City of Hope Shares What it Means to Seek Care at a Comprehensive Cancer Center

Five years ago, when Steve McGrew of Spokane, Washington, was diagnosed with prostate cancer, his physician could offer only a few options. McGrew didn’t like any of them, so he asked what he should do next. The doctor, sensing his own limitations, said simply: “Look farther.”

McGrew did exactly that. He went to a larger facility for more advanced treatment.

He’s glad he asked the question, because not long afterward, a routine exam turned up an unexpected malady: mesothelioma.

This time the advice was even less encouraging. His doctor suggested palliative care.

“I think he was overwhelmed,” recalled McGrew. “He’d probably never even seen mesothelioma before.”

But McGrew looked farther, and found what he needed at City of Hope.

“In a place like City of Hope,” he explained, “there’s so much information available. It’s like standing on a street corner in New York City. Everything passes by!”

“Looking farther” is what City of Hope and other comprehensive cancer centers do best. Guided by standards laid down by the National Cancer Institute (NCI), these top-of-the-line, all-in-one facilities combine the highest levels of research, trials and treatment, attracting world-class physicians and scientists who collaborate across disciplines to create an atmosphere where breakthroughs happen and lives are saved.

Before 1937, there was little coordination in cancer care. The National Cancer Act of 1937 addressed that gap, earmarking the first significant federal money for cancer and creating the National Cancer Institute, tasked with conducting research and training on the causes, diagnosis and treatment of cancer.

Then in 1971, President Richard Nixon declared a “War on Cancer” and signed an expanded National Cancer Act, increasing the NCI’s budget, authority and responsibilities, which now included the creation of NCI-designated cancer centers across the country: they would receive the bulk of federal attention and funding.

This was a critical change, says Steven T. Rosen, M.D., City of Hope’s chief scientific officer and director of its comprehensive cancer center. It served to “centralize resources of committed individuals.” Rosen, America’s longest-serving comprehensive cancer center director (seven years at City of Hope, 25 at The Robert H. Lurie Comprehensive Cancer Center of Northwestern University in Chicago) says this coming together of people and dollars “was instrumental to our many remarkable strides, in every area, over the past 10 to 15 years.”

The NCI delineated three types of eligible facilities: basic (laboratory) cancer centers, clinical cancer centers and comprehensive cancer centers.

The comprehensive cancer centers were given the broadest, most ambitious mission. To qualify as “comprehensive,” a cancer facility must demonstrate the highest achievements in research, clinical care, education and community contributions.

It’s a rigorous standard not easily achieved nor maintained. NCI-designated centers go through a tough review process every five years. Only those conducting the most promising cancer research are awarded comprehensive status. Out of some 1,500 cancer facilities across the U.S., barely 4% receive NCI designation. City of Hope is one of only 51 comprehensive cancer centers.

Those standards benefit patients, the medical community and the entire country in many ways:

Where typical oncologists may not know about the latest innovations, at a comprehensive cancer center you’ll “very likely be seen and evaluated by what I call a superspecialist — an expert in your particular cancer,” explained Michael Caligiuri, M.D., president of City of Hope National Medical Center, his fourth comprehensive cancer center. “They have seen everything, treated everything and know all the challenges for the particular cancer within their expertise.”

This makes a comprehensive cancer center the logical place to get a second opinion. “If you ever hear the words, ‘You have cancer,’” added Caligiuri, “get a second opinion, or even a first, from a superspecialist. Because your first shot is your best shot!”

All new cancer treatments begin as clinical trials, many of which take place at comprehensive cancer centers. Each year, thousands of patients who’ve run out of conventional options gain new hope, and frequently longer lives, by participating in those trials which, thanks to the work at comprehensive cancer centers, are no longer viewed as simply “experiments.”

“Clinical trials,” declared Rosen, the Morgan & Helen Chu Director’s Chair of the Beckman Research Institute, “are now the vehicle for receiving the latest treatment.” In fact, Rosen pointed out, some 20% of all City of Hope patients enter a clinical trial at some point.

“I am a big believer in comprehensive care centers such as City of Hope,” explained one City of Hope prostate cancer patient. “I would have never heard about the specific clinical trial that I am participating in had it not been for the phone call that I made to City Of Hope. I wonder how many patients just miss out.”

Comprehensive cancer centers attract the best and the brightest among scientists and physicians, who are then encouraged to reach across disciplines, talk to each other, work together and come up with new solutions, making their institution much greater than the sum of its parts. As NCI Director Norman Sharpless explained in a recent interview, “Working collaboratively is an opportunity to accelerate progress and help patients in a more direct way.”

More than an opportunity, collaboration is built into the core mission. Through the use of NCI-funded Cancer Center Support Grants (CCSG), centers are encouraged to create a collaborative atmosphere, because, as the NCI website says, “a culture of discovery, scientific excellence, trans-disciplinary research and collaboration yields tangible benefits extending far beyond the generation of new knowledge.”

“Grant money used to go mostly to individual labs,” recalled Caligiuri, the Deana and Steve Campbell Physician-in-Chief Distinguished Chair. “There was no incentive to collaborate. But these CCSGs changed that thinking, and also helped institutions build a collaboration infrastructure.”

The bottom line for patients like McGrew: “Such inevitable cross-fertilization makes everybody’s expertise better,” Caligiuri said.

Comprehensive cancer centers engage heavily in population studies, education and community outreach, making a strong contribution to our knowledge base, broadening our tool kit for preventing, diagnosing, treating and ultimately curing cancer and training the next generation of scientist to continue this work.

Fifty years into the “War on Cancer,” the experts unanimously feel the 1971 National Cancer Act changed the landscape dramatically for the better, though they do see room for improvement, especially regarding data- and resource-sharing, not only within institutions but across the entire cancer and scientific community.

But there’s no denying that NCI-designated comprehensive cancer centers bring world-class care to patients and much pride to the professionals who work there.

“It’s a badge of honor,” said Caligiuri. “One we never want to lose.”