It is difficult for all of us to identify and address, on our own, those areas where we should and can do a better job. Sometimes dealing with day to day challenges limits our ability to step back and look at the big picture. Sometimes we might see an issue that needs to be addressed but hesitate to do so because of concerns about unintended consequences we know or suspect might result from implementing a solution. Sometimes we might not realize there is a better way. Sometimes we might see a better way, but are simply unable to implement the needed change on our own. This certainly is true for a complex organization such as a comprehensive cancer center where we are working to reduce the burden of cancer across the spectrum of clinical care, research and education – where opportunities and challenges are ever present and ever changing.
Achieving our potential requires we ask ourselves whether we are we doing our best to…
Identify and support the most promising cancer research.
Recruit and retain the best faculty, staff, students and volunteers.
Bring advances from the research lab to where they help patients as quickly as possible.
Provide state-of-the-art, personalized clinical care and service to every patient.
Educate the next generation of cancer researchers and caregivers.
Work within our community and across the state to disseminate advances so they help as many people as possible.
Collaborate optimally with other units within our own institution (departments, colleges, the hospital, etc).
Collaborate optimally with outside institutions (referring physicians and medical centers, other cancer centers, the National Cancer Institute, etc).
Structure our own efforts to be as efficient and effective as possible to facilitate our ability to do all of these things well.
In addition to self-reflection and internal discussion, it helps to ask outsiders to take a fresh look and advise us on how to improve. One of the most forward-thinking aspects of the National Cancer Institute (NCI) Cancer Centers Program is the requirement that every cancer center have a yearly visit from an External Advisory Board (EAB) composed of experts from other cancer centers. Making optimal use of an EAB requires the hosting cancer center be totally open. We do not try to hide or paper over our major challenges when our EAB visits. Instead, we put them front and center. For the EAB to do its job and help us improve, it needs to be highly critical. As Oscar Wilde said “true friends stab you in the front.” Having an EAB say “keep it up, you are doing an excellent job,” just doesn’t cut it. We need the EAB to tell us how we can do better. Our EAB will be visiting next month and our presentations to them will include a discussion of what we are doing with a particular focus on where we feel we can improve. We will put down our armor, show them our soft underbelly, and say “hit me with your best shot.”
I have the privilege of serving on the EABs of nine other NCI-designated cancer centers and chairing five of them. I have no doubt participating on these boards helps me do my job at Holden more effectively. I get to see how other cancer centers handle particularly difficult issues. Sometimes I return home with a new idea of how we can address a gnarly challenge. Just as commonly, I return home after seeing a cancer center’s approach to dealing with a problem, grateful for the team we have at Iowa and the solution we have found to a problem that another center is struggling to address.
Sometimes it feels a bit awkward being on an EAB when I beat up on my colleagues and friends, and am rewarded for doing so by a nice meal and a sincere “thank you.” When our EAB visits next month, I am sure they will return the favor. I will say “hit me with your best shot,” and when they happily (and hopefully ruthlessly) comply, I will feed them and express my deepest appreciation.
Incredible advances in cancer genetics have revolutionized how we think about cancer. These advances are now being applied to patient care. A brief response to the question “how is our growing knowledge of cancer genetics impacting on cancer research and cancer medicine?” is to say “it’s complicated – and exciting!” That is not a very helpful answer. Here, I will summarize the big picture with the understanding that this brief summary will not even touch on some of the rapidly evolving, nuanced, yet very exciting concepts in cancer genetics.
Let’s start out with a review and discussion of why the genetics revolution in cancer is so important.
