An alternative cancer center model has been emerging at a number of healthcare institutions around the country that offers patients local access to more and earlier-phase clinical trials and better care than they might receive in traditional community settings, a 番茄社区 investigation found.
These new hybrid centers also provide oncologists an opportunity to practice medicine and conduct clinical research without some of the bureaucratic layers inherent in academe.
They appear to have one overriding common denominator: a director with a record of success at an NCI-designated comprehensive cancer center, who was recruited to establish a new cancer program within a not-for-profit -- but money-making -- regional health system that offered the needed resources and support.
番茄社区 spoke with several prominent clinical researchers whose experience in academic medicine helped them build community cancer centers that offer research programs and cutting-edge care, while also pursuing new career challenges for themselves.
None of those interviewed thought that this hybrid model should supplant the traditional physician clinical career pathways of working in an academic or community setting. Instead, they said it could be a viable way to enhance treatment to more patients while allowing oncologists to continue clinical research without the academic demands to publish and secure grants.
And one cancer center director said that he was ready to formally propose the model he has developed to the National Cancer Institute this fall.
Christiana's Graham Cancer Center
, MD, the Bank of America-endowed medical director of Christiana Care Health System's in Newark, Del., has been at the helm of his center since 2001, when he left after serving as chair of the department of surgical oncology and director of the surgical oncology fellowship training program. He's been president of the Society of Surgical Oncology and served on several influential advisory boards.
Under Petrelli, the Graham Cancer Center had been selected as one of 14 NCI Community Cancer Centers Program (NCCCP) sites; established multidisciplinary centers allowing patients to see a medical oncologist, surgeon, and radiation oncologist in one visit; participated in various national trials and projects; established a Statewide High Risk Family Cancer Registry; created a Center for Translational Cancer Research; and played a significant role in reducing cancer mortality in Delaware.
Petrelli told 番茄社区 in a telephone interviews (monitored by a media relations representative) that he and others who had reached many of their career goals in academia and were still looking for challenges, often sought new opportunities outside their longtime institutions.
In Petrelli's case, it was the challenge of moving to a state with the highest cancer mortality at the turn of the last century and moving it down the list (it's now 15th). He noted that about 20% of adult patients at the Graham Center are in clinical trials, well above the 2%-4% national average.
He has also been working closely with the NCI-designated basic cancer center Wistar Institute in nearby Philadelphia on various translational research projects over the last few years.
He said that this first-time model of collaboration between a basic research center and a community-based hospital would be presented to the NCI in October for a consortium agreement.
Carolinas Healthcare's Levine Cancer Institute
Several hundred miles southwest of Delaware, a former colleague of Petrelli's from Roswell Park has been building another type of hybrid center.
, MD, PhD, joined the Carolina's HealthCare System's in Charlotte, N.C., in 2011, after heading the at the Cleveland Clinic and holding the M. Frank and Margaret Domiter Rudy Institute Distinguished Chair in Translational Cancer Research.
In a telephone interview Raghavan said that he had proposed building a new facility at the Cleveland Clinic since he had run out of space, but was rebuffed because it would eclipse the Clinic's cardiovascular program.
A week later he received a call from Carolinas, he said, which was interested in creating a new cancer center.
On arriving in Charlotte, Raghavan realized Carolinas' vision of a cancer center did not match his own, but that its intention to make cancer the system's number one service line kept him interested.
"The NCI system is working as well as it can, maybe, but the problem is that everybody knows that only about 5% of patients get into clinical trials, and that's a fundamental flaw."
He said that when he was in Cleveland, patients would travel to the experts there for consultations, but upon arriving back home they would return to their community oncologists who were often overwhelmed, overworked, and lacked clinical trial support and would end up receiving the standard of care.
Carolinas HealthCare, with more than 40 hospitals, 60,000 staff and 2,500 physicians in both North Carolina and South Carolina, was originally interested in creating a regional cancer center," Raghavan said.
"They wanted to centralize cancer care in a Taj Mahal here in Charlotte, but after hours of discussion they agreed to consider what I wanted to do."
That vision included creating an "academic-clinical interface" model of cancer care that Raghavan said he would have liked to achieve in Cleveland, but couldn't because of the Clinic's "edifice complex." He added that he then took his centralized academic cancer center at Levine and "sliced and diced it" so that it could exist in multiple sites.
