Cancer Center Directors Research Articles

Improving the Quality and Value of Cancer Care: A Work in Progress-The 2016 Joseph V. Simone Award and Lecture.

It is a rare opportunity to give a lecture named after a living personwithwhomyou are professionally acquainted and have worked on multiple occasions. Thus, to be named the recipient of the first Joseph V. Simone Award and Lecture is a special honor, because I have admired the contributions of Dr Simone over many years and have been the beneficiary of his good counsel on multiple occasions. Joe Simone is a pioneering advocate for the importance of delivering evidence-based, quality cancer care, along with metrics to evaluate its implementation. Throughout his distinguished career as a pediatric oncologist, cancer center director, and leader in the development of oncology care guidelines and quality improvement strategies, Dr Simone has been a shining light for members of the oncology community who are focused on ensuring the delivery of high-value quality care to patients with cancer. I will make reference to his many contributions as I describe the content of my award lecture presentation.

Value, Access, and Cost of Cancer Care Delivery at Academic Cancer Centers.

Key challenges facing the oncology community today include access to appropriate, high quality, patient-centered cancer care; defining and delivering high-value care; and rising costs. The National Comprehensive Cancer Network convened a Work Group composed of NCCN Member Institution cancer center directors and their delegates to examine the challenges of access, high costs, and defining and demonstrating value at the academic cancer centers. The group identified key challenges and possible solutions to addressing these issues. The findings and recommendations of the Work Group were then presented at the Value, Access, and Cost of Cancer Care Policy Summit in September 2015 and multi-stakeholder roundtable panel discussions explored these findings and recommendations along with additional items.

Anthracycline Cardiotoxicity: Strategies for Prevention and Intervention

*Corresponding author: Guilherme H. Oliveira, MD, FACC Associate Professor of Medicine Chief, Heart Failure Section Director, Onco-Cardiology Program Seidman Cancer Center Director, Advanced Heart Failure and Transplantation Center Harrington Heart and Vascular Institute Case Western Reserve University School of Medicine University Hospitals Case Medical Center 11100 Euclid Ave. Cleveland OH 44106, USA E-mail: guilherme.oliveira@uhhospitals.org

Bernhardt treats pediatric oncology patients, participates in worldwide research projects

Bernhardt treats pediatric oncology patients, participates in worldwide research projects

Cancer-Focused Research

Cancer-Focused Research

Editorial introductions

Editorial introductions

Prof. Shukui Qin: strategy on liver cancer treatment for Asian population.

Prof. Shukui Qin is the deputy director of People’s Liberation Army (PLA) 81 Hospital (Nanjing, China), director of Cancer Center of Chinese PLA, and director of National Drug Clinical Trial Agency of PLA 81 Hospital. He serves as the executive member of the Asian Clinical Oncology Society (ACOS), chair of Chinese Society of Clinical Oncology (CSCO), council member of PLA Medical Science Commission (and the executive member of its oncology society), member of the Oncology Branch of Chinese Medical Association.

Prof. Yi-Long Wu: Patients on the afatinib arm had a significantly better quality of life according to the data of LUX-Lung 6.

Prof. Yilong Wu (Figure 1) is a consultant oncologist, PhD supervisor, Fellow of American College of Surgeons, Vice President of GGH and Guangdong Academy of Medical Sciences as well as Director of Cancer Center, Director of Guangdong Lung Cancer Institute, member of the Council of the Chinese Anti-cancer Association, Chairman of the Chinese Society of Clinical Oncology (CSCO), Chairman of the Chinese Society of Lung Cancer (CSLC), President of Guangdong Association of Clinical Trial.

An enduring enthusiasm for academic science, but with concerns

I turned 70 this year and started graduate school shortly after turning 20. Thus, at this writing, I have spent 71.3% of my life in academic science. I have no regrets and hope to continue for years to come, because I remain an unabashed enthusiast for both the research and education components of this profession. The high honor of the E. B. Wilson Medal and the accompanying request to write this essay give me an opportunity to reflect on why this is so, as well as on my concerns about the fouling of the nest that has made it harder for any of us—but particularly for younger people—to enjoy academic science as I have over the past 50 years. My enthusiasm should not be misunderstood as naivete. I well understand that not every aspect of the job is fun; some tasks are inevitably tedious or even painful. It hasn't always been easy for me personally; like most people, I struggle with my own limitations, notably an incurable perfectionism and the frequently linked traits of avoidance and procrastination, which have often made it difficult for me to finish papers and other tasks. I have had papers and grants rejected and seemingly great ideas that turned out to be lousy when actually tested. As a graduate student, postdoc on two continents, faculty member at three universities, and dean for graduate students and postdocs, I have seen plenty of nasty stuff: subcompetent people obstructing progress at all levels; arrogance and self-centered insensitivity to the feelings of others; exploitation of students and postdocs by faculty; dishonesty ranging from exaggerated claims and the concealment of inconvenient data to gross fabrication; pointless and demeaning squabbles about priority and authorship; abuse of the still-critical tenure system; inappropriate behavior by editors and reviewers; and behavior driven by lust for power, money, and fame rather than by any desire to understand nature and (perhaps) improve human well-being in the process. And, in recent decades, I have seen the environment in which science is done erode in ways that I deplore. Nonetheless, I still feel that doing science is fundamentally Good (even noble) and that universities are wonderful places. I still look forward (almost) every day to going to the lab, and I have liked (to various degrees) almost every scientist I have known over a long career. How can this be? My attempt at explanation follows.

