Nurses Who Specialize in Proton Therapy and So Much More


By Theresa Edwards Makrush

The depth of experience and specialization at the UF Health Proton Therapy Institute in every department is a distinction that sets us apart from other proton therapy centers and radiation oncology practices in the region. In recognition of National Nurses Week (May 6-12), we highlight the expertise of our adult nursing team, which is led by Gail Sarto, RN, BSN, director of adult nursing.

According to Gail, all of our nurses are both clinical – meaning they provide the day-to-day care of patients receiving treatment – and do research – meaning they conduct follow-up with patients on clinical trials. Each nurse works as a team member with the physician and has a specialty in the anatomical site that is being treated. There are multiple bilingual nurses, and we have five languages represented on the team besides English.

With over 400 years of combined experience, the adult nursing team is comprised of 20 full-time nurses and medical assistants, five part-time nurses and medical assistants and one administrative assistant. Their ranks include five oncology certified nurses, two nurses who have master’s degrees in nursing and one nurse who is working toward a doctoral degree in nursing research.

Our nurses apply their specialized knowledge and skill with compassion. Patient care is tailored to the individual, and the nurse case manager helps patients manage symptoms or treatment-related concerns during and after treatment.

Excellent nurses have a unique capacity to care and to take action to help others. Both on the job and on their own time, our nurses exemplify compassion, professionalism and leadership.

Adult Nursing Team Interesting Facts

Our nurses have a wide range of experiences and interests. The following list illustrates some of their exceptional accomplishments.

A member of the team:

  • Has been a combat airborne medic and received the Meritorious Service Medal
  • Is a board member on the local American Cancer Society
  • Was a supervisor of a phlebotomy lab
  • Worked in Africa in the Peace Corp
  • Was the assistant nurse manager of the Shands ER
  • Was a manager of a turtle farm
  • Is a member of the National Disaster Response Team
  • Was a Wildland Firefighter
  • Was an owner of a long-term assisted living center
  • Was a member of the United Nations refugee Relief program
  • Was a labor and delivery nurse for over 10 years
  • Has yoga certification working with patients with a cancer diagnosis

Many team members:

  • Were medical assistants or certified nursing assistants before they became nurses
  • Have Intensive Care experience and one had a specialty in Neurology

Clinical Research Documents the Benefits of Proton Therapy

UF Health Proton Therapy Institute clinical research program

By Theresa Edwards Makrush

Over the past 12 years, the volume of published research about proton therapy has grown significantly, thanks in part to the clinical research program at the UF Health Proton Therapy Institute. Our UF Physicians lead research on proton therapy for cancers of the breast, central nervous system, head and neck, lung, pancreas, and prostate as well as lymphoma, chordoma and sarcoma. Since August 2006, we have opened 65 clinical trials. Of those, 36 have been completed and more than 174 articles have been published in peer-reviewed medical journals.

“The main purpose of the research is to document in a scientifically credible way the benefits of proton therapy,” said Nancy P. Mendenhall, MD, medical director and University of Florida professor of radiation oncology. “We think these benefits are going to be present in every single application: pediatrics, brain tumors, head and neck cancer, breast cancer, prostate cancer, lung cancer, pancreatic cancer.”  

One clinical trial that opened in 2006 and is ongoing is the Outcome Tracking Project, or OTP. Nearly all adult patients – 97% – have elected to participate and a majority of pediatric patients – 76%. This registry is an important source of data since it collects information from patients and from their medical records regarding their disease, treatment and side effects to see what effect the radiation has on them and their disease.

Much of the work in analyzing the data collected by nurse case managers and reported by patients is supported by the 11 staff members in the Research Services department. Led by Robin Cacchio, RN, CCRP, the team has a combined 40 years of proton therapy experience. They include four who are registered nurses, or RNs, and five who are certified clinical research professionals, or CCRPs.

>> Click here to learn more about clinical research at the UF Health Proton Therapy Institute.

