Director's Message: 10-Year Outlook for Cancer Centers

At the October 1-2 Association of American Cancer Institutes (AACI) meeting in Chicago, there were a number of interesting sessions covering global cancer research and care, physician burnout (high in oncology), use of big data in cancer care and research, and the explosion in breast cancer genomics.

My favorite session (which I chaired) was on the 10-year outlook for cancer centers. I asked Candace Johnson, director of Roswell Park Cancer Institute, Steve Rosen, Director of City of Hope, and Mike Kastan, Director of the Duke Cancer Institute, to provide their wisdom after a collective 62+ years overseeing cancer center operations. They offered different perspectives on the topic with little overlap. You will notice that no one took on the challenge of identifying where the next new discovery will be and its impact in 10 years - that is just too hard!

Below is a summary of their comments and some possible solutions. I would be delighted to hear your thoughts about the prospects for each and what is missing from the inventory. 

New technologies and their impact:

  • "Liquid biopsies" for screening, early detection, and monitoring responses- is technology ahead of biology? Can this be the approach to detection that improves outcomes? 
  • Efficiently developing effective combinations of therapies- as so many new therapeutics are being developed; how can we most effectively and efficiently test all of the possible combinations, especially combinations including immunotherapies and targeted therapies?
  • Accurately assessing an individual's risk for cancer development- cancer susceptibility genes, modifying genes, family cancer genes, polygenic influences, environmental influences, etc.

Organization of cancer care and networks:

  • Consolidate care coordination across networks - provide more uniform care across broad geographic regions including the delivery of novel therapy, cell therapy, and the use of video medicine and bodily sensors for patient treatment and management.
  • Develop robust, patient-centric cancer care teams - consisting of a patient navigator, multi-disciplinary MD team, nurse coordinator, advanced practice nurse, and survivorship coordinator.
  • Organize a data care team to manage the burgeoning use and access to patient data including EMR, patient-reported outcomes, treatment, decision-making tools, genomics, risk assessment and follow-up instructions over time.
  • Allow broad access to novel therapeutics with extended access to clinical trials and use of real-world data with the early release of new agents.

Risks to cancer centers:

  • Disappearance of the physician scientist-value - promote and incentivize the clinical investigator. 
  • Diminishing reimbursement for services- promote legislation to not tier out a cancer center, implement cancer care pathways to standardize quality of care, be proactive in demonstrating value for academic versus community cancer care.
  • Shrinking federal/foundation/private grant dollars - team approach with more collaboration with other investigators and centers, develop mentoring programs to help young investigators, continuing lobbying efforts. 
  • Technology and communication issues, not integrated - consolidated EMR within communities, greater ability for data transfer and integration between laboratory and clinic.

We will look back and see how short-sighted we are in these projections but will enjoy the ride to get there.