“ I think the Cancer Center will be among the national leaders, if not the national leader, in areas of conducting translational research, applying precision medicine to a traditionally difficult population, and reforming cancer care delivery.”
Q: What’ s next for cancer care? A: For me, the future of cancer care is to apply what we already know effectively. We know that tobacco control is important, age-appropriate screening is critical, and healthy eating and physical activity are important. So if we can begin to make inroads in those three areas, we are talking a 50-percent reduction in current cancer deaths just by applying what we already know. We have to accelerate our progress there.
The other 50 percent is what we don’ t know, and that is where research comes in. We have to double down on our research in a time when we have exceptional technology that can advance our knowledge and help us fill in the gaps of what we do not know.
Q: Where do the opportunities lie? A: The opportunities are around precision medicine— determining the efficacy and the cost effectiveness of it. It is a great idea with great potential and can certainly reduce toxicity and potential cost. We have to bend the curve on cancer cost at some point. We just have to. We have said for 30 years that the system is going to implode at some point. It is not sustainable. I think we have reached that place; we’ ve reached the tipping point, and now we have to concentrate on fixing it.
Q: Can we fix it? A: Yes, I think we can absolutely fix it. The United States is an amazing country, and physicians are very smart. I think we can figure out a way to do it. I am confident that the new reforms in cancer care delivery are going to be physician-driven and value-based. If you are not providing high-quality care or you’ re an over-user of resources and ordering unnecessary tests, you’ re not necessarily going to stay in a value-based system.
Getting cancer care delivery right
Q: How do we get there? A: I have said we can eliminate cancer as a public health problem in the United States by 2050, but that is absolutely going to take applying what we know. Something simple, but still complex in a political situation, is ensuring that we have clean indoor air, high taxes on cigarettes, and organized screening programs instead of opportunistic screening programs. If we know Ms. Johnson has not had her colorectal screening, then we invite her to come have her screening instead of depending on her to show up on her own.
Q: Are you optimistic about the future of cancer care delivery? A: I am hopeful. I am more excited about the possibility of getting cancer care delivery right than I have ever been. I see real hope there. I believe that by 2050, if not sooner, we will be applying what we know. I imagine that in 2040, 95 percent of Americans will be compliant with age-appropriate screening and only 5 percent will be smoking. This alone will have a huge impact, and if we can reverse obesity trends, even more impact.
The next chapter
Q: How would you define the next level for the Cancer Center? A: I think the Cancer Center will be among the national leaders in areas of conducting translational research, applying precision medicine to a traditionally difficult population, and reforming cancer care delivery.
There is a lot that underlies that. Our six research programs will continue to inform our precision medicine, cancer control and population science, and health sciences research areas. The elements are in place to take this Cancer Center to its next level. We are in great shape.
Q: What do you have on the horizon after retirement? A: As an aspirational goal, I’ d like to finish the job around cancer care delivery redesign. The other area I’ ve been passionate about since day one is how to improve the poor end-of-life care that we deliver as a nation and as a health care delivery system. I know that I focused on giving wise end-of-life care from the get-go, because I was interested in it and paid attention to it. I spent a lot of time training my residents and fellows how to have a conversation at the end of life and how to frame it so that a patient had a fair opportunity to make a wise choice rather than it being a mandate.
There’ s a belief on one side to never give up, that medicine can do anything. But there are limitations, and it comes to an end for all of us— 100 percent. Understanding that and having that conversation is a huge opportunity. You’ re not giving up. You’ re having a conversation that is very important.
Personally, I have 15 grandchildren who I love being around. I probably have 10 more years of active life, and now I get to spend time with the little ones. I’ m looking forward to my next chapter.
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