As reported by The Hartford Courant, February 22, 2004.

Broadening Its Approach

By William Hathaway

The University of Connecticut Health Center wants to become the 39th institution in the United States designated by the National Cancer Institute as a comprehensive cancer center.

Getting there won't be easy.

Dr. Carolyn D. Runowicz, who was hired last fall as director of the UConn Cancer Center, says that the school already has the laboratory scientists to take its place among elite cancer centers in the country.

But to become a full-service cancer center, UConn will need more patients. Otherwise, the cancer center won't be able to fully leverage its basic research to offer innovative therapies - a necessary step to earn the "comprehensive" designation. And without innovative therapies to offer for a wide variety of cancers, it will be hard to attract new patients.

"It's a Catch-22," Runowicz acknowledged. "But I didn't come here to get stuck."

The Willimantic native and 1973 UConn grad knows that central Connecticut is a competitive market for cancer treatment. UConn not only competes for patients with some of the best cancer hospitals in the country in Boston and New York, but also with strong oncology programs at local hospitals.

Hiring a national cancer expert like Runowicz was the first step in becoming competitive, UConn officials said. Runowicz, who was the first female president of the Society of Gynecologic Oncologists, serves on the national board of the National Cancer Institute. She was vice chairwoman of the obstetrics and gynecology department at St. Luke's Hospital in New York City before taking the job at UConn.

To win the National Cancer Institute's designation, a cancer center must offer a full range of services, including cancer prevention, community outreach programs, basic research and so-called translational research - the ability to turn lab science into treatments for patients.

In simple terms, comprehensive cancer centers not only have to deliver state-of-the-art cancer treatments, but "develop the state-of-the-art cancer treatments," said Dr. Vincent DeVita, a former director of both the National Cancer Institute and Yale Cancer Center, the only comprehensive cancer center now in the state. "The guidelines are difficult to meet, and that's good. You have to do everything a cancer center should do, and do it well."

Winning a National Cancer Institute designation would mean about $1 million in annual funding to help underwrite the center. It would make the university eligible to receive the full range of lucrative cancer research grants from the National Institutes of Health. It would be a marketing boon for UConn's John Dempsey Hospital and help UConn attract cancer patients from throughout the state, and even the nation.

Runowicz said that UConn already has taken the initial steps toward the goal, a process she hopes will be complete in seven years. To meet the National Cancer Institute's prevention and outreach requirements, the cancer center has applied, along with several local hospitals, for a grant from the federal Centers for Disease Control and Prevention that would capitalize on strong basic research into the origins of colon cancer. Under the proposal, UConn would help develop early screening techniques for African Americans, who tend to be at higher risk for colon cancer.

To help provide better treatment of colon cancer, Runowicz said that UConn also has hired a new surgeon capable of handling advanced cases. Within the next seven years, UConn also will hire 12 to 14 new researchers and doctors, she said.

In addition, UConn plans to hire 11 more supporting staff for the cancer center in the next five years.

Today, cancer doctors and nurses are spread throughout the hospital, and UConn is committed to bringing them together in one location, said Dr. Peter Deckers, the health center's executive vice president for health affairs.

"I'm working to make that happen," Deckers said.

But exactly where the cancer center will be located on the health center campus is still undecided, he said.

The cornerstone of a comprehensive cancer center is its laboratory scientists, and, Runowicz said, "with basic research, we are already there."

Pramod Srivastava is a UConn cancer immunologist who has developed individualized cancer vaccines that are already in clinical trials for treatment of several types of cancers. Although Srivastava has been quite successful at winning basic research grants for UConn, until recently most of the trials of the vaccine have been conducted at other cancer centers, which also reap the financial rewards of treating patients.

Taking the basic scientific research from the lab to the clinic represents the biggest hurdle for UConn.

"We're really not that well-organized there," Runowicz acknowledged.

The availability of the experimental cancer vaccine and similar advances should attract patients from throughout the nation, she said. And, as the population in central Connecticut continues to age, there will be more cancer patients to go around, experts say.

Dr. Andrew Salner, director of the cancer program at Hartford Hospital, said cancer patients are living longer, so the demand for ongoing care will grow.

"We will see an increase in patients in the next decade or two," Salner said. "I'm sure every center is anticipating that, too."

Offering second opinions - which Runowicz recommends to anyone with a cancer diagnosis - also could draw in more patients.

"Cancer isn't an emergency, except emotionally," she said.

Attempts by UConn to draw cancer patients from other well-established cancer programs in the region undoubtedly will be met with fierce resistance.

Hartford Hospital treats more than 2,000 cancer patients annually, and St. Francis Hospital and Medical Center treats more than 1,500. By comparison, according to statistics kept by the American Cancer Society, UConn sees approximately 550 cancer patients annually. Manchester Memorial and New Britain General also treat more cancer patients than UConn. And the comprehensive Yale Cancer Center, at Yale-New Haven Hospital - which treats about 2,400 patients, according to DeVita - is only about 40 miles away.

Both Salner and DeVita suggest that there might be another way for UConn's cancer center to grow: Collaborate with other hospitals to offer innovative cancer treatments. Hartford Hospital, for instance, maintains an affiliation with major cancer research centers in Boston, such as the Dana-Farber Cancer Institute, Salner said.

"We would look forward to collaborating with UConn," Salner said.

Dr. Peter Tutschka, physician-in-chief of the St. Francis/Mt. Sinai Regional Cancer Center, said that he left UConn two years ago because he thought St. Francis offered more opportunities to provide innovative cancer treatments to patients.

Tutschka said that although St. Francis is building its own clinical research program, he would be willing to collaborate with UConn if its basic cancer research could benefit patients at St. Francis.

Proposals to form local alliances have caused political firestorms in the past. A plan to merge John Dempsey and Hartford Hospital in the late 1990s drew intense criticism from St. Francis, which successfully convinced Gov. John G. Rowland that such a union would hurt St. Francis financially.

But such collaborations between academic institutions and hospitals can be beneficial to both - and impress the National Cancer Institute, said DeVita, who helped draw up guidelines for comprehensive cancer designations.

Cooperation between Yale and UConn would benefit both cancer centers as well as their patients, he said.

"What patients want to know is: one, do you have a program, and two, if the answer is yes, is it a good one?" DeVita said. "If the answer is yes to both questions, they are happy to stay at home."

"Two cancer centers in the state wouldn't be overkill, not by a long shot," DeVita said.

Runowicz said that she would be willing to talk to hospitals in the state about collaborations, but that no such discussions have taken place.

"My goal is to raise the water level for patient care throughout Connecticut," she said.