A passion for protons
By Christine Boatwright
Nancy Mendenhall, M.D. ’80, fell in love with every specialty she practiced during clinical rotations at the UF College of Medicine. While she changed her mind at least a dozen times in terms of her future, Mendenhall discovered an interest with the disease process of cancer.
“To me, I just wanted to understand cancer better,” she said. “I wanted to understand why people got cancer and how to get ahead of it — how to get rid of it.”
Mendenhall was still undecided when she scheduled interviews with about 25 residency programs over a six-week span. She settled on a pathology residency followed by a surgical oncology program, but a suggestion by late pediatric pathologist William “Bill” Donnelly Jr., M.D., sent her on a new path that would not only greatly affect her life, but also the future of cancer care in Florida.
Donnelly impressed upon Mendenhall the need to take an elective in radiation oncology before she graduated. During her first week of the course in September 1979, a proverbial light bulb went on for Mendenhall.
“Suddenly, it wasn’t about what I liked — because I liked every aspect of medicine— it was about what I had to do because there was this field that was just perfect for me,” said Mendenhall, who recently was recognized by her alma mater for her contributions to the medical field by being named to the UF College of Medicine Alumni Wall of Fame.
For Mendenhall, radiation oncology combined her two medical interests — a focus on cancer and a process similar to surgery. Instead of wielding a scalpel, Mendenhall would use radiation to excise disease.
“I really found the geometry and the creativity of designing the radiation treatment fascinating,” she said. “I loved looking at the images and figuring out the angles from which to approach the tumor.”
Mendenhall also realized her relationships with her patients would not conclude when radiation treatments eliminated tumors. She would see her patients every week, as well as continue visits to monitor tumor control and any side effects of radiation.
“(Radiation oncologists) were always looking back at the outcomes of their patients,” Mendenhall said. “I loved that. I saw the opportunity as a physician to actually help medicine become better for patients.”
Mendenhall’s plans hit a snag when she learned the two UF radiation oncology matches had been awarded to her classmates. When one of her classmates decided not to take the position, Mendenhall jumped at the chance.
“From that, I never have looked back,” she said. “Going into radiation oncology was the best decision I’ve ever made.”
Mendenhall and William “Bill” Mendenhall, M.D., married before she started her internship and residency program. Bill Mendenhall was two years ahead of his wife in his residency program, and the couple worked as radiation oncologists under Rodney Million, M.D., first chair of the department of radiation oncology. Nancy Mendenhall joined the UF faculty in 1984, and she and her husband continue today as radiation oncology professors, though in different areas of interest.
“We understand each other in the commitment and expectations. He might give me a hard time about working on a paper too long but never about spending time with my patients,” Nancy Mendenhall said.
When Million stepped down as the radiation oncology chair in 1992, Mendenhall took his place, making her the first female department chair in the UF College of Medicine.
For 13 years, Mendenhall led her department through a financial crisis in the College of Medicine, leadership changes and updated college operations. She stepped down as chair in 2005 to embrace a new passion — proton therapy.
Mendenhall had learned about the power of protons during her residency program, but proton application in cancer care had to wait until technology progressed. In the mid-1990s, 3-D imaging improved to the point that doctors could detect a tumor’s precise boundaries and apply proton radiation therapy directly.
After hearing a 1998 presentation on protons, Mendenhall felt the treatments would be better for patients than traditional radiation methods. Proton treatments could reduce the negative effects of radiation on normal tissue and thus cause fewer future complications.
“It became a passion to get this technology for our patients,” she said.
Mendenhall explained the benefits of proton therapy to College of Medicine Dean Kenneth Berns, M.D., Ph.D., who immediately assigned future dean Craig Tisher, M.D., to create a task force to discover what was needed for a proton therapy center. The task force worked from 1998-2002 and decided Jacksonville would be an ideal location for the UF Proton Therapy Institute. Mendenhall became the medical director when the institute opened in 2006.
“It was clear to me that radiation was and would for a long time be an extremely valuable cancer tool. We cured patients who no one else thought we could cure by very carefully applying the technology we had,” Mendenhall said. “We saw problems in normal tissues, so there was always this balancing act. We realized that protons — when technology was mature enough — could be applied to most cancers and would probably both reduce side effects and increase cure rates. We realized we could make a difference, a huge step forward in patient outcomes.”
Mendenhall and her team continue to learn about the effects of protons through clinical research at the UF Proton Therapy Institute. She said she feels the responsibility to first treat patients safely and secondly to provide access to protons for as many patients as possible. Mendenhall also said clinical research is also a major priority because carefully documenting the benefits of proton therapy through clinical research will create the evidence necessary to change patterns of care across the country and ultimately make access to proton therapy easier for patients
“It’s exciting to be at a place like the University of Florida where it’s possible to do something like this,” Mendenhall said. “Many other people had similar ideas but their institutions were not as supportive or visionary as ours was. They didn’t get a chance to be an early adopter of proton therapy. I feel very fortunate to be at the University of Florida.”