Karen K. Fields, M.D., President and CEO
Cancer Therapy and Research Center
Conquering Cancer: Our Strategy, Our Future
Westin Riverwalk Hotel
May 8, 2006
Introductory Remarks by Mark Watson, III, CTRC Chairman
Thank you, Mark. And good evening.
And thank you to the CTRC Board of Directors whose gifts have generously made this evening possible.
We have many friends and supporters of CTRC here tonight. Scattered throughout the room we also have some of our key scientists and doctors – some of whom have been involved with CTRC for a long time, and others who literally just got here.
We wanted you, our friends and supporters, to have a chance to meet those scientists and doctors because they represent CTRC's future – and the real reason why we're all here.
As for me, I came to CTRC from the Moffitt Cancer Center & Research Institute in Tampa, and arrived here February a year ago with my husband, Paul, and our son, Michael.
Naturally, all three of us were excited to put the "GTT" – "Gone to Texas" – sign on our house back in Florida. We weren't sure what was expected of us as new Texans, but we vowed to acclimate as quickly as possible.
We had hardly gotten to town last year when Fiesta came along -- and I must say that "cascarones" are not something we were familiar with in Tampa. But, on the whole, I think the Fields family is making good progress as newly-minted Texans and San Antonians.
I was eager to get here, and honored to become only the second president of one of the nation's best academic cancer centers.
As a breast cancer doctor and researcher, I had been coming to San Antonio year after year for the world's biggest and most important breast cancer symposium started by CTRC's visionary physician/scientist and founder Charles Coltman. And that symposium now bears his name.
Chuck, could you please stand and be recognized for your contributions to the CTRC and to the world of oncology?
If you are in the breast cancer field, you come to the San Antonio Breast Symposium because it is Action Central – it's where you meet the world's top breast cancer experts, hear about their latest research, and get to ask questions and share ideas with your peers – absolutely the best and brightest from every corner of the globe.
Because of my previous trips to San Antonio for the breast cancer symposium, I also knew that CTRC's location here – in this city – was a huge plus because San Antonio already had a constellation of medical and bioscience stars, and the partnership possibilities were immense.
I knew that CTRC's partnership with the University of Texas Health Science Center was especially important, and I knew that this partnership – known as the San Antonio Cancer Institute which is a joint partnership of CTRC and the Health Science Center -- had earned the impressive National Cancer Institute designation back in 1991.
There are only 61 of these centers in the country – and only two in Texas. When you get an official NCI designation for your cancer center it means that you have arrived. It's the Good Housekeeping Seal of Approval. It means you have earned access to special federal funding as an asset to the nation, because of the demonstrated high quality of your work in cancer research and therapy development.
The other cancer center in Texas is a three to four hour drive to the northeast somewhere in Houston … and I think you all know what I'm talking about!
I also knew that CTRC, through its principal research division, the Institute for Drug Development, is internationally recognized as the largest Phase I clinical oncology drug trials program in the world. During the past five years, more than 2,600 patients from around the world have been treated on new drug protocols, and 14 of the cancer drugs most recently approved by the Federal Drug Administration underwent development or testing at the IDD.
Right here, in San Antonio. There isn't any single institution – anywhere in the world – that can meet or beat that record.
I was excited because the CTRC Board members I met throughout the interview process were themselves excited about what this institution is . . . and what it can be. I've come to know that our board members are all community leaders, too, and they have given, and continue to give, incredible time and effort to CTRC.
There is real commitment and engagement. And I can tell you from personal experience that there's nothing passive about our Board – no shrinking violets anywhere to be found!
Why did I come here? When I was interviewing there were long days of meetings and questions and at the end of one of those long days – at 4:00 – I had my first meeting with Dr. Chris Takimoto. Chris is the Director of Pharmacology and is one of the top scientists at the Institute of Drug Development. Chris impressed me with his energy, his enthusiasm, his excitement over the research, over the people he had been recruiting. It was very refreshing. It was just what I needed to see.
Until, thirty minutes later, after meeting Chris, when I sat down with Dr. Tony Tolcher. Tony is the Director of Clinical Research at the IDD, and when we got together, he made Chris look calm.
