Tag Archives: Holden Comprehensive Cancer Center


Those of us who work at academic cancer centers often talk about our three overlapping missions:

  • Research – Successful cancer centers conduct cutting-edge cancer research that helps advance cancer medicine so we can do more to help our patients in the future. To assess research productivity we count major research grants, important publications, and research advances that lead to better patient care.
  • Education – Successful cancer centers educate and train the next generation of cancer researchers and care givers, as well as the public about cancer. To assess education, we look at how competitive we are at attracting the best and brightest students to our education programs, as well as the accomplishments of our former trainees.
  • Clinical care – Successful cancer centers provide quality, state-of-the-art interdisciplinary care including cancer prevention, early detection and therapy. To assess clinical care, we track how well our patients do after they receive therapy from us by looking at survival and quality of life. We also track cancer incidence to evaluate the success of our cancer prevention efforts.

There is an additional component to clinical care that is more difficult to measure – delivery of quality service to our patients. Successful cancer centers work to provide a top-notch patient experience. Cancer centers are very different from settings such as retail where service excellence is a priority. Our patients never want to have to seek our services. They are scared and in unfamiliar surroundings, and they have great anxiety about the future. They should be treated not only for their life-threatening medical condition, but also based on their needs as a person.

How do we measure patient satisfaction and the patient experience in a consistent way? We ask patients about their experience through anonymous surveys distributed by an outside group (the company we work with is called Press Ganey). The results of these patient surveys are shared with us, including both ratings and comments from patients. This allows us to understand and track how well we are doing from the patient’s point of view, and what we can do better.

The surveys have been asking the same questions for a number of years which allows us to track patient satisfaction over time. Patients are asked to rank each question about our service on a simple scale of “very poor”, “poor”, “fair”, “good” and “very good”.

Here are the data on the percent of patients that ranked us at the top level (“very good”) over the past 3 years on three key questions.

“Efforts to include in decisions”HCCC patient satisfaction score graph for "efforts to include in decisions" metric


“Staff worked well together”HCCC patient satisfaction score graph for "staff worked well together" metric


“Likelihood of recommending practice”


It is wonderful to see this steady increase in patient satisfaction over the past three years (essentially all of the patients who did not give us a “very good” gave us a “good”). This is the result of incredible hard work and dedication by our cancer clinic leadership group (Mo Milhem, Hisakazu Hoshi, Zach Pollock, Tina Devery, Geri Quinn, Garen Carpenter and many others) as well as the entire cancer clinic team. They looked carefully at patient comments and suggestions, and used this information to improve the patient experience.

We want our patients to be satisfied with our service, yet we can never be fully satisfied with the service we provide. We recognize there is always room for improvement. We will continue to ask our patients about the areas they feel could be improved further. In recent surveys, these include “information about delays” and “wait time in clinic”. Our team is hard at work on these issues as we strive to provide ever improving service to our patients.

Yes, we must continue to focus on progress in cancer research, education, and cancer care. However, we can’t be satisfied solely with data demonstrating our success in these areas. We must also address the needs the patients themselves identify as important. Only then can we be satisfied that we are doing everything possible to reduce the burden of cancer for those we serve.

Making decisions based on facts we don’t like

Every day at Holden Comprehensive Cancer Center, we cancer specialists and researchers make decisions and recommendations based on facts we don’t like.  A patient’s cancer has recurred.  A treatment is not working.  The patient lacks the gene that would make them eligible for a promising clinical trial.  A highly promising research grant is not funded.  We can’t ignore the bad news.  Instead, we accept it, and do our best despite the bad news.

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Orion or ORIEN – The whole is greater than the parts

I am a bit of an astronomy buff.   When my kids were younger, I had an eight inch reflecting telescope I would set up in the backyard.  My kids and I would invite other families in the neighborhood to look at the night sky.  I recall one evening, we talked about the night sky while I was setting up.  The constellation Orion was particularly beautiful that evening.  We discussed about how the stars that make up Orion’s belt, legs, shoulders and sword, tell us a story we would not understand if we just looked through the telescope at each star separately.   We still wanted to look through the telescope (Orion’s sword was particularly interesting), but looking at the constellation as a whole told us an additional story.  The whole was greater than the parts.