It is not appropriate to “deform” dose along with deformable image registration in adaptive radiotherapy

It is not appropriate to “deform” dose along with deformable image registration in adaptive radiotherapy

FDA Commissioner Names Cancer Center Director as Agency's First Chief Scientist

FDA Commissioner Names Cancer Center Director as Agency's First Chief Scientist

Rallying to Oncology Patients & Cancer Care Professionals, Two New Orleans Cancer Center Directors Share Their Stories

Rallying to Oncology Patients & Cancer Care Professionals, Two New Orleans Cancer Center Directors Share Their Stories

Evaluating the financial impact of clinical trials in oncology: results from a pilot study from the Association of American Cancer Institutes/Northwestern University clinical trials costs and charges project.

Medical care for clinical trials is often not reimbursed by insurers, primarily because of concern that medical care as part of clinical trials is expensive and not part of standard medical practice. In June 2000, President Clinton ordered Medicare to reimburse for medical care expenses incurred as part of cancer clinical trials, although many private insurers are concerned about the expense of this effort. To inform this policy debate, the costs and charges of care for patients on clinical trials are being evaluated. In this Association of American Cancer Institutes (AACI) Clinical Trials Costs and Charges pilot study, we describe the results and operational considerations of one of the first completed multisite economic analyses of clinical trials. Our pilot effort included assessment of total direct medical charges for 6 months of care for 35 case patients who received care on phase II clinical trials and for 35 matched controls (based on age, sex, disease, stage, and treatment period) at five AACI member cancer centers. Charge data were obtained for hospital and ancillary services from automated claims files at individual study institutions. The analyses were based on the perspective of a third-party payer. The mean age of the phase II clinical trial patients was 58.3 years versus 57.3 years for control patients. The study population included persons with cancer of the breast (n = 24), lung (n = 18), colon (n = 16), prostate (n = 4), and lymphoma (n = 8). The ratio of male-to-female patients was 3:4, with greater than 75% of patients having stage III to IV disease. Total mean charges for treatment from the time of study enrollment through 6 months were similar: $57,542 for clinical trial patients and $63,721 for control patients (1998 US$; P =.4) Multisite economic analyses of oncology clinical trials are in progress. Strategies that are not likely to overburden data managers and clinicians are possible to devise. However, these studies require careful planning and coordination among cancer center directors, finance department personnel, economists, and health services researchers.

Concerns of special populations: cancer and the aging population--a meeting of the President's Cancer Panel, July 31, 1997.

Concerns of special populations: cancer and the aging population--a meeting of the President's Cancer Panel, July 31, 1997.

Clinical Trials: A Congressional Focus of Need

Senator Specter, Honorable Members of the Committee, it is my high privilege to speak on behalf of a subject near and dear to my heart. I have been involved in the care of patients with cancer and in cancer clinical trials for the past 34 years. I chair the Southwest Oncology Group, the largest National Cancer Institute-supported cancer clinical research organization. In 1996, this Group enrolled 6,359 patients to therapeutic cancer clinical trials from all 50 states (Fig. 1), and completed the randomization of 18,867 normal, healthy men into the intergroup Prostate Cancer Prevention Trial. Cancer clinical trials are always designed to improve the outcomes of cancer patients. However, only 2%-3% of all eligible cancer patients in this country are treated on these cutting-edge trials. It is clear that this number must increase dramatically in order for us to be able to translate the monumental advances emanating from the basic cancer research laboratories into effective diagnosis, prevention and treatment strategies for patients with and at high risk for cancer. This low accrual is related to multiple factors: First, managed care has had a negative impact related to its refusal to reimburse for the clinical care aspects of patients on cancer clinical trials. During my presentation to the President's Cancer Panel in San Antonio in September, I shared three thoughts as to what the Panel should be asking as they pursue the question of "Managed Care's Role in the War on Cancer": &bul; "Should managed care bear a portion of the costs of clinical research as a form of R & D?" &bul; "What State or Federal legislation is needed to assure that managed care patients have access to cancer clinical research?" &bul; "Will there be any future for cancer clinical research when the managed care tidal wave finally reaches Chicago and New York?" The NCI-Department of Defense and the NCI-Department of Veterans Affairs Interagency Agreements are superb models of what needs to be done for the rest of managed care. Secondly, the Southwest Oncology Group is outstripping its financial support at its current rate of accrual. Even if the managed care problem was resolved, there must be more money to support clinical research to translate this plethora of science to patients with cancer. I am also Director of the San Antonio Cancer Institute, a National Cancer Institute-designated Comprehensive Cancer Center. A recent astonishingly productive Breast Cancer Program Project Grant received a priority score one point below the pay line. While this grant will undoubtedly be funded by exception, it is representative of a nationwide problem of insufficient funds to support truly outstanding research. The following quote is from another Cancer Center Director, who is also a Cooperative Group Chair: "We never know where the next breakthrough will come from. Every time we discover a new gene, we also have a new marker for early diagnosis, a new predictor of response to therapy, a new target for chemoprevention, as well as for cancer treatment. Every discovery in a Cancer Center provides fuel for the Cooperative Group program, and requires affirmation in large clinical trials. Thus, the universe of cancer research is a continuum, (where) improved funding for any of it, impacts all of it, and improved funding for all of it will hasten the pace of discovery throughout." (Richard L. Schilsky, M.D.) Finally, I would like to paraphrase a futurist that I recently heard: &bul; "The present is obsolete." &bul; "The future has already been discovered" in the laboratories of molecular biologists throughout this country! We must search among those discoveries for the keys to cancer cures. &bul; "We are confronted with insurmountable opportunities!" &bul; "These new tools will change the rules of the game!" &bul; "We should not manage change, we should love change and make change our best friend," as all those involved in cancer research and the Congress must do every day. (Don Burrus) Thank you for your attention.