I don't know if it was too much caffeine or what, but Tony was just jazzed! Happily, he has been just as jazzed every day since I met him. Just as the rest of his team is.
I instantly connected with them and knew that with scientists like Tony and Chris as leaders . . . people who were committed . . . who believed in drug discovery . . . in getting cancer drugs to people . . . in curing people . . . that we could build on an already excellent reputation . . . and do truly extraordinary work that will make a difference in the lives of people around the world.
I was even more moved when I met some CTRC patients and their families . . . These were people who were dealing with tough things, and they were counting on CTRC's doctors and nurses and researchers and staff to find ways to help them through it . . . and they were passionate about CTRC . . .
There are no stronger advocates for CTRC than our patients and their families. This place is known for the very special, very personal care it provides for cancer patients.
CTRC has made a profound difference for them in their battles against cancer . . . in the thoughtfulness and completeness of the treatment regimen they receive . . . in their understanding of the disease and how they can deal with it in their quality of life.
So, I was pretty jazzed myself when I got here because I knew that the task for me, as President, wasn't one of generating passion for CTRC, but instead on focusing the passion that was already here to help CTRC take that next big step.
However, I also knew the institution was at a crossroads.
Dr. Coltman had stepped down as President, and as the new president, I would have to take the institution that Chuck built and deal with a new set of challenges such as developing strategies and policies that would help CTRC face the emerging realities and opportunities of cancer research and patient care.
There has been a lot to do. With the Board's support, we've taken a fresh look at how we're organized, how we provide care for our patients . . . how we do research . . . how we can make our partnership with the Health Science Center and the San Antonio Cancer Institute even more effective.
The president of the Health Science Center, Dr. Francisco Cigarroa, is here tonight – Francisco: thank you for being here. Your leadership for the Health Science Center and for this community means so much for the citizens of San Antonio. I have found it a privilege to work with you as we make the San Antonio Cancer Institute stronger and even more vital to the health and well-being of the community and the nation.
Francisco—could you please stand and be recognized?
On a parallel track, we've been going through a process to determine what we could be . . . what CTRC's potential is . . . and what it will take – in terms of people, facilities and finances – to achieve that potential.
It's not been easy. None of this work was something that could be done in an afternoon. The kind of changes we seek can't just happen. They need to be planned.
It has been intense . . . and the discussions have been at times, shall we say, "spirited."
But, we're getting there. And what I want to share with you tonight is a vision for a very bright future for CTRC.
Now, this isn't a dream. And it's not a hallucination. But, it's a shared vision by a lot of people who are ready to throw their hearts and souls into making this vision real.
We will do this! And, in fact, we are already doing it.
Our mission is simple: The mission of the Cancer Therapy & Research Center is to conquer cancer . . . through research, prevention and treatment.
Conquer cancer. Big words. Yes, it sounds like this is a battle and no, we won't survive unless we fight with all our might.
It's got to happen because cancer is a terrible disease. It strikes people of all ages, ethnic groups and economic strata. It attacks at many different points of the body. It can seem almost irrational or totally random in its targets. It remains the number 2 killer in our nation.
It happens to anyone. Peter Jennings, died of lung cancer. He was a smoker. So did Dana Reeve. She never smoked.
How will we conquer cancer? What kind of a cancer center do we need to be to conquer such a formidable foe?
We need to create a vision that describes what kind of cancer center wins the battle against cancer. It's not my vision, it's not the physicians' and scientists' vision, it's not our staff's vision or the board's vision…it's our vision. Our vision for the CTRC and for the people of San Antonio.
Simply stated: We will be one of the world's premier cancer research and treatment centers dedicated to the development of novel therapies, compassionate and comprehensive care, outreach to the diverse communities we serve, prevention of disease and promotion of wellness, and an uncompromising commitment to understanding the complex nature of cancer, its causes and consequences.
We will make the vision into reality because we have to find better ways of fighting back against cancer . . . better treatments for those who suffer from it . . . not only to improve their opportunities to beat cancer, but to improve their lives as they fight it . .