When I give a talk about cancer research, I like to highlight both the diversity of cancer research and that it is a continuum. One way to do this is by showing a scale that, going from smallest to largest, includes cancer research focused at the level of molecules, cells, tissues, organs, patients, clinical trials, cohorts, and communities. Much cancer research spans various points on this scale. I can take any two points on this scale, and talk about an important research project at Holden based on those two points. For example, molecular epidemiology involves taking samples from a large number of individuals in a group of cancer patients and evaluating them at the molecular level in order to improve our ability to predict how specific changes in genes might impact an outcome. Identifying new cancer drugs requires we screen large numbers of compounds to see which have the most promising effects on cancer cells, then after appropriate testing in the laboratory, assess the effects of these new drugs on patients in a clinical trial. Continue reading →
In Slaughterhouse-Five, the masterpiece by Kurt Vonnegut (from our own Iowa Writer’s Workshop), the protagonist Billy Pilgrim used the phrase, “So it goes,” repeatedly when considering various traumas including the incredible horrors of war. Much has been written about what Billy, and hence Mr. Vonnegut, really meant by this phrase. I will not weigh in on this debate, but instead reflect on what this phrase means to me. Continue reading →
I can think of nothing better than Yogi Berra quotes to organize a brief discussion of how molecular oncology is impacting cancer medicine.
“It’s tough to make predictions, especially about the future.”
When I was growing up in New York, if you had asked me which was more likely – for me to spend my career as a cancer center director in Iowa, or to own a flying car, I most definitely would have predicted the flying car. So much for predicting the future. Continue reading →
Popular psychology describes the left side of the brain as logical/analytic and the right side as emotional /creative. This dichotomy in anatomy and function is not supported by modern neuroscience, but I can’t resist using it since I want to talk about how my left brain and right brain have been going at each other this week. Continue reading →
We are currently recruiting to bring new faculty physicians to the Holden Comprehensive Cancer Center, faculty who will help us care for our patients, teach, and conduct research. The faculty candidates we have had visit the University of Iowa have been outstanding, and we look forward to having a number of them join us this summer.
During this process, I have been struck by the number of superb applicants who began their medical careers in many other countries around the world, completed their medical training at top-notch programs in the United States, and now want to join our faculty so they can practice medicine, teach and do research in the United States (indeed, in Iowa). Uniformly, these individuals were at the top of their class in school, had the drive to come to the United States to pursue opportunities they did not have in their native country, and have been highly successful in their new home. This represents a true “brain gain” for us. Continue reading →
There is a great debate raging among cancer research leaders around the country.
It is not about whether this is an incredible time in cancer research that is fundamentally changing our understanding of cancer – we all see advances being made in our centers every day.
It is not about whether this enhanced understanding of cancer will change how we approach cancer medicine – we all see research advances that have resulted in dramatic improvements in how we treat many of our patients, and many more are on the way.
It is not about whether some cancers have proven to be incredibly difficult to treat – we all know there are some types of cancer where progress has been devastatingly slow.
It is not about whether increased funding for cancer research would speed up progress against cancer – we all agree that increased funding is needed to accelerate progress, particularly for the most refractory cancers.
Earlier this month, Dr. Raymond Hohl, the Holden Family Chair and Associate Director for Clinical and Translational Research at the Holden Comprehensive Cancer Center, announced that, starting March 1, 2014, he will be moving to Penn State to become the Director of the Penn State Hershey Cancer Institute. Ray has been at the University of Iowa since 1991, and has served multiple roles in the Cancer Center, Department of Internal Medicine, and many other units on campus. The breadth of his clinical and research knowledge and interests made Ray a valued leader and collaborator in many of the activities at Holden. As a physician, his dedication to his patients was unquestionable. Continue reading →
Sometimes, progress brings uncertainty. The past few years have seen a steady increase in the number of drugs and other approaches to cancer treatment such as immunotherapy that can be used to treat cancer. Most of these new approaches do not cure cancer when given as a single therapy. Nevertheless, many of them are very effective at inducing a temporary shrinking of the cancer. For many cancers, we have a number of such treatments available. From a physician’s point of view, these new treatments create more options for patients. But they raise a question that cancer doctors have struggled with for decades. Do we … Continue reading →