Holden Comprehensive Cancer Center at the University of Iowa is one of 41 comprehensive cancer centers nationwide—and the only one in Iowa—designated by the National Cancer Institute. The cancer center’s director, George Weiner, MD, the C.E. Block Chair of Cancer Research and professor of internal medicine at the UI, visited with Medicine Iowa before starting a two-year term in October as president of the Association of American Cancer Institutes (AACI), which comprises 92 leading cancer research centers in the United States. Follow his blog, Holden the Line on Cancer.
Q: Why are cancer research centers so important today?
A: Cancer is much more complex than we ever thought. Indeed, every cancer is unique. Because of this complexity, it’s increasingly important to have cancer samples studied at the molecular level, and to have treatment plans discussed and reviewed by an interdisciplinary clinical team that focuses on a particular type of cancer. That’s something only a large cancer center can do.
Experts in medical oncology, surgery, radiation therapy, pathology, radiology, genetics, pharmacology, and cell biology who focus on specific types of cancer work together to look at each case and make a recommendation. Such interdisciplinary interactions are also vital for cancer research. A cancer research center supports teams of researchers with a broad range of backgrounds who can then collaborate on development and testing of new ideas related to cancer prevention, early detection, and therapy.
Q: How do these cancer type-specific teams collaborate with a patient’s local provider?
A: In many cases, once the team—a Multidisciplinary Oncology Group, or MOG, at our cancer center—renders an opinion, a member of the MOG will call the patient’s primary oncologist and discuss the recommendations so the patient can get care closer to home.
We’ve also started to pilot a program where community oncologists can discuss individual patient cases by remote access at the tumor board meetings of our MOGs and work together to come up with a treatment plan. The community oncologists who have participated really appreciated it. Their patients benefit from better care, based on the opinion of the group, and the local physicians learn about the newest treatments and gain a better understanding of the research here, including the availability of clinical trials of new therapies.
Q: How does molecular data from one person’s cancer advance understanding of that cancer type in the broader population?
A: We have launched a program we call our Molecular Epidemiology Resources (MERs). It is a technical name, but simply stated, for several cancer types we gather a blood sample and a tumor sample from participating patients and also collect robust clinical information. We track what treatments each patient receives and how well each treatment works, and also collect information on quality of life and other health problems. We have data on close to 5,000 patients.
MERs have the potential to yield results that change care. Our first MER started in lymphoma in 2002, in collaboration with the Mayo Clinic. Results from the lymphoma MER are changing care of patients with this type of cancer.
For example, traditionally patients with diffuse large B-cell lymphoma—the most common form—who went into remission were told to have CT scans annually for five years to ensure they were still in remission. The Iowa/Mayo team found if a patient is still in remission a year after chemotherapy is completed, the patient’s lifespan is no different than age-match controls and the chance of additional routine CT scans finding something important is very low. Based on this result, we are no longer doing routine CT scans on these patients if they are in remission one year after completing therapy. The anxiety patients feel about getting a scan is gone and the radiation exposure is gone. If this change were adopted nationally, we could save about $500 million by not doing annual CT scans on these patients. The practice is starting to change around the country.
Q: Are there MERs for other cancers besides lymphoma?
A: We’ve developed MERs for cancers where our researchers are poised to take advantage of the data and where we have resources to do it, including melanoma and sarcoma, breast cancer, pancreatic cancer, cancers of the urologic organs (prostate, bladder, kidney), and myeloma. We have similar programs for other cancers as well.
We’re just starting to realize the return on this research investment. The longer MERs go, the more valuable they become because more patients are enrolled and we have longer follow-up on individual patients. But they are very expensive. We need staff to explain the program to patients—who are enrolled only if they provide consent to participate after hearing about the research—gather the information and samples, and analyze the data. Grants and private donations are needed to support the effort.
Q: What are your goals as AACI president?
A: First, we need to continue to highlight the value of cancer research to society. Funding for cancer research is declining just at this point of incredible opportunity, and we need a better way to get the word out that what we are doing improves health, decreases costs, and improves the economy.
Second, we want to highlight the unique importance of academic centers. We train the next generation of cancer researchers and caregivers. We provide an interdisciplinary environment where collaborative research can thrive. Our approach to cancer care that includes interdisciplinary groups of physicians focused on specific cancer types can provide highly sophisticated, state-of-the-art opinions and therapies that are not available in the community. Growing evidence suggests care provided by academic centers may be less expensive, as well. AACI will be gathering data to strengthen the evidence that academic cancer centers are vital to all these aspects of the fight against cancer, then sharing the information with government leaders, payers, and patient advocates.
We realize it is not necessary for every cancer patient to receive all of his or her care at an academic center. What we need is a system where our opinions are sought when needed and patients get the right care in the right place at the right time. In many cases, this will involve a close collaboration between community and academic cancer centers.