We have to find better ways to prevent cancer in the first place, and then we have to develop programs to let people know what they can do – as individuals – to minimize their risk.
All of that is what CTRC is about, and has always been about.
There's no question that with the resources already in place as a strong foundation, CTRC is one of the few institutions in the nation that can make a real difference in the fight against cancer. And, that's what really charged me up about coming here.
We will stand shoulder to shoulder with Memorial Sloan Kettering, Johns Hopkins, Duke Cancer Center, Mayo Clinic, Moffitt Cancer Center . . . and, yes, that other place over there in Houston.
Now, when I say, quote "one of the world's premier cancer research and treatment centers," unquote, that's a mouth-full, in more ways than one.
What does that really mean? And, what will it take for CTRC to truly achieve that goal?
A comprehensive cancer center focuses on far more than diagnosis and treatment . . . It zeroes in on prevention, reaching at-risk people in the community, screening them for cancer and other predisposing factors . . . it teaches them how to decrease their risks of developing cancer.
It develops leading edge therapies and incorporates them into new standards of cancer care. It measures quality and outcomes and provides support for patients and their families.
Comprehensive cancer care should not begin when a patient is diagnosed. And it should not end when a patient's treatment has concluded.
Instead, care must start early in life, at the same time the risks of developing cancer begin. It ends only when patients with a history of cancer learn to live their lives with a focus on wellness.
For those of you already familiar with CTRC, that description ought to ring a bell, because that's the road this institution has been traveling for many years.
When CTRC opened its doors in 1974, the facility was less than 22,000 square feet, with only 15 employees and had a total budget of $186,000. But it became instantly important by providing outpatient radiation therapy for the community.
Now, fast-forward to 2006. CTRC has grown to occupy 357,000 square feet, it employs 470 people and it has an annual budget of $90 million.
This institution – your institution – has become an internationally-recognized, freestanding outpatient cancer center that combines top-flight research with up-to-date cancer treatment.
Over the last 30 years, CTRC has had more than one million patient visits . . . there were 120,000 patient visits last year alone, so you can see that the pace, unfortunately, is picking up.
These aren't just numbers on a page. These are real people whose lives we have treated and often saved.
The caliber of care patients receive at CTRC means that most patients can be treated right here in San Antonio . . . without having to travel to some other destination. And patients and their families who are dealing with this terrible disease don't want to have to travel elsewhere to receive the best possible care. They want to get it here!
Research is a critical component, and the partnership with the Health Science Center in creating the San Antonio Cancer Institute is a unique collaboration, and an incredible opportunity.
And then there is the work of our scientists at the Institute for Drug Development. With their track record, the IDD's research teams draw pharmaceutical companies large and small, from around the world, here to consult . . . to involve our people in their drug development efforts . . . to test and refine new therapies.
Our scientists also regularly advise the National Cancer Institute and the FDA in the drug development process.
The companies and the government agencies are not just coming to us to perform a service . . . they are paying our scientists to think. And we are providing intellectual capital and experience that can't be found anywhere else.
I'll bet that all of you are familiar with the baboon and monkey research facilities at Southwest Foundation for Biomedical Research. Well, they've got the monkeys, but we have the mice!
At the IDD, we have what is probably the most impressive mouse colony in the world for studying cancer drugs. There are more than 150 human tumor models bred into those many generations of mice. We have very nice "mouse hotels" . . . and that colony is a worldwide resource.
In an odd way, our success in Phase I clinical trials has been confusing because for some people CTRC had a reputation as the place you went when you had no place else to go…as the last resort . . . in an effort to get included in the trials for the latest experimental cancer drugs.
But, in reality, CTRC is the place to go for comprehensive cancer diagnosis and treatment from the start.
That's what the National Cancer Institute saw when it studied what CTRC and the Health Science Center were doing together with the San Antonio Cancer Institute.
NCI saw us jointly providing excellent care . . . leading in the discoveries of what causes cancer . . . who would most likely get it . . . what treatments worked . . . and helping patients have longer and better lives.
That's all good news, but . . .
What does it tell you that we've had one million patient visits in 30 years – but 120,000 of them came just last year? That says that cancer in our society – right here -- is a bigger, deeper problem than ever.