Students Make Donation in Support of Classmate


By Theresa Edwards Makrush

Last October, nine-year-old Hartley Georges had proton therapy for a rare brain tumor, medulloblastoma. The third grader at Orange Park Elementary School in Orange Park, Florida, kept up her studies with the help of her teacher Jennifer Allen, and kept up her spirits with the help of her schoolmates and the social services team at the UF Health Proton Therapy Institute. Hartley’s mother Michelle Georges said her teacher knew how much joy the art table brought to the entire family and organized the school’s student council holiday donation drive to collect art supplies for the Institute.

With a list from Pamela Gardener, artist-in-residence at the Institute, the entire school from Kindergarten through 6th grade chipped in to gather up enough art supplies to fill many large boxes to the brim with everything from acrylic paint to yarn. They also collected toys for the child life program and dropped them off to child life specialist Jennifer Duncanson, MS, CCLS. Michelle said the art program and the child life program helped the patients and their families connect with each other, relax, and feel more comfortable. “Pam was wonderful. We loved seeing her on Monday, Tuesday and Wednesday,” she said. “A smiling, familiar face and someone popping in and checking in each day was the joy that Jennifer Duncanson brought.”

The gift of art supplies and toys will help reduce anxiety and inspire creativity for patients and family members. “We are overwhelmed by the generosity of the Orange Park Elementary School and the people who made it happen,” said Pamela.




Executive Director Message

StuartKlein.pngI like to think of UF Health Proton Therapy Institute employees as family members, and there are many of our family members who are behind the scenes helping to make the Institute run smoothly. Last week we unfortunately lost one of our most highly valued family members. Jeff Rexford was a truly extraordinary man who led our team of on-site engineers, overseeing the maintenance of the proton equipment. Jeff served in this role as IBA’s site-manager since 2006. Thanks to his exceptional leadership, our proton therapy equipment was rarely out of service and was maintained to the highest standard. Jeff was recognized by our board of trustees in 2015 as the first recipient of the UF Health Proton Therapy Institute Excellence Award. His dedication was unquestionable. His expertise was undeniable. I am privileged and honored to have known Jeff as a friend, and I truly admire his many contributions to the Institute’s past and future success.


Stuart L. Klein

Executive Director

Caregiving: A Spouse Reflects on “Being Present” During Cancer Treatment

By Barb Hart


On November 15, 2018, my husband was diagnosed with esophageal cancer. I, of course, went online and this is one of the first sentences I saw: “Esophageal cancer is the sixth most common cause of cancer deaths worldwide.” It was not a good day.

Stew is fortunate. His cancer was caught early before he had any symptoms. Also, while we live on a boat and have sailed all over the Caribbean and across the Atlantic, we are currently living in St. Augustine and have very dear (and very smart) friends who work in medicine in Jacksonville. Consequently, we knew about the UF Health Proton Therapy Institute and were quickly referred to Dr. Michael Rutenberg, who has experience treating esophageal cancer and who is simply a wonderful person. (One of many wonderful people who work at Florida Proton.) With referrals to an oncologist and to a surgeon, we were off on this adventure.

On December 26, Stew had the first of 28 proton therapy treatments. In addition, every Friday we visited another facility where Stew had chemo. As I write this, we are waiting for tests prior to (we hope) surgery. It won’t be fun, but all of his physicians have been encouraging and we have reason to be hopeful.

What makes Florida Proton different? There’s a level of caring that goes beyond what happens in the treatment or exam rooms. There is an expectation that every single person at Florida Proton is pulling for both the patient and the caregiver and it slowly dawned on me that every single patient and caregiver we met felt they were all receiving special treatment, and we were. We were noticed. We may be part of a club that no one wants to join, but at Florida Proton that club is a team with a common goal.

The main lobby, the chimes, the art table, the puzzles, the Wednesday lunches, plus the attitude of the entire team at Florida Proton combine to provide a safe space for the patients and their caregivers to gather and chat and get to know each other. That interaction with other patients and caregivers is comforting and healing. It gives some of us a chance to help and others a chance to let go. Frankly, I had expected to take my laptop and get work done, but that’s not what happened. First, they don’t give out the Wi-Fi password at all and that’s a good thing. I didn’t need to write, or email, or text, or do research. I needed to be present for Stew, our fellow travelers, and myself.