For the past 4 years he's been building an academic center fully integrated in the community, which now includes about 25 sites mostly in rural and suburban communities.
He's hired about 130 clinicians, including other established researchers from MD Anderson Cancer Center, Johns Hopkins, Cleveland Clinic, Emory, Georgetown, and the NCI, and established various oncology fellowship programs, a bone marrow transplantation center, clinical pathways, a disparities-of-care program, and a phase 1 clinical trial unit among other things.
He said the quintessential beauty of the system is that with a central IRB he can now open a clinical trial simultaneously in many sites, something that might have required months back in Cleveland. And he's approaching his goal of placing about 25% of Levine's 20,000-25,000 new patients into trials each year.
, was recruited by Raghavan in 2012 as chair of Solid Tumor Oncology and Investigational Therapeutics, and, like Petrelli and Raghavan, boasts an extensive resumé of endowed professorships and committee posts.
Kim told 番茄社区 that when he was approached about the position he had never even heard of Carolinas HealthCare, but that Raghavan, whom had never met but whose reputation he knew, had promised to support him in solid tumor and early phase research.
"I looked at the opportunities here compared to elsewhere and thought this would be a cool experience. I had spent more than a decade in hardcore academic medicine, but could now get community-based experience while building an academic program integrated into the community," he said.
Kim has since developed Electronically Accessible Pathways () for community-based oncologists throughout the Levine system that outlines clinical treatment pathways, palliative care and social work pathways, and real-time availability of clinical trials. (A Carolinas media relations representative monitored the interviews with Kim and Raghavan.)
Gibbs Cancer Center
Not far from the Carolina's operation, , has been developing yet another hybrid model as director of and president of Gibbs Research Institute at the Spartanburg, S.C., Regional Healthcare System.
He joined Gibbs in fall 2012 after serving more than 20 years at in Tampa, Fla., where he had held a number of top positions.
Yeatman told 番茄社区 by telephone said that he was interested in becoming a cancer center director and putting his fingerprints on the center in a way that was novel, innovative, and brand new, but also knew that the path to an NCI-designated center could take 8-10 years,and required a really strong basic science component.
"So I found Gibbs, which already was an NCCCP center and was good and wanted to become great, and was a place that would allow innovation and could become an innovation center," he said, adding that it "wasn't too big, which could mean legacy issues, and it wasn't too small, which could lead to fear of the new world."
Another critical component, he said, was finding an open-minded CEO who would allow him to take the reins and support him.
Yeatman said that, with support from drugmaker Merck, he helped establish the world's largest human tumor bio-repository and database with comprehensive molecular profiling of approximately 20,000 tumor specimens to deliver personalized cancer care by using the database to find the right patients for the right drug trials, matching patients through genetic analysis of cancers.
"But Moffitt wasn't set up in a way to take this to the next level," he said, noting that he wanted to simplify clinical trial management by bringing pharma to the community, where 85% of patients receive care yet have little access to trials.
So he created the , which he described as a health IT ecosystem.
He said that he's building a network of networks, signing up health systems across the country. Guardian currently has more than 80 hospitals from five systems, but Yeatman said he eventually plans to recruit about 36 systems with a total of more than 300 hospitals so that their shared patient information can be part of a database that will match patients to industry-run clinical trials.
Inova's Schar Cancer Institute
After a medical career that has included senior clinical research positions at University of Wisconsin, Duke, University of Pittsburgh, and Roswell Park, where he stepped down as president after 7 years in 2014, , (no relation to the real estate mogul and presidential hopeful) started a new challenge this January when he assumed the position of CEO and Executive Director of the in northern Virginia.
During a telephone interview Trump acknowledged some of the limitations of working in a large academic cancer center and welcomed the opportunity to develop a cancer program in a well-run multihospital healthcare system with substantial resources, as well as patterns of care, pathways, and guidelines that can substantially impact the quality of care across a system.
"Inova has made a commitment to academics, including supporting the research of [former NCI director] [MD] who directs its Translational Medicine Institute," Trump said, adding that the newly established Inova Center for Personalized Health will be dedicated to advancing cancer treatment and personalized medicine through genomics.
"It's exciting and energizing to be part of a system -- with fewer constraints than an NCI-designated center -- that has clinical research and outstanding patient care as goals," he said.