Let's put it into perspective. Every three minutes, a woman in this country is diagnosed with breast cancer.
I understand that the new Toyota plant here will roll a completed pickup truck off the line every 75 seconds . . . and that's an incredible rate. But, before the 225 seconds it takes them to turn out three trucks, another woman will have been diagnosed with breast cancer.
In Texas nearly one-third of all cancer cases are breast cancer. And breast cancer accounts for close to 20 percent of all cancer deaths. Breast cancer is the number one killer of women aged 45 to 54 -- one of the most important times in a women's life.
And that's just breast cancer.
What about the continued numbers of men stricken with prostate cancer? Here is an astounding fact: One in six men will be diagnosed with prostate cancer in their lifetime. It is said that if a man lives long enough, he will develop prostate cancer.
We have had a little more luck fighting prostate cancer. We can usually diagnose it early and we even have some new strategies to prevent it….strategies that were developed right here in San Antonio. Despite that fact, we still lose men to prostate cancer. Tiger Woods' father – Earl Woods – just lost a very difficult battle with prostate cancer, and many men have been very public about their battle with prostate cancer.
As our population grows, as our baby boomers age, as you and I age, the numbers of cancer cases will continue to rise. Dramatically.
We'll see the numbers of breast and prostate cancers double in the next decade. Unfortunately, there are plenty of cancer cases to go around.
What about the inventory we did just a few months ago that shows barely more than 100 hospital beds dedicated to cancer patients in all of San Antonio? In the 8th largest city in the nation? There is a lot of cancer treatment going on in San Antonio, but the focus has to be much greater because the number of cancer patients continues to grow.
The amount of work yet to be done is essentially at a crisis level on the national and international level -- not only in discovering new therapies to treat cancer and understand it better . . . but also in bringing those research results home to treat cancer patients here with the absolute best care.
In my view – and in the view of our Board, and the doctors, scientists and staff of CTRC and the in the view of the Health Science Center and the San Antonio Cancer Institute – we have a responsibility to continue attacking cancer on the research front, as well as in one-on-one patient care. The size of the problem doesn't leave any room for slacking off.
To begin, we are redefining "comprehensive" and "multidisciplinary" care. In the future when you look up those words in the dictionary, there's going to be a picture of CTRC and it's just going to say: "see them."
Our Board has given us permission to use some special, non-endowment funds to kick-start the effort. And we're doing that, although we're going to need philanthropic assistance to really take us to the next level.
We are changing – right now – the way cancer care is provided in the San Antonio area . . . Typically, patients have had to travel from doctor to doctor, from office to lab to radiation or MRI or surgical centers. Not any more.
Our multidisciplinary cancer clinics will be the first in San Antonio and this region. In these clinics, patient care will be team-focused. All the subspecialties will work in the same clinical site and they will work collaboratively, so that patients can come to one place and get their care . . .
In our comprehensive breast cancer clinic, when a patient comes to us with a breast cancer, a team of breast cancer specialists will sit down – together – to study all aspects of her case and then devise a treatment program that's just about her . . . what's needed, who should do it, how best to get it done.
A team approach is clearly the most effective way to assure the best quality care. And that is what CTRC will be facilitating.
We'll be the "home team" and we'll collaborate with private physicians in the community to provide the best care for their patients.
The message is that we are changing cancer care from being provider-focused to patient-focused. A system of care that will shorten the time between evaluation and treatment . . . that will home in on research initiatives and outcomes, and will improve access to supportive care services . . . that will assure that all patients are offered care according to nationally published guidelines or offered clinical trials when we don't think that the standard therapy will do.
Here's a great example of increased supportive care services. We have just finished recruiting a psychologist—a psycho-oncologist, Dr. Joel Marcus—we have a staff that specializes in the psychological needs of cancer patients and their families. He will be a part of our multidisciplinary team.
Best of all, I can tell you that CTRC's Multidisciplinary Center for Breast Cancer will open this July on the 5th floor of the Zeller Building.