I believe he was the only person undergoing treatment for esophageal cancer at that time and I know I caught a few pitying looks from other caregivers when they learned why we were there. That was difficult for me until I looked around and saw others who were more seriously ill than Stew, and still others who had traveled from other countries with a sick child. We are fortunate. In some way, we were all fortunate. Our team of two was supported by everyone who works at Florida Proton and by many of the other patients and caregivers. I hope we gave something back to them, as well.

Esophageal Cancer and Proton Therapy

By Theresa Edwards Makrush
Edited by Michael Rutenberg, MD, PhD, UF assistant professor of radiation oncology


The esophagus, part of the digestive or gastrointestinal system, carries food and liquids from the mouth to the stomach. According to the National Cancer Institute and the American Cancer Society, most signs and symptoms of esophageal cancer occur when the disease is at a later stage and the cancer is more difficult to treat. Difficult or painful swallowing or worsening reflux symptoms are the most common symptoms of esophageal cancer symptoms, though they are also common symptoms of other benign diseases. Tests such as CT or PET scans, blood tests, endoscopy and biopsy are used to confirm and stage an esophageal cancer diagnosis.

Treatments often include chemotherapy, radiotherapy, and surgery. For many esophageal cancers, combined therapy (e.g., chemoradiation and surgery or chemotherapy and radiation) provides the best treatment. Proton therapy is an advanced form of radiotherapy that can deliver targeted radiation to the treatment area and minimize harm to surrounding healthy tissue. Because the esophagus is located adjacent to critical organs like the lungs and the heart, proton radiotherapy is ideally suited to deliver curative radiation to the cancer while reducing the dose to the heart and lungs.

Treatment planning studies and early patient outcomes reported by academic proton centers show very promising results with proton therapy in combination with chemotherapy. Among the advantages include reduced treatment related complications including reduced inflammation of the lungs (pneumonitis) and reduced damage to the heart. Reducing the impact of curative treatment on normal, healthy lungs and heart tissue may significantly improve the quality of life and long-term survival of esophageal cancer patients.

  1. Prayongrat A, Xu C, Li H, Lin SH. Clinical outcomes of intensity modulated proton therapy and concurrent chemotherapy in esophageal carcinoma: a single institutional experience. Advances in Radiation Oncology. 2017;2(3):301-307.
  1. Xi M, Xu C, Liao Z, Chang JY. Comparative Outcomes After Definitive Chemoradiotherapy Using Proton Beam Therapy Versus Intensity Modulated Radiation Therapy for Esophageal Cancer: A Retrospective, Single-Institutional Analysis. International Journal of Radiation Oncology Biology Physics. 2017;99(3):667-676


A Hollywood Ending for Five-Year-Old U.K. Patient


By Theresa Edwards Makrush

“The Force” was with five-year-old Lila Everest as she rang Aud’s Chime March 21 signifying her successful mission to complete 30 proton therapy sessions for a brain tumor. Lila’s mom Karen Steel arranged for Star Wars reenactors to be there on Lila’s chime-ringing day. Karen met the Squad 7 members of the 501st Legion at a February screening of the classic film Star Wars: A New Hope with the music score performed live by the Jacksonville Symphony Orchestra. Karen thought it would be the perfect way to help her daughter celebrate because Lila is a Star Wars fan.

According to Lila’s dad Tim Everest, her love for the Star Wars franchise began when she first watched The Empire Strikes Back. Since then, she has adored each of the movies and has become a huge fan. While in Florida, the family visited Disney World three times, the highlight each time being the Star Wars area of Disney’s Hollywood Studios. Tim recounted how Lila was delighted to interact with the characters, including a light saber battle with the villain Kylo Ren, whom she defeated, as well as one-on-one time with robot BB-8 and her favorite Chewbacca. 

