“ 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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