All the specialists involved in taking care of breast cancer patients from screening and diagnosis, through each stage of treatment and beyond . . . in one place . . . focused on one patient at a time. Nutritional support, physical therapy, education, and psycho-social support-- all in one place.
The building blocks for a Multidisciplinary Center for Genitourinary (GU) and Prostate Cancer are already in place.
Dr. Ian Thompson, of the Health Science Center and San Antonio Cancer Institute, heads the National Cancer Institute's prestigious Prostate Cancer Prevention Trial.
Ian's program currently follows more than 3,500 South Texas men and has already made several critical discoveries. His study is the largest national trial ever conducted to evaluate a new therapy to prevent prostate cancer.
He leads a multidisciplinary (there's that word again) team that has completely revolutionized how PSA testing is currently used for detection. That discovery was announced nationally last year at CTRC jointly with UTHSC.
His team also focuses on testicular, bladder and kidney cancers that are especially lethal if not detected early.
And, it is all centered right here in San Antonio at the CTRC, the Health Science Center and the San Antonio Cancer Institute.
I'm very happy to tell you that CTRC's Multidisciplinary Clinic for GU and Prostate Cancer, led by Dr. Ian Thompson, will also open this July on the 6th floor of the Zeller Building.
Next, under the leadership of one of the region's leading orthopaedic oncologists, Dr. Ron Williams, we have opened a Multidisciplinary Center for Sarcoma – which treats cancers in soft tissues and bones. It's located in the Urschel tower. It opened last week.
With a strong leader and a multidisciplinary team, patients with these rare tumors will receive state-of-the art care with a focus on new therapies like one of only a handful of such clinics in the entire United States.
Last year, CTRC opened San Antonio's first Multidisciplinary Center for Senior Adult Oncology. It's located on the 3rd floor in the Grossman building and is led by Dr. Anand Karnad, a dedicated medical oncologist who leads a team focused on the unique needs of the older patient undergoing cancer treatment. Only one other program exists like this in the entire state, a state that is home to the third largest population of older cancer patients in the country.
Next year we will focus on developing multidisciplinary clinics in gynecologic cancers, head and neck cancer, gastrointestinal cancers, brain tumors and lung cancers.
CTRC has always been a pioneer in bringing state-of-the-art radiation therapy systems to San Antonio . . . and we added another cancer-fighting weapon last December by bringing on-line the city's first TomoTherapy unit.
It's a new technology that lets us target tumors in real-time to provide increased accuracy, and it also decreases toxicity to surrounding tissue. It's such an important advance that barely a month after we had the machine operating, we had to go to two shifts to handle the patient load.
We are going to keep investing in research. The Human Genome Project identified more than 30,000 genes and that knowledge will allow us discover why some genes have gone awry and caused cells to become cancerous.
From there, we can develop new therapies to deal with those problems -- "guided missile" therapies with far fewer side effects because they are targeted to specific genes. Therapies that will either eliminate cancer cells or put them into a "resting state" so that patients will have better, longer lives.
In fact, we already have a long standing partnership with Brooke Army Medical Center and together we recently created a "Center for Targeted Therapies" for the Department of Defense.
BAMC is fast becoming the national focal point for military medicine. Dr. Chris Takimoto is leading the program. He has recruited Dr. Jose Diaz – as one of the few pathologists in the country who is board-certified in molecular diagnostics – to join the program along with our other key scientists who already study how genes and proteins cause cancer.
We are going to keep investing in people.
Since January 2005 through today, CTRC and the Health Science Center have recruited 32 new oncology-specific faculty members for the San Antonio Cancer Institute. CTRC has put millions of dollars into salary support for these SACI faculty because it is through SACI that we are going to recruit people to take us to the next level.
We are going to create a Cancer Prevention & Wellness Center because education is key. Part of our job is to do whatever we can to prevent cancer. And at this Center, doctors, nurses and other trained personnel will be available to help people learn prevention techniques.
That's integral to our philosophy that the continuum of care our patients require does not begin with diagnosis, nor end with treatment.
That's a program we'll need to raise money for . . . and it's going to happen.
But of all these things, the biggest missing piece for CTRC as San Antonio's only comprehensive cancer center is an in-patient hospital that specializes in cancer treatment and care.