Instruction in the techniques and concept of supportive care in oncology.

Cancer education merits a coordinated, vertical curriculum and an integrated planning strategy. It has become clear that it is as important to teach the techniques of supportive care in oncology as it is to teach the concepts of cancer biology, pathology, epidemiology, prevention, detection and aggressive treatments. Our aim is to determine whether the medical school and nursing school curricula give the students an introduction to the concepts of supportive care of the cancer patient. The spectrum of such supportive care encompasses a wide range of issues working towards a common goal of providing overall comfort with an emphasis on quality of life, and runs parallel with specific therapeutic strategies and associated problems. Do the graduate medical student and nursing student understand that cancer management is multidisciplinary and team-based? That the approach to pain management not only includes the administration of pain medications, but should also evaluate pain assessment and anesthetic, neurosurgical and behavioral approaches? That nausea and vomiting associated with chemotherapy can be ameliorated to a certain extent? That infections are common but algorithms exist for prevention and therapy? That certain metabolic complications are unique to cancer patients? That transfusions are vital procedures in patients with neoplasms undergoing aggressive treatments but are associated with certain risks and complications? That there are serious psychosocial, ethical and legal needs to be considered? To address these issues, the American Cancer Society Professors of Clinical Oncology, the American Cancer Society Professors of Oncology Nursing and the United States Cancer Center Directors were surveyed.(ABSTRACT TRUNCATED AT 250 WORDS)

Does chemotherapy fulfill its expectations in cancer treatment?

In 1949, Cornelius P. Rhoads, director of the Memorial Sloan-Kettering Cancer Center, made his famous report on the practical value of nitrogen mustard before the Committee on Growth of the National Research Council, a quasi-governmental agency which had accepted the responsibility for the clinical trial of this drug at the end of the war. Doctor Rhoads assigned to David A. Karnofsky the job of receiving reports from individual physicians and analyzing the results in each type of cancer. The conclusions, based on 2500 case reports, indicated that nitrogen mustard did not cure any form of cancer, but it was temporarily useful in chronic leukemias, Hodgkin's disease, malignant lymphomas, and lung cancer. The most valuable outcome of this report was the beginning of massive and direct attack on cancer in humans. Since that time, in fact, there was enthusiasm and interest in studying cancer; physicians have been educated, interested and motivated to treat the disease; investigators became engaged in the search of new growth-inhibiting compounds and research clinicians in the formulation of new treatment strategies. The result was a progressively growing list of tumors responding to drug treatment with increased complete remission, prolonged disease free and even total survival rates particularly in the early stages of given malignancies; patient care, the most important achievement in cancer medicine, has been drastically improved. Clinical chemotherapy of cancer has a long history of controversies. Though never advocated as panacea, this form of treatment has continuously fluctuated between excessive optimism and detraction. Recently, harsh criticism has pointed to the magnitude of the overall results achieved in terms of decreased national mortality statistics for the various malignancies. An impatient group of clinicians, biostatisticians and epidemiologists began to question whether medical oncology has reached a plateau in its control of cancer or whether the entire treatment strategy for the control of cancer is wrong. Since sweeping generalization cannot be supported for the results of treatment in each tumor subset require separate analysis, let us review the biological principles of cancer treatment, the main strategies utilized, and the results achieved in the major groups of malignancies. The paper will also outline the contributions of chemotherapy to the medical sciences and to the care of the patients with cancer during the last 40 years.