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Biden’s next silo?

Vice President Biden spoke recently about how he will spend his time when he leaves government in a few weeks.  The “Cancer Moonshot” will be behind him, but his dedication to the cause of reducing the burden of cancer will not.  Through his Cancer Moonshot, he has spoken with passion and eloquence about the importance of breaking down cancer research silos that limit our ability to share information about the genetics of cancer.  He has challenged us to change our culture and develop new collaborative models for cancer research.

He also expressed concerns about the economics of cancer therapy.   More specifically, as we develop better cancer therapeutics, can we afford them?  This is one of the items he will address when his term as Vice President comes to an end.

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Cancer immunotherapy, research funding, and new cancer drugs – a year in review

It has been a while since I submitted a blog entry, and one of my New Year’s resolutions is that I will get back to posting entries more regularly. I thought I would start with a summary of the past year in the field of cancer in general and the Holden Comprehensive Cancer Center in particular.
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Addressing complex, painful, inescapable truths

I spent an evening last week doing two things that, at first, I thought were unrelated.

First, I viewed a preview of “Cancer: The Emperor of All Maladies,” a PBS documentary based on the book by Siddhartha Mukherjee. His preview was sponsored by the Iowa Cancer Consortium, The American Cancer Society, The Iowa Department of Public Health and Iowa Public Television. It included excerpts from the 3 part PBS documentary by producer Ken Burns that starts tonight, March 30 and runs through Wednesday, April 1. The preview was followed by a panel discussion. My fellow panelists and I made brief statements, and then entertained a range of outstanding questions from the audience.

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Hope Without Hype

Last week, I had the honor of moderating a panel discussion on Capitol Hill on behalf of the Association of American Cancer Institutes and the American Association for Cancer Research. This panel was sponsored by the congressional cancer caucus and focused on the importance of the nation’s premier cancer research centers. In such settings, it can be challenging to talk about the vital importance of the work done at our cancer centers in a way that highlights the hope without appearing to be resorting to hype.

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Environmental biologists have studied it for years – cancer biologists are just starting to think about it – and it has the potential to result in a fundamental change in our understanding of cancer. I am talking about ecosystems.

We all learned in elementary school that diversity helps an ecosystem thrive. Bees need flowers so they can make honey from the nectar. Flowers need bees for pollination. Neither would be able to exist without each other.

How does this concept apply to cancer? Our traditional view of cancer is that cancer cells within a tumor are the same. One cell starts growing out of control, pushes out the normal cells, and the result is cancer. Indeed, we talk about cancer as being “monoclonal,” i.e. all cells being the same. A major goal of cancer research over the past decade has been to understand the changes in genes that drive the monoclonal growth of cancer cells. In some cases, such as chronic myelogenous leukemia and some cases of melanoma, we have identified the gene that causes the cancer to behave badly, and have been able to treat the cancer successfully by targeting the product of the rogue gene.

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Attention Deficit

I am writing this on a weekend morning. It is really cold outside, and there is nothing on my calendar for a few hours. Instead of doing something productive, I find myself curled up on the couch in front of the fireplace surfing the web on my laptop. I am having no trouble finding totally useless but entertaining sites – a few thoughtful, some silly, and all too many outrageous. I know this is keeping me from more important projects (such as getting our family photos in order or writing a cancer research grant) but I am having a hard time focusing. My wife, who has experienced my channel flicking when I have the TV remote, knows this side of me all too well.

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A smile, a laugh, a cry, and when medically permitted, a hug

People of different faiths have varied perspectives on the value and meaning of the December holidays. Getting past the commercialization can also be a challenge. Nevertheless, with the possible exception of individuals who are humbug down to the core, we are all affected positively by the spirit of giving, receiving, and togetherness this time of year. I am not speaking here about giving and receiving “stuff,” but giving, receiving, and being together in a much more profound sense.

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