Cancer can't always be treated on an outpatient basis . . . and the best way to treat patients who are hospitalized with cancer is in a multidisciplinary setting where everyone is dedicated to helping those patients and families . . . just like in the out-patient multidisciplinary clinics.
While a lot of cancer care eventually evolves to an out-patient setting, much of the initial care requires an in-patient capability -- surgery, early therapies and complications of treatment and of the cancer itself can mean hospital stays.
If a member of your family develops some form of cancer, you want them in a hospital facility that is totally dedicated to helping cancer patients. A hospital where the surgeons and nurses in the operating room are working on cancer patients all day.
A hospital where the nurses and staff and volunteers have special training in helping patients with cancer – and their families . . . not a hospital where we still put the cancer patients in a separate place . . . but a hospital where the entire hospital exists just to take care of cancer patients.
A hospital with individualized rooms where families could sleep over. Where visiting hours are a thing of the past. Where dietitians are focused on the needs of cancer patients, even down to the aromas of certain foods on the days when patients are going through chemo.
A hospital where there are specialized social workers and where there's a chaplain who has a particular understanding of cancer situations.
A hospital where a pain team focuses on the unique pain problems of a patient with cancer . . . where treating pain is one of the most important things we do, not just another thing that we do for a patient.
A hospital where we have pet therapy and art therapy and whatever therapy patients need to cope with cancer.
And, you know what? A cancer hospital should be for everyone, regardless of their ability to pay . . . and part of a Cancer Center that is for everyone.
I've worked in cancer hospitals before. They are very special places. San Antonio should have a comprehensive cancer hospital.
It needs to happen.
I know all this should happen – not because I have a crystal ball, but just because it all makes so much sense . . . and because nothing that I have described is altogether new or unique.
These facilities and treatment approaches and the research focus exist at all of the major comprehensive cancer centers in this country. All of them.
With our unique assets and international research reputation, CTRC has a contribution to make – to the nation and the world. I don't believe for a second that I'm over-stating this fact.
From a cancer care and treatment perspective, we've got another contribution to make – it's really an obligation -- to cancer patients and their families in San Antonio, in Texas, in Mexico and beyond.
We've got to put all the pieces of the cancer puzzle together.
We've got to conquer cancer.
I grew up in a little town near Cleveland, Ohio called Columbia Station. I can remember that as far back as the third grade I wanted to be a doctor. I had read about "scientific healers" and I wanted to be one.
So, I did all the academic work you do in college, medical school, internship, residency and fellowship.
In the 1980s, a lot of important discoveries were starting to take place in the cancer field . . . new drugs that worked, important clinical trials that were changing the way we treated cancer . . . science at the bedside making a difference in the lives of patients.
Clinical trials were just beginning on a series of new cancer drugs . . . and as a resident I was seeing patients and beginning to understand just how much they needed those new drugs . . . what a difference we could make. I remember meeting the researchers that found the first cures for leukemia and testicular cancer.
At that same time, pain control and "quality of life" were becoming better understood as critical for the care of cancer patients . . . and that treatment should be coupled with very special care and compassion for the unique emotional impact cancer has on patients and their families.
The whole specialty of oncology was taking off, and I knew that I wanted to be a part of it -- working to save the lives of patients, but also working to make their lives better as they fought cancer.
It's been my good fortune to have been associated with some extraordinary doctors, and some extraordinary scientists.
I've been greatly influenced by their devotion in finding ways to beat this disease called cancer and help those who have it.
I have had the privilege of caring for patients with cancer.
They made me an optimist . . . and if you're a cancer doctor, you have to be an optimist.
In the final analysis, I came to San Antonio because of the vision of those who created a very special place called the Cancer Therapy & Research Center . . . a place to better understand and fight that disease.
I came to CTRC to further that vision -- to work with the Health Science Center and to help build a special group of "scientific healers" who are optimistic that we can develop the knowledge and the tools to turn the tide against cancer.
I like our chances . . . and I hope you share our optimism.
Thank you. Thank you for being here. Thank you for listening. Good night.