With the help of child life specialist Jennifer Duncanson and the radiation therapists, Lila was able to do her treatment without daily general anesthesia. To help her cope, Lila’s parents would tell her Star Wars jokes and trivia to share with the radiation therapists who in turn would share other Star Wars facts. Even the mask used to help her head stay in position during treatment was painted with the face of the famed robot character R2-D2. “Everyone’s been so kind, the therapists especially,” said Karen. “Even though some days are quite dark.”

The family made a donation to the artists-in-medicine program in the name of the reenactors group as a thank you. Tim said the arts table was a welcome diversion for Lila, especially on days she didn’t want to go to treatment.

Lila will celebrate her sixth birthday at the end of March at her home in Brighton in the United Kingdom.

The Everest family with Star Wars characters

Lila with Kilo Ren and Chewbacca


Here Comes the Sun

The Artists-in-Medicine duo Barbara Fryefield Holmes and Pamela Gardener led patients in an exploration of the sun – its energy, warmth, and uplifting joy. The resulting artworks are currently on display in the patient luncheon room. Methods used to create the expressions of sunshine include wax resistance, acrylic painting, mono-printing and collage.

A few selections from the exhibit are shown below.

sun art

sun art

Executive Director Message

StuartKlein.pngThere are now 32 operating proton therapy centers in the U.S. and more on the way. While this means a greater number of cancer patients may have a facility nearby, it also means patients need to look deeper at the quality of the centers offering proton therapy before deciding where to be treated. Just because the equipment is in the building doesn’t necessarily guarantee the center has the expertise and experience needed to provide high-quality proton therapy. The training and skill of the physicians and the entire clinical team can mean the difference in a patient’s outcome including quality of life following treatment. The UF Health Proton Therapy Institute has the most experienced proton therapy physicians and staff in the Southeast U.S. and is nationally accredited by the American College of Radiology. To read more about us and what sets us apart, I invite you to visit our website.


Stuart L. Klein

Executive Director

Positive Proton Moment: Firefighters Gather to Celebrate One of Their Own

By Theresa Edwards Makrush

When patients complete their course of proton therapy at the UF Health Proton Therapy Institute, they ring Aud’s Chime in The Players Lobby. Often their friends and family are there to help celebrate the moment along with fellow patients and caregivers. Applause, hugs, and smiles always accompany the sound of the chime.

A recent “graduate,” as patients who complete treatment are called, had an extraordinary group assembled for his chime-ringing day. Brian Kernohan, a lieutenant with 15 years of experience at the Jacksonville Fire and Rescue Department, was surrounded by an estimated 100 fellow firefighters and first responders. News crews from three local TV stations were there to capture the remarkable scene. (See news stories at news4jax, actionnewsjax and firstcoastnews.)

The outpouring of support was overwhelming, said Brian’s wife Katie. “I don’t know of any other company that is this supportive. We are grateful and overjoyed,” she said. “We love everyone here. They are such an encouragement.”

Brian said that two weeks before Thanksgiving he was suffering from intense head pain and went to the emergency room at a local hospital. After receiving the results of an MRI less than 24 hours later, the 36-year-old was told he needed surgery to remove a rare medulloblastoma brain tumor that is more typical in children under the age of 10. Following a successful surgery, Brian had 30 proton therapy sessions to target radiation in the area where the tumor was removed as part of a treatment plan that may also include chemotherapy.

According to Brian, having a positive attitude has helped him cope with treatment, along with the support of his family members and coworkers he thinks of as family. “My brothers really stepped up today,” he said as he looked out at the smiling faces lining the spiral staircase from top to bottom.


About This Newsletter

The Precision Newsletter is an electronic-only publication that is distributed by email. Each issue is sent monthly to patients, alumni patients and friends of the University of Florida Health Proton Therapy Institute. As the official newsletter of the Institute, the content is compiled and prepared by our communications representative and approved by the editor Stuart Klein, executive director of UF Health Proton Therapy Institute. Special bulletin newsletters may occasionally be prepared when timely topics and new developments in proton therapy occur. If you would like to send a Letter to the Editor, please click here.


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