the health system’s affiliation with the CCN is “a wonderful service” for everyone participating. “All the oncologists here are very happy to be involved with UC Davis clinical trials,” she said. “We have a long-term relationship with Davis, referring patients back and forth. And it’s good for our patients. It would be a great hardship for them to have to travel to UC Davis for these trials.”